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Anxiety disorders are among the most common mental disorders worldwide, and most previous studies have focused solely on alcohol drinking or tobacco smoking as risk factors for anxiety.
Aim
This study investigated the associations of alcohol drinking and tobacco smoking with anxiety.
Method
The data of 30 836 individuals in the Taiwan Biobank were retrieved and analysed in our study. To investigate the associations of tobacco and alcohol use with anxiety, we analysed Patient Health Questionnaire 4 (specifically scores for the first two questions assessing generalised anxiety disorder) results of the included participants and data on their tobacco and alcohol use, and other covariates.
Results
Participants who used only tobacco and those using both tobacco and alcohol were more likely to experience anxiety than were those who did not use tobacco or alcohol. Among men, the use of alcohol and/or tobacco was associated with a significantly higher risk of anxiety. Among women, the use of both alcohol and tobacco was associated with a significantly higher risk of anxiety. Older age was associated with a lower risk of anxiety.
Conclusions
Tobacco and alcohol use significantly influence the risk of anxiety, particularly in men, and older age also influences this risk. The associations of anxiety with tobacco and alcohol use in women may change because of the increasing prevalence of their use among women in Taiwan in recent years.
Prescription medications are highly regulated to make sure they are as safe and effective as possible.
The last decade has seen an emerging black market for prescription medications particularly from unscrupulous online pharmacies,
Some of the products sold illegally by these pharmacies are poor quality counterfeits
Tobacco is the largest killer of all the psychoactive drugs, but smoking rates are now falling.
Electronic cigarettes are safer than tobacco smoking because they only contain nicotine and none of the other harmful chemicals found in tobacco.
The aggressive marketing of electronic cigarettes to young people has rapidly driven up their use causing concern that they will result in a new generation addicted to nicotine.
If you don’t smoke, don’t vape!
Young people are drinking less, but tend to binge drink when they do drink
Reduce the many risks of alcohol intoxication but pacing drinking, avoiding drinking, understanding alcohol ‘units’ and knowing how to put a friend in the recovery position.
There is emerging research suggesting that some illegal psychoactive drugs, such as cannabis and some hallucinogens, may have therapeutic value, but further research is needed to understand their potential benefits.
The incidence of congenital malformations (CM) among non-Hispanic White American (NHWA) mothers was reviewed to identify and evaluate the geographic differences in the most frequent CM subtypes associated with smoking and other risk factors. Data on CM were obtained from 150,775 children (2000-2004) from the Centers for Disease Control and Prevention. Risk factors associated with CM development were the mother’s age < 21 and > 35 years, body weight gain during pregnancy, anemia, diabetes mellitus, eclampsia (cases of preeclampsia were omitted), smoking, and alcohol use during pregnancy. Among smoking mothers, the most common CM was omphalocele, club foot, cleft lip, and polydactyly. The highest incidences (CM/10,000 births/year) of observed CM in children of smoking mothers were clubfoot, 25.51 cases (Utah), cleft lip, 22.47 (South Dakota), polydactyly, 21.23 (North Dakota), and omphalocele, 13.14 (Montana). The presence of maternal comorbidities, tobacco and alcohol consumption, and their association with other environmental factors can affect the incidence of CM in NHWA mothers. Further comparisons among the American states regarding the overall changes in CM over the last two decades should uncover crucial outcomes in terms of CM and smoking.
Although rarely at the center of the most influential human historical narratives, the stories of human-plant interaction are nonetheless sporadically recorded in a variety of literary genres and other cultural media across nearly five centuries. This chapter aims to provide a contextual outline of our present human–plant culture as it developed in North America through the early nineteenth century, and to orient readers to the most frequently discussed texts, questions, and resources in the field. It introduces the early modern history of settler cash crops – cotton, sugar, and tobacco – and the longer history of changing agricultural practice during the early contact period. Early American literature in English – poetry, herbals, prose tracts, and instructional writing – was deeply engaged with the movement of indigenous and imported plant species as they flowed in and out of North America as rapidly as humans moved into the region from the rest of the globe.
◦ The Spanish raw tobacco market offers a story of two cartels that operated simultaneously. The first cartel operated on the seller side of the market. It was set up by the three agricultural unions that managed contract negotiations for the tobacco producers (“the producer representatives’ cartel”). The second cartel, on the buyer side, was formed by the purchasers of raw tobacco (“the processors cartel”).
◦ The case study tells a rich story of cartel formation. Government regulation sought to establish fair prices for tobacco producers through a system of production quotas. This led those producers to form a cartel to collectively negotiate with downstream tobacco processors. The processors formed their own cartel to counterbalance the one upstream. We then have regulation inducing one cartel which then inspires a second cartel.
◦ The processors’ cartel exemplifies some of the challenges in achieving effective collusion as well as the critical complementary role of monitoring and punishing mechanisms. The cartel was ineffective in its first two years in spite of a high level of market concentration and effective monitoring. Only when an internal compensation mechanism was put in place did firms comply with the collusive outcome.
Observational studies consistently report associations between tobacco use, cannabis use and mental illness. However, the extent to which this association reflects an increased risk of new-onset mental illness is unclear and may be biased by unmeasured confounding.
Methods
A systematic review and meta-analysis (CRD42021243903). Electronic databases were searched until November 2022. Longitudinal studies in general population samples assessing tobacco and/or cannabis use and reporting the association (e.g. risk ratio [RR]) with incident anxiety, mood, or psychotic disorders were included. Estimates were combined using random-effects meta-analyses. Bias was explored using a modified Newcastle–Ottawa Scale, confounder matrix, E-values, and Doi plots.
Results
Seventy-five studies were included. Tobacco use was associated with mood disorders (K = 43; RR: 1.39, 95% confidence interval [CI] 1.30–1.47), but not anxiety disorders (K = 7; RR: 1.21, 95% CI 0.87–1.68) and evidence for psychotic disorders was influenced by treatment of outliers (K = 4, RR: 3.45, 95% CI 2.63–4.53; K = 5, RR: 2.06, 95% CI 0.98–4.29). Cannabis use was associated with psychotic disorders (K = 4; RR: 3.19, 95% CI 2.07–4.90), but not mood (K = 7; RR: 1.31, 95% CI 0.92–1.86) or anxiety disorders (K = 7; RR: 1.10, 95% CI 0.99–1.22). Confounder matrices and E-values suggested potential overestimation of effects. Only 27% of studies were rated as high quality.
Conclusions
Both substances were associated with psychotic disorders and tobacco use was associated with mood disorders. There was no clear evidence of an association between cannabis use and mood or anxiety disorders. Limited high-quality studies underscore the need for future research using robust causal inference approaches (e.g. evidence triangulation).
This chapter explores several legal opinions (pl. fatāwa) from the minority theological and legal tradition known as Ibāḍism, as represented by the work of the modern Ibāḍī jurist Ibrāhīm Bayyūḍ (d. 1401/1981). The Ibāḍiyya are usually regarded as the inheritors of the early Khārijite movement and are thus neither Sunnī nor Shīʿī. Important Ibāḍī communities are today found in Oman and in smaller numbers in North Africa (Jerba Island in Tunisia, the Jabal Nafūsa mountains of Libya and the M’zab valley in Algeria). Ibrāhīm Bayyūḍ was the most prominent figure of the so-called ‘Ibāḍī Rennaisance’ (al-Nahḍa al-Ibāḍiyya) of the late 19th and 20th centuries, in which the Ibāḍī community in M’zab sought to find a place for themselves in their Sunnī-dominated environment, leading to an upsurge of Ibāḍī legal and theological scholarship. The fatwās excerpted here discuss the lawfulness of television and radio, eating the meat of non-Muslims, Pepsi and Coca Cola, smoking and various drugs.
Lobbyists sometimes represent clients with seemingly adversarial policy interests. We seek to explain the occurrence of such ostensible conflicts of interest. In hiring lobbyists, interests encounter a tradeoff between access and agency. Although some lobbyists promise access to lawmakers, they may not lobby as contracted. Interests hire seemingly conflicted lobbyists more often when access is costlier and reputational risks are smaller. We examine the hiring of tobacco lobbyists by health interests, given the possibilities for shirking and reputational damage. We find that institutions such as hospitals hire tobacco lobbyists regularly and more often than membership-based health groups. Intergroup competition for access and lobby laws, especially anti-conflict laws, affect the use of tobacco lobbyists independent of rates of multi-client lobbying. Conflicts are more common today than ever but interests can protect themselves somewhat from opportunistic agents. Our findings also suggest that reforms can improve the representation of client interests.
Substance use is a complex condition with multidimensional determinants. The present study aims to find the prevalence and determinants of substance use among young people attending primary healthcare centers in India.
Methods
A multicentric cross-sectional study was conducted across 15 states in India on 1,630 young people (10–24 years) attending primary health centers. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to capture data on substance use. The degree of substance involvement was assessed and multivariate regression analysis was conducted to determine the risk factors of substance use.
Results
The prevalence of substance use was 32.8%, with a median substance initiation age of 18 years. Among the substance users, 75.5% began before completing adolescence. Tobacco (26.4%), alcohol (26.1%) and cannabis (9.5%) were commonly consumed. Sociodemographic determinants included higher age, male gender, urban residence, positive family history, northeastern state residence and lower socioeconomic class. Over 80% of users had moderate or high involvement.
Conclusions
High substance use prevalence among young people in Indian healthcare centers underscores the urgency of targeted intervention. Insights on determinants guide effective prevention strategies for this complex public health issue.
The causes of ill health and death are changing and, as we live longer, new health-preventable problems emerge, bringing new challenges. Improving health (physical, mental or both) and promoting general well-being remain major priorities.
Just as important, the difference in health status between rich and poor continues to grow. At a global level, the picture is even more complex. Although there is some evidence that life expectancy is beginning to plateau in developed countries such as the UK, the biggest potential to improve health still lies in addressing inequality between or within countries.
Therefore, this chapter:
summarizes the models of health improvement that are prevalent today;
introduces a combined conceptual model to describe the factors affecting health in modern times; and
presents some case studies of interventions designed to improve health which offer important insight and learning.
Chapter 2 traces the historical development of mass tort litigation from the 1970s through the 1990s, documenting plaintiffs attorneys initial unsuccessful attempts in the 1990s to extend public nuisance theory to mass tort products and marketing litigation. During this initial foray into public nuisance theory, courts instead universally defaulted to a narrow view of nuisance grounded in property law. In cases involving tobacoo, asbestos, lead paint, and gun litigation courts declined to accept plaintiffs public nusiance claims, refusing invitations to expand a claim for public nuisance beyond its grounding in real property concepts. Courts contended that these mass tort harms sounded in causes of action for traditional products liability, not public nuisance, and that public nuisance law had never been applied to products cases. Courts noted the deleterious effects of accepting an expanded concept of public nuisance, which would allow any plaintiff to describe a harm from a lawful product as producing a public nuisance. Such a concept would invite unlimited liability for manufacturers of legal products.
Edited by
Deepak Cyril D'Souza, Staff Psychiatrist, VA Connecticut Healthcare System; Professor of Psychiatry, Yale University School of Medicine,David Castle, University of Tasmania, Australia,Sir Robin Murray, Honorary Consultant Psychiatrist, Psychosis Service at the South London and Maudsley NHS Trust; Professor of Psychiatric Research at the Institute of Psychiatry
A prominent but under-appreciated concern for individuals with schizophrenia and psychotic disorders using cannabis is the co-use of tobacco. Rates of cannabis and tobacco co-use are on the rise, which may reflect the changing legal landscape surrounding cannabis use. Currently, there are no approved medications for cannabis use disorders and behavioural treatments yield only modest abstinence rates that decline once treatment is discontinued. Converging evidence suggests that treatments for cannabis use disorder may be augmented among co-users if tobacco use is considered and addressed, highlighting the need for a better understanding of cannabis use in the context of tobacco. This chapter reviews the evidence for: (1) mechanisms facilitating the high rates of tobacco use among cannabis users, including those with psychosis; (2) the interactive effects of co-use on the brain, clinical outcomes, and physical health; and (3) the implications for treating cannabis and tobacco co-use in general, and in psychotic disorders in particular. Overall, we present evidence that attests to the public health significance of cannabis and tobacco co-use and the urgent need for the development of empirically informed treatments for these individuals, particularly for those with co-occurring psychosis.
Tobacco smoking is highly prevalent among patients with serious mental illness (SMI), with known deleterious consequences. Smoking cessation is therefore a prioritary public health challenge in SMI. In recent years, several smoking cessation digital interventions have been developed for non-clinical populations. However, their impact in patients with SMI remains uncertain. We conducted a systematic review to describe and evaluate effectiveness, acceptability, adherence, usability and safety of digital interventions for smoking cessation in patients with SMI. PubMed/MEDLINE, EMBASE, CINAHL, Web of Science, PsychINFO and the Cochrane Tobacco Addiction Group Specialized Register were searched. Studies matching inclusion criteria were included and their information systematically extracted by independent investigators. Thirteen articles were included, which reported data on nine different digital interventions. Intervention theoretical approaches ranged from mobile contingency management to mindfulness. Outcome measures varied widely between studies. The highest abstinence rates were found for mSMART MIND (7-day point-prevalent abstinence: 16–40%). Let's Talk About Quitting Smoking reported greater acceptability ratings, although this was not evaluated with standardized measures. Regarding usability, Learn to Quit showed the highest System Usability Scale scores [mean (s.d.) 85.2 (15.5)]. Adverse events were rare and not systematically reported. Overall, the quality of the studies was fair to good. Digitally delivered health interventions for smoking cessation show promise for improving outcomes for patients with SMI, but lack of availability remains a concern. Larger trials with harmonized assessment measures are needed to generate more definitive evidence and specific recommendations.
Tobacco is a highly prevalent substance of abuse in patients with psychosis. Previous studies have reported an association between tobacco use and schizophrenia. The aim of this study was to analyze the relationship between tobacco use and first-episode psychosis (FEP), age at onset of psychosis, and specific diagnosis of psychosis.
Methods
The sample consisted of 1105 FEP patients and 1355 controls from the European Network of National Schizophrenia Networks Studying Gene–Environment Interactions (EU-GEI) study. We assessed substance use with the Tobacco and Alcohol Questionnaire and performed a series of regression analyses using case-control status, age of onset of psychosis, and diagnosis as outcomes and tobacco use and frequency of tobacco use as predictors. Analyses were adjusted for sociodemographic characteristics, alcohol, and cannabis use.
Results
After controlling for cannabis use, FEP patients were 2.6 times more likely to use tobacco [p ⩽ 0.001; adjusted odds ratio (AOR) 2.6; 95% confidence interval (CI) [2.1–3.2]] and 1.7 times more likely to smoke 20 or more cigarettes a day (p = 0.003; AOR 1.7; 95% CI [1.2–2.4]) than controls. Tobacco use was associated with an earlier age at psychosis onset (β = −2.3; p ⩽ 0.001; 95% CI [−3.7 to −0.9]) and was 1.3 times more frequent in FEP patients with a diagnosis of schizophrenia than in other diagnoses of psychosis (AOR 1.3; 95% CI [1.0–1.8]); however, these results were no longer significant after controlling for cannabis use.
Conclusions
Tobacco and heavy-tobacco use are associated with increased odds of FEP. These findings further support the relevance of tobacco prevention in young populations.
The critical importance of tobacco to the Zimbabwean economy is reflected by the profoundly flattering epithets deployed over the years to describe the crop: ‘leaf of gold’, ‘most promising weed’, ‘crucible’, ‘lifeblood’, ‘golden lining’. Tobacco is situated at the nerve centre of the body politic, central to the country’s political economy. Zimbabwe is the largest producer of tobacco in Africa, and the fifth largest producer of flue-cured tobacco in the world after China, Brazil, India and the United States.
This chapter discusses the impact of the 1966 tobacco embargo and the war of liberation, 1972–1980 on tobacco farming landscapes in Southern Rhodesia. It integrates the political and economic aspects of the Unilateral Declaration of Independence of 1965 into ecological narratives towards understanding how the pressures of economic sanctions and war prompted new patterns of agrarian development and conservation practices in tobacco farms that had an impact on the environment and landscapes.
This chapter uses the lens of political ecology and environmental history to interrogate the use of pesticides in tobacco farming in Southern Rhodesia (now Zimbabwe) from 1945 to 1980, and their effects on the human body, the body politic and the natural environment. It traces the growth of pesticide use from the end of the Second World War, which saw a turning point in the global pesticides’ regime as crop chemicals such as DDT became widespread. It explores the problems that arose with the use of these pesticides and connects this narrative with the various global debates on ‘environmentalism’ that arose in the 1960s, and how this impacted on the evolution of legislation and policies to curtail pesticide use in tobacco production in Southern Rhodesia. The chapter constructs a contextual reading of Silent Spring in Southern Rhodesia and Africa.
Exploring over a century of Zimbabwe's colonial and post-colonial history, Elijah Doro investigates the murky and noxious history of that powerful crop: tobacco. In a compelling narrative that debunks previous histories glorifying tobacco farming, Doro reveals the indelible marks that tobacco left on landscapes, communities, and people. Demonstrating that the history of tobacco farming is inseparable from that of colonial encounter, Doro outlines how tobacco became an institutionalised culture of production, which was linked to state power and natural ecosystems, and driven by a pernicious heritage of unbridled plunder. With the destruction of landscapes, the negative impacts of the export trade and the growing tobacco epidemic in Zimbabwe, tobacco farming has a long and varied legacy in southern African and across the world. Connecting the local to the global, and the environmental to the social, this book illuminates our understandings of environmental history, colonialism and sustainability.
Caffeine consumption occurs throughout life, while nicotine use typically begins during adolescence, the period when caffeine-nicotine epidemiological association begins in earnest. Despite that, few studies in animal models parallel the pattern of coexposure that occurs in humans. Therefore, the neurobehavioral consequences of the association between these drugs remain unclear. Here, we exposed Swiss mice to lifetime caffeine. Caffeine solutions of 0.1 g/L (CAF0.1), 0.3 g/L (CAF0.3), or water (CTRL) were used as the sole liquid source, being offered to progenitors until weaning and, after that, directly to the offspring until the last day of adolescent behavioral evaluation. The open field test was used to evaluate acute effects of nicotine, of lifetime caffeine and of their interaction on locomotion and anxiety-like behavior, while the conditioned place preference test was used to assess the impact of caffeine on nicotine (0.5 mg/Kg, i.p.) reward. Frontal cerebral cortex dopamine content, dopamine turnover, and norepinephrine levels, as well as hippocampal serotonin 1A receptor expression were assessed. CAF0.3 mice exhibited an increase in anxiety-like behavior when compared to CAF0.1 and CTRL ones, but nicotine coexposure mitigated the anxiogenic-like caffeine-induced effect. Distinctively, caffeine had no effect on locomotion and failed to interfere with both nicotine-induced hyperactivity and place preference. There were no significant effects on dopaminergic and serotonergic markers. In conclusion, although caffeine did not affect nicotine reward, considering the strong association between anxiety disorders and tobacco consumption, caffeine-induced anxiety-like behavior advises limiting its consumption during development, including adolescence, as caffeine could be a risk factor to nicotine use.
This study aimed to systematically review and synthesise the available evidence on the prevalence and associations between psychotic-like experiences (PLEs) and substance use in children and adolescents aged ⩽17 years, prior to the typical age of development of prodromal symptoms of psychosis. As substance use has been associated with earlier age of psychosis onset and more severe illness, identifying risk processes in the premorbid phase of the illness may offer opportunities to prevent the development of prodromal symptoms and psychotic illness. MEDLINE, PsycINFO, and CINAHL databases were searched for chart review, case-control, cohort, twin, and cross-sectional studies. Study reporting was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist, and pooled evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Searches identified 55 studies that met inclusion criteria. Around two-in-five substance users reported PLEs [rate = 0.41, 95% confidence interval (CI) 0.32–0.51; low quality evidence], and one-in-five with PLEs reported using substances (rate = 0.19, 95% CI 0.12–0.28; moderate-to-high quality evidence). Substance users were nearly twice as likely to report PLEs than non-users [odds ratio (OR) 1.77, 95% CI 1.55–2.02; moderate quality evidence], and those with PLEs were twice as likely to use substances than those not reporting PLEs (OR 1.93, 95% CI 1.55–2.41; very low quality evidence). Younger age was associated with greater odds of PLEs in substance users compared to non-users. Young substance users may represent a subclinical at-risk group for psychosis. Developing early detection and intervention for both substance use and PLEs may reduce long-term adverse outcomes.