Heavy-Drinking Mothers Linked to Their Child’s Path Toward the Justice System

This study investigated whether children whose mothers had an alcohol-related disorder would be at risk of early-life contact with the justice system, which can lead to many negative outcomes across an individual’s life span. Such outcomes can include repeated contact with the justice system, social disadvantages and marginalization, and mental-health and substance-use issues.

The study made use of linked administrative data from Western Australia. It used records of women who had a birth recorded on the Midwives Notification System between 1983 and 2007. The exposed cohort included mothers with an alcohol-related diagnosis, which served as a proxy for heavy drinking. A comparison group of mothers with no alcohol-related diagnoses was randomly selected, matching on maternal age within race and the year of the child’s birth. The study cohort included 10,211 exposed mothers and 47,688 comparison mothers. Child contact with the justice system was identified from Department of Corrective Services data — including those 10 years or older with a justice-system record for juveniles (10 — 17 years) and/or adults (18 years and older) from 1985 to 2011.

Children whose mothers had a maternal alcohol-related diagnosis had almost twice the odds of contact with the justice system as children whose mothers had no alcohol-related diagnosis. Additional risk was associated with being Indigenous and with markers of social disadvantage such as low socioeconomic status. Significant child-level factors associated with greater odds of justice-system contact included being male, having a mental-health diagnosis or child-protection contact, and academic failure. The authors suggest that these factors be considered in the development of targeted prevention programs.


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Journal Reference:

  1. Katherine Hafekost, David Lawrence, Colleen O’Leary, Carol Bower, James Semmens, Stephen R. Zubrick. Maternal Alcohol Use Disorder and Risk of Child Contact with the Justice System in Western Australia: A Population Cohort Record Linkage Study. Alcoholism: Clinical and Experimental Research, 2017; DOI: 10.1111/acer.13426

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Research Society on Alcoholism. “Heavy-drinking mothers linked to their child’s path toward the justice system.” ScienceDaily. ScienceDaily, 22 June 2017. .

Research Society on Alcoholism. (2017, June 22). Heavy-drinking mothers linked to their child’s path toward the justice system. ScienceDaily. Retrieved June 23, 2017 from www.sciencedaily.com/releases/2017/06/170622182809.htm

Research Society on Alcoholism. “Heavy-drinking mothers linked to their child’s path toward the justice system.” ScienceDaily. www.sciencedaily.com/releases/2017/06/170622182809.htm (accessed June 23, 2017).

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Interventions to prevent cognitive decline, dementia

Cognitive training, blood pressure management for people with hypertension, and increased physical activity all show modest but inconclusive evidence that they can help prevent cognitive decline and dementia, but there is insufficient evidence to support a public health campaign encouraging their adoption, says a new report from the National Academies of Sciences, Engineering, and Medicine. Additional research is needed to further understand and gain confidence in their effectiveness, said the committee that conducted the study and wrote the report.

“There is good cause for hope that in the next several years much more will be known about how to prevent cognitive decline and dementia, as more clinical trial results become available and more evidence emerges,” said Alan I. Leshner, chair of the committee and CEO emeritus, American Association for the Advancement of Science. “Even though clinical trials have not conclusively supported the three interventions discussed in our report, the evidence is strong enough to suggest the public should at least have access to these results to help inform their decisions about how they can invest their time and resources to maintain brain health with aging.”

An earlier systematic review published in 2010 by the Agency for Healthcare Research and Quality (AHRQ) and an associated “state of the science” conference at the National Institutes of Health had concluded that there was insufficient evidence to make recommendations about any interventions to prevent cognitive decline and dementia. Since then, understanding of the pathological processes that result in dementia has advanced significantly, and a number of clinical trials of potential preventive interventions have been completed and published. In 2015, the National Institute on Aging (NIA) contracted with AHRQ to conduct another systematic review of the current evidence. NIA also asked the National Academies to convene an expert committee to help inform the design of the AHRQ review and then use the results to make recommendations to inform the development of public health messaging, as well as recommendations for future research. This report examines the most recent evidence on steps that can be taken to prevent, slow, or delay the onset of mild cognitive impairment and clinical Alzheimer’s-type dementia as well as steps that can delay or slow age-related cognitive decline.

Overall, the committee determined that despite an array of advances in understanding cognitive decline and dementia, the available evidence on interventions derived from randomized controlled trials — considered the gold standard of evidence — remains relatively limited and has significant shortcomings. Based on the totality of available evidence, however, the committee concluded that three classes of interventions can be described as supported by encouraging but inconclusive evidence. These interventions are:

cognitive training — which includes programs aimed at enhancing reasoning and problem solving, memory, and speed of processing — to delay or slow age-related cognitive decline. Such structured training exercises may or may not be computer-based. blood pressure management for people with hypertension — to prevent, delay, or slow clinical Alzheimer’s-type dementia. increased physical activity — to delay or slow age-related cognitive decline.

Cognitive training has been the object of considerable interest and debate in both the academic and commercial sectors, particularly within the last 15 years. Good evidence shows that cognitive training can improve performance on a trained task, at least in the short term. However, debate has centered on evidence for long-term benefits and whether training in one domain, such as processing speed, yields benefits in others, such as in memory and reasoning, and if this can translate to maintaining independence in instrumental activities of daily living, such as driving and remembering to take medications. Evidence from one randomized controlled trial suggests that cognitive training delivered over time and in an interactive context can improve long-term cognitive function as well as help maintain independence in instrumental activities of daily living for adults with normal cognition. However, results from other randomized controlled trials that tested cognitive training were mixed.

Managing blood pressure for people with hypertension, particularly during midlife — generally ages 35 to 65 years — is supported by encouraging but inconclusive evidence for preventing, delaying, and slowing clinical Alzheimer’s-type dementia, the committee said. The available evidence, together with the strong evidence for blood pressure management in preventing stroke and cardiovascular disease and the relative benefit/risk ratio of antihypertensive medications and lifestyle interventions, is sufficient to justify communication with the public regarding the use of blood pressure management, particularly during midlife, for preventing, delaying, and slowing clinical Alzheimer’s-type dementia, the report says.

It is well-documented that physical activity has many health benefits, and some of these benefits — such as stroke prevention — are causally related to brain health. The AHRQ systematic review found that the pattern of randomized controlled trials results across different types of physical activity interventions provides an indication of the effectiveness of increased physical activity in delaying or slowing age-related cognitive decline, although these results were not consistently positive. However, several other considerations led the committee to conclude that the evidence is sufficient to justify communicating to the public that increased physical activity for delaying or slowing age-related cognitive decline is supported by encouraging but inconclusive evidence.

None of the interventions evaluated in the AHRQ systematic review met the criteria for being supported by high-strength evidence, based on the quality of randomized controlled trials and the lack of consistently positive results across independent studies. This limitation suggests the need for additional research as well as methodological improvements in the future research. The National Institutes of Health and other interested organizations should support further research to strengthen the evidence base on cognitive training, blood pressure management, and increased physical activity, the committee said. Examples of research priorities for these three classes of interventions include evaluating the comparative effectiveness of different forms of cognitive training interventions; determining whether there are optimal blood pressure targets and approaches across different age ranges; and comparing the effects of different forms of physical activity.

When funding research on preventing cognitive decline and dementia, the National Institutes of Health and other interested organizations should identify individuals who are at higher risk of cognitive decline and dementia; increase participation of underrepresented populations; begin more interventions at younger ages and have longer follow-up periods; use consistent cognitive outcome measures across trials to enable pooling; integrate robust cognitive outcome measures into trials with other primary purposes; include biomarkers as intermediate outcomes; and conduct large trials designed to test the effectiveness of an intervention in broad, routine clinical practices or community settings.

How serious is binge drinking among college students with disabilities?

A new study finds that college students with disabilities binge drink more often than their non-disabled student peers. The study, providing the first picture of alcohol use and binge drinking by US college students with disabilities, is out in Public Health Reports, a SAGE Publishing journal and the official journal of the Office of the U.S. Surgeon General and the U.S. Public Health Service.

“Substance abuse is the topic of high public interest, yet little attention is given to the experiences of college students with disabilities,” wrote the study authors Steven L. West et al. “Given that binge drinking is highly correlated with academic failure, drop-out, and an increased risk for various negative health conditions, such use by students with disabilities may place them at extreme risk for various negative outcomes.”

The study authors surveyed 1,285 students with disabilities from 61 U.S. colleges and universities in 2013. The students answered questions regarding alcohol and other drug use and the use of substances by student peers. The researchers found that 80% reported drinking alcohol at least once. Among these students:

  • 70% reported binge drinking, defined as having five or more drinks in one sitting by males or having four or more drinks in one sitting by females, at least once in the previous year. This number is about 30% higher than the national average of college students as a whole, according to the National Survey on Drug Use and Health (NSDUH), 2012 and 2013
  • Of those who binge drank at least once in 2012, 10% reported binge drinking monthly, 9% reported binge drinking 2 or 3 times per week, and 1% reported binge drinking more than 5 times per week
  • 42% drank alcohol once a month or less, 14% drank 2 to 4 times per week, 6% percent drank more than 5 times per week, and 10% drank daily

“Alcohol and drug prevention efforts are common on college campuses, and many are specific to the groups they target, such as members of fraternities or sororities or student athletes,” continued the study authors. “However, students with disabilities are largely overlooked in such programming. Our finding that students with disabilities drink and binge drink at considerable rates calls for more preventive efforts targeting this underserved population.”

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Perceptions about body image linked to increased alcohol, tobacco use for teens

How teenagers perceive their appearance, including their body image, can have significant impacts on health and wellness. Prior body image research has shown that people with negative body image are more likely to develop eating disorders and are more likely to suffer from depression and low self-esteem. Now, Virginia Ramseyer Winter, a body image expert and an assistant professor in the University of Missouri’s School of Social Work, found negative body image also is associated with increased tobacco and alcohol use, with implications for both young men and women. Notably, she also found relationships between substance use and perceived attractiveness, with girls who believe they are very good looking being more likely to drink.

“We know alcohol and tobacco can have detrimental health effects, especially for teenagers,” Ramseyer Winter said. “I wanted to see if the perception of being overweight and negative body image leads to engaging in unhealthy or risky substance use behaviors. Understanding the relationship means that interventions and policies aimed at improving body image among teenage populations might improve overall health.”

Ramseyer Winter and her co-authors, Andrea Kennedy and Elizabeth O’Neill, used data from a national survey of American teenagers to determine the associations between perceived size and weight, perceived attractiveness, and levels of alcohol and tobacco use. The researchers found that perceived size and attractiveness were significantly related to substance use. Adolescent girls who perceived their body size to be too fat were more likely to use alcohol and tobacco. Boys who thought they were too skinny were more likely to smoke, and boys who considered themselves fat were more likely to binge drink.

“While poor body image disproportionately affects females, our findings indicate that body image also impacts young males,” Ramseyer Winter said. “For example, it’s possible that boys who identified their bodies as too thin use tobacco to maintain body size, putting their health at risk.”

In addition to body size, the researchers looked at the connection between perceived attractiveness and substance use. Girls who thought they were not at all good looking were more likely to smoke. Girls who thought they were very good looking were more likely to binge drink. Ramseyer Winter suggests this is because attractiveness may be associated with popularity, which is related to increased alcohol use.

To improve body image awareness, Ramseyer Winter suggested that parents, schools and health providers need to be aware of body shaming language and correct such behavior to help children identify with positive body image messages. Body shaming language can affect teenagers who have both positive and negative perceptions of themselves.

“Adolescent tobacco and alcohol use: the influence of body image,” recently was published in the Journal of Child and Adolescent Substance Abuse. Kennedy is a doctoral candidate at the University of Southern California and O’Neill is a doctoral candidate at the University of Kansas. The MU School of Social Work is in the College of Human Environmental Sciences.

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Losing train of thought or it's hard to multi-task? You may be having one drink too many

Impairments in processing and using information that help with decision-making and planning simple tasks such as grocery shopping are linked with one’s frequency of alcohol or drug use according to a new study. Researchers at Columbia University’s Mailman School of Public Health and Columbia University Medical Center found that cognitive impairments are not a problem limited to addiction patients in treatment, but constitute a broader problem among substance users in the U.S. general population. Results are published online in the journal Addiction.

This is the first study to find associations between deficits in attention and executive functioning with frequency of binge drinking and use of marijuana, cocaine, opioids, sedatives and tranquilizers, and stimulants in the general population ages 18 and older.

“Regardless if cognitive impairments precede substance use or vice versa, poorer cognitive functioning negatively impacts daily life and may cause lack of insight into one’s substance use as a source of problems, impeding treatment utilization or decreasing the likelihood of effective treatment,” said senior author Deborah Hasin, PhD, Columbia Mailman School of Public Health professor of Epidemiology and in the Department of Psychiatry at Columbia University Medical Center.

The researchers analyzed data from 36,085 respondents to the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III, a representative sample of the U.S. adult population, to create two cognitive scales based on dimensionality and reliability.

“Our study shows the validity of two scales for assessing how cognitive impairments are associated with many substance disorders including alcohol, cannabis, cocaine and one’s ability to function well in important interpersonal or occupational areas,” said Efrat Aharonovich, PhD, Department of Psychiatry, Columbia University Medical Center, and first author. “Our validation of the cognitive scales will facilitate further investigations of the relationships of cognitive functioning to the use of multiple substances, substance use disorders and treatment utilization, advancing our knowledge of substance use, a major public health problem.”

Poorer attention was linked with frequent and infrequent binge drinking and use of drugs, in particular, stimulants. A lower score on executive functioning scale was associated with frequent binge drinking and drug use, cocaine in particular.

Binge drinking was defined as four or more drinks in a day for women and at least 5 drinks in a day for men. About half the sample was female, 45 years of age or older, with an income of $20,000 or less. Slightly more than two-thirds were Non-Hispanic White; and 60 percent completed at least some college. Prevalence of substance use ranged from 33 percent for binge drinking to 1 percent for cocaine.

“While abstinence or reduced substance use may partially improve cognition, future research should determine whether factors shown to protect against cognitive impairments in aging adults, such as a healthy diet, and physical and intellectual activities, also protect against cognitive impairments in populations with difficulties in reducing substance use,” said Dr. Hasin.

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Wearable sensor helps people keep tabs on drinking

Electrical engineers are creating a wearable sensor to help people manage their alcohol intake.

Activity trackers monitor your steps; this innovative sensor measures your blood alcohol level. Worn like a watch, this sensor picks up vapors from the skin and sends the data to a server. If the alcohol reading is high, via an app, a designated loved one gets an alert to check in on the user. This easy-to-wear gadget will help address issues with social drinking and addiction.

“We wanted to create an unobtrusive sensor that would be easy to wear, and help people struggling with alcohol,” said the inventor, Shekhar Bhansali, an Alcatel Lucent professor and chair of the Department of Electrical and Computer Engineering. “This is one step toward active intervention that only requires the user wear the sensor.”

According to the Centers for Disease Control (CDC), excessive drinking cost the American economy $249 billion in 2010. Alcohol abuse is also known to kill about 88,000 people in the United States every year.

Bhansali explains that people struggling with alcoholism typically will lapse when it comes to self-reporting their alcohol intake. Also, alcohol clears the body within eight hours so someone who has to take a urine test in the morning can technically sleep off any binge drinking they may have undergone the night before.

The wearable sensor detects alcohol off the skin within 15 to 20 minutes of consumption. The device is made from start to finish by engineers. First, they create the alcohol sensors in a hot press. Then they test and calibrate the sensor with a gas sensing setup. Once the sensor reads the expected alcohol levels, engineers wire the sensor to the board, print the interface for the device on a 3D printer, and then assemble it all together.

“The calibrated sensor acts like an ‘electronic nose;’ it can sense alcohol odor from the skin in a fraction of second,” said Yogeswaran Umasankar, a research assistant professor working with Bhansali.

In addition to managing alcoholism, this wearable sensor may help monitor social drinking on college campuses. It can also help keep an eye on liver transplant patients who are unable to drink or risk additional liver damage.

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Rates of marijuana use, heavy use, and cannabis use disorder depend on where you live

Adult marijuana use rose significantly in states that passed loosely regulated medical marijuana laws (MMLs) according to a new study by Columbia University’s Mailman School of Public Health and Columbia University Medical Center. Highest increases were reported among adults ages 26 and over. Little change was found in past-month marijuana use among adolescents or young adults between the ages 18 and 25. The findings are published online in the journal Addiction.

Adults 26 years of age and older living in states with less regulated medical marijuana programs increased past-month marijuana use from 4 percent to 6.59 percent after the laws were enacted. No significant change was found in the prevalence of cannabis use disorder among adolescents or adults after states enacted medical marijuana laws, regardless whether programs were highly regulated or “loose.”

Using data from the National Survey of Drug Use and Health from 2004-2013 the researchers analyzed trends over time with particular emphasis on age groups. This included obtaining prevalences of marijuana use outcomes at the state level by year and whether the enacted laws included a highly regulated (“medicalized”) or less regulated (“non-medical”) program. Participants were classified as having marijuana abuse or dependence based on DSM-IV criteria.

“In addition to the increase in rates of marijuana use among this age group, we found that the magnitude of impact on rates of marijuana use was greatest among heavy users,” said Silvia Martins, MD, PhD, professor of Epidemiology at the Mailman School of Public Health, and senior author. Findings showed an annual increase in near-daily users of 2.36 percent.

There remains concern that with the increase in prevalence of marijuana use, especially heavy use, there will be a proportionate increase in the percent of the population meeting diagnostic criteria for cannabis use disorder. “If this is the case, states with non-medical or lax programs may bear the brunt of this increase, especially among adults over age 25,” noted Arthur Robin Williams, MD, fellow, Department of Psychiatry at Columbia, and first author of the study.

However, it may be too early to detect trends regarding the prevalence of cannabis use disorder as the time lag between initiation of marijuana use, escalation of use, and meeting diagnostic criteria for the disorder is often several years.

“We believe our current, largely negative findings however cannot definitely rule out impending increases in cannabis use disorder without further study. The effects of changes in marijuana use prevalences might only be reflected with analyses conducted in future years with more data points,” said Dr. Martins.

As of the November 2016 election, 28 states and Washington D.C. had legalized the use of marijuana for medical indications through the passage of medical marijuana laws either by voter initiative or legislative action. Additionally, 8 states and Washington D.C. (all of which allow for medical marijuana) have now fully legalized the recreational use of marijuana by adults over age 21. In addition to differing combinations of these laws, states also vary tremendously in regulations guiding their programs and participant eligibility.

Drs. Martins and Williams recommend further investigation of key aspects of regulation that are currently lacking among non-medical programs. These include active physician oversight, requiring participation in state-licensed dispensaries, and the use of state-licensed products as they may have greater influence on individual morbidity and social costs than the mere passage of medical marijuana laws.

“While the United States has entered a new era of marijuana control policy over the past two decades, our findings strongly suggest researchers should not treat all states with medical marijuana laws uniformly,” said Dr. Martins.

Drop in violence associated with smoke-free policy at psychiatric hospital

New King’s College London research reveals a 39 per cent drop in physical assaults — both between patients and towards staff — following the introduction of a smoke-free policy at the South London and Maudsley NHS Foundation Trust (SLaM).

Published in The Lancet Psychiatry, the study has important implications for the introduction of smoke-free policies, not only in psychiatric hospitals but also in other institutions such as prisons.

Smoking within psychiatric hospitals has long been a cultural norm, and is thought to be a major reason why people with mental health problems die 15-20 years earlier than the general population. Despite this, smoke-free policies have previously been hampered by concerns, especially from hospital staff, that physical violence will increase.

In 2013, the National Institute of Health and Care Excellence (NICE) recommended the introduction of smoke-free policies in acute, maternity and mental health services, with on-site help for patients — whether they want to stop smoking or not — to manage their withdrawal symptoms.

As part of SLaM’s policy, smoking is prohibited in the buildings and grounds of its four south London hospitals, smokers are offered stop smoking treatment such as nicotine replacement therapy (NRT) and patients are allowed to use e-cigarettes.

The researchers from King’s College London, SLaM, University of Nottingham and University of York, analysed incident reports of physical assaults 30 months before and 12 months after the smoke-free policy was introduced.

During this study period, there were 4,550 physical assaults, with 2,916 towards staff and 1,634 between patients.

Researchers found a 39 per cent reduction in the number of physical assaults per month following the introduction of the policy. This was after accounting for general and seasonal trends and a range of factors that could also have influenced the rates of violence. For example, the number of patients on the wards each month who were male, of a younger age and detained under the Mental Health Act.

Dr Debbie Robson, Senior Post-Doctoral Researcher in Tobacco Addiction at King’s College London, said: ‘Hopefully our findings will reassure staff that introducing a smoke-free policy does not increase physical violence as is often feared. We believe there are a number of possibilities why rates of violence actually decreased. Historically, cigarettes have been used as a tool to manage patient behaviour and patients often coerce their peers into handing over cigarettes. To support the introduction of the smoke-free policy SLaM invested in new treatment pathways for smokers and a staff training programme, which may have contributed to changing the culture of how staff and patients interact.’

Mary Yates, Nurse Consultant and smoke-free lead at the South London and Maudsley NHS Foundation Trust, added: ‘Tobacco withdrawal often prompts restlessness, irritability and a fixation on finding opportunities to smoke, and hospital staff understandably mistake this as a sign of worsening mental health. Smoking during a period of tobacco withdrawal only serves to reinforce this misinterpretation, as patients will appear calmer and less irritable as nicotine levels are topped up. This is incorrectly taken as evidence that smoking is therapeutic and necessary to prevent agitation.’

This study was undertaken at the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, where a team of researchers are investigating ways to help people with severe mental illness to improve their physical health.

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Drinking during adolescence can alter brain cell nerve growth

The developmental period from adolescence to adulthood is accompanied by a greater vulnerability to addictions — including alcohol use disorders — than is seen in other periods of life. This increased risk may be due to genetic predisposition, poor impulse control, or heightened sensitivity of the still-developing brain to drug-related toxicity. This report describes a study in mice of the neurobehavioral impact of chronic, intermittent alcohol-vapor exposure during adolescence, in an effort to model periodic heavy drinking and compare it with similar drinking behavior during adulthood.

Researchers conducted two parallel tests in adult male mice following their exposure to alcohol vapors during adolescence (4-6 weeks old) or adulthood (8-10 weeks old). First, they tested the adult mice for changes in the density and structure of dendritic spines (nerve endings) in the infralimbic cortex (IL), prelimbic cortex (PL) and basolateral amygdala (BLA) regions of the brain. Second, they tested the adult mice for alcohol drinking, sensitivity to alcohol intoxication, blood-alcohol clearance, and measures of response to food reward.

Chronic exposure to alcohol vapors during adolescence produced significant, persistent, and strong regional-specific alterations in neuronal dendritic spine density in IL and BLA neurons, accompanied by a limited set of behavioral alterations. Comparable effects were not seen in the mice exposed to alcohol only during adulthood. Together, these data demonstrate that specific key brain circuits are vulnerable to alcohol’s effects during adolescence, with lasting and potentially detrimental consequences for behavior.

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Marijuana use among college students on rise following Oregon legalization, study finds

College students attending an Oregon university are using more marijuana now that the drug is legal for recreational use, but the increase is largely among students who also report recent heavy use of alcohol, a new study has found.

Oregon State University researchers compared marijuana usage among college students before and after legalization and found that usage increased at several colleges and universities across the nation but it increased more at the Oregon university. None of the universities were identified in the study.

“It does appear that legalization is having an effect on usage, but there is some nuance to the findings that warrant further investigation,” said the study’s lead author, David Kerr, an associate professor in the School of Psychological Science in OSU’s College of Liberal Arts.

“We found that overall, at schools in different parts of the country, there’s been an increase in marijuana use among college students, so we can’t attribute that increase to legalization alone.”

The results were published today in the journal Addiction. Co-authors are Harold Bae and Sandi Phibbs of OSU’s College of Public Health and Human Sciences and Adam Kern of the University of Michigan.

The study is believed to be the first to examine marijuana usage patterns following legalization of recreational marijuana in Oregon and the first to examine the effects of any state’s legalization on college students. Voters in Oregon approved legalization in 2014 and the law took effect in 2015.

Oregon’s legalization of marijuana is part of a larger trend among U.S. states, but little research has been done so far to understand the impact. In their study, Kerr and his colleagues set out to begin addressing some of those questions.

“It’s an important current issue and even the most basic effects have not been studied yet, especially in Oregon,” he said. “There are a lot of open questions about how legalization might affect new users, existing users and use of other substances.”

Researchers used information collected in the Healthy Minds Study, a national survey of college students’ mental health and well-being — including substance use — conducted by the University of Michigan. The study is designed to give colleges and universities information to help them understand the needs of their student populations.

As part of the survey, participants are asked about marijuana and cigarette use in the previous 30 days, as well as frequency of heavy alcohol use within the previous two weeks.

Using data from a large public university in Oregon and six other four-year universities around the country where recreational marijuana is not legal, researchers compared rates of marijuana use before and after the drug was legalized in Oregon. They also examined frequency of heavy alcohol use and cigarette use at those points.

The researchers found that the overall rates of marijuana use rose across the seven schools. Rates of binge drinking — where a person consumes four to five or more drinks in a period of about two hours — stayed the same and cigarette use declined in that period.

“It’s likely that the rise in marijuana use across the country is tied in part to liberalization of attitudes about the drug as more states legalize it, for recreational or medical purposes or both,” Kerr said. “So legalization both reflects changing attitudes and may influence them even outside of states where the drug is legal.”

Researchers also found that marijuana use rates were generally higher, overall, among male students; those living in Greek or off-campus housing; those not identifying as heterosexual; and those attending smaller, private institutions.

One area where legalization had a marked impact was among college students who indicated recent binge drinking; students at the Oregon university who reported binge drinking were 73 percent more likely to also report marijuana use compared to similar peers at schools in states where marijuana remains illegal.

“We think this tells us more about the people who binge drink than about the effects of alcohol itself,” Kerr said. “Those who binge drink may be more open to marijuana use if it is easy to access, whereas those who avoid alcohol for cultural or lifestyle reasons might avoid marijuana regardless of its legal status.”

The researchers also found that Oregon students under age 21 — the minimum legal age for purchasing and using marijuana — showed higher rates of marijuana use than those over 21.

“This was a big surprise to us, because legalization of use is actually having an impact on illegal use,” said Bae, the study’s primary statistician.

These initial findings about marijuana use among college students help form a picture of how legalization may be affecting people, Kerr said, but more study is needed before researchers can quantify the harms or net benefits of legalization for young people.

“Americans are conducting a big experiment with marijuana,” Kerr said. “We need science to tell us what the results of it are.”

Risky bingeing: Women in Appalachian Ohio report higher rates of alcohol misuse

Appalachia — stretching from the southern tier of New York state to northern Alabama, Mississippi and Georgia — has long experienced deep economic distress and deprivation, and the gamut of accompanying social problems.

Compared with women living in urban areas, women who reside in these rural areas face multiple health concerns, including substance abuse issues, and often at greater rates. While the opioid epidemic in rural areas has gained attention, the rampant alcohol use has not.

“Alcohol continues to be the most prevalent and widely used and abused substance among Appalachian adults and is reported to be the primary reason for seeking substance use treatment in the region, surpassing drug abuse,” says Golfo K. Tzilos, Ph.D.

Tzilos is an assistant professor in the University of Michigan’s Departments of Family Medicine and Psychiatry and the U-M Addiction Center. She and Mack T. Ruffin IV, M.D., MPH, professor emeritus and chair of the Department of Family and Community Medicine at Penn State Hershey Medical Center, studied excessive drinking behavior in women from rural Appalachian Ohio because of a surprising lack of empirical data.

Tzilos and Ruffin analyzed data from the Community Awareness, Resources, and Education (CARE) Project, which investigated determinants of abnormal cervical cytology. More than 6,000 women older than 18 and representing 14 counties in Appalachian Ohio, 95 percent of whom were non-Hispanic whites, participated in the original study.

Approximately 2,300 of those women supplied relevant information about their alcohol use and other possible predictive alcohol abuse variables. Of these, one-fifth (19.9 percent) reported recent, heavy episodic drinking.

Heavy episodic drinking, or binge drinking, is defined as consuming four or more alcoholic beverages — beer, wine, wine coolers, mixed drinks and liquor — in one sitting for women.

Younger women (under age 26) were five times more likely to binge drink than women older than 50, researchers found. Those who identified themselves as current smokers, single and with four or more lifetime sexual partners also had an increased adjusted risk of binge drinking.

“One interpretation of the findings is that these women are a vulnerable population,” says Tzilos.

“Typically, these women face a number of disadvantages in their environment, including chronic stressors such as limited resources and living in poverty, as well as acute stressors such as exposure to violence and abuse, which can all play a role in the likelihood of higher rates of alcohol use.”

Their results are published in the Journal of Rural Mental Health.

Clinical takeaways and broader implications

Binge drinking is associated with a broad range of hazardous behaviors, including tobacco use, risky sexual activity, higher risks of unintended pregnancy and sexually transmitted infections. These behaviors can lead to harmful consequences that can negatively affect society as a whole.

Tzilos says primary care physicians have an opportunity to act as a conduit between their patients and critical health resources.

“Clinicians have the opportunity to inquire about risky alcohol use among their patients,” says Tzilos. “In rural settings, there are often barriers to health services that women face, including stigma, cultural concerns of confidentiality and trust, lack of anonymity, and lack of access and providers.”

This gap is particularly important to address given that rural women, including those from Appalachian regions, report a higher rate of health concerns that may be associated with, or a consequence of, unaddressed or undertreated alcohol misuse.

Tzilos and Ruffin’s findings also reflect what is happening at the national level. Women are increasingly participating in risky alcohol use at younger ages.

They suggest increasing sensitivity to this fact and work to address the obstacles to improving health outcomes for women from Appalachian communities. This could include leveraging technology to increase reach and access to screening, treatment and referrals.

“My future work will explore the relationship between stress and alcohol use among women in this region,” says Tzilos. “It may shed light on opportunities for prevention.”

Tzilos also plans to help adapt integrative strategies to identify and reduce health risk behaviors and to enhance protective factors among these women.

Mixing booze, pot is a serious threat to traffic safety

Use of marijuana in combination with alcohol by drivers is especially dangerous, according to a latest study conducted at Columbia University’s Mailman School of Public Health. Drivers who used alcohol, marijuana, or both were significantly more likely to be responsible for causing fatal two-vehicle crashes compared to drivers who were involved in the same crashes but used neither of the substances. The findings are published in the journal, Annals of Epidemiology.

“The risk of crash initiation from concurrent use of alcohol and marijuana among drivers increases by more than fivefold when compared with drivers who used neither of the substances,” said Guohua Li, MD, DrPH, professor of Epidemiology at the Mailman School of Public Health. The study also indicates that when used in isolation, alcohol and marijuana increase crash culpability by 437 percent and 62 percent, respectively.

The researchers analyzed data for 14,742 fatal two-vehicle crashes between 1993 and 2014 recorded in the Fatality Analysis Reporting System, a database containing information on crashes that resulted in at least one fatality within 30 days and that occurred on U.S. public roads. Included in the study were 14,742 drivers who were responsible for causing the fatal crashes and 14,742 non-culpable drivers who were involved in the same crashes. Crashes involving single vehicles, more than two vehicles, commercial trucks, and two-vehicle crashes in which both drivers were responsible were excluded from the analysis.

Drivers who were responsible for the crashes were significantly more likely than non-culpable drivers to test positive for alcohol (28 percent vs. 10 percent), marijuana (10 percent vs. 6 percent), and both alcohol and marijuana (4 percent vs. 1 percent). Drivers who tested positive for alcohol, marijuana, or both were more likely than those who tested negative to be male, aged 25 to 44 years, and to have had a positive crash and violation history within the previous three years.

The three most common driving errors that led to these fatal crashes were failure to keep in proper lane (43 percent), failure to yield right of way (22 percent), and speeding (21 percent).

Since the mid-1990s, the prevalence of marijuana detected in fatally injured drivers has increased markedly. During the same time period, 28 states and the District of Columbia have enacted legislation to decriminalize marijuana for medical use, including eight states that have further decriminalized possession of small amounts for adult recreational use. Although toxicological testing data indicate a continuing increase in marijuana use among drivers, a positive test does not necessarily infer marijuana-induced impairment.

“While alcohol-impaired driving remains a leading cause of traffic fatalities in the United States, driving under the influence of marijuana and other drugs has become more prevalent in the past two decades,” said Dr. Li, who is also the founding director of Columbia University’s Center for Injury Epidemiology and Prevention. “Countermeasures targeting both drunk driving and drugged driving are needed to improve traffic safety.”

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Materials provided by Columbia University’s Mailman School of Public Health. Note: Content may be edited for style and length.

E-cigarettes less addictive than cigarettes, study shows

People who regularly use electronic cigarettes are less dependent on their product than those who regularly use traditional cigarettes, according to Penn State College of Medicine researchers.

While cigarette use has declined in recent years in the United States, the use of e-cigarettes is increasing, especially among adolescents and young adults. Although the new findings suggest that electronic cigarettes — also known as e-cigarettes — cause less nicotine dependence than traditional cigarettes, planned follow-up studies will help determine if e-cigarettes could lead to use of traditional cigarette dependence down the line.

E-cigarettes include a range of battery-powered devices that heat and vaporize a liquid mixture (e-liquid) that may contain nicotine, flavorings and other chemicals. The vaporized e-liquid is then inhaled as an aerosol. Although the use of e-cigarettes (called vaping) is believed by many experts to be less toxic than cigarette smoking — and could even help some people quit smoking — recent research at Penn State College of Medicine and other institutions indicates that inhaled aerosols produced by vaporizing e-liquids are not harmless.

In addition, experts have raised concerns that e-cigarette use could cause nicotine dependence and lead to cigarette use, reversing hard-won public health gains.

A 2016 report by the Surgeon General called for more research on the use and health impact of e-cigarettes. To that end, health experts and government regulators have been awaiting the first results of the Population Assessment of Tobacco and Health (PATH) study, a comprehensive, ongoing national survey of tobacco use among more than 30,000 young people and adults.

To compare e-cigarette and cigarette dependence, researchers at Penn State College of Medicine analyzed responses to surveys taken in the PATH study. In these responses, they looked for daily or almost daily users of either e-cigarettes or cigarettes.

Out of 32,320 who answered the survey, 3,586 fit the study criteria. Among those, about 5 percent exclusively used e-cigarettes and about 95 percent exclusively smoked cigarettes. Of the e-cigarette users, 93 percent once regularly smoked cigarettes and about 7 percent experimented with cigarette smoking.

Compared with cigarette smokers, e-cigarette users waited longer to start using their product after waking up. Vapers were less likely to consider themselves addicted, to have strong cravings or to feel like they really needed their product. They were also less likely to say they found it difficult to refrain from using their product in restricted places. Researchers report their findings in Preventive Medicine.

All of the participants included in the analysis were considered dependent due to their regularity of use. But the study’s lead author, Guodong Liu, assistant professor of public health sciences, said the findings indicated that e-cigarette users were relatively less dependent than cigarette users.

“No doubt about it, e-cigarettes are addictive, but not at the same level as traditional cigarettes,” Liu said.

Follow-up studies will focus on further analysis of e-cigarette users’ dependency and evolution of e-cigarette use. Around 80 percent of adult PATH participants also submitted blood and urine samples when they were surveyed. Liu’s group plans to study this data when the National Institute on Drug Abuse makes it available to see if participants’ nicotine levels agree with their self-reported dependence.

The researchers also plan to analyze dual users of both e-cigarettes and cigarettes — to draw a more complete picture of nicotine dependence on the entire spectrum of e-cigarette use.

“We suspect that most e-cigarette users are either experimental users or dual users of e-cigarettes and at least one type of traditional tobacco product, like cigarettes,” Liu said. “We want to learn if dual users’ dependence levels differ from each other and also from exclusive e-cigarette or cigarette users.”

Perhaps most critically, the same PATH participants will be surveyed on an ongoing basis, and the results of future waves of data will show if experimental e-cigarette users eventually are converted to regular cigarette users.

“This will be the first time we’ll be able to look at this phenomenon longitudinally,” Liu said. “Before that, almost all of the surveys were cross-sectional, meaning they were just snapshots.”

The PATH study findings are expected to inform future tightening or loosening of regulations around vaping products. In May 2016, the U.S. Food and Drug Administration began regulating e-cigarettes, ruling that they could not be marketed or sold to minors under 18 years of age.

“Adolescents very much by nature want to experiment with everything and anything,” Liu said. “We have to know a lot on almost every aspect of this device before we can have a coherent action plan to better manage this new emerging tobacco delivery product.”

Relationship between pain and opioid abuse examined

The drug overdose epidemic is largely driven by opioids, which continue to be prescribed for chronic pain despite recommendations to use non-opioids for most cases. A new review published in the British Journal of Pharmacology examines the interaction between pain and the abuse of opioids, and investigates the circuits in the brain that may be behind this link. The review is part of a special theme issue on Emergent Areas of Opioid Pharmacology.

“We have shown that the brain’s natural opioid system is drastically changed by the presence of pain, and these changes may very well contribute to the difficulty of treating chronic pain with opioids,” said first author Adrianne Wilson-Poe, PhD of the Washington University in Saint Louis School of Medicine. “We have just glimpsed the tip of the iceberg when it comes to pain’s effect on the brain, however, and we need a lot more research and grant funding to get to the bottom of the extremely complex interaction between drug abuse and pain.”

She and senior author Jose Moron-Concepcion, PhD, Associate Professor in the Department of Anesthesiology at Washington University, note that without a fundamental understanding of pain-induced changes in the brain and how these adaptations interact with subsequent drug exposure, investigators are merely fishing for solutions to the opioid crisis. “Our work is attacking this problem head-on by diligently characterizing the mechanisms involved in pain, addiction, and the interaction between them,” said Dr. Wilson-Poe. “We envision a future where chronic pain is considered a disease in its own right, not merely a symptom of some other biological process.”

The review stresses that opioids are the most powerful analgesics known to man, and their continued use in the treatment of severe pain is inevitable; however, opioid therapy of the future must look very different from how it does today. Efforts to address this issue include a 2016 guideline by the Centers for Disease Control and Prevention that recommends using non-opioids for most cases of chronic pain, using the lowest effective dose when prescribing opioids, and ensuring that patients who are treated with opioids are closely monitored.

The review is part of a larger themed issue, ‘Emergent Areas of Opioid Pharmacology,’ that will publish at a later time.

The National Institute on Drug Abuse notes that the emergence of illicitly manufactured synthetic opioids including fentanyl, carfentanil, and their analogues represents an escalation of the ongoing opioid overdose epidemic. Also, prescription opioid misuse is a significant risk factor for heroin use, and 80% of heroin users first misuse prescription opioids.

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Materials provided by Wiley. Note: Content may be edited for style and length.

Epigenetic changes at birth could explain later behavior problems

Epigenetic changes present at birth — in genes related to addiction and aggression — could be linked to conduct problems in children, according to a new study by King’s College London and the University of Bristol.

Conduct problems (CP) such as fighting, lying and stealing are the most common reason for child treatment referral in the UK, costing an estimated £22 billion per year. Children who develop conduct problems before the age of 10 (known as early-onset CP) are at a much higher risk for severe and chronic antisocial behaviour across the lifespan, resulting in further social costs related to crime, welfare dependence and health-care needs.

Genetic factors are known to strongly influence conduct problems, explaining between 50-80 per cent of the differences between children who develop problems and those who do not. However, little is known about how genetic factors interact with environmental influences — especially during fetal development — to increase the risk for later conduct problems.

Understanding changes in DNA methylation, an epigenetic process that regulates how genes are ‘switched on and off’, could aid the development of more effective approaches to preventing later conduct problems.

The study, published in Development & Psychopathology, used data from Bristol’s Avon Longitudinal Study of Parents and Children (ALSPAC) to examine associations between DNA methylation at birth and conduct problems from the ages of four to 13.

The researchers also measured the influence of environmental factors previously linked to early onset of conduct problems, including maternal diet, smoking, alcohol use and exposure to stressful life events.

They found that at birth, epigenetic changes in seven sites across children’s DNA differentiated those who went on to develop early-onset versus those who did not. Some of these epigenetic differences were associated with prenatal exposures, such as smoking and alcohol use during pregnancy.

One of the genes which showed the most significant epigenetic changes, called MGLL, is known to play a role in reward, addiction and pain perception. This is notable as previous research suggests conduct problems are often accompanied by substance abuse, and there is also evidence indicating that some people who engage in antisocial lifestyles show higher pain tolerance. The researchers also found smaller differences in a number of genes previously associated with aggression and antisocial behaviour, including MAOA.

Dr Edward Barker, senior author from King’s College London, said: ‘We know that children with early-onset conduct problems are much more likely to engage in antisocial behaviour as adults, so this is clearly a very important group to look at from a societal point of view.

‘There is good evidence that exposure to maternal smoking and alcohol is associated with developmental problems in children, yet we don’t know how increased risk for conduct problems occurs. These results suggest that epigenetic changes taking place in the womb are a good place to start.’

Dr Charlotte Cecil, first author from King’s College London, said: ‘Our study reveals significant epigenetic changes which differentiate children who go on to develop conduct problems and those who don’t. Although these findings do not prove causation, they do highlight the neonatal period as a potentially important window of biological vulnerability, as well as pinpointing novel genes for future investigation.

‘Given that the postnatal environment is also crucial for children’s development, future research should examine whether positive environmental experiences can help to modify these epigenetic changes.’

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Materials provided by King’s College London. Note: Content may be edited for style and length.