Public Health Campaigns to Change Industry Practices That Damage Health: An Analysis of 12 Case Studies

Health Education & Behavior, Vol. 36, No. 2, 230-249 (2009

Industry practices such as advertising, production of unsafe products, and efforts to defeat health legislation play a major role in current patterns of U.S. ill health. Changing these practices may be a promising strategy to promote health.

The authors analyze 12 campaigns designed to modify the health-related practices of U.S. corporations in the alcohol, automobile, food and beverage, firearms, pharmaceutical, and tobacco industries.

The objectives are to examine the interactions between advocacy campaigns and industry opponents; explore the roles of government, researchers, and media; and identify characteristics of campaigns that are effective in changing health-damaging practices. The authors compared campaigns that operate at different levels of organization and use different strategies.

Findings suggest that many campaigns achieve policy or mobilization outcomes that may contribute to improved health; local campaigns may be more effective than national ones; and advocates frequently frame their campaigns on the themes of children's health and social justice.

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Wage Penalty of Abstinence and Wage Premium of Drinking -A misclassification bias due to pooling of drinking groups?

Several studies have found protective effects of low/moderate (hereafter “light”) alcohol consumption compared with “abstinence” on mortality, health and wage. Some of these studies have been criticised because former drinkers have been included among the abstainers, which may overstate the protective effect of light alcohol consumption. It has also been proposed, but not shown, that the commonly pooled group of light drinkers and former heavy drinkers would understate the protective effect of light drinking. We also suggest that former abstainers might cause the same effect when pooled with light drinkers.

The aim of this paper is to study whether pooled groups risk create bias in the form of misclassification and confounding. The analysis focuses on: ‘former drinker error’ (pooling of lifelong abstainers and former drinkers); ‘former abstainer error’ (pooling of former abstainers and lifelong light
drinkers); and ‘former heavy drinker error’ (pooling of light drinkers with and without history of heavy drinking). Swedish panel data were used in a multinomial logit model, presenting odds ratios when comparing the subgroups.

The results demonstrate that commonly pooled groups are heterogeneous with respect to a number of variables, which may implicate confounding. Given appropriate controls, misclassification bias is likely in the pooled group of light drinkers.

The direction of the misclassification bias, however, is to underestimate the beneficial effect of light alcohol consumption on wage and can therefore not explain the wage penalty of abstinence compared to light drinking.

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Fetal ethanol exposure increases ethanol intake by making it smell and taste better

PNAS March 31, 2009 vol. 106 no. 13 5359-5364

Human epidemiologic studies reveal that fetal ethanol exposure is highly predictive of adolescent ethanol avidity and abuse. Little is known about how fetal exposure produces these effects. It is hypothesized that fetal ethanol exposure results in stimulus-induced chemosensory plasticity. Here, we asked whether gestational ethanol exposure increases postnatal ethanol avidity in rats by altering its taste and odor.

Experimental rats were exposed to ethanol in utero via the dam's diet, whereas control rats were either pair-fed an iso-caloric diet or given food ad libitum. We found that fetal ethanol exposure increased the taste-mediated acceptability of both ethanol and quinine hydrochloride (bitter), but not sucrose (sweet). Importantly, a significant proportion of the increased ethanol acceptability could be attributed directly to the attenuated aversion to ethanol's quinine-like taste quality.

Fetal ethanol exposure also enhanced ethanol intake and the behavioral response to ethanol odor. Notably, the elevated intake of ethanol was also causally linked to the enhanced odor response. Our results demonstrate that fetal exposure specifically increases ethanol avidity by, in part, making it taste and smell better.

More generally, they establish an epigenetic chemosensory mechanism by which maternal patterns of drug use can be transferred to offspring. Given that many licit (e.g., tobacco products) and illicit (e.g., marijuana) drugs have noteworthy chemosensory components, our findings have broad implications for the relationship between maternal patterns of drug use, child development, and postnatal vulnerability.

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Health professionals add more support for pricing controls on alcohol

The Royal College of Physicians and Royal College of Nursing Survey on Alcohol Treatment Services published last week asked gastroenterologists, hepatologists, acute physicians and nurses for their expert opinion on Government policy initiatives and national strategies to tackle alcohol related harm, the provision of service for people with alcohol related health problems and the scale of alcohol related health harms in their particular clinical environment. . . . . .

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PATHWAYS TO ABSTINENCE: IMPACT OF ALCOHOLICS ANONYMOUS





-The results of the present study support the efficacy of the fellowship of Alcoholics Anonymous to promote abstinence


-In 1992 Americans with alcohol use disorders who continued to attend AA were more likely to achieve abstinence (64%) than those who dropped out of AA (37%) or those who never attended AA (16%)

-Abstinence recovery status varies as a function of increasing age and level of severity of alcohol symptoms.


-The findings suggest that a substantial portion of the "AA drop outs" attain sobriety or abstinence after a period of AA membership and maintain their abstinence without AA


- The unmet need for AA referral is concentrated in the younger age groups, 35% in the 18-29 years group and 30% in the 30-39 years age group.


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Effectiveness of Making Alcoholics Anonymous Easier: A group format 12-step facilitation approach

Journal of Substance Abuse Treatment Article in Press 1 April 2009

Most treatment programs recommend clients attend 12-step groups, but many drop out posttreatment. The effectiveness of Making Alcoholics Anonymous [AA] Easier (MAAEZ ), a manual-guided intervention designed to help clients connect with individuals encountered in AA, was tested using an “OFF/ON” design (n = 508).

MAAEZ effectiveness was determined by comparing abstinence rates of participants recruited during ON and OFF conditions and by studying the effect of the number of MAAEZ sessions attended. At 12 months, more clients in the ON condition (vs. OFF) reported past 30-day abstinence from alcohol (p = .012), drugs (p = .009), and both alcohol and drugs (p = .045). In multivariate analyses, ON condition participants had significantly increased odds of abstinence from alcohol (odds ratio [OR] = 1.85) and from drugs (OR = 2.21); abstinence odds also increased significantly for each additional MAAEZ session received.

MAAEZ appeared especially effective for those with more prior AA exposure, severe psychiatric problems, and atheists/agnostics. MAAEZ represents an evidence-based intervention that is easily implemented in existing treatment programs.

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Request Reprint E-Mail: lkaskutas@arg.org

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Tracking Adolescent Substance Use and Abuse in North Carolina


Duke University has just launched a great website that allows policymakers and others to get information about teen aclohol and drug use in North Carolina. It pulls from multiple public information sources about teen arrests for possession by drug, emergency room visits, and much more. County data can be compared to state data, data can be examined by county on a map of North Carolina ... and that's just the start.
. . . . .


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Problemas relacionados con el consumo de alcohol en jóvenes de la provincia de Jujuy, Argentina.

Salud pública Méx [online]. 2008, v. 50, n. 4, pp. 300-307.

To examine drinking patterns and alcohol-related problems among youth in Jujuy, Argentina.

A survey was conducted in 2005 with a representative sample of 9th grade youth (12 to 17 years old) including sociodemographic and consumption data, and the AUDIT-C test.

Nine percent of girls and 11% of boys reported hazardous drinking; 12% of girls and 19% of boys reported dependence symptoms. The odds ratio for dependence symptoms (adjusted OR 0.7; 95%CI: 0.6-0.8) and for hazardous drinking (adjusted OR 0.7; 95%CI: 0.6-0.8) was significantly lower for girls compared with boys. Older age, working, and attending night school were risk factors for hazardous drinking, dependence symptoms, and harmful drinking.

A significant proportion of youth reported problematic patterns of alcohol drinking, highlighting the need to implement prevention and treatment interventions tailored to the adolescent population

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Request Reprint E-Mail: e_alderete@arnet.com.ar

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Children Living with Substance-Dependent or Substance-Abusing Parents: 2002 to 2007

Highlights:

Combined data from SAMHSA's 2002 to 2007 National Surveys on Drug Use and Health were used to provide average annualized estimates of the number of children under age 18 living with a substance abusing parent, that is, a parent who was dependent on or abused alcohol or an illicit drug.

Over 8.3 million children (11.9%) lived with at least one parent who was dependent on or abused alcohol or an illicit drug during the past year.

Of the children living with a substance abusing parent, almost 7.3 million (10.3%) lived with a parent who was dependent on or abused alcohol, and about 2.1 million (3.0%) lived with a parent who was dependent on or abused illicit drugs.

About 5.4 million children under 18 years of age lived with a father who met the criteria for past year substance dependence or abuse and 3.4 million lived with a mother who met the criteria.

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Reclaiming Futures Launches Blog Dedicated to Substance Abuse and Teens in the Juvenile Justice System

Reclaiming Futures Every Day is a professionally-staffed blog that aims to keep people informed of the latest happenings in juvenile justice and substance abuse treatment. Launched by Reclaiming Futures, an initiative of the Robert Wood Johnson Foundation, it can be found at http://blog.reclaimingfutures.org/, and is designed to help readers:

• Discuss the national challenge of helping teens break the cycle of drugs, alcohol and crime.

• Comment on new developments in teen alcohol and drug treatment and juvenile justice reform.

• Stay in touch with what's going on in the 23 communities using the proven Reclaiming Futures approach.

• Receive expert opinions and commentary from regular contributors who are leaders in the field.

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Disparity Between Tonic and Phasic Ethanol-Induced Dopamine Increases in the Nucleus Accumbens of Rats
Alcoholism: Clinical and Experimental Research Published Online: 9 Apr 2009

Dopamine concentrations in the nucleus accumbens fluctuate on phasic (subsecond) and tonic (over minutes) timescales in awake rats. Acute ethanol increases tonic concentrations of dopamine, but its effect on subsecond dopamine transients has not been fully explored.

Microdialysis samples yielded significant tonic increases in dopamine concentrations at 1 to 2 g/kg ethanol in each rat, while repeated saline infusions had no effect. When monitored with fast scan cyclic voltammetry, ethanol increased the frequency of dopamine transients in 6 of 16 recording sites, in contrast to the uniform effect of ethanol as measured with microdialysis. In the remaining 10 recording sites that were unresponsive to ethanol, dopamine transients either decreased in frequency or were unaffected by cumulative ethanol infusions, patterns also observed during repeated saline infusions. The responsiveness of particular recording sites to ethanol was not correlated with either core versus shell placement of the electrodes or the basal rate of dopamine transients. Importantly, the phasic response pattern to a single dose of ethanol at a particular site was qualitatively reproduced when a second dose of ethanol was administered, suggesting that the variable between-site effects reflected specific pharmacology at that recording site.

These data demonstrate that the relatively uniform dopamine concentrations obtained with microdialysis can mask a dramatic heterogeneity of phasic dopamine release within the accumbens.

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Proopiomelanocortin Peptides Are Not Essential for Development of Ethanol-Induced Behavioral Sensitization
Alcoholism: Clinical and Experimental Research Published Online: 9 Apr 2009

Behavioral sensitization is a result of neuroadaptation to repeated drug administration and is hypothesized to reflect an increased susceptibility to drug abuse. Proopiomelanocortin (POMC) derived peptides including β-endorphin and α-melanocyte stimulating hormone have been implicated in development of behavioral sensitization and the reinforcing effects of alcohol and other drugs of abuse.

This study used a genetically engineered mouse strain that is deficient for neural POMC to directly determine if any POMC peptides are necessary for the development of ethanol-induced locomotor sensitization.

There was no significant difference in BEC between genotypes (WT = 2.11 ± 0.06; KO = 2.03 ± 0.08 mg/ml). Both WT and nPOMC-deficient mice treated repeatedly with ethanol demonstrated a significant increase in locomotor activity on test day when compared to repeated saline-treated counterparts. In addition, mice of both genotypes in the repeated saline groups showed a significant locomotor stimulant response to acute ethanol injection.

Central POMC peptides are not required for either the acute locomotor stimulatory effect of ethanol or the development of ethanol-induced locomotor sensitization. While these peptides may modulate other ethanol-associated behaviors, they are not essential for development of behavioral sensitization.

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The Impact of Underage Drinking Laws on Alcohol-Related Fatal Crashes of Young Drivers
Alcoholism: Clinical and Experimental Research Published Online: 9 Apr 2009

This study used a pre- to post-design to evaluate the influence on drinking-and-driving fatal crashes of 6 laws directed at youth aged 20 and younger and 4 laws targeting all drivers..

Significant decreases in the underage fatal CIR were associated with presence of 4 of the laws targeting youth (possession, purchase, use and lose, and zero tolerance) and 3 of the laws targeting all drivers (0.08 blood alcohol concentration illegal per se law, secondary or upgrade to a primary seat belt law, and an administrative license revocation law). Beer consumption was associated with a significant increase in the underage fatal CIR. The direct effects of laws targeting drivers of all ages on adult drinking drivers aged 26 and older were similar but of a smaller magnitude compared to the findings for those aged 20 and younger. It is estimated that the 2 core underage drinking laws (purchase and possession) and the zero tolerance law are currently saving an estimated 732 lives per year controlling for other exposure factors. If all states adopted use and lose laws, an additional 165 lives could be saved annually.

These results provide substantial support for the effectiveness of under age 21 drinking laws with 4 of the 6 laws examined having significant associations with reductions in underage drinking-and-driving fatal crashes. These findings point to the importance of key underage drinking and traffic safety laws in efforts to reduce underage drinking-driver crashes.

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IgA Immune Responses Against Acetaldehyde Adducts and Biomarkers of Alcohol Consumption in Patients with IgA Glomerulonephritis

Alcoholism: Clinical and Experimental Research Published Online: 9 Apr 2009


The pathogenesis of IgA glomerulonephritis (IgAGN) involves intense deposition of IgAs within the glomerulus. Although previous studies have shown that heavy drinking frequently leads to the generation of IgA antibodies against neo-antigens induced by ethanol metabolites and tissue deposition of IgAs, the associations between alcohol consumption, IgA immune responses, and kidney disease have not been examined.

In male IgAGN patients, drinking status was significantly associated with MCV, p < 0.001; CDT, p < 0.01; and γ -CDT, p < 0.05. In the reference population, all biomarkers and anti-adduct IgA levels were found to vary according to drinking status. In IgAGN patients, anti-adduct IgA levels were elevated in 63% of the cases but the titers did not associate with self-reported ethanol intake

These data indicate high levels of IgA antibodies against acetaldehyde-derived antigens in IgAGN patients, which may hamper the use of the immune responses as markers of alcohol consumption among such patients. Future studies on the pathogenic and prognostic significance of anti-adduct immune responses in IgAGN patients are warranted


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Request Reprint E-Mail: kati.kaartinen@elisanet.fi
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New Manual Teaches Strategies to Manage Depressive Symptoms in Substance Abuse Clients

Managing Depressive Symptoms in Substance Abuse Clients During Early Recovery, a new manual which offers substance abuse counselors new insights on working with clients with depressive symptoms and substance use disorders, is now available from the Substance Abuse and Mental Health Services Administration (SAMHSA).

The manual is #48 in the Treatment Improvement Protocol (TIP) series. TIPs are best-practice guidelines used for the treatment of substance use disorders, issued by SAMHSA’s Center for Substance Abuse Treatment (CSAT). This and future TIPs will be organized in a new format.

The new format consists of three parts. The parts of this TIP are:
- Part 1 - Managing Depressive Symptoms in Substance Abuse Clients During Early Recovery
- Part 2 - Managing Depressive Symptoms: An Implementation Guide for Administrators
- Part 3 - Managing Depressive Symptoms: A Review of the Literature

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A Behavioral Economic Reward Index Predicts Drinking Resolutions: Moderation Revisited and Compared With Other Outcomes

Journal of Consulting and Clinical Psychology Volume 77, Issue 2, April 2009, Pages 219-228

Data were pooled from 3 studies of recently resolved community-dwelling problem drinkers to determine whether a behavioral economic index of the value of rewards available over different time horizons distinguished among moderation (n = 30), abstinent (n = 95), and unresolved (n = 77) outcomes.

Moderation over 1- to 2-year prospective follow-up intervals was hypothesized to involve longer term behavior regulation processes than abstinence or relapse and to be predicted by more balanced preresolution monetary allocations between short-term and longer term objectives (i.e., drinking and saving for the future).

Standardized odds ratios (ORs) based on changes in standard deviation units from a multinomial logistic regression indicated that increases on this “Alcohol-Savings Discretionary Expenditure” index predicted higher rates of abstinence (OR = 1.93, p = .004) and relapse (OR = 2.89, p < .0001) compared with moderation outcomes. The index had incremental utility in predicting moderation in complex models that included other established predictors.

The study adds to evidence supporting a behavioral economic analysis of drinking resolutions and shows that a systematic analysis of preresolution spending patterns aids in predicting moderation.

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Request Reprint E-Mail: jtucker@uab.edu

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