The latest medical research on Addiction Medicine

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Racial/ethnic variations in inflammatory markers: exploring the role of sleep duration and sleep efficiency.

Behavioral Medicine

Individuals from minoritized racial/ethnic groups have higher levels of circulating inflammatory markers. However, the mechanisms underlying these ...

Culturally specific health-related features on cigarette packs sold in China.

Tobacco Control

China is the country with the highest burden of tobacco-caused disease. We characterised the extent to which cigarette pack marketing features (eg, imagery, text, pack color) could potentially mislead consumers by suggesting products are healthy.

We used two methods: group concept mapping and content analysis. First, we used a group concept mapping approach to generate and sort Chinese consumer responses to an open-ended prompt asking what marketing features suggest a product is 'healthy' or 'good for you'. Second, based on the concept mapping results, we developed a codebook of health-related features on cigarette packs that were relevant to the unique cultural context of product marketing in China. Two trained coders who were native Chinese speakers double-coded a sample of 1023 cigarette packs purchased in 2013 (wave 1) and 2017 (wave 2). We examined differences in the presence of features overall and over time.

Overall, 83.5% (n=854) of Chinese cigarette packs in our sample contained at least one 'healthy' or 'good for you' feature, and the presence of health-related features on packs remained constant between wave 1 (83.5%, n=354) and wave 2 (83.5%, n=500; p=1.00). Across both waves, the most common categories of culturally specific health features present related to recycling symbols, rare animal imagery, bright colours (eg, bright yellow) and botanical imagery (eg, bamboo, mint).

Health-related features on cigarette packs sold in China are common. Enhanced policies to address tobacco packaging, labelling and branding could support and facilitate a reduction in the high tobacco burden in China.

Going 'Super Value' in New Zealand: cigarette pricing strategies during a period of sustained annual excise tax increases.

Tobacco Control

Between 2010 and 2020, the New Zealand (NZ) Government increased tobacco excise tax by inflation plus 10% each year. We reviewed market structure changes and examined whether NZ tobacco companies shifted excise tax increases to maintain the affordability of lower priced cigarette brands.

We cluster-analysed market data that tobacco companies supply to the NZ Ministry of Health, created four price partitions and examined the size and share of these over time. For each partition, we analysed cigarette brand numbers and market share, calculated the volume-weighted real stick price for each year and compared this price across different price partitions. We calculated the net real retail price (price before tax) for each price partition and compared these prices before and after plain packaging took effect.

The number and market share of Super Value and Budget brands increased, while those of Everyday and Premium brands decreased. Differences between the price of Premium and Super Value brands increased, as did the net retail price difference for these partitions. Following plain packaging's implementation, Super Value brand numbers more than doubled; contrary to industry predictions, the price difference between these and higher priced brands did not narrow.

Between 2010 and 2020, NZ tobacco companies introduced more Super Value cigarette brands and shifted excise tax increases to reduce the impact these had on low-priced brands. Setting a minimum retail price for cigarettes could curtail tobacco companies' ability to undermine tobacco taxation policies designed to reduce smoking.

Assessing the profile of support for potential tobacco control policies targeting availability in Great Britain: a cross-sectional population survey.

Tobacco Control

To examine the level of support for tobacco availability policies across Great Britain (GB) and associations between support for policy and sociodemographic, smoking and quitting characteristics.

A cross-sectional representative survey (the Smoking Toolkit Study) of adults in GB (n=2197) during September 2021. Logistic regressions estimated the associations between support for each policy and sociodemographic and smoking characteristics.

There was majority support for requiring retailers to have a license which can be removed if they sell to those under-age (89.6%) and for restrictions on the sale of cigarettes and tobacco near schools (69.9%). More supported than opposed raising the legal age of sale of cigarettes and tobacco to 21 (49.2% supported; 30.7% opposed; 20.1% unsure) and reducing the number of retailers selling tobacco in neighbourhoods with a high density of tobacco retailers (46.5% supported; 23.3% opposed; 30.2% unsure). More opposed than supported a ban on the sale of cigarettes and tobacco to everyone born after a certain year from 2030 onward (a 'tobacco-free generation') (41.3% opposed; 34.5% supported; 24.2% unsure). Age was positively associated with support for raising the age of sale and inversely associated with requiring tobacco retailer licenses. Women were more likely to support raising the age of sale and reducing the number of retailers.

Requiring tobacco retailer licensing and restrictions on sales near schools received majority support. Other tobacco availability policies received substantial support despite considerable opposition.

Who feels affected by "out of control" sexual behavior? Prevalence and correlates of indicators for ICD-11 Compulsive Sexual Behavior Disorder in the German Health and Sexuality Survey (GeSiD).

Behavioral Addiction

The purpose of this study was to examine the prevalence and correlates of indicators consistent with Compulsive Sexual Behavior Disorder (CSBD)-defined and operationalized according to the ICD-11 guidelines-in a large (n = 4,633; 50.5% male; 49,5% female) probability-based German national sample.

Participants were asked if they had ever experienced "intense and recurring sexual impulses or sexual urges that I had difficulty controlling and resulted in sexual behavior" over a period of several months. Those who reported this experience were queried about the associated distress.

Overall, 4.9% of men [95% CI = 3.9-6.1] and 3.0% of women [95% CI = 2.3-3.9] reported experiences consistent with ICD-11 diagnostic requirements for lifetime diagnosis. In the 12 months preceding the study, 3.2% of men [95% CI = 2.4-4.2] and 1.8% of women [95% CI = 1.2-2.5] reported experiences consistent with CSBD requirements. Compared to controls and participants who reported elements of compulsive sexuality but without accompanying distress, strict religious upbringing was most prevalent in the CSBD group. The CSBD group was more likely to view sexual practices like men having sex with men as unacceptable and to report the belief that pornography has negative impacts on their sex life and life in general. Compared to the other two groups, the CSBD group was significantly more likely to have received psychiatric treatment for depression or another mental health problem during the past 12 months.

The current study provides novel and important insights into the prevalence and characteristics of CSBD in the general population.

The role of IQOS risk perceptions on cigarette smoking behaviours: results from a prospective pilot study.

Tobacco Control

IQOS is a heated tobacco product marketed as an alternative to combustible cigarette smoking. Little is known about cigarette smokers' IQOS health risk perceptions and if these risk perceptions impact IQOS use and cigarette smoking behaviour.

Adult, daily, non-treatment-seeking cigarette smokers (n=27), naïve to IQOS, were recruited from Philadelphia, Pennsylvania, USA. Participants were introduced to IQOS and then completed measures of risk perceptions. Participants were given an IQOS 2.4 holder, charger and HeatSticks, and asked to switch completely from cigarettes to IQOS for 14 days. The effects of risk perceptions on changes in IQOS use, cigarettes per day (CPD), the substitution of IQOS for cigarettes and motivation to quit smoking were evaluated.

Over the 14-day switch period, CPD significantly decreased (B=-0.18, 95% CI=-0.26 to -0.09, p<0.0001), IQOS use significantly increased (B=0.02, 95% CI=0.00 to 0.03, p=0.042), as did the percentage IQOS HeatSticks that replaced CPD (B=0.02, 95% CI=0.01 to 0.03, p=0.005). Participants who perceived IQOS as less risky than cigarettes used fewer IQOS HeatSticks per day. A lower percentage of IQOS HeatStick substitution for cigarettes was observed for participants with higher versus lower risk perceptions (B=-0.14, 95% CI=-0.28 to -0.01, p=0.042). Motivation to quit increased from a mean of 5.53 to 6.79 on the contemplation ladder from baseline to day 14 (B=1.26, 95% CI=0.54 to 1.97, p<0.001).

Smokers reduced their smoking rate and increased motivation to quit smoking while using IQOS. IQOS risk perceptions did not directly account for reductions in smoking, although they may contribute indirectly through increased IQOS use.

Regional implications of the tobacco value chain in Paraguay.

Tobacco Control

Paraguay is a major supplier of illicit cigarettes for the Latin American region and beyond. In July 2022, Paraguay ratified the FCTC Protocol. This is an opportunity and a challenge for neighboring countries to implement coordinated actions. This is the first analysis of the foreign trade data for cigarettes and their inputs using Paraguayan data to contextualise the illicit trade problem in Latin America and globally.

Combining publicly available Paraguayan databases, this research constructs a database to analyse imported cigarette inputs, particularly by identifying the companies and their national origins.

A complex multinational supply chain perpetuates a flow of inputs into Paraguay that contributes to the production and export of illicit tobacco products. Brazil is a relevant legal supplier of intermediate goods for the Paraguayan tobacco industry yet is not a significant destination of the legal exports of cigarettes produced in Paraguay. Yet, Paraguayan cigarettes are widely available in the Brazilian market, almost all of them illicit. Trade data also show the role of other countries in the region as major cigarette input exporters to Paraguay. Evidence also supports that high volumes of legal exports from Paraguay to third countries (including Bolivia, Suriname, Aruba and Curacao) may be fuelling illicit trade through triangulation to other countries.

The oversupply-that is, more supply than necessary for domestic consumption and legal exports-of cigarette inputs likely divert illegally back to the countries exporting these inputs and others. Thus, the responsibility for illicit trade in cigarettes falls not only on Paraguayan companies but also on companies exporting inputs to Paraguay to producing these illicit goods. Furthermore, Paraguay is not only exporting illicitly directly to Brazil and Argentina, but also appears to oversupply other countries in South America and the Caribbean that cannot legally absorb this trade through domestic consumption and/or legal re-export.

Longitudinal association between parental involvement and internet gaming disorder among Chinese adolescents: Consideration of future consequences as a mediator and peer victimization as a moderator.

Behavioral Addiction

Internet gaming disorder (IGD) in adolescents is a concerning issue. Positive parenting has been found to protect against adolescent IGD, but the underlying mechanisms await further investigation. As such, this study examined the longitudinal association between parental involvement (PI) - a specific type of positive parenting understudied in the literature of adolescent gaming disorder - and IGD. Moreover, this study also tested consideration of future consequences (CFC) as a mediator and peer victimization (PV) as a moderator.

A two-wave longitudinal research spanning 6 months apart was conducted. Participants were Chinese adolescents (final N = 434; 222 females; M age = 14.44 years, SD = 1.56). They provided ratings on PI, PV, and IGD at Wave 1, and CFC-immediate, CFC-future, and IGD at Wave 2.

Descriptive statistics showed that the prevalence rate of IGD was 10.81% and 9.45% at Waves 1 and 2, respectively. Moreover, results of moderated mediation model found that after controlling for Wave 1 IGD and covariates, Wave 1 PI was associated with Wave 2 IGD via preventing adolescents who had higher levels of PV from developing a tendence of CFC-immediate and via promoting adolescents who had lower levels of PV to develop a tendence of CFC-future.

Altogether, these results suggest that facilitative ecological systems (e.g., positive parenting and good relationships with peers) and personal strengths (e.g., positive future orientation) jointly contribute to the mitigation of adolescent IGD.

Patient-caregiver dyads in pancreatic cancer: identification of patient and caregiver factors associated with caregiver well-being.

Behavioral Medicine

We aimed to examine the psychosocial well-being in the pancreas cancer patient-caregiver dyad, and determine patient and caregiver characteristics ...

Coping self-efficacy, perceived helpfulness of coping, and distress: a longitudinal investigation of breast and gynecologic cancer patients undergoing chemotherapy.

Behavioral Medicine

We examined changes in coping self-efficacy (CSE) pre- and post-chemotherapy and whether these changes predicted depressive symptoms and perceived ...

Prevalence of internet addiction in Africa: A systematic review and meta-analysis.

Behavioral Addiction

In the last two decades, the proportion of internet users has greatly increased worldwide. Data regarding internet addiction (IA) are lacking in Africa compared to other continents. This systematic review and meta-analysis aimed to estimate the pooled prevalence of IA in African countries.

We systematically sought relevant articles in PubMed/MEDLINE, EMBASE, PsycINFO and Cochrane database published before September 25, 2021. The risk of bias was assessed using the Joanna Briggs Institute tool, and we estimated the pooled prevalence of IA using a random-effects meta-analytic model. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.

We included 22 studies (13,365 participants), and collected data from Egypt, Ethiopia, Morocco, Nigeria, South Africa, Tanzania and Tunisia between 2013 and 2021. The mean age of participants ranged from 14.8 to 26.1 years, and the most used tool for IA screening was the Young's 20-item Internet Addiction Test. The pooled prevalence rate of IA was 40.3% (95% CI: 32.2%-48.7%), with substantial heterogeneity. The pooled prevalence for Northern Africa was 44.6% (95% CI: 32.9%-56.7%), significantly higher than the prevalence in sub-Saharan Africa, which was 31.0% (95% CI: 25.2%-37.1%). The risk of bias was moderate for most studies, the certainty was very low, and we found no publication bias.

Four in every ten individuals was considered to have IA in Africa. Further research with methodological optimization seems needed, especially for IA screening tools and the representativity of some subregions.

Income and cigarette price responsiveness: evidence from Vietnam.

Tobacco Control

Vietnam has an ad valorem tobacco excise structure, with the tax base being factory gate price, making the excise susceptible to tax avoidance and less effective in reducing tobacco use. To address these issues, therefore, the government has considered switching to a mixed system in which a specific rate would be imposed on every cigarette pack in addition to the existing ad valorem rate. However, little is known about how smokers with different incomes respond to price increases in Vietnam, raising the concern of regressivity of the tax reform.

This paper aims to provide timely and more updated evidence to support policy discussion on tobacco excise tax reform.

The study relies on the smokers' stated preferences, which are elicited from the Tobacco Consumption Survey in Vietnam in 2017-2018. We use data on actual purchases and the stated maximum prices that smokers are willing to pay for their cigarette brands to calculate conditional price elasticity at the individual level. Regression analysis then is used to quantify the extent to which income and other socioeconomic characteristics shape the smokers' price sensitivity.

Both the individual incomes and household incomes have negative and significant effects on the price elasticity of conditional demand for cigarettes. This effect is particularly strong after taking the product heterogeneity into account by considering only the most popular brand, but becomes smaller when looking at a more heterogeneous market by excluding that brand from the original sample. The magnitude of the impact of income adjusted for cigarette price is much higher than unadjusted income. The implication is that with sufficiently large variation in price across cigarette brands, which are often the case for countries with ad valorem tobacco excise tax structures, the low-income smokers may not be more sensitive to cigarette price than the high-income smokers so that a uniform percentage increase does not necessarily result in larger consumption fall for the low-income smokers. Narrowing the price gaps between cigarette brands by adding a specific tax component can help address this issue.

Raising tobacco tax can make the tax policy more progressive and benefit the poor more than the rich in Vietnam. Thus, the Government of Vietnam should switch from the current, purely ad valorem excise tax structure to the mixed system to reduce price variation and make the tobacco tax more progressive.