title: Nicotine, alcohol, and drug findings in young adults in a population-based postmortem database.
abstract: BACKGROUND
  To obtain reliable information on nicotine and drug use through a population-based study, the prevalence of nicotine use in deceased young adults was studied in the Finnish postmortem toxicology database for a 3-year period. The nicotine user and non-nicotine user groups were compared by alcohol, drug, and drug-of-abuse findings and by the manner of death.
  
  
  METHODS
  Nicotine users were identified based on detection of nicotine, cotinine, and/or trans-3'-hydroxycotinine in urine from a population-based sample of deceased young adults aged 15-34 years at the time of death (n = 1,623, ∼60% of all fatalities). Background information from case referrals was used to distinguish the abuse of medicines from their therapeutic use. The manner of death was taken from death certificates.
  
  
  RESULTS
  Nicotine use was more common in young adults (75%) than among all cases in the database (55%). There were twice as many ethanol-positive cases in nicotine users (60%) than in non-nicotine users (30%). Nicotine use was common (70%-79%) among individuals on antipsychotics, antidepressants, anxiolytics, and/or hypnotics and sedatives. The proportion of nicotine users was also high among the drugs-of-abuse positive cases (85%). There were fewer deaths that were classified as natural in the nicotine users group.
  
  
  CONCLUSIONS
  Among deceased young adults, nicotine use was two to three times as common as has been estimated for the corresponding living population (20%-30%). Nicotine use was also strongly associated with substance abuse and mental illnesses requiring pharmacotherapy. This group of young adults usually cannot be reached by traditional health surveys.
authors.affiliation: Department of Forensic Medicine, Hjelt Institute, PO Box 40, FI-00014 University of Helsinki, Finland. terhi.launiainen@helsinki.fi
authors.forename: Terhi
authors.initials: T
authors.lastname: Launiainen
authors.forename: Ulla
authors.initials: U
authors.lastname: Broms
authors.forename: Kaisu
authors.initials: K
authors.lastname: Keskitalo-Vuokko
authors.forename: Janne
authors.initials: J
authors.lastname: Pitkäniemi
authors.forename: Anna
authors.initials: A
authors.lastname: Pelander
authors.forename: Jaakko
authors.initials: J
authors.lastname: Kaprio
authors.forename: Ilkka
authors.initials: I
authors.lastname: Ojanperä
mesh_terms: D000293:Adolescent; D000328:Adult; D001344:Autopsy; D002423:Cause of Death; D003367:Cotinine / Q000652:urine; D000431:Ethanol / Q000652:urine; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D009538:Nicotine / Q000652:urine; D011619:Psychotropic Drugs / Q000652:urine; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000652:urine; D014029:Tobacco Use Disorder / Q000453:epidemiology* / Q000652:urine; D014556:Urine / Q000737:chemistry; D055815:Young Adult
chemical_list: D011619:Psychotropic Drugs; D000431:Ethanol; D009538:Nicotine; D003367:Cotinine