Noncurrent Use Research Articles

Patterns of poly tobacco use among adults in the Population Assessment of Tobacco and Health (PATH) study, 2013–2017: a multistate Markov transition analysis

BackgroundA better understanding of sociodemographic transition patterns between single, dual and poly tobacco product use may help improve tobacco control policy interventions.MethodsHRs of transition between never, non-current (no past 30-day...

Changing patterns of cigarette and ENDS transitions in the USA: a multistate transition analysis of adults in the PATH Study in 2017–2019 vs 2019–2021

IntroductionThe use of cigarettes and electronic nicotine delivery system (ENDS) has likely changed since 2019 with the rise of pods and disposables, the lung injuries outbreak, flavour bans, Tobacco 21...

Multistate transition modelling of e-cigarette use and cigarette smoking among youth in the UK

IntroductionE-cigarette use remains a controversial topic, with questions over how people transition between e-cigarette use and cigarette smoking. This paper examined transitions into and out of nicotine product use in...

Serious psychological distress and higher associations with tobacco and cannabis use among college students in the United States

ObjectiveTo examine associations between serious psychological distress (SPD) and tobacco and cannabis use among college students in the United States. MethodsThis cross-sectional study included 257,626 college students from the 2019–2022 National College Health Assessment survey. SPD was defined as having symptoms in the past month. Current tobacco (i.e., cigarettes, e-cigarettes) and cannabis use was defined as past month use. Multiple product use was categorized for single, dual, or triple products. Adjusted logistic regression models were used to examine associations between SPD, tobacco, cannabis, and multiple product use. ResultsSPD increased over time (18.4% to 23.8%) among students and nearly 30% of tobacco or cannabis users reported SPD. Cigarette, e-cigarette, or cannabis use was associated with about a 50–60% increased likelihood of reporting SPD than non-current use of each product, with the highest associations in Fall 2020. Triple product users had double the likelihood of reporting SPD, followed by dual users at 70% and single users at 47%, relative to non-current users. Daily users also had nearly twice the likelihood of reporting SPD, followed by non-daily users at 13–35%, relative to non-current users. ConclusionsCollege students have an increasing burden of SPD which is significantly associated with tobacco and cannabis use. There is a dose-response relationship between the number of tobacco and cannabis products used, as well as the frequency of use, and SPD among U.S. college students. Colleges addressing student mental health should prioritize the implementation of screening and treatment support for tobacco, cannabis, and multiple product use.

Cross-sectional patterns and longitudinal transitions of unflavored and flavored cigar use without and with cigarettes among United States adults

IntroductionOver half of US adults who smoke cigars use flavored cigars, illustrating their broad appeal; however, their long-term impact on cigar and cigarette use is unknown. MethodsUsing restricted data from Waves 1–5 (2013–2019) of the Population Assessment of Tobacco and Health Study, we investigated cross-sectional patterns and longitudinal transition rates of unflavored and flavored cigar use with and without cigarettes among a nationally representative sample of US adults. ResultsProportionally, more adults who used flavored cigars without or with cigarettes were younger and female. More adults with exclusive cigar use were non-Hispanic Black. More adults with dual use had lower educational attainment. The median number of cigars smoked daily and tobacco dependence was highest among adults who used flavored cigars with cigarettes. Only 14.6% of adults with exclusive flavored cigar use at Wave 1 continued their use to Wave 5, with most transitioning to non-current (46.4%) or exclusive cigarette use (22.9%). Likewise, 13.8% of adults with dual flavored cigar and cigarette use at Wave 1 continued their use to Wave 5, with 57.6% transitioning to exclusive cigarette use and 19.7% transitioning to non-current use. Comparatively, 72.9% of adults with exclusive cigarette use continued their use to Wave 5, while 23.6% transitioned to non-current use. ConclusionAdult cigar use was less stable than cigarette use, particularly among those who use flavored cigars. Future research should investigate whether these transition patterns between flavored and unflavored cigar and cigarette use vary across sociodemographic groups and their potential long-term health implications.

Differences in health care provider screening for tobacco use among youth in the United States: The National Youth Tobacco Survey, 2021

ObjectiveHealth care providers (HCP) are encouraged to screen youth for tobacco product use as a key step in preventing such use and associated health outcomes. However, recent data examining differences in HCP tobacco screening by sociodemographic characteristics and tobacco use is scant. MethodsData from the 2021 National Youth Tobacco Survey (N = 14,685) were analyzed. Three types of HCP screening were examined: no screening, any e-cigarette use (e-cigarette only, e-cigarette and other tobacco), and non-e-cigarette tobacco product use. Differences by HCP screening were examined using multinomial logistic regression adjusted for age, sex, gender identity, sexual orientation, race/ethnicity, and tobacco use (non-current, sole, dual/poly). ResultsAmong the sample, 42.8% were screened for any tobacco use, with 30.6% screened for any e-cigarette use and 12.2% for non-e-cigarette tobacco product use only. Youth who were older (vs. younger) (OR = 5.98, 95% CI: 4.78–7.49) and gay/lesbian (vs. heterosexual) (OR = 1.47, 95% CI: 1.02–2.12) were more likely to be screened for e-cigarette use. Youth who were non-Hispanic Black (vs. non-Hispanic White) were less likely to be screened for e-cigarette use (OR = 0.53, 95% CI: 0.42–0.67) and more likely to be screened for non-e-cigarette tobacco use (OR = 1.34, 95% CI: 1.10–1.63). Current sole tobacco use (vs. non-current use) and dual/poly tobacco use (vs. non-current use) increased the likelihood for HCP screening for e-cigarette use. ConclusionsThe majority of U.S. youth continue to not be screened for tobacco use by their HCP. Evidence of disparities in tobacco use screening suggest the need for policies and training that promote equity in screening.

Longitudinal transitions in tobacco use in youth and young adults: A latent transition analysis of the population assessment of tobacco and health study from Wave 1 to 5

BackgroundTobacco use by youth and young adults can lead to significant long-term health problems. We aim to understand transitions in tobacco use patterns among these groups and the factors that affect transition patterns. MethodsUsing the five waves of data from the nationally representative Population Assessment of Tobacco and Health (PATH) Study (2013–2019), we conducted latent class analysis and latent transition analysis to understand tobacco use classes and the longitudinal transitions between classes. We also adjusted for covariates, including demographics, individual behaviors, household environment, and psychosocial factors, to capture their effects on class transition probabilities. ResultsThree tobacco use behaviors were identified: non-current user (C1), moderate e-cigarette user (C2), and poly-tobacco user (C3). At baseline (Wave 1), 94.4% of participants were classified as C1, 3.2% as C2, and 2.4% as C3, and the distribution shifted towards C2 and C3 over time. Progression to the next class represented the most common transitions (14.1% C2 to C3, 10.7% C1 to C2), while the direct progression from C1 to C3 was rare (0.6%). Being male, White, adult, living in smoking-allowed households, past-year alcohol use, drug use, internalizing problems, and social media follower of tobacco brands were associated with a faster progression to poly-tobacco use. ConclusionsThe transition patterns implied that e-cigarette use might be an intermediate progression from non-current use into poly-tobacco use. Individual behaviors, household environment, and psychosocial factors are associated with elevated risks of progression. The findings may inform tobacco prevention and cessation policies among youth and young adults.

The Impact of Current Tobacco Product Use Definitions on Estimates of Transitions Between Cigarette and ENDS Use

Definitions of current tobacco and nicotine delivery product use vary and depend on frequency of use, established-use criteria, and the product type. Previous research has not considered how transition rates between current use of different products depend on the current use definition. We applied a multistate transition model to data on U.S. adults from waves 1-4 (2013-2017) of the Population Assessment of Tobacco and Health (PATH) study. We estimated transition rates between never, non-current, cigarette, electronic nicotine delivery systems (ENDS), and dual use states with and without established-use criteria (has smoked 100+ cigarettes in their lifetime; ever fairly regularly used ENDS) and different frequency thresholds (1+, 10+, 20+, and 30 days of the past 30 days). We considered use below a frequency threshold as either non-current use or a distinct, infrequent use category. When treating use below a frequency threshold as non-current use, transition probability estimates were largely robust to the choice of use frequency threshold, although sole ENDS users were more likely to transition to non-current use or dual use as the current use threshold increased. Removing the established-use criterion for ENDS reduced the estimates of sole ENDS and dual users staying in their use state. When treating infrequent use as a separate category, transition probability estimates were dependent on the use frequency threshold, particularly transitions among the dual use states. Product use definitions have important implications for assessing product use transitions and thus the public health implications of cigarette and ENDS control strategies. How we define "current use" of tobacco and nicotine delivery products changes our estimates of how individuals transition to, between, and from different patterns of use. We show that the robustness of transition estimates to whether or not non-established users are included as current users and to different frequency-of-use threshold depends in part on whether low-frequency users are categorized as non-current users or as a distinct category. Our results emphasize the importance of intentional definitions of product use that reflect the larger goals of public health and tobacco control.

Short communication: Racial/ethnic disparities in cigar and cigarette exclusive, dual, and polyuse among adults

BackgroundDespite documented racial/ethnic differences in cigar use, disparities in the context of dual and polyuse with cigarettes are unclear. MethodsUsing the Population Assessment of Tobacco and Health Study (2016–18), we examined prevalence and intensity of use patterns among adults (18+) who were Non-Hispanic (NH) Black, NH White, Hispanic, or another race/ethnicity: exclusive cigarillo, filtered cigar, traditional cigar, or cigarette use; dual use of each cigar product with cigarettes; dual or polyuse of cigars without cigarettes; and cigar and cigarette polyuse. We used multinomial logistic regression to compare odds of each pattern of use to non-use of cigars or cigarettes and quantile regression to assess differences in median products used per day. ResultsIn our sample (n = 33,424), NH Black adults were more likely to exclusively smoke cigarillos (1.8%), cigarillos and cigarettes (1.6%), and multiple cigar products with or without cigarettes than other racial/ethnic groups. In adjusted models, NH Black compared to NH White adults had higher odds of exclusive cigarillo use (aOR 5.24, 95% CI 3.74–7.34), exclusive filtered cigar use (aOR 2.40, 95% CI 1.33–4.35), cigarillo and cigarette dual use (aOR 2.19, 95% CI 1.60–3.00), and dual/polyuse of cigar products (aOR 2.03, 95% CI 1.22–3.38) compared to non-current use. However, NH White adults tended to smoke the most cigarettes and filtered cigars per day. ConclusionsWhile the prevalence of cigar use was generally highest among NH Black adults, intensity of use was often highest among NH White users. These patterns may further explain racial/ethnic disparities in tobacco-related health outcomes.

Electronic nicotine delivery systems use predicts transitions in cigarette smoking among young adults

BackgroundAlthough cigarette smoking during young adulthood is characterized by volatility, few studies examine if use of electronic nicotine delivery systems (ENDS) impacts transitions in cigarette use behaviors across this developmental period. The purpose of this longitudinal study was to examine the role of ENDS use on three transitions in cigarette smoking among young adults; initiation, desistance, and re-uptake. Methods: Participants were 5029 18–29-year-olds (64.2% female) enrolled in one of 24 Texas colleges at baseline and involved in an eight-wave, 4.5-year study. A multi-state, continuous time Markov model was used to assess the role of current/past 30-day and ever ENDS use on three transitions, spanning at least six months 1) never to current smoking (initiation); 2) current to non-current smoking (desistance); and 3) non-current to current smoking (re-uptake). The model also contained time-invariant socio-demographic, and time-varying intrapersonal (other tobacco use, nicotine dependence, sensation seeking, depressive symptoms) and interpersonal (peer cigarette use) covariates. Results: Both current and ever ENDS use increased the probability of transitioning from never to current cigarette use (initiation) and decreased the probability of transitioning from current to non-current use (desistance). Current, but not ever, ENDS use also increased the probability of transitioning from non-current to current use (re-uptake). Adjustment for socio-demographic, intrapersonal, and interpersonal covariates did not alter these findings. Discussion: ENDS use in young adulthood increases the risk for cigarette smoking behaviors across the continuum of uptake and progression. Prevention and cessation efforts targeting both ENDS and cigarette use during young adulthood are needed.

Association of cigarette and electronic nicotine delivery systems use with internalizing and externalizing problems among US adults: Findings from wave 3 (2015-2016) of the PATH study.

AimsElectronic Nicotine Delivery System (ENDS) use is increasing among US adults. While existing research has demonstrated higher cigarette smoking rates among people with mental health conditions, there is sparse information on the association between ENDS use and mental health such as internalizing and externalizing problems. The aim of this study was to evaluate associations between internalizing and externalizing problems for cigarette only, ENDS only, and dual users, as well as changes in mental health among those groups.MethodWe used the U.S. Population Assessment of Tobacco and Health (PATH) Study Wave 3 adult data. Internalizing and externalizing problems were self-reported and assessed via the Global Appraisal of Individual Needs-Short Screener; response options were dichotomized to reflect past 12 months and any lifetime problems. Self-reported changes in mental health over the past 12 months were also assessed. Participants’ tobacco use status was categorized as ENDS only use (n = 618), cigarette only use (n = 6,779), dual use (cigarettes and ENDS) (n = 681), and non-current use (n = 16,515).ResultsLifetime and past 12 month internalizing problems were reported by 63.8% (n = 18,706) and 50.4% (n = 15,326), respectively, while lifetime and past 12 months externalizing problems were reported by 63.3% (n = 18,835) and 52.7% (n = 16,005), respectively. Six percent of participants reported worse mental health over the past 12 months. Compared to non-current use of any tobacco product, and adjusting for age, sex, race, education, and household income, those reporting ENDS use only had higher odds of ever (aOR = 1.52; 95%CI: 1.22–1.89) and past 12 months (aOR = 1.49; 95%CI: 1.22–1.84) internalizing, and externalizing problems (aOR = 1.32; 95%CI: 1.04–1.66 and aOR = 1.34; 95%CI: 1.07–1.67, respectively), and higher odds of reporting worse mental health over the past 12 months (aOR = 1.50; 95%CI: 1.05–2.12).ConclusionHealth care providers should be aware that internalizing and externalizing problems, and worsening mental health, are more common among adults who use ENDS, cigarettes, or both of these tobacco products.

Age at first alcohol use predicts current alcohol use, binge drinking and mixing of alcohol with energy drinks among Ontario Grade 12 students in the COMPASS study.

This study investigates the influence of age at first use of alcohol on current alcohol use and associated behaviours in a large sample of Canadian youth. This descriptive-analytical study was conducted among Ontario Grade 12 students enrolled in the COMPASS Host Study between 2012 and 2017. We used generalized estimating equations (GEE) modelling to determine associations between age at first alcohol use and likelihood of current versus non-current alcohol use, binge drinking and mixing of alcohol with energy drinks among respondents. Students reporting an age at first alcohol use between ages 13 and 14 years were more likely to report current alcohol use versus non-current use (OR = 2.80, 95% CI: 2.26-3.45) and current binge drinking versus non-current binge drinking (OR = 3.22, 95% CI: 2.45-4.25) compared to students reporting first alcohol use at age 18 years or older. Students who started drinking at 8 years of age or younger were more likely to report current versus non-current alcohol use (OR = 3.54, 95% CI: 2.83-4.43), binge drinking (OR = 3.99, 95% CI: 2.97-5.37), and mixing of alcohol with energy drinks (OR = 2.26, 95% CI: 1.23-4.14), compared to students who started drinking at 18 years or older. Starting to drink alcohol in the early teen years predicted current alcohol use, current binge drinking and mixing of alcohol with energy drinks when students were in Grade 12. Findings indicate a need for development of novel alcohol prevention efforts.

Young Adult Tobacco and E-cigarette Use Transitions: Examining Stability Using Multistate Modeling.

The objective of this study was to describe tobacco and nicotine product use state transition probabilities among youth and young adults over time. A national sample of young adult tobacco product users and nonusers between the ages of 18 and 34 years at baseline was surveyed at 6-month intervals for 3 years. Use and nonuse states were defined as mutually exclusive categories based on self-reported, past 30-day use of the various products. Never use, noncurrent use, and current use of combustible, noncombustible tobacco, and electronic cigarette (e-cigarette) products was assessed at each interval. A multistate model was fit to estimate transition probabilities between states and length of stay within each state. After 6 months, same-state transition probabilities were high for all use states (0.76-0.96), except for dual product use (0.48). After 3 years, transition probabilities were smaller and tended to converge toward combustible product use for baseline e-cigarette (0.42), combustible (0.51), and dual product users (0.52). Age was inversely associated with transition risk from never or noncurrent use to use of combustible or e-cigarette products. Never and noncurrent users, followed by combustible product users, were most likely to remain in those states throughout the 3-year observation interval. Users of any tobacco or e-cigarette product at baseline were most likely to transition to combustible product use or noncurrent use by the final follow-up. This study describes the probability of transitioning between various states of tobacco product use, including never and no current use, over a span of 3 years in a sample of young adults. This type of longitudinal description, which includes all tobacco product use states, is lacking in most studies that tend to focus on one or only a few products. The results suggest that it is important to assess outcomes over a sufficiently long period to capture true variability in patterns of product use.

Identifying behavioural characteristics of tobacco product and e-cigarette use clusters: A repeat cross-sectional analysis

BackgroundYouth may use a variety of tobacco products and e-cigarettes. However, there is a lack of evidence for the combinations of tobacco products and e-cigarettes commonly used by youth in Canada and whether youth from different usage classes share similar characteristics. MethodsA cohort of 9th grade students from Ontario, Canada was identified at baseline (2013–14) of the COMPASS study (n = 4651). Classes of youth that currently use similar combinations of tobacco products and e-cigarettes were identified at baseline, one (FY1) and two years later (FY2) using latent class analysis. Multinomial logistic regression models identified demographic and behavioural characteristics (e.g., environmental influences, substance use behaviours, etc.) of youth in current tobacco and e-cigarette use classes relative to youth in non-current use classes. ResultsAt baseline, a three-class model was identified as best, while a four-class model was identified at FY1 and FY2. A non-current use group and an all-product use group were identified every year. Students that reported having friends that smoked cigarettes, binge drinking, and using marijuana were more likely to be classified into a current use class. ConclusionsTobacco cigarettes were more likely to be used with other products than on their own. An all-product use group was identified across all three survey waves and the prevalence of this group increased over time. Given that many youth in this study used more than one tobacco product or e-cigarette and commonly reported binge drinking and using marijuana, prevention and cessation activities should address the use of multiple products.

Longitudinal Tobacco Use Transitions Among Adolescents and Young Adults: 2014-2016.

Among youth, the frequency and prevalence of using more than one tobacco (small cigar, cigarette, and hookah) or nicotine-containing product (e-cigarettes-ENDS) are changing. These shifts pose challenges for regulation, intervention, and prevention campaigns because of scant longitudinal data on the stability of use patterns in this changing product landscape. A nationally representative longitudinal survey of 15- to 21-year olds (n = 15,275) was used to describe transitions between never use, noncurrent use, and past 30-day use of combustible tobacco, e-cigarettes (ENDS), and dual use of both kinds of products. A multistate model was fit to observations collected every 6 months across 2.5 years to estimate the probability of transitions between states (TPs), the average time in state (sojourn time), and the effect of age on transitions. Current state strongly predicted future state over time intervals of 1 year or less, but only weakly predicted future state at longer intervals: TP to noncurrent use was higher for ENDS-only than combustible-only users over a 6-month interval but was similar for both groups over a 2-year interval. Sojourn time was significantly longer for combustible-only (0.52 years) and dual use (0.55 years) than ENDS-only use (0.27 years); older youth were more likely than younger youth to stay combustible tobacco users or noncurrent users. The dynamics of transitions between combustible tobacco products and ENDS in a population of youth and young adults suggest that policy and prevention efforts must consider the frequent changes and instability over a 1-year or less time period in use patterns among young people. The study addresses an urgent need in public health for timely information on how youth and young adults use tobacco and nicotine products. We found that youth, particularly adolescents, moved frequently between using ENDS and combustible tobacco products either alone or together. Importantly, the utility of current-use states for predicting future use states declined for time horizons longer than 1 year. Our results demonstrate a need for caution in interpreting product transitions. Longitudinal data with frequent observations and coverage of a wide range of possible product types is required to fully characterize usage patterns in youth.

Exploring the Predictive Validity of the Susceptibility to Smoking Construct for Tobacco Cigarettes, Alternative Tobacco Products, and E-Cigarettes.

Within tobacco prevention programming, it is useful to identify youth that are at risk for experimenting with various tobacco products and e-cigarettes. The susceptibility to smoking construct is a simple method to identify never-smoking students that are less committed to remaining smoke-free. However, the predictive validity of this construct has not been tested within the Canadian context or for the use of other tobacco products and e-cigarettes. This study used a large, longitudinal sample of secondary school students that reported never using tobacco cigarettes and noncurrent use of alternative tobacco products or e-cigarettes at baseline in Ontario, Canada. The sensitivity, specificity, and positive and negative predictive values of the susceptibility construct for predicting tobacco cigarette, e-cigarette, cigarillo or little cigar, cigar, hookah, and smokeless tobacco use 1 and 2 years after baseline measurement were calculated. At baseline, 29.4% of the sample was susceptible to future tobacco product or e-cigarette use. The sensitivity of the construct ranged from 43.2% (smokeless tobacco) to 59.5% (tobacco cigarettes), the specificity ranged from 70.9% (smokeless tobacco) to 75.9% (tobacco cigarettes), and the positive predictive value ranged from 2.6% (smokeless tobacco) to 32.2% (tobacco cigarettes). Similar values were calculated for each measure of the susceptibility construct. A significant number of youth that did not currently use tobacco products or e-cigarettes at baseline reported using tobacco products and e-cigarettes over a 2-year follow-up period. The predictive validity of the susceptibility construct was high and the construct can be used to predict other tobacco product and e-cigarette use among youth. This study presents the predictive validity of the susceptibility construct for the use of tobacco cigarettes among secondary school students in Ontario, Canada. It also presents a novel use of the susceptibility construct for predicting the use of e-cigarettes, cigarillos or little cigars, cigars, hookah, and smokeless tobacco among secondary school students in Ontario, Canada.

Socio‐economic differentials in cannabis use trends in Australia

To test if the degree of change in cannabis use between 2001 and 2013 differed according to socio-economic status. Repeated cross-sectional household surveys that were nationally representative. Australia. Adult samples from the 2001 and 2013 National Drug Strategy Household Surveys (n=23 642 in 2001 and n=21 353 in 2013), the largest nationally representative survey on drug use in Australia. Frequency of cannabis use coded as daily use, weekly use, less than weekly use and non-current use; socio-economic status (SES) as measured by personal income and educational level. There were significant differences in changes to levels of cannabis use between SES groups. Among participants who completed high school, the probability of daily use decreased from 0.014 to 0.009 (P<0.001), and the probability of weekly use decreased from 0.025 to 0.017 (P<0.001). These probabilities remained stable for participants who did not complete high school. The probability of weekly cannabis use decreased from 0.032 to 0.023 among participants with middle level income (P=0.004), and from 0.021 to 0.013 among those with high income (P=0.005). There were no significant changes in these probabilities among those with low income (0.026 in 2001 and 0.032 in 2013; P=0.203). The decline in cannabis use in Australia from 2001 to 2013 occurred largely among higher socio-economic status groups. For people with lower income and/or lower education, rates of frequent cannabis use remained unchanged.

Hormonal contraception, sickle cell trait, and risk for venous thromboembolism among African American women

We evaluated the effect of oral and other hormonal contraceptive (HC) use on venous thromboembolism risk among African American women and investigated whether the association was modified by the sickle cell trait. We report the findings of a case-control study that included 60 African American women with an idiopathic, first episode of venous thromboembolism and 196 African American controls. The odds of current HC use compared with noncurrent use contrasting cases and controls is 3.8 (95% confidence interval [CI], 1.7-8.1; P < .001). Among subjects with sickle cell trait, the odds ratio is higher (odds ratio [OR], 6.7; 95% CI, 1.0-43) than the odds ratio among subjects without sickle cell trait (OR, 2.6; 95% CI, 1.1-6.2), but the difference is not statistically significant. This study provides persuasive evidence that hormonal contraceptive use increases venous thromboembolism risk among African American women and that the increase in risk may be larger among women with sickle cell trait.

Risk of ischemic stroke among users of the oral contraceptive pill: The Melbourne Risk Factor Study (MERFS) Group.

Use of oral contraceptives has increased, and there is uncertainty about the stroke risk associated with their use. Our aim was to investigate this issue. Using case-control techniques, we identified consecutive women with ischemic stroke from 4 Melbourne hospitals. All patients were between 15 and 55 years of age and had no prior stroke. Neighborhood-based control subjects were individually age-matched (+/-5 years) and geographically matched to subject cases. A questionnaire administered to participants elicited information about prior exposure to various potential risk factors, including the oral contraceptive pill (OCP). We included 234 cases and 234 controls (mean age, 42 years). Compared with noncurrent use, current use of the OCP, in doses of <or=50 microg estrogen, was not associated with an increased risk of ischemic stroke (odds ratio [OR] 1.76; 95% CI, 0.86 to 3.61; P=0.124). Factors associated with an increased risk of ischemic stroke were a history of hypertension (OR, 2.18; 95% CI, 1.22 to 3.91), transient ischemic attack (OR, 8.17; 95% CI, 1.69 to 39.6), previous myocardial infarction (OR, 5.64; 95% CI, 1.04 to 30.61), and diabetes mellitus (OR, 5.42; 95% CI, 1.42 to 20.75); family history of stroke (OR, 2.22; 95% CI, 1.12 to 4.43); and smoking >20 cigarettes per day (OR, 3.68; 95% CI, 1.22 to 11.09). There was no evidence for an association between ischemic stroke and use of the OCP in low doses (<or=50 microg estrogen) in young Australian women. Other modifiable risk factors such as hypertension, diabetes mellitus, and smoking are important.

Retention in a low-threshold methadone maintenance program

In 370 opioid-dependent patients included consecutively in a low-threshold methadone maintenance program, the effect of different variables on the retention rate was assessed. The variables included the patients' age, sex, family situation, employment status, length of heroin use, current route of drug consumption, previous treatments, current consumption of cocaine, alcohol and benzodiazepines, needle sharing, HIV serostatus and methadone dose. The retention rate after 2 years of methadone maintenance was 72%. Dose of methadone > 80 mg/day, age > 30 years, living with family or stable partner and non-current use of alcohol were significant predictive variables for retention.