China Eyes Smoking Ban

December 25, 2013

Chinese officials are exploring ways to curb smoking as deaths mount and medical costs rise, an effort that has generated one proposal to take apart the nation’s vast and politically connected government-run tobacco monopoly.

Within the next year, China’s legislators will accelerate efforts to enact a national regulation banning smoking in public places in China, said Yang Jie, deputy director of Tobacco Control Office for the Chinese Center for Disease Control and Prevention, at a news briefing on tobacco-related health problems in China. Mr. Yang said China’s State Council, the country’s cabinet, is currently planning the regulation and it is expected to be enacted next year.

“We can see what is happening in the rest of the world,” said Mr. Yang, suggesting that China is due to follow the smoking cessation trends of other countries.

The statement follows the release of a book by China’s Central Party School, an elite Chinese Communist Party think tank, in recent months urging officials to shake up China’s tobacco monopoly, which is responsible for tobacco production and sales and has the freedom to donate to schools and sell cigarette cartons without pictures of black lungs for warnings. Its authors call for higher tobacco taxes, halting government financing to tobacco companies and encouraging them to find alternative business models.
China’s State Tobacco Monopoly Administration wasn’t immediately available for comment. The tobacco industry pulled in 865 billion yuan ($142.5 billion) from taxes and profit in 2012, up 16% from a year earlier, according to the State Tobacco administration.

China is the world’s largest consumer and producer of tobacco, home to more than 300 million smokers and 43% of the world’s cigarette production, according to the American Cancer Society and the World Lung Foundation. Tobacco is also a leading cause of death in China, causing 1.2 million deaths annually and expected to cause 3.5 million deaths annually by 2030, the groups said.

Nearly nine out of 10 Chinese children aged 5 and 6 are able to identify at least one cigarette brand, according to a recent study by Johns Hopkins University on the effects of tobacco marketing on children in low- and middle-income countries. “Rather than thinking ‘I’m going to be Superman,’ young boys are aspiring to smoke,” said Bernhard Schwartländer, the World Health Organization’s representative in China.

The party-school book said the government should develop measures to deal with “conflicts of interest” between the tobacco industry and the government, that it should reform the tobacco industry and enforce lower production of tobacco.

Health experts say policy recommendations and potential legislation are promising signs of structural change.

But changing the current system won’t be easy. Beijing has said long said it is determined to tackle the country’s smoking problem, but so far has had little success. Cigarettes remain cheap, with many available for less than $1 a pack. The World Health Organization recommended last year that China triple its tobacco tax to 70% to discourage young would-be smokers from buying.

The country’s main tobacco companies are state-owned and feed revenue into state coffers, which activists have long said conflicts with the country’s efforts to address smoking’s harmful effects. The current deputy director of China’s State Tobacco Monopoly Administration is the brother of China’s premier, Li Keqiang.

Attempts in previous years to ban advertising for cigarettes on radio, television and newspapers have largely failed, experts say, adding that cigarette companies have found loopholes in the restrictions, placing their logo on advertisements for other companies’ products. The Ministry of Health issued a ban on smoking in 28 types of public places, such as hotels, restaurants and theaters, but it lacks the authority to enforce the ban.

Several major cities, such as Tianjin, Harbin and Guangzhou, have already passed smoke-free bans preventing smoking in public buildings. Beijing implemented a smoking ban several years ago to limit smoking and the effects of second-hand smoke in public buildings and restaurants.

Still, enforcement of laws even in cities that have them remains one of the largest obstacles in China, said Gregory Yingnien Tsang, a tobacco control specialist who advises the Beijing Municipal Health Bureau. “In Beijing, we have laws to ban smoking, but have you ever seen anyone not smoking?” Mr. Tsang said, adding that businesses that violate laws should be fined.


Early Marijuana Use Results in Abnormal Brain Structure, Poor Memory

December 24, 2013

Teens who were heavy marijuana users – smoking it daily for about three years – had abnormal changes in their brain structures related to working memory and performed poorly on memory tasks, reports a new Northwestern Medicine study.

A poor working memory predicts poor academic performance and everyday functioning.

The brain abnormalities and memory problems were observed during the individuals’ early twenties, two years after they stopped smoking marijuana, which could indicate the long-term effects of chronic use. Memory-related structures in their brains appeared to shrink and collapse inward, possibly reflecting a decrease in neurons.

The study also shows the marijuana-related brain abnormalities are correlated with a poor working memory performance and look similar to schizophrenia-related brain abnormalities. Over the past decade, Northwestern scientists, along with scientists at other institutions, have shown that changes in brain structure may lead to changes in the way the brain functions.

This is the first study to target key brain regions in the deep subcortical gray matter of chronic marijuana users with structural MRI and to correlate abnormalities in these regions with an impaired working memory. Working memory is the ability to remember and process information in the moment and – if needed – transfer it to long-term memory. Previous studies have evaluated the effects of marijuana on the cortex, and few have directly compared chronic marijuana use in otherwise healthy individuals and individuals with schizophrenia.

The younger the individuals were when they started chronically using marijuana, the more abnormally their brain regions were shaped, the study reports. The findings suggest that these regions related to memory may be more susceptible to the effects of the drug if abuse starts at an earlier age.

“The study links the chronic use of marijuana to these concerning brain abnormalities that appear to last for at least a few years after people stop using it,” said lead study author Matthew Smith, PhD, an assistant research professor in psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine. “With the movement to decriminalize marijuana, we need more research to understand its effect on the brain.”

The paper was published Dec. 16 in the journal Schizophrenia Bulletin.

In the U.S., marijuana is the most commonly used illicit drug and young adults have the highest – and growing – prevalence of use. Decriminalization of the drug may lead to greater use.

Because the study results examined one point in time, a longitudinal study is needed to definitively show if marijuana is responsible for the brain changes and memory impairment. It is possible that the abnormal brain structures reveal a pre-existing vulnerability to marijuana abuse. But evidence that the younger a subject started using the drug the greater his brain abnormality indicates marijuana may be the cause, Smith said.

The groups in the study started using marijuana daily between 16 to 17 years of age for about three years. At the time of the study, they had been marijuana free for about two years. A total of 97 subjects participated, including matched groups of healthy controls, subjects with a marijuana use disorder, schizophrenia subjects with no history of substance use disorders, and schizophrenia subjects with a marijuana use disorder. The subjects who used marijuana did not abuse any other drugs.

Few studies have examined marijuana’s effect on the deep regions in the brain — the ‘subcortical gray matter’ below the noodle-shaped cortex. The study also is unique in that it looked at the shapes of the striatum, globus pallidus and thalamus, structures in the subcortex that are critical for motivation and working memory.

The Marijuana and Schizophrenia Connection

Chronic use of marijuana may contribute to changes in brain structure that are associated with having schizophrenia, the Northwestern research shows. Of the 15 marijuana smokers who had schizophrenia in the study, 90 percent started heavily using the drug before they developed the mental disorder. Marijuana abuse has been linked to developing schizophrenia in prior research.

“The abuse of popular street drugs, such as marijuana, may have dangerous implications for young people who are developing or have developed mental disorders,” said co-senior study author John Csernansky, MD, chair of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital. “This paper is among the first to reveal that the use of marijuana may contribute to the changes in brain structure that have been associated with having schizophrenia.”

Chronic marijuana use could augment the underlying disease process associated with schizophrenia, Smith noted. “If someone has a family history of schizophrenia, they are increasing their risk of developing schizophrenia if they abuse marijuana,” he said.

While chronic marijuana smokers and chronic marijuana smokers with schizophrenia both had brain changes related to the drug, subjects with the mental disorder had greater deterioration in the thalamus. That structure is the communication hub of the brain and is critical for learning, memory and communications between brain regions. The brain regions examined in this study also affect motivation, which is already notably impaired in people with schizophrenia.

“A tremendous amount of addiction research has focused on brain regions traditionally connected with reward/aversion function, and thus motivation,” noted co-senior study author Hans Breiter, MD, professor of psychiatry and behavioral sciences and director of the Warren Wright Adolescent Center at Feinberg and Northwestern Memorial. “This study very nicely extends the set of regions of concern to include those involved with working memory and higher level cognitive functions necessary for how well you organize your life and can work in society.”

“If you have schizophrenia and you frequently smoke marijuana, you may be at an increased risk for poor working memory, which predicts your everyday functioning,” Smith said.

The research was supported by grants R01 MH056584 and P50 MH071616 from the National Institute of Mental Health and grants P20 DA026002 and RO1 DA027804 from National Institute of Drug Abuse, all of the National Institutes of Health.

Why Family Dinners Won’t Stop Drug Abuse

December 23, 2013



Food-fueled family gatherings at Thanksgiving undoubtedly are a boon for turkey farmers, football broadcasters and airlines. Do they also keep teenagers from using drugs and alcohol?

The role of family dinners in preventing substance abuse has become a surprisingly fertile field of research. For a decade, an organization affiliated with Columbia University has reported on the result of asking teenagers about how often they eat dinner with their families, as well as their use of, and attitudes toward, drugs, tobacco and alcohol. The surveys’ consistent finding, that the most frequent family diners are the least frequent drug abusers, has been trumpeted in many news articles touting the benefits of family meals.

The finding was satisfying to family-values advocates and, in the view of many, consistent with common sense. The idea that family dinners protect teens “conjures up Norman Rockwell images of families seated around the table together,” said Daniel P. Miller, assistant professor of human behavior at the Boston University School of Social Work. “It plays into what we think a family ought to look like.”

Some researchers, however, including Dr. Miller, were skeptical, wondering if other factors, such as a family’s income or parents’ weekly work hours, accounted for both the frequency of family meals and drug use. Or maybe, these researchers said, the conclusion that such dinners suppress drug use mixes up cause and effect: Teens out misbehaving with their friends might not get home in time for dinner, for example.

“I wanted to see if some of the findings still held up if we took a more careful look at it,” said Dr. Miller.

Last year, he and some colleagues tapped into a data set that allowed them to isolate the role of family dinners more precisely. A federal survey tracked more than 21,000 American children, many for nearly a decade. While researchers didn’t directly measure drug use, they could check whether more family meals were linked with fewer behavioral problems after controlling for other factors—and which caused which. And they found that family-meal frequency had little or no effect on academic or behavioral results.

Another paper published last year more directly addressed the link with drug use. Using a different federal study of teenagers, Kelly Musick and Ann Meier found that changes in teens’ frequency of family dinners at one time didn’t predict changes in their substance abuse at a later time, after controlling for other changes in the family environment.

Prof. Musick, a sociologist at Cornell University, though cautious about the value of dinners in reducing drug use, did point to evidence from the study of other benefits, such as reducing teens’ depressive symptoms. “Something about dinners hangs in, albeit less than would be suggested by prior work,” she said.

Dr. Miller agreed that family meals are valuable even if they don’t by themselves curb drug abuse. “They might not be important in the way we typically talk about them, but that doesn’t mean they don’t have all sorts of benefits,” he said.

The National Center on Addiction and Substance Abuse, the Columbia-affiliated organization known as CASAColumbia that helped publicize family dinners’ potential to curb drug use with its first paper on the topic in 2003, has released eight reports in all, the most recent one last September. While that contained a statement from the group’s founder that “frequent family dinners make a big difference,” the rest of the report is more cautious, noting for the first time that “the data cannot be used to establish causality.”

“At the suggestion of advisers we spelled it out in clean, clear English,” said Emily Feinstein, senior policy analyst at CASA and author of last year’s report.

CASA is now exiting the field, Ms. Feinstein said, though it may continue to mark Family Day each year, a day when families have been encouraged to eat together since 2001. “We have been covering most of the points that could be covered, and have done it well,” she said. “We’re evolving.”

I first wrote about the CASA surveys in 2005, my first year writing this column. Since then, as CASA and the field has evolved, so has the Numbers Guy column: from online-only to twice-monthly in Marketplace, then to the A section, and most recently to its weekly home in U.S. News.

The column will continue to evolve, under a new byline: This is my last one before heading for a new data-driven project. I am deeply grateful to former managing editor Bill Grueskin for conceiving of the column, and to my many astute colleagues and readers—top-notch numbers people, all—who were indispensable to making it work with their wise ideas and feedback.

Photos: Students Complete Life Skills Program

December 20, 2013

CADA, along with prevention partners, DNDC and PRIDE, celebrated as a group ofBerkeley Institute students completed the Life Skills Program. Shadow Minister Michael Weeks handed out certificates to the 22 students at a special ceremony.


CADA spokesperson Anthony Santucci stated “Life Skills Training [LST] is a research-validated substance abuse prevention program, proven to reduce the risks of alcohol, tobacco, drug abuse and violence by targeting the major social and psychological factors that promote the initiation of substance use and other risky behaviors.

“This comprehensive and exciting program provides adolescents and young teens with the confidence and skills necessary to successfully handle challenging situations.”

Link to more photos

2013 Monitoring the Future Survey Finds Fewer Teens View Regular Marijuana Use As Harmful

December 20, 2013

WASHINGTON, Dec. 18, 2013 /PRNewswire-USNewswire/ — More than 60 percent of high school seniors don’t view regular marijuana use as harmful, according to the 2013 Monitoring the Future Survey, an annual survey of eighth, 10th, and 12th-graders by the National Institute on Drug Abuse (NIDA) and the University of Michigan.In addition, marijuana use over the past decade has continued to trend upwards among all three grades. Community Anti-Drug Coalitions of America (CADCA), the nation’s leading substance abuse prevention organization, is concerned about these findings and calls for an increase in effective prevention efforts, such as the Drug-Free Communities program.

The survey found that only 39.5 percent of 12th graders view regular marijuana use as harmful, down from last year’s rate of 44.1 percent, and considerably lower than rates from the last two decades. The findings also show that marijuana use increased among 8th and 10th graders between 2012 and 2013. In 2013, the annual prevalence rate of marijuana use (the percent using once or more in the prior 12 months) increased from 11.4 percent to 12.7 percent among 8thgraders and from 28 percent to just under 30 percent among 10th graders, while among 12thgraders, use continued at 36.4 percent.

Equally concerning is that there were no declines in daily marijuana use, which has the most impact on a young person’s cognitive ability. Today, one in every 15 high school seniors (6.5 percent) is a daily or near-daily marijuana user. The comparable percentages among 8th and 10th graders are 1.1 percent and 4.0 percent, respectively.

“Whether youth perceive a drug to be harmful is a key indicator of future use so CADCA is extremely concerned that fewer teens view regular marijuana use as harmful. Not only are attitudes softening, but marijuana use is continuing to increase among our young people. These findings should concern parents, educators or anyone who cares about the ability of youth to succeed and thrive in our society,” said Gen. Arthur T. Dean, CADCA’s Chairman and CEO. “I would ask parents out there if they are comfortable with their kids using marijuana, which research shows lowers IQ and is addictive, especially in young people.  I have a feeling if more people understood what’s at stake, they would stand up on this issue.”

The study also explored whether states with medical marijuana laws had an impact on youthmarijuana use. According to the findings, of the 12th graders who say that they have used marijuana in the 12 months prior to the survey and who reside in states that passed such laws by the end of the year prior to the survey, a third (34 percent) say that one of their sources of marijuana is another person’s medical marijuana prescription. And 6 percent say they get it from their own prescription.

“This proves that states with medical marijuana laws have failed at preventing diversion to young people and are in fact offering teens yet another avenue of obtaining the drug,” CADCA’s Gen. Dean noted.

The report also showed positive trends. For example, for the first time, the percentage of students in all three grades combined who say they smoked tobacco in the past month is below 10 percent (9.6 percent) compared to 16.7 percent 10 years ago and 24.7 percent in 1993. Daily smoking of cigarettes is now at 8.5 percent for 12th-graders, 4.4 percent for 10th-graders, and 1.8 percent for eighth-graders. The use of alcohol by teens also continued to decline. For 12th-graders, alcohol usepeaked in 1997, with more than half (52.7 percent) reporting drinking alcohol in the past month. Only 39.2 percent of seniors reported past month use this year. Binge drinking (defined as having five or more drinks in a row at least once in the past two weeks) dropped considerably for 10th- graders (to 13.7 percent from 15.6 percent in 2012.)

“We’re incredibly pleased to see that alcohol and tobacco use are now at historic lows. That shows that when community coalitions push back on something, and we as a nation also push back in a systematic way, we see major results. However, with marijuana we’re doing the opposite by calling for the legalization of the drug and now we’re experiencing the results of those actions,” CADCA’s Gen. Dean said. “We need a greater investment in programs like the Drug-Free Communities programs, which funds community-based coalitions that have shown to be effective vehicles for reducing drug use rates among teens.”

CADCA (Community Anti-Drug Coalitions of America), is the national membership organization representing coalitions working to make America’s communities safe, healthy and drug-free. CADCA’s mission is to build and strengthen the capacity of community coalitions by providing technical assistance and training, public policy advocacy, media strategies and marketing programs, conferences, and special events.

For more information about CADCA, visit

Contact: Natalia Martinez Duncan 703-706-0560 ext. 256


Heavy Marijuana Use in Teen Years Linked to Damaged Brain Structures: Study

December 19, 2013

Heavy marijuana use in the teenage years could damage brain structures vital to memory and reasoning, a new study suggests.

The study found changes in the sub-cortical regions of the brain, which are part of the memory and reasoning circuits, NBC News reports. Young people who had changes in this region of the brain performed more poorly on memory tests than their peers who did not use marijuana. The heavy marijuana users in the study had not used the drug on average for more than two years before the memory testing occurred.

The results appear in the journal Schizophrenia Bulletin.

“We see that adolescents are at a very vulnerable stage neurodevelopmentally,” said lead researcher Matthew Smith of the Northwestern University Feinberg School of Medicine in Chicago. “And if you throw stuff into the brain that’s not supposed to be there, there are long-term implications for their development.”

The study included 10 people with a history of cannabis use disorder, 15 people with a history of cannabis use disorder and schizophrenia, and 28 with schizophrenia but no past regular marijuana use. The study also included 44 healthy people without a history of marijuana use. The participants who had used marijuana had been heavy users in their teen years. Their average age at the time of the study was mid-20s.

The participants’ brains were scanned using MRI. They were then given tests of working memory, such as remembering number sequences. People who had a history of heavy marijuana use, whether or not they had schizophrenia, performed more poorly on the tests. They also showed abnormalities in regions of the brain related to reward and motivation, cognition input and movement and memory.

“We saw poor performance in the marijuana groups…” Smith said. “And the younger somebody started using, the more abnormal they looked.” He noted the study does not prove using marijuana caused the results. He said it is possible the brain differences made heavy users more likely to smoke marijuana in the first place.


E-Cigarettes Used Indoors Could Expose Non-Users to Nicotine: Study

December 18, 2013

People who use e-cigarettes indoors may be exposing the people around them to nicotine, a new study suggests. The amount of secondhand nicotine exposure from e-cigarettes is much smaller than from traditional cigarettes, the researchers conclude.

The study evaluated vapor from three brands of e-cigarettes, using a smoking machine in controlled exposure conditions, MedicalXpress reports.

The researchers, from the Roswell Park Cancer Institute in Buffalo, New York, also compared secondhand smoke exposure from conventional cigarettes to secondhand exposure to e-cigarette vapor. They concluded using e-cigarettes in indoor environments may involuntarily expose nonusers to nicotine, but not to toxic tobacco-specific combustion products.

E-cigarettes are designed to produce nicotine vapor without the combustion of tobacco, the article notes. When a person takes a puff of an e-cigarette, the nicotine solution is heated, and the vapor goes into the lungs. No sidestream vapor is generated between puffs, but some of the mainstream vapor is exhaled by the e-cigarette user.

“Our data suggest that secondhand exposure to nicotine from e-cigarettes is on average 10 times less than from tobacco smoke,” lead researcher Maciej Goniewicz, PhD, PharmD, said in a news release. “However, more research is needed to evaluate the health consequences of secondhand exposure to nicotine from e-cigarettes, especially among vulnerable populations including children, pregnant women and people with cardiovascular conditions.”

The study appears in Nicotine and Tobacco Research.

The Food and Drug Administration (FDA) was expected to propose rules on regulating e-cigarettes by October, but the agency has yet to do so. The agency did send a proposed rule in mid-October to the federal Office of Management and Budget, which will review the rule before it is available for public comment.

The FDA is expected to consider e-cigarettes as tobacco products, which will allow the agency to provide the same federal oversight that applies to cigarettes, chewing tobacco, cigarette tobacco, and roll-your-own tobacco.


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