Reduce Cigarette Use Research Articles

Effects of Pictorial Warning Labels for Cigarettes and Quit-Efficacy on Emotional Responses, Smoking Satisfaction, and Cigarette Consumption.

Experimental research on pictorial warning labels for cigarettes has primarily examined immediate intentions to quit. Here, we present the results of a clinical trial testing the impact on smoking during and after a 28-day period of naturalistic exposure to pictorial versus text-only warnings. Daily cigarette smokers (N = 244) at two sites in the USA were randomly assigned to receive their regular brand of cigarettes for 4 weeks with one of three warnings: (a) text-only, (b) pictures and text as proposed by FDA, or (c) the warnings proposed by FDA with additional text that elaborated on the risks of smoking. Analyses examined the effects of pictorial versus text-only warnings and self-efficacy for quitting on cigarette consumption during and 1 month after the trial as mediated by emotional and cognitive responses as well as satisfaction with smoking. Stronger emotional responses to pictorial than text-only warnings predicted reduced satisfaction with smoking during the trial and lower cigarette consumption at follow-up among the majority of smokers who continued to smoke. Consistent with the efficacy-desire model, those with moderate efficacy reported the greatest reduction in consumption at follow-up. However, a small proportion of smokers (7%) who reported 7-day abstinence at follow-up did not exhibit a significant relation with self-efficacy. Pictorial warning labels proposed by FDA create unfavorable emotional reactions to smoking that predict reduced cigarette use compared to text alone, with even smokers low in self-efficacy exhibiting some reduction. Predictions that low self-efficacy smokers will respond unfavorably to warnings were not supported.

E-cigarettes: promise or threat?

Use of the electronic cigarette or electronic nicotine delivery system (ENDS) is increasing globally. Its vapour delivers nicotine without the 6000 odd chemicals released during cigarette smoking and the associated harm. Experts are divided on whether ENDS promise reduction in tobacco use or threaten tobacco control. This review presents up-to-date evidence. Two trials showed an increase in cessation, but not a reduction in cigarette use. Eight cohort studies showed no increase in cessation, and two cohort studies and a recent trial showed an increased reduction in cigarette use. A US population study showed association between ENDS use and smoking cessation. Nicotine addiction and potential harm to non-smokers who use ENDS are key concerns. Nicotine affects lung and brain development. An increase in accidental poisoning, though mild, is reported in children. No significant short term health effects are reported. When heated, ENDS may emit potential toxic and carcinogenic substances such as aldehydes, acrolein, flavouring agents etc. at very low levels - but their long term impact is not known. ENDS bring potential benefits to smokers, but there are concerns about their potential for nicotine addiction, gateway effect and renormalisation of smoking. However, in the UK and the US, a rise in ENDS use is associated with a fall in the prevalence of smoking. Countries differ in their approach to ENDS. India seems to be edging towards a total ban. India should collect local data and conduct research to monitor the impact and make informed, evidence based decisions, where needed.

Behavioral change in response to a statewide tobacco tax increase and differences across socioeconomic status

BackgroundTobacco use is a leading behavioral risk factor for morbidity and mortality, and the tobacco epidemic disproportionately affects low-socioeconomic status (SES) populations. Taxation is effective for reducing cigarette use, and it is an effective population-based policy for reducing SES-related tobacco disparities. However, progress in implementing cigarette excise taxes has stalled across the United States, and there is a dearth of research on the full spectrum of behavioral shifts that result from taxes, particularly among low-SES populations. This project documents the impact of Minnesota's $1.75 cigarette tax increase implemented in 2013. MethodsData come from the 2014 Minnesota Adult Tobacco Survey. Descriptive analyses and Latent Class Analysis (LCA) were used to provide a typology of the tax impact. ResultsFrom the LCA, six classes were identified, and 42% of respondents were classified as reporting action-oriented behavioral change related to the tax—8% reported sustained smoking abstinence. We found differential behavior change across levels of SES. Low-SES and medium/high-SES individuals were equally likely to report complete tobacco cessation, but the prevalence of daily smokers who reported action-oriented behavior without sustained cessation was nearly double for low-SES individuals. ConclusionsSmokers report a range of behavioral changes in response to cigarette taxes, with differences across SES. The majority of smokers, and particularly low-SES smokers, report behavioral steps toward quitting or achieving sustained tobacco cessation in response to cigarette taxes. Complementary population-based programs geared toward assisting individuals, especially low-SES individuals, to achieve continuous tobacco cessation could increase the reach and effectiveness of cigarette taxes.

Cigarette Smoking among Out-of-School Adolescents in Sokoto Metropolis, North-West Nigeria

Introduction: Many factors have been put forward for adolescents engagements in smoking; influence of peers, the need to conform, low self-esteem, need for approval, and family influences have been identified. Also, knowledge of health problems associated with smoking is a major reason for not smoking by never smoked adolescents. It is against this background that this study becomes relevant, also, coupled with the fact that no previous study on cigarette smoking has been conducted among out-of-school adolescents in Sokoto. Methodology: The study was conducted among out-ofschool adolescents in sokoto metropolis. The study site consisted of the commercial motor-parks, central and other market sites as well as busy roads in sokoto metropolis where out of school adolescents frequent. A total of 213 study participants were recruited using a 2- staged sampling technique and subsequently interviewed using an interviewer administered structured questionnaire. Data was entered and analysed with IBM version 21 statistical software package. Level of significance was set at 5% and all tests were conducted using 2 tails. Result: Most of the respondents had good knowledge of health hazard of cigarette smoking, 11.3% of respondents had ever smoked cigarette and 3.3% were current cigarette smoker. There was an association between respondents ever smoking cigarette with respondentsâ educational status (X2=9.575, p=0.002), age group (X2=17.548, p=0.000), fathers smoking cigarette (X2=5.655, p=0.02, OR=2.78), mother smoking cigarette (X2=12.162, p=0.000, OR=13.36). Main determinant of respondent ever smoking was their perception that smokers should be allowed to smoke in public [OR=17.026, p=0.002, CI= (2.82-102.807]. Conclusion: Eleven percent of respondents had ever smoked cigarette, 3.3% were currently smoking cigarette. Most of the adolescents had good knowledge of health hazards of cigarette smoking. Main determinant of respondents ever smoking was the perception that people should be allowed to smoke in public. Sustained antismoking campaigns targeting out-of school adolescents may go a long way in reducing cigarette use among this group of adolescents.

Gradual Versus Abrupt Smoking Cessation.

Patients may vary in their expressed preferences about how to attempt smoking cessation. Whether an initial gradual reduction in cigarette use before an attempt to quit is as effective as abrupt ce...

Outcomes of the Smoker's Health Project: a pragmatic comparative effectiveness trial of tobacco-dependence interventions based on self-determination theory.

A pragmatic comparative effectiveness trial examined whether extending the duration of a cost-effective, intensive tobacco-dependence intervention designed to support autonomy will facilitate long-term tobacco abstinence. Participants were randomly assigned to one of three tobacco-dependence interventions based on self-determination theory, namely, Intensive Treatment (IT; six contacts over 6 months), Extended Need Support (ENS; eight contacts over 12 months) and Harm Reduction (HR; eight contacts over 12 months with medication use if willing to reduce cigarette use by half). Among participants who completed the interventions, analyses revealed beneficial effects of ENS (15.7 versus 3.8%; χ 2(1) = 6.92, P < 0.01) and HR (13.6 versus 3.8%; χ 2(1) = 5.26, P < 0.05), relative to IT, on 12-month prolonged abstinence from tobacco. Also, analyses revealed beneficial effects of ENS (77.7 versus 43.0%; χ 2(1) = 24.90, P < 0.001) and HR (84.0 versus 43.0%; χ 2(1) = 37.41, P < 0.001), relative to IT, on use of first-line medications for smoking cessation. Hence, two new interventions were found to be efficacious particularly among participants who completed the interventions. Smokers who stay in treatment for an additional 6 months may benefit from an additional two contacts with practitioners, and thus it seems reasonable for policy makers to offer additional contacts given the health benefits associated with prolonged tobacco abstinence.

The Economic Impact of Cigarette Smoking on the Poor in Jordan

ObjectivesTo examine the expenditure on cigarette smoking in Jordan and compare the costs with potential investments in food and other essential items. MethodsReview of available statistics and calculations were performed to estimate the economic cost of cigarette smoking in the Hashemite Kingdom of Jordan. Data on tobacco use and on household expenditures were collected from the Hashemite Kingdom of Jordan official databases. Information on the percentage of adult male smokers in each income group was based on cross-sectional data from 804 adult smokers. The average daily expenditure on cigarettes by cigarette smokers was based on a sample selected using a multistage, geographically clustered design. An example of a balanced diet was constructed on the basis of the recommendations of the jointly published dietary guidelines of the US Department of Health and Human Services and the US Department of Agriculture. ResultsCigarette smoking prevalence is the highest among the poorest, with the highest rate (57%) being among adult males with an income of 100 to 250 Jordanian dinars per month as compared with the prevalence rate of 14% among adult males with an income of 500 Jordanian dinars or more per month. Our calculations show that the poorest 40% of adult males are 1.7 times more likely to smoke cigarettes than the richest 17% of adult males. The average poorest adult male cigarette smoker with an income of 100 to 250 Jordanian dinars per month spends approximately 25 times more on cigarettes than on health, approximately 10 times more on cigarettes than on education, approximately 2.5 times more on cigarettes than on housing, and approximately 1.5 times more on cigarettes than on food. The amount spent on cigarettes could potentially add up to 115 calories of a balanced diet per capita daily or 850 calories of a balanced diet per average cigarette smoker daily. Smoking cost the country 1 billion Jordanian dinars in 2012, including money spent on tobacco and smoking-related diseases, which amounted to approximately 5% of the gross domestic product. These calculations underestimate the real cost of smoking because these do not include the loss in work productivity due to smoking, which can be substantial. ConclusionsOur positive analysis shows that by adopting policies that reduce cigarette use, Jordan would be able to achieve both short- and long-run economic gains that will disproportionally benefit the poorest. Normative analysis suggests that an increase in tobacco taxes is likely to be the most efficient policy tool to reduce cigarette smoking in Jordan.

Annals for Educators - 3 May 2016

<i>Annals</i> for Educators - 3 May 2016

Affordable Care Encourages Healthy Living: Theory and Evidence from China's New Cooperative Medical Scheme

In developing a theory of medical insurance and health behavior with bequest motive, we discover that whether ex ante moral hazard or the opposite occurs hinges upon the differential effects of health behavior on morbidity and mortality. Providing insurance can encourage healthy living by making longevity more affordable. We test the theory utilizing a unique experiment of China introducing the new cooperative medical scheme, unique in its long-term credibility necessary for our proposed channel. This scheme reduced cigarette use by around 9%. Further empirical analysis failed to falsify our theory or the alternative mechanism of health insurance reducing stress and thus the demand for cigarettes and hard liquor. Both newly proposed mechanisms alleviate concerns over ex ante moral hazard caused by providing affordable care for the poor.

Multiple tobacco product use among young adult bar patrons in New Mexico

IntroductionUse of non-cigarette tobacco products is common, and e-cigarette use is increasing among young adults. We aimed to identify use of other tobacco products among young adult bar patrons in the context of a bar-based intervention to decrease cigarette smoking. Methods2291 cross-sectional surveys were collected from young adults in bars in Albuquerque, New Mexico using time–location sampling between 2011 and 2013 (N=1142 in 2011, N=1149 in 2012–2013), 2 and 3years into an intervention to reduce cigarette use, and analyzed in 2014–2015. Participants reported current (i.e. past 30-day) use of cigarettes, snus, dip, cigarillos, hookah, and e-cigarettes, demographics, and tobacco-related attitudes. Multiple imputation was used to account for planned missing data. Logistic regression determined correlates of multiple tobacco product use. ResultsCigarette smoking in the population decreased during the intervention from 43% to 37%. Over 60% of current cigarette smokers reported poly-use, most frequently with e-cigarettes (46%) and hookah (44%), followed by cigarillos (24%), dip (15%), and snus (14%) in 2012–2013. Among cigarette smokers, current e-cigarette use increased, while use of other products decreased during the intervention. Odds of poly-use (versus smoking cigarettes only) were greater among males and those reporting past 30-day binge drinking, and lower in those who strongly believed secondhand smoke exposure is harmful. ConclusionsAmong young adult bar patrons in Albuquerque, New Mexico, most cigarette smokers reported currently using at least one other tobacco product. Public health interventions should address use of all tobacco products, use of which may rise despite decreased cigarette use.

The impact of prices and taxes on the use of tobacco products in Latin America and the Caribbean.

We examined the impact of tobacco prices or taxes on tobacco use in Latin America and Caribbean countries. We searched MEDLINE, EconLit, LILACS, unpublished literature, 6 specialty journals, and reviewed references. We calculated pooled price elasticities using random-effects models. The 32 studies we examined found that cigarette prices have a negative and statistically significant effect on cigarette consumption. A change in price is associated with a less than proportional change in the quantity of cigarettes demanded. In most Latin American countries, own-price elasticity for cigarettes is likely below -0.5 (pooled elasticities, short-run: -0.31; 95% confidence interval=-0.39, -0.24; long-run: -0.43; 95% CI=-0.51, -0.35). Tax increases effectively reduce cigarette use. Lack of studies using household- or individual-level data limits research's policy relevance.

A translational investigation targeting stress-reactivity and prefrontal cognitive control with guanfacine for smoking cessation.

Stress and prefrontal cognitive dysfunction have key roles in driving smoking; however, there are no therapeutics for smoking cessation that attenuate the effects of stress on smoking and enhance cognition. Central noradrenergic pathways are involved in stress-induced reinstatement to nicotine and in the prefrontal executive control of adaptive behaviors. We used a novel translational approach employing a validated laboratory analogue of stress-precipitated smoking, functional magnetic resonance imaging (fMRI), and a proof-of-concept treatment period to evaluate whether the noradrenergic α2a agonist guanfacine (3 mg/day) versus placebo (0 mg/day) reduced stress-precipitated smoking in the laboratory, altered cortico-striatal activation during the Stroop cognitive-control task, and reduced smoking following a quit attempt. In nicotine-deprived smokers (n=33), stress versus a neutral condition significantly decreased the latency to smoke, and increased tobacco craving, ad-libitum smoking, and systolic blood pressure in placebo-treated subjects, and these effects were absent or reduced in guanfacine-treated subjects. Following stress, placebo-treated subjects demonstrated decreased cortisol levels whereas guanfacine-treated subjects demonstrated increased levels. Guanfacine, compared with placebo, altered prefrontal activity during a cognitive-control task, and reduced cigarette use but did not increase complete abstinence during treatment. These preliminary laboratory, neuroimaging, and clinical outcome data were consistent and complementary and support further development of guanfacine for smoking cessation.

Adolescent Use of Electronic Cigarettes: An Emergent Health Concern for Pediatric Nurses

Recent statistics show an increasing trend of electronic cigarette usage among adolescents. Despite common misconceptions, electronic cigarette use does not reduce cigarette use among adolescents and can potentially increase cigarette dependence via nicotine addiction and modeling of smoking behaviors. Pediatric nurses and health care providers should be aware of the popularity and safety concerns of electronic cigarettes so that they can properly provide education regarding the possible negative health effects of adolescent electronic cigarette use, raise awareness of this public health concern, and impact policies in their communities.

Effectiveness of Electronic Cigarettes as a Tool for Smoking Cessation or Reduction.

Objective: To examine the evidence concerning effectiveness of electronic cigarettes (e-cigarettes) in smoking cessation or reduction and reduction in desire to smoke and withdrawal symptoms. Data Sources: A PubMed literature search through May 2014 was performed using search terms electronic cigarettes or e-cigarettes; smoking or tobacco; and efficacy or effectiveness limited to clinical trials in humans. Cochrane Library and International Pharmaceutical Abstracts were searched using the term electronic cigarettes. Relevant citations from identified articles were reviewed. Study Selection and Data Extraction: All English-language clinical trials assessing cessation, reduction in cigarette use, desire to smoke, and/or reduction in withdrawal symptoms with e-cigarettes were included. Data Synthesis: Of 7 trials, one showed similar 6-month abstinence rates between e-cigarettes and nicotine patches. Another trial reported 12.5% of participants achieving abstinence at 24 months with e-cigarettes. Three studies demonstrated significant percentages of patients maintaining ≥50% reduction in cigarettes/day from baseline to 24 or 52 weeks. Another trial showed significant reductions in cigarette use from baseline through 52 weeks with e-cigarettes; no difference in abstinence rates beyond 12 weeks was found between nicotine and placebo e-cigarettes. Only 2 trials assessed reduction in desire to smoke or withdrawal symptoms, and results varied. Conclusions: The limited evidence available supports that e-cigarettes may be effective as monotherapy for smoking cessation and reduction. However, superiority to nicotine replacement therapy was not proven. Limited conclusions can be drawn regarding reduction in desire to smoke and withdrawal symptoms. The unknown long-term safety risk should also be considered.

The Effects of Parental Acculturation and Parenting Practices on the Substance Use of Mexican-Heritage Adolescents from Southwestern Mexican Neighborhoods

A sample of 189 Mexican-heritage seventh grade adolescents reported their substance use, while one of the child's parents reported parent's acculturation and communication, involvement, and positive parenting with his or her child. Higher levels of parental acculturation predicted greater marijuana use, whereas parent communication predicted lower cigarette and marijuana use among girls. A significant parent acculturation by parent communication interaction for cigarette use was due to parent communication being highly negatively associated with marijuana use for high acculturated parents, with attenuated effects for low acculturated parents. A significant child gender by parent acculturation by parent positive parenting interaction was found. For girls, positive parenting had a stronger association with lower cigarette use for high acculturated parents. For boys, positive parenting had a stronger association with reduced cigarette use for low acculturated parents. Discussion focuses on how acculturation and gender impact family processes among Mexican-heritage adolescents.

Reframing the Governance of Addictions

The ALICE RAP (Addictions and Lifestyles in Contemporary Europe – Reframing Addictions Project; www. alicerap.eu) is a five year E 10 million endeavour, cofinanced by the European Commission, studying the place of addictions in contemporary Europe. Based on ALICE RAP s new research and its synthesis of existing research, in this editorial, I highlight three themes that can drive a reframing of the governance of addictions. The first theme is that an ecological analysis of addictive substances suggests that humans are active and functional in relation to the drugs thatwe take, rather thanbeing passive and vulnerable (Sullivan & Hagen, 2014). For example, in the story of life over the last 400 million years, one of the developments has been the battle between plants, and the animals that eat them. Of many defence mechanisms, plants produce secondarymetabolites, including nicotine, morphine, and cocaine, potent neurotoxins that evolved because they punished and deterred consumption by plant-eating animals. Counterbalancing this, animals have evolved to counter-exploit the products of these hundreds of millions of years of research by plants to inhibit and kill their own parasites by subsisting on a mixed diet of palatable and toxic plants, trading off diet quality (and thus growth) for what is termed enemy-reduced or enemy-free space. This also applies to humans. Amongst Congo basin hunter gatherers, the quantity of cigarettes smoked is titrated against intestinal worm burden – the higher the worm burden, the greater the number of cigarettes smoked. Further, when treated with the anthelmintic drug, abendazole, the number of cigarettes smoked is reduced (Roulette et al., 2014). In another example, the presence of ethanol within ripe fruit suggests low-level but chronic dietary exposure for all fruit-eating animals, with volatilized alcohols from fruit potentially serving in olfactory localization of nutritional resources (Dudley, 2014). The same seems to apply to humans, since, whereas primate ancestors living 16–21 million years ago could not effectively metabolize consumed ethanol, by 6–12 million years ago, human s last common ancestor with gorillas and chimpanzees had evolved a digestion fully capable ofmetabolizing consumed ethanol, at levels found in fermenting fruits (Brenner, 2013). That humans are active and functional in relation to the drugs that we take, including alcohol and nicotine, has at least three implications. First, prohibition and “war(s) on drugs” are likely to fail, because substance use is not “caused” by biological frailty in people in general; second, understanding the ecological contexts and dynamics of drug use may point to new preventive and clinical approaches – the above example of anti-worm treatment reducing cigarette use; third, active and functional speak to potency as being a primary driver of drug use and related harm. This brings us to the second theme, toxicological analysis. For example, margin of Exposure (MoE) analysis compares the ratio of a toxic dose of a drug with the dose consumed (Lachenmeier & Rehm, 2014). A MoE of 1 implies consuming the toxic dose; a MoE of 100 implies consuming 1/100 toxic dose. The European Food Safety Authority (EFSA) sets a MoE of 1,000 for carcinogens whose toxic dose is assessed in humans and whose consumption is voluntary (unlike drinking water). Such aMoE does not imply that consumption is safe, only low risk. The MoE for the consumption of alcohol by European adults is assessed at 1.3 when based on animal studies in which the equivalent does increases death rates by 10 %, and 1.0 when based on human studies with a 1.5 % increased risk of death from liver cirrhosis. This means that European adults consume alcohol at the toxic dose, or 1,000 times the dose were the EFSA guidelines applied to alcohol (EFSA does not assess alcohol). This, together with the fact that the risk of premature death under the age of 70 years for an alcohol-related cause increases linearly with the dose of alcohol consumption (Rehm, Lachenmeier &Room, 2014) implies that the potency of the alcohol we consume is far too high. The strength of alcoholic products could be reduced without consumer preferences being compromised (Lachenmeier, Kanteres & Rehm, 2014). In another example, almost all of the nicotine humans consume (West, Brown&Beard, 2014) is in the form of the SUCHT, 60 (6), 2014, 309 – 311

Health and well‐being of secondary school students in New Zealand: Trends between 2001, 2007 and 2012

To describe indicators of health and well-being for New Zealand secondary school students; explore changes between 2001, 2007 and 2012; and compare these findings to international estimates. Three national health and well-being surveys of randomly selected New Zealand secondary school students were conducted. Data are presented as prevalence and variation over time (adjusted odds ratio (aOR)). Comparisons with international estimates were made with subsets of the data. Between 2001 and 2012, students reported reductions in cigarette use (aOR 0.27, 95% confidence interval (CI) 0.23-0.32), alcohol use (aOR 0.39, 95% CI 0.33-0.46), marijuana use (aOR 0.37, 95% CI 0.31-0.43), sexual abuse (aOR 0.52, 95% CI 0.46-0.58), fighting (aOR 0.63, 95% CI 0.55-0.73), seatbelt use (aOR 1.47, 95% CI 1.31-1.65) and risky driving behaviours (aOR 0.39, 95% CI 0.33-0.45). Positive connections to school (perception that the school cares, aOR 1.22, 95% CI 1.10-1.35; liking school, aOR 1.55, 95% CI 1.33-1.82) and family (good family relationship, aOR 1.83, 95% CI 1.70-1.97) also improved. Indicators that did not improve and compared poorly with international estimates were protected sex (condom use at last sexual intercourse, aOR 0.77, 95% CI 0.68-0.87) and healthy life-style (daily physical activity, aOR 0.88, 95% CI 0.78-0.99; overweight/obese, aOR 1.09, 95% CI 0.92-1.31). Exposure to family violence (aOR 1.37, 95% CI 1.11-1.68) and depressive symptoms (aOR 1.03, 95% CI 0.91-1.17) also did not improve. There have been important improvements in the health and well-being of New Zealand adolescents over a relatively short period. These findings demonstrate that population rates of adolescent risk behaviours are amenable to change. Current policy efforts should not lose momentum, while identified priority areas must be adequately resourced to ensure young people have opportunities to thrive now and in the future.

A decade of tobacco control: The South African case of politics, health policy, health promotion and behaviour change

The South African (SA) government has implemented comprehensive tobacco control measures in line with the requirements of the Framework Convention on Tobacco Control. The effect of these measures on smoking prevalence and smoking-related attitudes, particularly among young people, is largely unknown. To describe the impact of a comprehensive health promotion approach to tobacco control amongst SA school learners. Four successive cross-sectional Global Youth Tobacco Surveys (GYTSs) were conducted in 1999, 2002, 2008 and 2011 among nationally representative samples of SA grades 8 - 10 school learners. We assessed the prevalence of current smoking (having smoked a cigarette on ≥1 day in the 30 days preceding the survey) and smoking-related attitudes and behaviours. Over the 12-year survey period current smoking among learners declined from 23.0% (1999) to 16.9% (2011) - a 26.5% reduction. Reductions in smoking prevalence were less pronounced amongst girls and amongst black learners. We observed an increase in smoking prevalence amongst learners between 2008 and 2011. Smoking-related attitudes and behaviours showed favourable changes over the survey period. These surveys demonstrate that the comprehensive and inter-sectorial tobacco control health promotion strategies implemented in SA have led to a gradual reduction in cigarette use amongst school learners. Of concern, however, are the smaller reductions in smoking prevalence amongst girls and black learners and an increase in smoking prevalence from 2008 to 2011. Additional efforts, especially for girls, are needed to ensure continued reduction in smoking prevalence amongst SA youth.

Adolescent risk perception, substance use, and educational attainment

This paper studies whether adolescents who are more aware of the risks on substance use in the early teenage years are later less likely to turn into binge drinkers or smokers. It also examines if reduction in substance use, due to high risk perception among adolescents, consequently improves their educational achievement. This research is important for two reasons. First, enhancing risk perception of substance use is an important strategy to prevent the youth from binge drinking and smoking. Second, adolescent substance use and educational achievement are key predictors of adulthood outcomes. We apply a bivariate probit model to a large representative dataset which codes youth risk perception, substance use, and educational attainment. The analysis shows high risk perception lowers the likelihood of substance use among the high school seniors. The resulting low alcohol use increases the chance of attending college and decreases the probability of dropping out of high school. The reduction in cigarette use caused by high risk perception has a similar effect on such two educational outcomes. It also increases high school graduation by 22%. Overall, this study suggests that enhancing recognition on the hazards of substance use is an effective policy intervention to reduce adolescent binge drinking and smoking, as well as improve educational attainment.

Association between cigarette smoking and erectile tumescence: the mediating role of heart rate variability

Cigarette smoking deleteriously affects erectile function, and conversely, quitting smoking improves erectile hemodynamics. Underlying mechanisms by which smoking (or reduction of smoking frequency) may affect erectile physiology are not well understood. This study examined the mediating role of heart rate variability (HRV; a marker of sympathovagal balance) among a sample of male chronic smokers from the United States. Sixty-two healthy men (Mage = 38.27 years; SD = 10.62) were assessed at baseline (while smoking regularly), at mid-treatment (while using a nicotine patch), and at follow-up, four weeks after patch discontinuation. Cigarette use, frequency-domain parameters of HRV (low frequency [LF], high frequency [HF], LF/HF ratio), and physiological sexual arousal responses (via penile plethysmography) were assessed at each visit. Results were consistent with mediation, in that greater reductions in cigarette use from baseline to follow-up were associated with longitudinal increases in LF, which in turn showed positive relations with across-time changes in erectile tumescence. Neither HF or LF/HF ratio mediated the relationship between smoking and erection. In conclusion, HRV mediated the inverse relationship between reductions in smoking and enhancements in erectile tumescence. Results underscore the possibility that cigarette use may deleteriously affect erectile function peripherally, in part, by disrupting cardiac autonomic function.