Search

Background and aims: Ontologies are ways of representing information that improve clarity and the ability to connect different data sources. This paper proposes an initial version of an ontology of tobacco, nicotine and vaping products with the aim of reducing ambiguity and confusion in the field. Methods: Terms related to tobacco, nicotine and vaping products were identified in the research literature and their usage characterised. Basic Formal Ontology was used as a unifying upper‐level ontology to describe the domain, and classes with definitions and labels were developed linking them to this ontology. Labels, definitions and properties were reviewed and revised in an iterative manner until a coherent set of classes was agreed by the authors. Results: Overlapping, but distinct classes were developed: 'tobacco‐containing product', 'nicotine‐containing product' and 'vaping device'. Subclasses of tobacco‐containing products are 'combustible tobacco‐containing product', 'heated tobacco product' and 'smokeless tobacco‐containing product'. Subclasses of combustible tobacco‐containing product include 'cigar', 'cigarillo', 'bidi' and 'cigarette' with further subclasses including 'manufactured cigarette'. Manufactured cigarettes have properties that include 'machine‐smoked nicotine yield' and 'machine‐smoked tar yield'. Subclasses of smokeless tobacco product include 'nasal snuff', 'chewing tobacco product', and 'oral snuff' with its subclass 'snus'. Subclasses of nicotine‐containing product include 'nicotine lozenge' and 'nicotine transdermal patch'. Subclasses of vaping device included 'electronic vaping device' with a further subclass, 'e‐cigarette'. E‐cigarettes have evolved with a complex range of properties including atomiser resistance, battery power, properties of consumables including e‐liquid nicotine concentration and flavourings, and the ontology characterises classes of product accordingly. Conclusions: Use of an ontology of tobacco, nicotine and vaping products should help reduce ambiguity and confusion in tobacco control research and practice. [ABSTRACT FROM AUTHOR]

Background and Aim: Public health policy development is subject to a range of stakeholders presenting their arguments to influence opinion on the best options for policy action. This paper compares stakeholders' positions in the discourse networks of two pricing policy debates in the United Kingdom: minimum unit pricing for alcohol (MUP) and the soft drinks industry levy (SDIL). Design Discourse analysis was combined with network visualization to create representations of stakeholders' positions across the two policy debates as they were represented in 11 national UK newspapers. Setting: United Kingdom. Observations: For the MUP debate 1924 statements by 152 people from 87 organizations were coded from 348 articles. For the SDIL debate 3883 statements by 214 people from 175 organizations were coded from 511 articles. Measurements Network analysis techniques were used to identify robust argumentative similarities and maximize the identification of network structures. Network measures of size, connectedness and cohesion were used to compare discourse networks. Findings The networks for both pricing debates involve a similar range of stakeholder types and form clusters representing policy discourse coalitions. The SDIL network is larger than the MUP network, particularly the proponents' cluster, with more than three times as many stakeholders. Both networks have tight clusters of manufacturers, think‐tanks and commercial analysts in the opponents' coalition. Public health stakeholders appear in both networks, but no health charity or advocacy group is common to both. Conclusion: A comparison of the discourse in the UK press during the policy development processes for minimum unit pricing for alcohol and the soft drinks industry levy suggests greater cross‐sector collaboration among policy opponents than proponents. [ABSTRACT FROM AUTHOR]

Background and Aims: Youth alcohol consumption has declined significantly during the past 15 years in many high‐income countries, which may have significant public health benefits. However, if the reductions in drinking occur mainly among lighter drinkers who are at lower risk, then rates of alcohol‐related harm among young people today and adults in future may not fall in line with consumption. There is conflicting evidence from Swedish school studies, with some suggesting that all young people are drinking less, while others suggest that alcohol consumption among heavier drinkers may be stable or rising while average consumption declines. This paper extends the geographical focus of previous research and examines whether the decline in youth drinking is consistent across the consumption distribution in England. Design Quantile regression of 15 waves of repeat cross‐sectional survey data. Setting: England, 2001–16. Participants: A total of 31 882 schoolchildren (50.7% male) aged 11–15 who responded to the Smoking Drinking and Drug Use among Young People surveys. Measurements Past‐week alcohol consumption in UK units at each fifth percentile of the consumption distribution. Findings Reductions in alcohol consumption occurred at all percentiles of the consumption distribution analysed between 2001 and 2016, but the magnitude of the decline differed across percentiles. The decline in consumption at the 90th percentile [β = −0.21, confidence interval (CI) = −0.24, −0.18] was significantly larger than among either lighter drinkers at the 50th percentile (β = −0.02, CI = −0.02, −0.01) or heavier drinkers at the 95th percentile (β = −0.16, CI = −0.18, −0.13). Conclusions: Alcohol consumption among young people in England appears to be declining across the consumption distribution, and peaks among heavy drinkers. The magnitude of this decline differs significantly between percentiles of the consumption distribution, with consumption falling proportionally less among the lightest, moderate and very heaviest youth drinkers. [ABSTRACT FROM AUTHOR]

The article comments on a paper by H. Tattan-Birch and colleagues on the impact of the increase use of disposable vapes among young adults on the implementation of policy in the United Kingdom. Topics mentioned include the need of policy actions that should impact both young adults, smokers, and vapers, the importance of considering the evidence before making policy decisions to avoid unintended consequences, and the difficulty of using target advertising to promote disposables.

Background and Aims Exposure to alcohol marketing is considered to be potentially harmful to adolescents. In addition to statutory regulation, industry self-regulation is a common way to protect adolescents from alcohol marketing exposures. This paper critically reviews research designed to evaluate the effectiveness of the alcohol industry's compliance procedures to manage complaints when alcohol marketing is considered to have violated a self-regulatory code. Methods Peer-reviewed papers were identified through four literature search engines: PubMed, SCOPUS, PsychINFO and CINAHL. Non-peer-reviewed reports produced by public health agencies, alcohol research centers, non-governmental organizations, government research centers and national industry advertising associations were also included. Results The search process yielded three peer-reviewed papers, seven non-peer reviewed reports published by academic institutes and non-profit organizations and 20 industry reports. The evidence indicates that the complaint process lacks standardization across countries, industry adjudicators may be trained inadequately or biased and few complaints are upheld against advertisements pre-determined to contain violations of a self-regulatory code. Conclusions The current alcohol industry marketing complaint process used in a wide variety of countries may be ineffective at removing potentially harmful content from the market-place. The process of determining the validity of complaints employed by most industry groups appears to suffer from serious conflict of interest and procedural weaknesses that could compromise objective adjudication of even well-documented complaints. In our opinion the current system of self-regulation needs major modifications if it is to serve public health objectives, and more systematic evaluations of the complaint process are needed. [ABSTRACT FROM AUTHOR]

Background and Aims The concern that alcohol advertising can have detrimental effects on vulnerable viewers has prompted the development of codes of responsible advertising practices. This paper evaluates critically the concept of vulnerability as it applies to (1) susceptibility to alcohol-related harm and (2) susceptibility to the effects of marketing, and describes its implications for the regulation of alcohol marketing. Method We describe the findings of key published studies, review papers and expert reports to determine whether these two types of vulnerability apply to population groups defined by (1) age and developmental history; (2) personality characteristics; (3) family history of alcoholism; (4) female sex and pregnancy risk; and (5) history of alcohol dependence and recovery status. Results Developmental theory and research suggest that groups defined by younger age, incomplete neurocognitive development and a history of alcohol dependence may be particularly vulnerable because of the disproportionate harm they experience from alcohol and their increased susceptibility to alcohol marketing. Children may be more susceptible to media imagery because they do not have the ability to compensate for biases in advertising portrayals and glamorized media imagery. Conclusion Young people and people with a history of alcohol dependence appear to be especially vulnerable to alcohol marketing, warranting the development of new content and exposure guidelines focused on protecting those groups to improve current self-regulation codes promoted by the alcohol industry. If adequate protections cannot be implemented through this mechanism, statutory regulations should be considered. [ABSTRACT FROM AUTHOR]

Editorial. Focuses on the publication of the United Kingdom government's White Paper on tobacco. Purpose of the White Paper; Policy initiatives contained in the White Paper; Information on the National Health Service smoking cessation treatment.

Background and Aims: E‐cigarettes have the potential either to decrease or increase health inequalities, depending on socio‐economic differences in their use and effectiveness. This paper estimated the associations between socio‐economic status (SES) and e‐cigarette use and examined whether these associations changed between 2014 and 2017. Design A monthly repeat cross‐sectional household survey of adults (16+) between January 2014 and December 2017. This time‐period was chosen given that the prevalence of e‐cigarette use stabilized in England in late 2013. Setting: England. Participants: Participants in the Smoking Toolkit Study, a monthly household survey of smoking and smoking cessation among adults (n = 81 063; mean age = 48.4 years, 49% were women) in England. Subsets included past year smokers (n = 16 232; mean age = 42.8, 46% women), smokers during a quit attempt (n = 5305, mean age = 40.6, 49% women) and long‐term ex‐smokers (n = 13 562, mean age = 59.3, 44% women). Measurements: The outcome measure for the analyses was current e‐cigarette use. We also included smokers during a quit attempt where use of an e‐cigarette during the most recent quit attempt was the outcome measure. Social grade based on occupation was the SES explanatory variable, using the National Readership Survey classification system of AB (higher and intermediate managerial, administrative and professional), C1 (supervisory, clerical and junior managerial, administrative and professional), C2 (skilled manual workers), D (semi‐skilled and unskilled manual workers) and E (state pensioners, casual and lowest‐grade workers, unemployed with state benefits only). The analyses were stratified by year to assess the changes in these associations over time. Findings: Among past‐year smokers, lower SES groups had lower overall odds of e‐cigarette use compared with the highest SES group AB (D: odds ratio = 0.53, 95% confidence interval = 0.40–0.71; E: 0.67, 0.50–0.89). These differences in e‐cigarette use reduced over time. The use of e‐cigarettes during a quit attempt showed no clear temporal or socio‐economic patterns. Among long‐term ex‐smokers, use of e‐cigarettes increased from 2014 to 2017 among all groups and use was more likely in SES groups C2 (2.03, 1.08–3.96) and D (2.29, 1.13–4.70) compared with AB. Conclusions: From 2014 to 2017 in England, e‐cigarette use was greater among smokers from higher compared with lower socio‐economic status (SES) groups, but this difference attenuated over time. Use during a quit attempt was similar throughout SES groups. Use by long‐term ex‐smokers increased over time among all groups and was consistently more common in lower SES groups. [ABSTRACT FROM AUTHOR]

Background This paper reviews the early work of Griffith Edwards and his colleagues on alcohol in the criminal justice system and outlines the direction of research in this area in the Addiction Research Unit in the 1960s and 1970s. The paper outlines the link between that work and work undertaken in the more recent past in this area. Methods The key papers of the authors are reviewed and the impact of this work on policy and practice is discussed. Conclusions There is a rich seam of work on deprived and incarcerated populations that has been under way at the Addiction Research Unit and subsequently the National Addiction Centre, Institute of Psychiatry, London. Griffith Edwards initiated this work that explores the risks and problems experienced by people moving between the health and criminal justice system, and demonstrated the need for better care and continuity across this system [ABSTRACT FROM AUTHOR]

This paper provides a personal memoir of historical work at the Addiction Research Unit, in particular the genesis of the book Opium and the People. This topic had policy significance for US drug policy and a competing US study was funded. The development of the substance use history field is surveyed, and its expansion in recent times through a focused professional association and a critical mass of researchers in the area, covering a wide range of topics. The politics of using history in this area can be problematic. History now sits at the policy table more easily, but there is still a tendency for professionals in the field to use (and misuse) it, rather than calling on the interpretive and challenging approach they would obtain from professional historians. The paper calls for historians and others to move beyond a substance specific focus and to avoid the tendency for 'naive history' implicit in using only digitized industry archives as the sole source. [ABSTRACT FROM AUTHOR]

Aims This paper estimates how far monthly changes in prevalence of cigarette smoking, motivation to quit and attempts to stop smoking have been associated with changes in prevalence of high-risk drinking, and motivation and attempts to reduce alcohol consumption in England. Design Data were used from the Alcohol and Smoking Toolkit Studies between April 2014 and June 2016. These involve monthly household face-to-face surveys of representative samples of ~1700 adults in England. Measurements Autoregressive Integrated Moving Average with Exogeneous Input (ARIMAX) modelling was used to assess the association over time between monthly prevalence of (a) smoking and high-risk drinking; (b) high motivation to quit smoking and high motivation to reduce alcohol consumption; and (c) attempts to quit smoking and attempts to reduce alcohol consumption. Findings Mean smoking prevalence over the study period was 18.6% and high-risk drinking prevalence was 13.0%. A decrease of 1% of the series mean smoking prevalence was associated with a reduction of 0.185% of the mean prevalence of high-risk drinking 2 months later [95% confidence interval (CI) = 0.033 to 0.337, P = 0.017]. A statistically significant association was not found between prevalence of high motivation to quit smoking and high motivation to reduce alcohol consumption (β = 0.324, 95% CI = -0.371 to 1.019, P = 0.360) or prevalence of attempts to quit smoking and attempts to reduce alcohol consumption (β = −0.026, 95% CI = -1.348 to 1.296, P = 0.969). Conclusion Between 2014 and 2016, monthly changes in prevalence of smoking in England were associated positively with prevalence of high-risk drinking. There was no significant association between motivation to stop and motivation to reduce alcohol consumption, or attempts to quit smoking and attempts to reduce alcohol consumption. [ABSTRACT FROM AUTHOR]

This paper explores and develops issues raised by recent debates about the cost of alcohol to England and Wales. It advances two arguments. First, that the commonly used estimates for alcohol harm in England and Wales are outdated, not fully reliable and in need of revisiting. These estimates rely on data that are between 4 and 12 years out of date and sensitive to questionable assumptions and methodological judgements. Secondly, it argues that policymakers, academics and non-governmental organizations should be more careful in their use of these numbers. In particular, it is imperative that the numbers quoted fit the argument advanced. To help guide such appropriate usage, the different types of cost of alcohol are surveyed, alongside some thoughts on the questions they help us to answer and what they imply for policy. For example, comprehensive estimates of the total social cost of alcohol provide an indication of the scale of the problem, but have limited policy relevance. External cost estimates represent a 'lowest common denominator' approach acceptable to most, but require additional assumptions to guide action. Narrower perspectives, such as fiscal, economic or health costs, may be relevant in specific contexts. However, optimal policy should take a holistic view of all the relevant costs and benefits. Similarly, focusing solely on tangible costs may be less controversial, but will result in an under-estimate of the relevant costs of alcohol. [ABSTRACT FROM AUTHOR]

Background and aims Regulation of electronic cigarettes has moved to the top of the addiction policy agenda, as demonstrated by the recent focus across the United Kingdom on introducing age-of-sale restrictions. However, the views of those affected by such regulation remain largely unexplored. This paper presents the first detailed qualitative exploration of adolescents' perceptions of existing, and opinions about potential e-cigarette regulation. Methods Sixteen focus groups, including a total of 83 teenagers between the ages of 14 and 17 years, were conducted in deprived, mixed and affluent urban areas in Scotland and England between November 2014 and February 2015. Transcripts were imported into Nivivo 10, coded thematically and analysed. Results Participants critically considered existing evidence and competing interests in regulatory debates and demonstrated sophisticated understanding of the advantages and disadvantages of regulation. They overwhelmingly supported strong e-cigarette regulation and endorsed restrictions on sales to minors, marketing and e-cigarette use in public places. Concern about potential health harms of e-cigarette use and marketing increasing the acceptability of vaping and smoking led these adolescents to support regulation. Conclusions In focus group discussions, a sample of UK adolescents exposed to particular communications about e-cigarettes supported strict regulation of e-cigarettes, including banning sales to minors and use in indoor public areas. [ABSTRACT FROM AUTHOR]

Background and Aims If socio-economic disadvantage is associated with more adolescent smoking, but less participation in tertiary education, and smoking and tertiary education are both associated with heavier drinking, these may represent opposing pathways to heavy drinking. This paper examines contextual variation in the magnitude and direction of these associations. Design Comparing cohort studies. Setting United Kingdom. Participants Participants were from the 1958 National Child Development Study (NCDS58; n = 15 672), the British birth cohort study (BCS70; n = 12 735) and the West of Scotland Twenty-07 1970s cohort (T07; n = 1515). Measurements Participants self-reported daily smoking and weekly drinking in adolescence (age 16 years) and heavy drinking (> 14/21 units in past week) in early adulthood (ages 22-26 years). Parental occupational class (manual versus non-manual) indicated socio-economic background. Education beyond age 18 was coded as tertiary. Models were adjusted for parental smoking and drinking, family structure and adolescent psychiatric distress. Findings Respondents from a manual class were more likely to smoke and less likely to enter tertiary education (e.g. in NCDS58, probit coefficients were 0.201 and -0.765, respectively; P < 0.001 for both) than respondents from a non-manual class. Adolescent smokers were more likely to drink weekly in adolescence (0.346; P < 0.001) and more likely to drink heavily in early adulthood (0.178; P < 0.001) than adolescent non-smokers. Respondents who participated in tertiary education were more likely to drink heavily in early adulthood (0.110 for males, 0.182 for females; P < 0.001 for both) than respondents with no tertiary education. With some variation in magnitude, these associations were consistent across all three cohorts. Conclusions In Britain, young adults are more likely to drink heavily both if they smoke and participate in tertiary education (college and university) despite socio-economic background being associated in opposite directions with these risk factors. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim This paper provides a historical overview of licensing law in Scotland. It seeks to put important contemporary policy developments into their historical context and to draw attention to key themes in licensing policy debates across the United Kingdom. Design Based on a survey of statutes, commissions of enquiry and consumption and retail data, this paper draws together historical evidence to present a synopsis of Scottish licensing history. Settings The article focuses on Scotland, but also discusses UK-wide licensing policy over a 250-year period. Findings Scottish licensing has diverged from licensing in England and Wales and has addressed some historical licensing weaknesses, including problems of accountability, overprovision and systemic oversight regarding off-sales. Distinctive features of current Scottish legislation include public health protection as a statutory licensing objective; local Licensing Forums and Licensing Standards Officers; a requirement for explicit policies on the 'overprovision' of licensed premises; mandatory restrictions on price promotions in the on- and off-trades; and limitations on opening hours for off-licences. Conclusion Scotland has developed alcohol policies several times addressing long-standing licensing weaknesses throughout the United Kingdom. Some Scottish alcohol policies have later become the norm in England and Wales. [ABSTRACT FROM AUTHOR]

In 1998 the UK government published a White Paper on tobacco which set out the development of smoking cessation treatment services across England. This paper presents a detailed analysis of the events leading up to the inclusion of smoking cessation treatment services within the White Paper, and the background to the evaluation of those services, the results of which are the subject of the remaining papers in this supplement. [ABSTRACT FROM AUTHOR]

Nicotine replacement therapy (NRT) describes a group of products delivering nicotine that are licensed for the relief of withdrawal as an aid to smoking cessation. This paper examines areas where public health considerations suggest changes should be made to the current indications and characteristics for NRT products. It is argued that the current regulatory framework restricts access to NRT without adequately considering that the likely consequence is continued dependent use of a far more harmful and widely available version of the same drug: tobacco. The paper argues that minors, pregnant smokers and smokers with cardiovascular disease (CVD) be allowed to use NRT. NRT use for smoking reduction, to support temporary abstinence, for long-term use should also be enabled and NRT products should be made as widely available as cigarettes. This paper also recommends that regulators encourage the development of less harmful forms of nicotine delivery devices to compete with cigarettes. Although this paper is written largely with reference to the UK medicines regulatory framework, these issues also apply to many other countries. [ABSTRACT FROM AUTHOR]

This paper focuses on the marketing of alcohol to young people in the United Kingdom, but the lessons that emerge have international significance. Alcohol is a global enterprise and recent consolidation means that it is controlled by a decreasing number of expanding multi-nationals. Alcohol companies are able to allocate significant resources to researching consumer preferences, developing new products and promoting them on an international level. Recent years have seen a growth in the value that youth culture attaches to brand labels and symbols and a move away from the healthy-living ethos. The alcohol industry's response to these trends has been to design alcoholic beverages that appeal to young people, using well-informed and precisely targeted marketing strategies. This has led to growing concerns about the implications for public health and a demand for tighter controls to regulate alcohol marketing practices. In the United Kingdom, controls on alcohol are piecemeal and reactive and the current system of voluntary regulation appears ineffective. This paper argues for more research to establish current industry practice and inform the development of a comprehensive regulatory structure and system of monitoring. [ABSTRACT FROM AUTHOR]

Griffith Edwards played an important role in cannabis policy debates within government advisory committees in the United Kingdom from the early 1970s until the early 1980s. This has largely been hidden from public knowledge by the confidentiality of these committee discussions. The purpose of this paper is to use Griffith's writings and the results of recent historical scholarship to outline the views he expressed, the reasons he gave for them, and to provide a brief assessment of his contribution to the development of British cannabis policy. [ABSTRACT FROM AUTHOR]

In 1976 Edwards & Gross proposed the concept of the alcohol dependence syndrome, based on the clinical observation that heavy drinkers manifested an inter-related clustering of signs and symptoms. That this modest 'provisional description' turned out to be so significant and influential is perhaps unsurprising when the context in which it was made is appreciated. Griffith Edwards and his colleagues at the Maudsley Hospital had undergone a rigorous 3-year training in clinical psychiatry, during which they had been taught to think critically and were grounded in the art of clinical observation. As he assessed patients for various alcohol research studies he realized that there was a clustering of certain elements. Thus clinical observation and an appreciation of the patient's drinking history contributed to the genesis of the concept. This paper reflects on the integration of his rigorous training at the Maudsley, his enquiring mind and encyclopaedic knowledge of the historical and research literature which enabled him to formulate a testable hypothesis about the alcohol dependence syndrome. [ABSTRACT FROM AUTHOR]

This paper describes the political origins of the National Treatment Outcomes Research Study (NTORS) and the outputs and impacts of the study. NTORS was designed to meet the request of the Health Secretary and of a Government Task Force for evidence about the effectiveness of the national addiction treatment services. NTORS was a prospective cohort study which investigated outcomes over a 5-year period of drug users admitted to four major treatment modalities: in-patient treatment, residential rehabilitation, methadone reduction and methadone maintenance programmes. The study investigated treatments delivered under day-to-day operating conditions. Outcomes showed substantial reductions in illicit drug use and reduced injecting risk behaviours. These changes were accompanied by improved psychological and physical health and by reductions in criminal behaviour. However, not all outcomes were so positive. There was a continuing mortality rate in the cohort of about 1% per year, and many clients continued to drink heavily throughout the 5-year follow-up. NTORS findings informed and influenced UK addiction treatment policy both at the time and subsequently. The findings were influential in supporting an immediate increase in funding for treatment, and Government Ministers have repeatedly cited NTORS as evidence of the effectiveness of addiction treatment. One finding that received political attention was that of the cost savings provided by treatment through reductions in crime. This important finding led to an unanticipated consequence of NTORS; namely, the greater focus on crime reduction that has increasingly been promoted as a political and social priority for drug misuse treatment. [ABSTRACT FROM AUTHOR]

Aims Britain's first wave of non-therapeutic drug users during the 1960s were more likely to come into contact with the criminal courts than previous, therapeutic, drug users. This paper recounts the untold history of probation officers' work with drug misusing offenders in the United Kingdom during the 1960s. Methods Using 'snowballing' to source participants (in which study subjects recruit future subjects from among their acquaintances) and in-depth interviews as a means of eliciting information, probation officers who had supervised drug users during this time were interviewed about their experiences. Interviews were transcribed verbatim and a thematic data set produced. Results Front-line probation officers in the United Kingdom in the 1960s had considerable contact with drug-misusing offenders. In explaining drug addiction, officers tended to draw upon a psychotherapeutic interpretation, and in terms of intervention they relied heavily upon the psychiatric services to deliver treatment. Probation officers did not always make the connection between addiction and an increase in criminality. Conclusion In Britain's first wave of non-therapeutic drug users in the 1960s, probation officers appear not to have made a connection with criminality, which may have limited how far they developed a formalized approach to applying the expertise of the Probation Service. [ABSTRACT FROM AUTHOR]

Aim To examine whether receipt of alcohol industry sponsorship is associated with problematic drinking in UK university students who play sport. Methods University students ( n = 2450) participating in sports were invited to complete a pen-and-paper questionnaire by research staff approaching them at sporting facilities and in university settings. Respondents were asked whether they, personally, their team and/or their club were currently in receipt of sponsorship (e.g. money, free or subsidized travel or sporting products) from an alcohol-related industry (e.g. bars, liquor stores, wholesalers), and whether they had solicited the sponsorship. Drinking was assessed using the Alcohol Use Disorders Identification Test ( AUDIT). Results Questionnaires were completed by 2048 of those approached (response rate = 83%). Alcohol industry sponsorship was reported by 36% of the sample. After accounting for confounders (age, gender, disposable income and location) in multivariable models, receipt of alcohol sponsorship by a team (adjusted βadj = 0.41, P = 0.013), club (βadj = 0.73, P = 0.017), team and club (βadj = 0.79, P = 0.002) and combinations of individual and team or club sponsorships (βadj = 1.27, P < 0.002) were each associated with significantly higher AUDIT-consumption substance scores. Receipt of sponsorship by team and club [adjusted odds ratio ( aOR) = 2.04; 95% confidence interval ( CI) = 1.04-3.99] and combinations of individual and team or club sponsorships ( aOR = 4.12; 95% CI = 1.29-13.15) were each associated with increased odds of being classified a hazardous drinker ( AUDIT score >8). Respondents who sought out sponsorship were not at greater risk than respondents, or whose teams or clubs, had been approached by the alcohol industry. Conclusions University students in the United Kingdom who play sport and who personally receive alcohol industry sponsorship or whose club or team receives alcohol industry sponsorship appear to have more problematic drinking behaviour than UK university students who play sport and receive no alcohol industry sponsorship. Policy to reduce or cease such sponsorship should be considered. [ABSTRACT FROM AUTHOR]

Background and aims Minimum unit pricing is a fiscal intervention intended to tackle the social and health harms from alcohol to individual drinkers and wider society. This paper presents the first large-scale qualitative examination of how newsprint media framed the debate around the harms of alcohol consumption to 'others' during the development and passing of minimum unit pricing legislation in Scotland. Methods Qualitative content analysis was conducted on seven UK and three Scottish national newspapers between 1 January 2005 and 30 June 2012. Relevant articles were identified using the electronic databases Nexis UK and Newsbank. A total of 403 articles focused on the harms of alcohol consumption to 'others' and were eligible for detailed coding and analysis. Results Alcohol harms to wider society and communities were identified as being a worsening issue increasingly affecting everyone through shared economic costs, social disorder, crime and violence. The availability of cheap alcohol was blamed, alongside a minority of 'problem' youth binge drinkers. The harm caused to families was less widely reported. Conclusions If news reporting encourages the public to perceive the harms caused by alcohol to wider society as having reached crisis point, a population-based intervention may be deemed necessary and acceptable. However, the current focus in news reports on youth binge drinkers may be masking the wider issue of overconsumption across the broader population. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To identify and assess the effectiveness of experimental studies of interventions that report on multiple risk behaviour outcomes in young people. Methods A systematic review was performed to identify experimental studies of interventions to reduce risk behaviour in adolescents or young adults and that reported on both any substance (alcohol, tobacco and illicit drug) use and sexual risk behaviour outcomes. Two authors reviewed studies independently identified through a comprehensive search strategy and assessed the quality of included studies. The report was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results From 1129 papers, 18 experimental studies met our inclusion criteria, 13 of which were assigned a strong or moderate quality rating. The substantial heterogeneity between studies precluded the pooling of results to give summary estimates. Intervention effects were mixed, with most programmes having a significant effect on some outcomes, but not others. The most promising interventions addressed multiple domains (individual and peer, family, school and community) of risk and protective factors for risk behaviour. Programmes that addressed just one domain were generally less effective in preventing multiple risk behaviour. Conclusions There is some, albeit limited, evidence that programmes to reduce multiple risk behaviours in school children can be effective, the most promising programmes being those that address multiple domains of influence on risk behaviour. Intervening in the mid-childhood school years may have an impact on later risk behaviour, but further research is needed to determine the effectiveness of this approach. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To re-examine various aspects of the benzodiazepines (BZDs), widely prescribed for 50 years, mainly to treat anxiety and insomnia. It is a descriptive review based on the Okey Lecture delivered at the Institute of Psychiatry, King's College London, in November 2010. Methods A search of the literature was carried out in the Medline, Embase and Cochrane Collaboration databases, using the codeword 'benzodiazepine(s)', alone and in conjunction with various terms such as 'dependence', 'abuse', etc. Further hand-searches were made based on the reference lists of key papers. As 60 000 references were found, this review is not exhaustive. It concentrates on the adverse effects, dependence and abuse. Results Almost from their introduction the BZDs have been controversial, with polarized opinions, advocates pointing out their efficacy, tolerability and patient acceptability, opponents deprecating their adverse effects, dependence and abuse liability. More recently, the advent of alternative and usually safer medications has opened up the debate. The review noted a series of adverse effects that continued to cause concern, such as cognitive and psychomotor impairment. In addition, dependence and abuse remain as serious problems. Despite warnings and guidelines, usage of these drugs remains at a high level. The limitations in their use both as choice of therapy and with respect to conservative dosage and duration of use are highlighted. The distinction between low-dose 'iatrogenic' dependence and high-dose abuse/misuse is emphasized. Conclusions The practical problems with the benzodiazepines have persisted for 50 years, but have been ignored by many practitioners and almost all official bodies. The risk-benefit ratio of the benzodiazepines remains positive in most patients in the short term (2-4 weeks) but is unestablished beyond that time, due mainly to the difficulty in preventing short-term use from extending indefinitely with the risk of dependence. Other research issues include the possibility of long-term brain changes and evaluating the role of the benzodiazepine antagonist, flumazenil, in aiding withdrawal. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim This paper examines how smokers' beliefs about 'light/mild' cigarettes in Australia, Canada and the United Kingdom were affected by the removal of misleading 'light/mild' terms from packs. Design, setting and participants The data come from the first seven waves (2002-09) of the International Tobacco Control Policy Evaluation (ITC) Four-Country Survey, an annual cohort telephone survey of adult smokers in Canada, the United States, the United Kingdom and Australia (21 613 individual cases). 'Light' and 'mild' descriptors were removed in 2003 in the United Kingdom, in 2006 in Australia and in 2007 in Canada. We compare beliefs about 'light' cigarettes both before and after the bans, with those of smokers in the United States serving as the control condition. Measures Smokers' beliefs about 'light' cigarettes were assessed using a set of statements rated on a five-point 'agree'-'disagree' scale. Findings The proportions of respondents reporting misperceptions about light cigarettes declined between 2002 and 2009 in all four countries. There were marked temporary reductions in reported misperceptions in the United Kingdom and Australia, but not in Canada, following the removal of 'light/mild' descriptors. Conclusions Removal of 'light/mild' descriptors and tar, nicotine and carbon monoxide yield information from cigarette packs is insufficient to effectively eliminate false beliefs. The combination of alternative descriptors and design features that produce differences in taste strength and harshness, independent of actual intakes, are sufficient to produce or sustain the same misbeliefs. [ABSTRACT FROM AUTHOR]

Aim The goal of this report is to provide a framework for understanding and interpreting political, scientific and cultural attitudes towards drink driving in 20th-century Britain. Exploring the inherent conservatism of successive governments, Members of Parliament (MPs) and the public towards the issue during the interwar years, the contribution seeks to explain the shift from legislative paralysis to the introduction of the breathalyser in 1967. Design Based on governmental, parliamentary and administrative records, the report follows a mainly narrative route. It places particular emphasis on connections between post-war extra-parliamentary and parliamentary movements for reform. Setting The paper follows a linear path from the 1920s to the 1970s. Britain lies at the heart of the story but comparisons are made with nations—particularly the Scandinavian states—which took radical steps to prosecute drinking and dangerous drivers at an early date. Findings The report underlines the vital post-war role played by Graham Page, leading parliamentary spokesman for the Pedestrians' Association; the centrality of the Drew Report (1959) into an ‘activity resembling driving’; the pioneering Conservative efforts of Ernest Marples; and Barbara Castle's consolidating rather than radically innovative activities between 1964 and 1967. Conclusion Both before and after the Second World War politicians from both major parties gave ground repeatedly to major motoring organizations. With the ever-escalating growth of mass motorization in the 1950s, both Conservative and Labour governments agonized over gridlock and ‘murder on the roads’. Barbara Castle finally took decisive action against drink drivers, but the ground had been prepared by Graham Page and Ernest Marples. [ABSTRACT FROM AUTHOR]

This paper describes three important strands in the career of Griffith Edwards that define him as a leader and an innovator. Believing that education and science were critical for the development of addiction as a profession and as a field of inquiry, his approach was multi-faceted: educating all doctors to appreciate the fundamental issues in addiction; training psychiatrists in the complexity of 'dual diagnosis' and specific specialist intervention; and teaching that addiction could be a chronic condition which required care management over the life course. These three inter-related areas are directly related to the need for a range of practitioners to have an understanding of addiction so that patients can be properly managed. The greater our understanding of the nature of addiction behaviour, the more likely the potential to optimize treatment and train practitioners from different professional disciplines. [ABSTRACT FROM AUTHOR]

An introduction is presented noting that the special supplement issue focuses on the contributions of British addictions researcher Griffith Edwards, with the articles in the issue adapted from papers given at a January 2013 conference at the Institute of Psychiatry, Kings College, London, England.

Aims To illustrate the ways in which community pharmacists in Great Britain have been able to benefit from a close association with tobacco and smoking from its initial importation to the present time. Design An analysis of relevant texts and documents, together with brief transcripts from an oral history investigation of community pharmacy in Great Britain. Setting Community pharmacies in Great Britain during the 20th century. Participants Retired and practising community pharmacists with experience of the sale of tobacco products during the period. Measurements Oral testimony of retired and practising community pharmacists about the use and sale of tobacco products, and quantitative analysis of commercially available products designed to help people stop smoking during the period. Findings Community pharmacists have been involved continuously with the tobacco habit since its first introduction into Britain. During the course of the 20th century the emphasis shifted from the sale of tobacco products to the sale of medicines intended to help people to give up smoking. Smoking cessation initiatives continue to be an important part of the business of many pharmacies. Conclusions The paper illustrates the continuing tension that exists between pharmacy as business and pharmacy as profession. The sale of tobacco products and, more recently, products to help people give up smoking, has been a small but significant part of the business of many community pharmacists throughout the centuries. [ABSTRACT FROM AUTHOR]

This paper summarizes and discusses the key findings of the evaluation of the English smoking treatment services, which were established in 1999 as part of the English National Health Service. Within 4 years these services existed throughout the country and were working at full capacity, a total of£76 million having been spent on them over this period, excluding medication costs. In the fourth year almost 235 000 people attended treatment and set a quit date, and the total budget, including medications, was approximately£50 million. At the end of the fourth year the government allocated£138 million for the services for the period April 2003–March 2006. The CO-validated 4-week abstinence rate was 53%, the validated 52-week abstinence rate was 15%, and the relapse rate from 4 to 52 weeks was 75%. There was no sex difference in cessation rates at long-term follow-up. The cessation results and relapse rate from weeks 4 to 52 are consistent with results from published studies, including clinical trials. The estimated cost per life-year saved was£684 and the figure is even lower if the potential future health care cost savings are taken into account at£438 per life-year saved. This compares with the benchmark of£20 000 per life-year saved, which the National Institute for Clinical Excellence (NICE) is using to recommend new health care interventions in the National Health Service. The services were also succeeding in reaching disadvantaged smokers. However, there have been problems, and other health care systems considering an initiative of this kind should: set national training standards and increase training capacitybeforelaunching the services; standardize the provision of pharmaceutical treatments and make them as accessible as possiblebeforelaunching the services; and give the services at least 5 years of central funding to allow them to become well established. Monitoring is extremely important but should not be so much of a burden that it detracts from developing a quality service and although cessation targets can be helpful, care needs to be taken that they are reasonable and do not promote throughput at the expense of quality. [ABSTRACT FROM AUTHOR]

Recognizing the dearth of qualitative research on hepatitis C virus (HCV) infection associated with injecting drug use in the UK, this paper summarizes qualitative insights from a study exploring the social relations of HCV risk management among drug injectors in London. Adopting an inductive approach to data collection and analysis, 59 depth tape-recorded qualitative interviews were undertaken in 2001 with drug injectors recruited via drug user networks. While access to injecting equipment was reportedly good, needle and syringe sharing continued in exceptional circumstances and in the context of ‘trust relationships’. Analyses of drug injectors’ accounts of variations of ‘I never share’ showed that this construction denoted less a descriptor of actual risk behaviour than presentation of perceived risk status. Paraphernalia sharing, including spoons and filters, was common. There was much confusion and uncertainty concerning HCV knowledge, including its medical and transmission risks. Injectors were aware of the provisionality and partiality of their HCV knowledge. Confusion also surrounded the meaning of HCV antibody test results, with some feeling that their positive diagnosis had been ‘trivialized’ by their experiences of HCV testing. Injectors tended to make sense of HCV risk in relation to HIV. With most viewing HCV prevalence as high and HCV transmission as an inevitable consequence of injecting, HCV risk was perceived as ubiquitous and unavoidable. There is an urgent need to renew UK policies of harm reduction in order to support perceptions that HCV is avoidable and preventable. [ABSTRACT FROM AUTHOR]

Aims. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) has produced methodological guidelines for national drug prevalence estimation. This paper pilots the methods to estimate prevalence for Great Britain and provides a commentary on the methods and resulting estimates. Design. Three types of methodology were used to estimate prevalence: (a) the multiple indicator (MI) method, (b) multipliers applied to (i) drug-treatment records (ii) HIV estimates and (iii) mortality statistics and (c) the British/Scottish Crime Surveys. Setting. England, Scotland and Wales. Participants. Aggregated data on people recorded on databases and respondents in household surveys. Measurements. Prevalence estimates of different forms of problematic drug use. Findings. The estimates are 161 133 (range: 120 850-241 700) for people at risk of mortality due to drug overdose; 161 000-169 000 for people who have ever injected drugs; 202 000 (range: 162 000-244 000) problem opiate users and 268 000 problem drug users (all types). Conclusions. The multiple indicator method offers a comprehensive approach to estimating the prevalence of problematic drug use in the United Kingdom. Simple multiplier methods and household surveys also provide a range of estimates corresponding to different types of drug use in the United Kingdom. The current study suggests that previous national estimates of 100 000-200 000 were conservative. The new estimate of 161 000-266 000 should enable a more focused response. For further development of this method, reliable and timely estimates of anchor points are required for specific geographical areas such as cities or Drug Action Teams (DAT), as well as routine aggregation of drug indicators for these areas. [ABSTRACT FROM AUTHOR]

This paper reviews the current practice of injectable opiate treatment (IOT) in the United Kingdom, i.e. the "British system" of prescribing injectable heroin and methadone, and considers some of the clinical and ethical issues it raises. There is very limited research evidence supporting either the safety or effectiveness of IOT as practised in Britain. In particular there is almost no evaluation of long-term outcomes of IOT, which is of potential concern given the possibility of some patients remaining indefinitely in IOT, the risk of vascular complications, and its higher cost compared with oral maintenance. It would be easy to assess this controversial intervention as in need of further research. However, striving towards best practice in IOT involves more than generating evidence. The likelihood of a patient receiving IOT in the United Kingdom appears to be influenced more by the personal inclinations of prescribers than by outcome data (if any), or identified community needs for access to IOT. The author asks is this good clinical practice and is it sustainable? The "British system" needs to modernise itself consistent with international paradigms of continuous quality improvement, and the NHS's own agenda of clinical governance. [ABSTRACT FROM AUTHOR]

Objectives. The aim of this study was to explore in detail the relationship between various social aspects of young people's lives and substance use and differences in the degree of influence exerted by the different social factors as a function of age. Design, setting, participants. The study was a survey of pupils aged 11-16 in a stratified sample of five English schools. Data from 4516 participants were obtained in relation to their cigarette, alcohol and illicit drug use and their contact with the police, perceived academic achievements and future expectations, religious beliefs, family structure, the importance of family versus peer opinions and suspension from school. Measures. Cumulative, age-specific preferences of substance misuse were compared. Logistic regression was used to rank the various risk factors. Results. Substantial differences were found between substance users and non-users and the various risk factors being examined. For example, of those who had only been in trouble with the police, 18.8% used illegal drugs compared with 1.6% of those who had not had a police contact and who had no other risk factors. Many of these relationships were age-sensitive. For instance, the negative relationship between belief in God and illicit drug use became stronger as age increased (non-believers: y = 8.1886x - 9.16 R[sup 2] = 0.9484; believers: y = 5.1514x - 8.08 R[sup 2] = 0.9247). These results suggest that, within this sample of English adolescents, there was a strong relationship between substance use and the social factors examined. Although there were differences depending upon whether cigarette, alcohol or illicit drug use was being modelled, logistic regression indicated that the social factors could be ranked in the following order of importance: concurrent use of the second and third substances, having been in trouble with the police, perceived poor academic performance and low future academic expectations, a lack of religious belief, coming from a non-intact family, favouring peer over family opinion and having been suspended from school. Many of these relationships were age-sensitive with substance use peaking at age 15. Conclusion. The models and relationships presented in this paper show that a constellation of behaviours are related to adolescent substance use. Also demonstrated is that behaviours cannot be considered in isolation, but need to be examined from an holistic or biopsychosocial standpoint. These relationships are complex and future research should consider not only causality of adolescent substance use, but also of the aetiology of the satellite behaviours. [ABSTRACT FROM AUTHOR]

Abstract: Background and aims: Estimating ‘return on investment’ (ROI) from smoking cessation interventions requires reach and effectiveness parameters for interventions for use in economic models such as the EQUIPT ROI tool ( http://roi.equipt.eu). This paper describes the derivation of these parameter estimates for England that can be adapted to create ROI models for use by other countries. Methods: Estimates were derived for interventions in terms of their reach and effectiveness in: (1) promoting quit attempts and (2) improving the success of quit attempts (abstinence for at least 12 months). The sources were systematic reviews of efficacy supplemented by individual effectiveness evaluations and national surveys. Findings: Quit attempt rates were estimated to be increased by the following percentages (with reach in parentheses): 20% by tax increases raising the cost of smoking 5% above the cost of living index (100%); 10% by enforced comprehensive indoor public smoking bans (100%); 3% by mass media campaigns achieving 400 gross rating points (100%); 40% by brief opportunistic physician advice (21%); and 110% by use of a licensed nicotine product to reduce cigarette consumption (12%). Quit success rates were estimated to be increased by the following ratios: 60% by single‐form nicotine replacement therapy (NRT) (5%); 114% by NRT patch plus a faster‐acting NRT (2%);124% by prescribed varenicline (5%); 60% by bupropion (1%); 100% by nortriptyline (0%), 10) 298% by cytisine (0%); 40% by individual face‐to‐face behavioural support (2%); 37% by telephone support (0.5%); 88% by group behavioural support (1%); 63% by text messaging (0.5%); and 19% by printed self‐help materials (1%). There was insufficient evidence to obtain reliable, country‐specific estimates for interventions such as websites, smartphone applications and e‐cigarettes. Conclusions: Tax increases, indoor smoking bans, brief opportunistic physician advice and use of nicotine replacement therapy (NRT) for smoking reduction can all increase population quit attempt rates. Quit success rates can be increased by provision of NRT, varenicline, bupropion, nortriptyline, cytisine and behavioural support delivered through a variety of modalities. Parameter estimates for the effectiveness and reach of these interventions can contribute to return on investment estimates in support of national or regional policy decisions. [ABSTRACT FROM AUTHOR]

The article reflects on the developments of the adolescent smoking cessation services in Great Britain. The author asserted that there have been various attempts to lessen youth smoking including Great Britain government's White Paper entitled Smoking Kills. Key information regarding a new law implemented in England and Wales that raise the cigarette purchasing age limit are also discussed.

The author reflects on a paper by researcher Kim and colleagues that discusses drink driving in Hong Kong. He argues that random breath testing would help to build up the cohort of drivers with those who comply with the law and those who are discouraged by a single offence. He states that road safety is connected with the long-term damage that alcohol can cause; hence it is important to deal with this issue.