Tobacco Documents Online

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I I I 280 ,jaut E. 1fewrfrWidd, RioAatd Clayso+i & i1''illfam PollM Ttb1U 1. Ptrenu oJrtrrm rtponmxg Ory qJ S Drebiniu m tbeir lEJtaww tAuh wvea a:rrrbsud ro ru of the rsarraw Prnexoed b,v a ft drmF ard !br occa»onal md NOort frtqwm wu+r oJ ukt rrbumrct I Probkeu w Lfetsaoe Mr imP (Yew) sttributed to tiubtttase use 12-17 16-IS 26-34 35 - Total C16artvv: aud at kax oNCt I (Unweiabttd M) Ta.d to cut dowa (i92) 36.6 (1,255) (1,633) 49.9 54.7 (1,325) 57.4 (5,105) 54.2 1.4W ir73psats 9.1 11.6 12.9 11.6 11.7 firetT dy 27.7 46,0 52.4 54.! 51.1 I NtedeQ, depeadftt 20.2 33.4 36.9 41.1 37.9 Withdraw4l qtaptapst 7.7 13.3 16.8 18.4 16.5 CfBaret<tt nrnt,uly rnso4r abeus a poak er Owrt 1er dy I (Uawa4hted x) Thed to cut dowa (4i) 77.0 (241) (419) d4.b e6.2 (302) 83.6 (1,010) 84.3 LseVr .mousa 38.4 26.2 I1.8 21.0 23.9 E.et7 dt? 94.1 59.9 91.8 91.2 91.2 I veeded,depeadeat $4.4 76.6 75.9 $1.2 79.2 Withdt4wsl t7myte= 26.9 33.2 31.0 33.2 33.3 AkoAoi• a+ed ar ksrt o+w (Cawt4bsed a) (1,116) (1,578) (1,942) (1,466', (6,122) Tried to cut dowa 21.! 31.1 26.4 21.6 24,6 Larm IANMBU 12.2 14.9 11.3 4.7 6.6 Enrf dq 6,6 14.6 19.2 17.1 16.2 t d 4.5 5.4 9.3 5.0 5.7 ~~ 2.6 3.2 4.4 2.3 2.9 A1ceb0l: Jivt or mrort iri" eR twe ettatim m 3 ot ewn dayt fx Pw 30daDI (Ucve4ihttd s) (62) (154) (171) (t7) (474) Tr+.d to ear dawa 34.2 W1 52.9 $4.7 51.6 LWer adlaoata 90.5 39.7 313 16.5 29.8 I 3=.6 46.1 41.9 66.1 51.3 *iad4 dePaadaat 10.4 14.8 21.9 22.7 19.4 p}tbdrawal t7mpcow 4.1 7.2 14.5 15.0 12.2 I Cotam wed at Lau ew (Uarreipa+d a) (10t) (373) (425) (76) (9i1) Trird to esu do.a 24,1 14.0 17.1 10.1 15.0 LAW -AM 13.7 6.1 11.2 2.1 1.1 I iZ!w4 dlpad= 13.7 S.i 4.7 2.6 !.6 5.4 10.2 1.4 7.7 3.7 Wi(bQa+wal nmptootl 7.9 2.1 3.6 4.3 3.4 I Cumiw: rtnd !! or aton Ott (Va.ai6haed R) (1t) (125) (162) (11) (324) TtS.d to ast dews 46.5 33A 32.3 I0.0 31.2 Lanw amom 39.E 20.7 t4.i $17 20.8 I 34 0 12.4 19.3 21.7 18.0 N depednt . 14.6 == 5.7 12.3 4.6 9.1 WitkawOlI, m Rome 14.0 4.4 8.7 4.6 6.7 I 0 ~ I ~ ~ ~ Y~'

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I I I I I I I I I I I I I I I I I Inoolcentritt of sodocco is akoJwlim and slliNt •dakt tur vuious forme of iubstance use are hi8hly correlatcrl a a stati,stical, if not causal ftahioII. Moreo.er, ualike substances ruch a aulk, candy, vitutuna, or asptri.n, aiconae itseif ineeta e11 eetablisbed criteria for a dependence producia8 drug (US DHHS, 1988). Tobacco also 6olds a ipecsal status u a`pteway' substance in the developmeat of other drug depen• deacies not only because tobacco use reliably pt'ecadet use of illicit dru;s, but also because use of tobacco is asare likely to escalate to dependent patterns of we than use of most other dependence producing drugs (US DHHS, 1988). Similariy, slthougJl alcobol use oftea pteeedes tobscco use, the iacsdence of skchol dapesdencc appears tauch lowa thsn the incidestce of tobacco depeadeace itt routh; and whems oaly 10-15% of alcohol ueen are conudesed akoholic, closer to 90% of tobacco users appear dependent (US DHHS, 1988). In fact, development of depezdence to tobacco appean to generally preeede de reiopmeat of depenckace to alcohol and illicit dtup.'These obarranona have led arowin8 oumbers of re"Arches and policy makets concerned with illieit drng use to cotuider the role of tot*acco in prograaie aimed at pre.antiag otber fotasi of drug abtue (US DHHS, 1987). Lereli of we of tobaece euad other aabataacea ae edated Tht irscsdeteee and reoer*y of oariesu dmq depeRdew- cies an relaud to toboeco wte Pattetns of tobacco use prediet the emnt of use of other psTehoaeti.e druge. Clayooa ! ltJttet (1985) found that akohol driakia; aad ciiarette emoltieS .as the moet powerfti predictors of aurijnaaa uee for both males tad fetztales and that the relatsoaahip was itroagsst whea cigLttte smokiag had be6aa beibn the indiriQuals were 17 years old. In a ::zutidinal etudy, Ary es aL (1987) (1987) ittter.iewed tnom than 3000 ttsak adoisceata, twice, at mae. month lntenrau, to detetmiae their un of vaSioue psychoactive eabetances. Tbe, fiand that users of smokeleee tobacco were asore likely to use c;f. rettes, tnarduaaa, or a..eohol tllaa aon-wert, and thu sasokdae tobaeeo ueea who were wJng tbeae otbar ntbetaacee at the tame of the ast iatermw shewed subeuatially Srater iacreaae in le.eh+ of use of thae other substaaca by the time of the second iater.lew. Azalogot;afy, mtdeats in Veea 7-12 in New Yorlt State showed a paitive corteL- tioe berweea freque>scy of dtinhie; akoholie be.ee- a8es and daily c*Letfle eoasasaption (fTeme ! Baraee, 1987). The 1985 Natioaal HouuboJd 233 Table 3. Currm un of ako" warjxona, ond roeaw aMO+V 'crrrehr' cWCatae Mare+t and ,rom•nKaherr by qr t*o10 ft AR g-p, 'Curssat' c4srem we curraat drug nse No Ya Alwbol 12-17 23.5 74.2 18-25 64.7 82.6 26-34 62.5 $1.0 ?35 52.5 68.6 titanluani 12-17 5'8 47.3 18-25 13.7 35.4 26-34 10.6 26.0 2t 35 1.7 3.5 Coaiae 12-17 0.4 8.8 18-25 3.9 1319 26-34 4.1 9.2 t35 0.4 0.6 Naet: Cucsest use a any use reporteo ia tJie 30 days priot to tbe iarce.tew. (US DHtiS, 1988) TsbJk 3. fJn oJ aJcokwa+ijrma, sad caabie amor4 'n+v~' ct[a++aY oweY~b beea+~onal' cstanmr n~ok~r; ad af.ity eWrm +swooer++ vy ar r'v* (K ) Ap vvnp, dru8 We Cipeetee nse paura Never Tried, oever Smoked saAked uwd dail7 daily Alcoboli 12-17 2.1 15.9 3a.S 18-25 12.3 31.9 49.6 26-34 9.8 23.0 41.3 Z3s $.b 9.2 20.1 1Kaeiiaaoai 13-17 0.2 3.3 22.7 1 s-25 3.3 8.3 37.4 26-34 2.8 12.9 30.3 Z3S 0.6 1.8 3.8 Comaoe' 12-17 0.2 0.8 6.4 1i-25 1.3 4.s 14.2 26-34 1.8 7,2 15.6 X35 0.2 0.3 1.9 ' Disat 5re ee mae drioks ia a eo. oa at kaa I da71a put 30 days. = Uwd e.n*aea un ehaa 10 tima. ~ Used eeeaiae ato[e tiae 10 times (Ui DHHS,I9Y) wr+rey alao teta{ad a erude bot oontisteat does re~poa~e relaaoaahip betlreea emoking end other drug w. (Tahk 3). I

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MM M W~WMM M M MMMMMMM MIN I I , F.co.d Pems.ooea Depee uf Iepesdesos tqdiwnc irnp.itateK I Tabh !. S}.din tllsniW eoihaar Jirrfiscns amiwed 1:rA rshmpA, by ,utrtara Strufics T.b.coo Hdt, llerning a at (19b4), rat.cdasr a.L (197!), T'rffimY a e.ker (19t6), /.rvilc (1979), MiA'mtw (19",1984) 3 McArli[6e et af (19e6)y ASillas.n a.[ (1978), Riosd.n a.t (1976) No.rodiew AicLeil.n a.l. (1lB3). Roao..rille rt.1. (11eS) No Stwlie. Sioproe & Sclh (1992),larLcoa (1965) DrIn"VelFbic. Trcker.t.l (19ss)s Swi.a a d Tudia arL (1965), simpsoe • (H65)r HiriRw (1971), Ga+pbcb 5.lla (1%2) (NS3) Ttcatincn LaWIN N. aeidies Simpsam i SeK. (1962)y Okl.c.o ir.R (1962) !</adaliq Xaw et.L (190), EFooc & Slrawn Simpena & 5dla (1%2), lele (197f)r, IllFaot & IDeasey, (li7!)ti et al (1910) Ericl.a. t.[ (1983b ?ifl.ar, Martis i Wt,et (1!%) U.e.f rLrp/in~l ir aiooe No toudla Siiapo. ! Sell'. (1962) t«itite aoreoeaaw .f uutaate (kssdua u aL ( I9e6) Simp.ns S Sell. (19s2) 1'b.mermtwl FYady Ma1Ln & Gor3dao (19eD),1[.rwitz fhll Oao (1974), [t.p (1972), a.L (19fS), Cw*p.eelli R Sta.eak Tadd, Stein (1979), Rho.da Orlana (HaS), ASawdweta e rf. (196t)y,lFdiaA « K.ufmaw (19i3) (1975), Hrtbin & Muicr (1975), lkjuaeu R Pind (1971s). Ksufin.o (1965), Staaton (1979. 1979) Alw4.li Fay a d. (1%4), Hcatbar .r al. (19ij). Iln.elbrac6 a.L (19tl3). Ki.Miun a.d. (i+ Ptc+y. Litaat at e[ (19s4)y OtPord a a[ (1976), IPo" a.l (1990) ALbot & Grcpoo (1961), Grelsm Ic'i'.ytn. (1977), Hcdfxun A Ti.bes (7976), O'Gr.ry rr a! (1979), Donoraa a al (1964), liAc[.e0m ae d (1963)4 Roum.wlk ee a[ (1967) [Vo avwia T.ry K K at (19es), renne„oo (I?67). Arr% a.L (197A), Yoeltk. A Deaat (1949), Faut 4 Ssiilk (196#) a{iJkr ! Hcster (1906b) Entrich (1974), Milkr & Hertcr (19f+6.) No studin Ffttm.n A tlarit ( M92) Fiwey er .f (19!!0),11S.berj a ml. (1992), funa. & Kttlbt (196t), Moo. & INo.. (19/4), JMadrn & Gadar (19eD),1MIiaSt & Moos (1%?a, k), Muos n d (1979), Ot[ord N.l. (1976) a i M66M0Z

4 retr, lseldim Laclc ei irwlremut ia wak l.ack d tioli.e keirrtc Pkjsime rwotiwa.l .t.tes `i Lack of aeed.d acnrioe. (US IIHHS, l4W) c.aaia8s et aC (19A0), Slilfmsu (19`2), IEsa.s & [.ae (1981), Licits:sacin et at (1977), llfalrn a Gocdon (i91{O), Cummiap et a[ (l9M) No.tudits S6i4fmso (19A4) Hsakami et at (1984), Medutt & Ge.ao. (p9•o). Lic6ieasteir et.L (1971), lNrtmtiwcin (1983), lNetmtInein er aR (1986)y SkiRarWt e aL (19 ), Lickunteio (1906) Po=rkw (1919). Skdi'msn (1979) 11{rlMt i Gonion (1980), Siffam (S98t,19r4)ti Cwry & U.Am (1"5) BUiW n at (198i) No aadies , HaaWas & Fiset (k987), Qoss7 st eL (19i2), Mu1.u. & Gmri+ow (1980,1985) [Jencr a at (1978), M.rlett (1978), Mulut & GosJoo (1980) Hs+.Iums & F.rree (i98?) iWnokcr8 (1979). SSV+91< lk Simpseo (1979),SiReQawt (1981)t Strad dt Yidet4 (1970) Sroroel & Maoa (1977), Finncy a d (1980) Simp.as tt af. (l9l6), Simptioas R t.f"d (1979) Siarpson st at (1981), NtDA (19110) Fi.ncy rt at (1980),1lfeber8 a.4 (19t12), Moos et.R (19T9)ySeud & videss (1979). Tackfe/d (1981), TucMrEd.td (1983) ~ Skepsem & f•ancen (1972), Qmnoiep n at (19e0), M.drtt & t'~arrfow (1980), Hwulrmi Luwtrid (1982), M.rIMt (1978)t Clwrcy et at (197r). Fiaoey ct a[ (N88), S4im & liun (1982-81), et .i (19E1), Ctsnsy et af (19112) Irickews et d. (19k5), S.aKat.witi ! sjpbM(wel), Ssod.lJ (1904), °. Kknani er a/. (1979), Ckanty et at (19s2),lAsalsa t Gmd.a fExlwkuoie at (NA1) Finney et at (1980), Moos et rtf 1979) ~ (l9W), bl.atia (1972) ~ Sri11(1963), CActk N wf. (1973), Fott (1966), Cnwlaso A Hawkir ,F1ilkt et af. (1974)L O'lxary u al. (19J6), IlosesEaj (198)), MiIIcr lt ~ (196'S) Eisla (1977) ~ Jud.en R Goldgma (1963), Rkoaxis (1983) Jlios et 41 (1979, 1981), Finney st at (191f0), Rosrnber; (19b5), Hull 0. &6wrae (1978), Hawkos 8t Catahno (19115), McAuWI! a erl (1985) ! Yw.& (1987), Yachmctk & Tuckee (1964) Feit (1VW), Aslley ct at (1976), 08borae (1978), AAks et aR (1919), ItoA Dusuraa (1986) ~ f ~ ~ I : 6TMM-09

I I I I I I I I I I I I I I I I I 288 Jack E. JYot+eem&1d, RicAmd Clayton & R'illiaw Pollir sucb dsta. For rsaalPk, obatMtioas that people tend to relapse to tobacco sad heroin use in stres:ful settiags his ltd to invesuptioas coaceraing the potenciai useful actiou of these dru8s which might coatribute to their abuee (Crowley t Rhiae,1985). Data resulua; from studies of the cosra of dr4 use and quittia= patterns (Vaillant, 1970) have also coatributed tub:uataallY to theory sad baac M- search, sad reaearah of this type could probably be conducted more essily with tobaxo than with substances wbieh ue illicit tad for which smaller aumbers of users are evesleble for study. Many dtu8 users quit while ttot in the coateYt of a fortaal tnataseat proFaat (CS DHHS,1988).'rhis pheaoa rnsaa is aottutimes referred to a`spotauaeo+u remissioo' althougs as Table 4 shows, icteatib.blo factors in often asaociated with such quittia8. Furthermore, the factors sre oftea equi.aleat in their potential power to modify bebavior ssti tbose offend in drn= trmmeat pro8rama For essmpie, life-tbreetenia; health ptoblems can help prompt a: auay a. 40 to 50% of patieats to quit smokia3 (kurliaa tt al., 1984; West & EvRat, 198b). Relapse to drss use is also dotcrasiaed, in put, by env9roameaul presisses. Table S summart:es dau that have been colkcted re,6ardia8 the factms associated with relapse to tobareo, opioida, u.d alcohol. Tbese oburatioas hare led to inaeaing aplsiatiuuon in trettaseat proSrama in w>sica efforts to scbieve relapee prcveaaaa are recopaad as being es important as are the effotn to achieve dru; abstiaence tIIeaseelves (Mulatt 8t f}ordon, 105; US DHH5,1968). De.elopitit asore eflacaci- oua tneaa: to pre*eat relapee might be supuated witb alore estesulve data aoaceraia= the relative role of ruiosu facaey leedia3 to relapse wd to t3e mat effecti.e taaaa to treduee th=ir immp.ct. As is tLe we with reSerO to fectvrs eaweiated with remi~sioa, studies of reispee fiotors snay be asors re.dily coaducted witD tobacco than with iliicit ied leu eommoa2y ibused drussL ftioneas of khmiord and pharasacolojlc osros- Nststt approoeJta and aeamesst delisery {ysrem Eraluatioa of nutment ser.ice:, refiaemeat of sytteas: for dispostic evaluation, as well as evalua- uoa of the asimears themselves, pose a mt}or cbalieup to hnkh cate providera ea treatmeat tueds coacinue to rise for many categoties of drug depe>u4eace. Many baaic iaeuea mi;st be e.aluated in the coatest of tobeeeo depea6race trat7aeat prov.ass whuch may often be m up at less e:pease thaa progtam., for otber substances. Furthersaore, the poteaWally eaormove patient population prtr sides an opportuauy to rapidly conduct a varsety of studies. For eumple, in addition to inteasave behavioral and phurMacolopc iaterveatiocs (e.g. Potzserle.u & Pomerleau, 1968; Jsrvih k Heaaia3• 9eld,1988; 2ie1l tt aL, 1987; Iianuy.t ot.,1987), a broad raa8e of ahool, mau medu, and work-bued intervention prearaass for the treatmeat of niconae dependence have been under recent evaluation (Levettthel er al„ 1989; Jssoa a al., 1987,1989; US DHHS, 1988). bsaeul,yation of bosfc iearntxj and cosdirioni,g proorus iRnotoed in t/te stabluAme,a and a,ain• uume ol drV dspendence Tobacco depeadeacr also offers a model for the iavestiptsoa of beha"oral factors aad proces.e: in otber depeadcardes. For esample, the fuactioa&l role of eavironmeatal stimuli that can elicit either drug admiaiscratioa or drug abeuaeace-like effeots cm be studied with tobscco assocaued itiasuli. The reluiowhip betweea eliaud ef*ects such as uttes to use drnp ('rrssia3') sad drue i*elf•aduuaisuatioa is aurely amoa; the asoet widely discuued but littk reuercbed psobleasa ia substance abuse (Kosiowslu & Wilhiaaoa, 1987; VS DHHS, 1968). From a practical pettpeetive, using tobacco and aicotiae as aplonttoey tools, a wide range of interactions betweeti sariroameaal sitimuli, acroal drug edmia- iartoae or eeli edmiaieaation, and cra.ia;, aa be readily tested. Finally, eraktanoa of treatmeat eppro.ches iarol.iar epplicetion of tlseoeertusl learaia= priacipies eoujd be enluated ia tobacco de} peadeaa rreatmeat pcovens (e.g. O'Brua, 1975; Stiues et al, 1913; McLellaa a al., 198b). Paet ors 4ftceiv eke acq+dsuiox of drut j 4pnsdsPsu Factors rach s,s drtt8 eoet, e.eilability, social arsi- tudes, and tbe dru6 forasduicn itself ue esauawd to play tipti5caat roks in the occarreaee aad sprad of drui eepeadeaet (e.i. US DHHS, 1987, 1988, 19e9). In fact, Tar+ous eapeeta of curreat " use control Lod pnr.eation proSr.asa an ba:ed upoa aud tbeory. F3owerer, the dua upon which tbeorxm regarding the role of auch !lsctors ere 3ess amaai.e than deeitebie for ia:piemeatat;oa of mqor pro- 8raatie. The elfeett of prioe on ctprette easotiM ba.e already been es.aaiaed in some detail (Warner, 19i6; US DHHS, 19.*9) aad assry pswridc some =bfisis for predietiap the degree to which eaforcemeat i I

I I I I I I I I I I I I I I I I I txvo(oemm of tobacco iA arkoAolim cnd illici: dnq ute 289 efforts would need to reduce illicit dtng supplia to stgmfictatlT raise the prsce end therebY reduce drug use. The effects of fictoTS such as astricetfa8 esaied et chaapnd social etutudt: and alteraaoas in the drug £o~zrsuluioa mey be res,dily stvdied with the aistin` bue of data resudias the ttsocietsost of tDese varubles and chanse+ 1a tobacco sad behavior. For essaipie, Fig. 2 ehows the dramaoc iacrease In smakeless tobacco use that occurred in e,eociatioa v, ith chaa8ee in markeda= strtoepes sad the inem- duction of 'stsrter' products (Heaniag5eld S; *kmeth-C,ae1ett, 19a7). As sbotro in FiS. 2 within just 16 yeara, tobacco use by male ywitb iacreised mors than wcfold (US DHHS, 1986, 1988; Glover a al., 1988). Such observations have coatributrd to heiihuned concerns about the widespread dim=- aaioa of nicotiae and other drug delivery qetemt that c*t be used .a the iaitiaz;oa of tobacco dependence, as well M to support the surreptitioue diuributioa, posessuoa, wd etea ase of other subctaaces (e.g. the crack fonn of cocaiae, Coae & Heaniagfield, 1989; Comasittec on $aer=y and Cosnaserce, 1968). 17-ti E3 - 1170 M-1e96 20•24 30•3! •0•4i 1160 _ ACr On011' (YWe1 Fle1W =.14'e06reiW 1f We oftliOhekw i1bOG6o W/MM1W MR (tao awt cAOwW mracei eow69W) bn Ar U09rrd SfCa<i M a fiMlCifOM o11VJ1'ONI dMlllr tM (fpoodbarl) eed !!1t (Oofit Iari) (US DIfXS, 1N1). Casalutbops tYhether ruarchm or clistiei.ae are primsalF iatere+ted ia the ttvcly iod trs.cmeat of aieati»s, eocai:se, herena, alcohol, or otba dat8 depeadeacia, importset wd rek.aat iaformaooe M be =.ioed f= enasiwtioa of tob.cco wd aiootiae wodteed pbenomeaL SpwAficall7r as dexsibed ebo.e, ihe ecqui~itiou, sprnd, sad even sereszt7 of srioU drug depeadeades msy be related to psior oe current tob.cco use pitterns. Estant coacepts re- 8udiat dle8aoui ead treatasent of skoboliim and other drug depeadencies need to be carefully rr e:easiaed in iiaht of such observ.tions. Quest,ons such as the following should be iddressed: which b the'primary' Nddiesioa in the hav7 smokiai hes= aser-heroin or aicotiae? or,.rhich.ddicrioa should be treated drst ia the alcoholic, i.e. alcohol or nlcoaae? iateresdssgly, the role of slcohol usd other eddieti.e drup as relapst factors for tobaeeo use ue asnere!!l uoderstood by people who trrst cigarette smokers, but the converse, that tobacco use m*t serve as a relapse factor for the use of otlter drugs, has rarely beea diectused (Heaaia8iseid, 1984b). Other pbeaomesa U well, such u the factors that dettsasiae whether or not a person pro8ressa from ocwioaai tuo (i.a 'chippiag') to ri6ular use taey be esploted in stadies of tobacco use. SimilulT, the lat=e numbess and readl .ccee% to tobaxo uaers may faci2itm .dvtacas in quertions rresrdioa teaetic wd other biologscal .ulaerebilitr fectors fa the de.elopa~mt of dru; dependencies (e.g. Pickans k Srikis, 1987). Pipw i. Z;Sow 'e M s04hta aOWear aMwepAOa iw &W iJ.od Jtam evn aEwe ad bsuoadom atR «rrma t4e+ri a iiliieow in ae P'i~tr (ilmluri 1![S). Furtbet in"gdptiotu of tobscco tue to pso.ids dus ueeful to reducing the pre.alessce of both tobacto ud other form: of draS use pose cipifcaat e>s.1lenSa but :ppear to be wosthwhi3a The VS sutlOa Geae:.i reoeath eoaclua.a thst dap+fle tbe billioat of dol'l.es .pesu to aa.iataia w4 pre.d tobaceo use by tbe rob.eao Wduettt, +ppeOZ+UNW7 7SO,000 premetare deaths hed baa pre.ented from 19W to 1985 by ystemaic public balth egbsts (VS DHftS, 1989). As ehowa in F'* 3, treod5 in I

I I I I I I I 290 Jack B. Fteutn4*ld, R{ekar4 Cayw & tailliatu PoWn tobecco use ia the Uaited Stues hs.e eatvally been re.ased ia receat yean (US DHHS, 1989). Fur- thetmore, tuccessee in t.ozse target pvupe ba.e been p.ruculariy eacouragiag; for esaatple, c.i6uette smoking by youth decliaed by 35% from the yeaa 1975 to 1486 (US DHHS, I988), Such etlcceuei aire reuoa foc optimiam, e.en when confsoated by the somewhat difieria; but ao mon dif8ault chillenaee of reduciaB i1licit dtu; use. Aeferesca A1tY, D. V., LtdrrDszMl, !i. lt Stlvt3lox, H. FI. (1987) Smokeless totuaco we tnfpoi maLe sQolexeatu pu- tetas, eoteelatei, ptedietoti, tad tbe use of other drugs, Pnoextioe Mt>tirrnt, 16, pp. 385-401. BtUM1otG, H. H., Coaat, 5. D., Dwr+rem.a, B. E., MoVWA, b. A., RoasIS, J. C. # tiAwu, D. (1974) Bntisb opiste usen: I. ?eopk tpptaehiai Loodoa dev; treatmeat ceaten, lwmaw+tat lorsrual4f Addlrnok, 9, pp. 1-23. Evwnc, T. A., Srt;clarox, B. G., atbet.ow, 0. B., BAtLi, W. F. « GoTrbt;i, S. H. (1464) Soohia; kllowia{ mfoeardial iAfitstsoa t cribeaw review oi tbe litetepur, Xoo1t+t P:ycMelqV, 3, pp. l3-9b. CtArroN, L L Ic Itrrlslt, C. (1985) Tae epsdeotiolop of ilcohol tod dtu~ tbust amosi tdoiexean, Adooatu iw Alcelwlim oad SrJmrrce .tiwe, 4, pp. 69-97. Comxrtsa on btrtsaY Axa Coetwucs, tJS Hotns os ltatiistexsATtvst, 100stt CoitoRat (14N) Natmk CoKa/wescrt of SxukAw NfeOlGw AdAetfoe ( WashiBr taa, DC, tTS ()oretttmeat Ptiatay Ofiue). Cotes, Il. J. & Htw,rlrroF=, J: fi. (1989) Premier 'tmete1ess upcettes' cun be wed to deiiar ctselt, purnat oJAmnicon MNieai.tuoewnoR, 261, p. 41. Ctowcat, T. (198i) Lesta+ttf sed ual.aeaiae dsaS sbuee in the etal worfd elioiotl treatment and pubL'c Policy, ia: 8. 1lAT (Ed.) LtaitiW Fisrovrt oe Srbetmw A+ wr, Netaooat Itutitote oo Drtt; Abae Reseatch Moaoaspb 64, pp. 100-121 (W.Wttstoo, DC, L'S Cioresameae P:iatieS OfSee). Cwwt.n, T. J. kRwtk M. W. (1995) The sabetaaes we disordest, la: L C. Susote (Bd) uelers>os>tlbe j 1Ywsme &haoaa. tn X.atrit swt iWas, pp. 730-744 (1loltimore, Wiluims & Wilitt") Dtxon, W. S & i.a, W. b. (1912) Teiettooe to aiootasc, Qrsrwrb' )or^ui oJ f.vmwsaMd ftri~ (LM- doe). S, pp. 373-Sd3. Faeino.x,1. L, L.wax, P. S. ! HAn+c., IL _. (1945) T1M role of aieoose in the cipeeRS habit, Seiew, 14 pp. o4-98. Bit>m, !. A., WA=saqotf, !., Dtia,oet, 0. F.& DecsseG, D. S. (1957) Neoaetai setuoloocal sutw m e low-eak yopaJ+tion el4er pt:naul espoeure to cisat.etM, muslts• ant, aad aleobol, D.rtlopnswiast sed &wew./ Prdw- tr+a, 8, pp. D1i-s26. Get,mwt, A. G., Gooomaa, L. S., Bal.6 T. p. & MMAa, F. (5ds) (19dS) Goedam d Citaws't !Ar rhwww- co/e8se &ti iV Tk0norreey pt. l32-Sil (New Yark, Mxmillae). GLova, 5. D., sataoUMV,1C t-, xu+xxaro*t:s.a,1. B., S=YM=, H. 3iK t Cotrrrra+, A. 0. (1lSt) Aa intetprecre re.iew of ta+okeleu tobacco reseuch:a the L'n,t.d Saus: P.n 1, 7orrMa/ ojD,V Educanow,18, pp. 285-310. HAl.t., S. M., Tt.MAU„ C., GtxsUeo, D., atr+owrr¢, `. L, & Joxss, R T. (1987) NicOtsoe Suas e,ad beDa.iorit untmeac i pLabo eoatroUed tael, jok"tot oJCon.trk- tiy ond GiWa! POVbole6, 56, pp. 603-606. HAVASsY, B. 8., EiAU., S. M. A TscaAlat+, J. M. (1997) Soeul suppott aad telapse to tob.ao, alcohol, and oputri: pcekasieu7 SndiaBs, in: L. S. HwRss (Bd.) Pro6km of Drvj De)enaew, t9d6, Naioo.l fastitut: on Dru= Abuse Sesearch MoooSrapb 76, pp. 207-213 (Wrshia3soa, DC, US Gorernaxat Priauat otSce). HatxsHorw:i,J. 8. & Got.aenn, S. S. (1ota) Iatroduc• tion: peoSms in oadaYtaodea8 the telatioalup betweea the phumscoloscsl Kfiets of =cotiae and huatsa tob.ao depeadeocq pkawecoloo eiotb-pn+y oitd &ltaoiop 30, pp. 217-220. HEWutl+Wnt.D, J. 8. (1984s) Behuv'soea1 phttmeeolop of cipatte smokuag ia: T. Taeom»oN, P. i. Dews Ic J. S. SAeltret (Sds) l.doasut 0 maotora! PiMmtacobv, i/oi. IV, pp. 131-210 (New Yort, Aeademic Ftsu). HirxmltBtA, 1. F. (19b4h) FharmecoloSic besis npd tsatmeIIt of totrao depeadeaee, jow+W of CJinical hyu4ialry, 45, pp. 24-34. KDWD+GtiZL% J. 8. t NUtsS7t-Cou=, R. (1997) Nicotlae depeodeace: laterfaee betaem eobscco aad mbeccaalated dmue, Chea, 93, pp. 37S-55S. HiwdtLteAa[, C. K. (1942) The moephim .bst„seoee sJndeame, m aattitte ead tttatm.at, A+uedr ol( htrrral MtdJevu,15, pp. 12'9-l39. HufA, G. J., Warow, J. A. ! aE3r77.ii, P. M. (1981) A sompMtoa of two leteat variabk oausel tocdeit foe sdolescmt dru8 nse, lorreal ol re+m"a14Y .nd Soslal PrycAoroV, 40, pp. 1i0-I91. b+CW.ot, J. A. (Sd.) (1989) Amennea dati poltay ead tlse leplisetion deb.oe, AWMen ar"v,onoi Sae+seta, 30, No. 3. JARVZ;, M. &k HsttMi+Oi>7Az,1. B. (1988) P1termKo{a pe trelsmeae of tobacco depeadaac., P6atttoMtejy &ioeAenIA'y w1 &baoW, 30, pp. 279-294. JAyott, L. A., CItAwfom, t. ! thttrDM C. L. (1969) UsiaB .cowaiwy modei in toedie-bwud Yalth p:omotioa i8tes~e~oos. ;°w+s.t qFrrs~ Pn4ewfM (in PM)• JAwx, L A., Gauamt, C. L., BveFiNsnmse, L„ Loa. wlR, T., aa01iDAN, J., FLT, B. L & OAi11fCJC1,1t. !. (1987) A 12-moath hOpow•ap of sveek~iee tlmol4aj rsesasra latu+eatsoe, /Y.ofet ddroeeiat Jtnem't, 2, pp.1aS-194. JA b D.rep xmm~~ tJte~a~. L (e0em~1)de9Comaeptud e id O. F. PoKiiliAiT k C. S. PcMtiRi,iAtT (bds) 1VYootfee Rrtiseersenr s oritiuf evolaiatioR, pp. 13-34 (New Y.et, Alae IZ. Liw). JwtufloN, L M. (1942) Tobacco smekia5 aad aieotiae, LweK, 2, p. 742. >LAStML, D.1. (iv7s) sn" in .doisooeae 1n.ot.eseat an dnq uM, Srinrt,190, pp. 912-414. Iwtast, D. E» Moscvaae, t. 2„ & DAVSes, M. (147!) Adytiat sas, lia foa asdyia; Uzasuioas iato okrd- vpsmtil wpee, Soae4v qt aa"eroR, S 1, pp. 162-176. 1