American Academy of Pediatrics. Committee on Substance Abuse. Marijuana: A continuing concern for pediatricians.

Marijuana, the common name for products derived from the plant Cannabis sativa, is the most common illicit drug used by children and adolescents in the United States.(1) Despite growing concerns by the medical profession about the physical and psychological effects of its active ingredient, Delta-9-tetrahydrocannabinol, survey data continue to show that increasing numbers of young people are using the drug as they become less concerned about its dangers.(1)

Predictors of quitting smoking: the NHANES I followup experience.

There are no published prospective studies on the predictors of spontaneously quitting cigarette smoking in a nationally-representative U.S. population. This paper describes such a study, using a cohort taken from the First National Health and Nutrition Examination Survey (NHANES I, 1971-1975) and traced by the NHANES I Epidemiologic Followup Survey (1982-1984). "Successful" quitting (for at least 1 year at time of followup) was ascertained among 4779 adults (age 25-74 years) who were smokers at the time of NHANES I and not disabled at followup. Independent predictors of quitting (by proportional hazards multiple regression) were: (1) older age; (2) White race; (3) fewer cigarettes smoked/day; (4) higher household income; and (5) hospitalization in the followup period. Predictors of relapse (ex-smokers at NHANES I who were smoking again at time of followup) were: (1) younger age; (2) urban residence; and (3) female gender. These findings have implications for intervention strategies, public health projections and further research.

Alcohol and the family: opportunities for prevention.

OBJECTIVE: The intent of this supplement issue is to present current research on the role of families in the development of alcohol-related risk, to assess the potential of efficacy of family-based preventive interventions and to identify new directions for research. METHOD: The National Institute on Alcohol Abuse and Alcoholism convened a working group of family and alcohol researchers in December 1996, to address these issues in a 2-day meeting. RESULTS: The articles presented in this supplement reflect the major presentations and discussions at that meeting. CONCLUSIONS: There is theoretical and empirical support for the potential efficacy of universal and selective family-based preventive interventions for children. Studies testing the generalizability of intervention approaches are especially needed. Some additional preintervention research is needed, but should be directed toward questions with direct applicability to intervention development. Relatively little is known about family influences on adult risk, and the potential efficacy of family interventions for adults is not known at this time.

Smokeless tobacco use by youth in the U.S.

Oral snuff and chewing tobacco, commonly referred to as smokeless tobacco, are being used by many adolescent and young adult males, and no indication exists that use by this group is declining. Users are at risk for oral cancer, noncancerous oral pathology such as leukoplakias, and addiction. Information about patterns of smokeless tobacco use and motivations of users may help planners develop and implement interventions. Variables include the importance of peer and family influences, social image, knowledge of harmful effects, regional differences, use of other substances, and addiction. Due to the addictive nature of smokeless tobacco, older youth may need cessation programs. Health educators are encouraged to include smokeless tobacco in their tobacco use prevention programs and to develop and implement comprehensive tobacco interventions appropriate for their youth population.

Essential elements of self-help/minimal intervention strategies for smoking cessation.

Two decades of research suggest that self-help/minimal intervention strategies for smoking cessation may be the preferred means by which smokers stop and can produce success rates approximating those of more formal programs, at lower cost and with greater access to relevant populations. In order to make the best possible use of these self-help/minimal intervention approaches, the National Cancer Institute (NCI) supported a series of randomized, controlled intervention trials and, in June of 1988, convened an Expert Advisory Panel to address the question "What are the essential elements of self-help/minimal intervention strategies for smoking cessation?". The panel's recommendations were that: (1) Intervention efforts should focus on increasing smokers' motivations to make serious quit attempts; (2) Delivery of programs be broadened to include all smokers; (3) Programs be targeted to stages of cessation and specific populations; (4) All programs include (a) elements focused on health and social consequences of smoking, and (b) strategies and exercises aimed at quitting, maintenance of nonsmoking, relapse prevention, and recycling; (5) Materials and programs be made widely available rather than "fine tuning" existing programs or developing new ones; and (6) Programs make use of specific adjunctive strategies. In this way, a reacceleration of the decline in smoking prevalence may be realized in the 1990s and significantly contribute to the NCI's Year 2000 goals and the Surgeon General's aim of a smoke-free society.

'Common courtesy' and the elimination of passive smoking. Results of the 1987 National Health Interview Survey.

The tobacco industry recommends "common courtesy" as the solution to potential conflicts over smoking in public places and as an alternative to policies that restrict or ban smoking. Specifically, the industry suggests that nonsmokers "mention annoyances in a pleasant and friendly manner" and that smokers ask others, "Do you mind if I smoke?" We analyzed data for 22,000 adults who responded to the 1987 National Health Interview Survey of Cancer Epidemiology and Control to determine if common courtesy is being used in passive-smoking situations. Almost half (47%) of smokers said they light up inside public places without asking if others mind. When someone lights up a cigarette inside a public place, only 4% of nonsmokers ask the person not to smoke despite the fact that most nonsmokers consider secondhand smoke harmful and annoying. We compared these data with similar data collected by the Roper Organization in the 1970s and found that smokers today are less likely to smoke inside public places. However, nonsmokers' actions in response to secondhand smoke have changed very little. These findings show that the common courtesy approach endorsed by the tobacco industry is unlikely, by itself, to eliminate exposure to environmental tobacco smoke. Though no one would oppose the use of common courtesy, we conclude that legislative or administrative mechanisms are the only effective strategies to eliminate passive smoking.

Tobacco use trends and control strategies in the United States.

The future of U.S. smoking control efforts and for all countries lies in strengthening existing cooperative relationships among smoking control advocates (Coalitions on Smoking or Health) and facilitating linkages among others who have not previously worked together. In this way with numerous Governmental and Non-Governmental organizations converging on the single issue of reducing prevalence, a multiplicative effect is possible. With it comes the realization of a smoke-free U.S. society by the year 2000.

A comparison of smoking patterns in the People's Republic of China with the United States. An impending health catastrophe in the middle kingdom.

Half of the global increase in tobacco use from 1976 to 1986 occurred in the People's Republic of China. In 1984, the first national smoking survey was conducted in China, involving over a half-million subjects. Sixty-one percent of Chinese males over age 15 smoke, with higher rates in all occupational groups than for corresponding groups in the United States. Current smoking patterns in China are similar to those in the United States during the 1950s, and these patterns forecast a steadily increasing epidemic of smoking-related deaths. It is estimated that by 2025, two million Chinese men will die annually from smoking. Foreign tobacco companies are mounting massive production and advertising campaigns in China. Government health education programs lack funds to counter these influences with sustained and comprehensive educational and interventional campaigns. To avert an impending national health catastrophe, China must launch a comprehensive smoking-control initiative aimed at public education, cessation, and legislation and policy.