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Aims: To measure the association between problem gambling severity and 19 different gambling activities among emerging adults (aged 16–26). Design: An online non‐probability longitudinal survey collecting data in two waves: wave 1, July/August 2019; wave 2, July/October 2020. Setting: Great Britain Participants: A total of 2080 young adults participating in both waves. Measurements Problem gambling scores were collected using the Problem Gambling Severity Index (PGSI). Binary variables recorded past year participation in 19 different gambling forms, ranging from lotteries to online casino and gambling‐like practices within digital games (e.g. loot box purchase, skin betting). Controls included socio‐demographic/economic characteristics, the Eysenck Impulsivity Scale and the number of gambling activities undertaken. Findings Zero inflated negative binomial model lacked evidence of an effect between past year participation in any individual activities and subsequent PGSI scores. However, negative binomial random effects models for current gamblers (n = 497) showed that skin betting (incidence‐rate ratio [IRR] = 2.32; 95% CI = 1.69–3.19), fixed odd betting terminals (IRR = 2.21, 95% CI = 1.61–3.05), slot/fruit machines (IRR = 1.43, 95% CI = 1.07–1.91), online betting on horse/dog races (IRR = 1.53, 95% CI = 1.17–2.00) and online betting on non‐sports events (IRR = 1.44, 95% CI = 1.11–1.89) were associated with increased PGSI scores. Online casino gambling had a significant interaction by wave; the impact of online casino betting in wave 2 on PGSI scores increased by a factor of 1.61. Conclusions: Past year participation of young adults (aged 16–26) in certain forms of gambling does not appear to be associated with future Problem Gambling Severity Index scores. Among young adults who are current gamblers, past year participation in certain land‐based (e.g. electronic gaming machines) and online forms (e.g. skin betting) of gambling appears to be strongly associated with elevated Problem Gambling Severity Index scores. [ABSTRACT FROM AUTHOR]

Aims: To estimate recent trends in the prevalence of disposable e‐cigarette vaping in Great Britain, overall and across ages, and to measure these trends in the context of changes in smoking and vaping prevalence. Design: The Smoking Toolkit Study, a monthly representative cross‐sectional survey. Setting: Great Britain. Participants: A total of 36 876 adults (≥ 18 years) completed telephone interviews between January 2021 and April 2022. Measurements Current e‐cigarette vapers were asked which type of device they mainly use. We estimated age‐specific monthly time trends in the prevalence of current disposable e‐cigarette use among vapers and inhaled nicotine use (vaping/smoking), smoking and vaping among adults. Findings From January 2021 to April 2022, there was an 18‐fold increase in the percentage of vapers who used disposables, rising from 1.2 to 22.2% [prevalence ratio (PR) = 18.0; 95% compatibility interval (CI) = 9.18–49.0]. Growth in disposable e‐cigarette vaping was most pronounced in younger adults (interaction P‐value = 0.013): for example, the percentage of 18‐year‐old vapers using disposables rose from 0.4 to 54.8% (PR = 129; 95% CI = 28.5–4520), while it rose from 2.1 to 10.0% (PR = 4.73; 95% CI = 2.06–23.6) among 45‐year‐old vapers. However, the overall percentage of people currently using any inhaled nicotine remained stable over time both among all adults (20.0 versus 21.2%; PR = 1.06; 95% CI = 0.92–1.22) and among 18‐year‐olds (30.2 versus 29.7%; PR = 0.99; 95% CI = 0.80–1.22). In 18‐year‐olds, vaping prevalence grew (11.3 versus 17.7%; PR = 1.57; 95% CI = 1.12–2.29), and there was imprecise evidence for a decline in smoking (24.5 versus 19.5%; PR = 0.80; 95% CI = 0.63–1.04). In 45‐year‐olds, there was relatively little change in vaping (PR = 1.08; 95% CI = 0.88–1.33) or smoking prevalence (PR = 1.01; 95% CI = 0.88–1.16). Conclusions: Use of disposable e‐cigarettes in Great Britain grew rapidly between 2021 and 2022, especially among younger adults, but the overall prevalence of inhaled nicotine use was stable over time. Most young adult vapers in Great Britain now use disposable products. [ABSTRACT FROM AUTHOR]

Aim: To measure the cost‐effectiveness of adding text message (TMB), exercise (EB) and abstinent‐contingent financial incentive‐based (CFIB) stop smoking interventions to standard smoking cessation support for pregnant women in England. Design: Modelling cost‐effectiveness outcomes by separately adding three cessation interventions to standard cessation care offered to pregnant women in England. English National Health Service Stop Smoking Services (NHS SSS) statistics from 2019 to 2020 were used for estimating the base quit rate. Intervention effectiveness and cost data for interventions were taken from trial reports. Cost‐effectiveness was derived using the economics of smoking in pregnancy (ESIP) model from a health service and personal social services perspective. Interventions were compared with each other as well as against standard cessation care. Setting English NHS SSS. Participants/cases: A total of 13 799 pregnant women who accessed NHS SSS. Interventions and comparator; comparator: standard stop smoking support comprising behavioural intervention and an offer of nicotine replacement therapy (NRT). Three additive interventions were TMB, EB and CFIB. Measurements Incremental cost‐effectiveness ratios per quality‐adjusted life‐years gained for both mothers and offspring over their life‐times; return on investment (ROI); and cost‐effectiveness acceptability curves (CEACs). Findings The addition of any of the interventions compared with standard care alone was preferred, but only significant for the addition of CFIB, with the CEAC suggesting an at least 90% chance of being favoured to standard care alone. When compared against each other CFIB appeared to yield the largest returns, but this was not significant. The estimated ROI for CFIB was £2 [95% confidence interval (CI) = £1–3] in health‐care savings for every £1 spent by the NHS on the cessation intervention. Conclusions: For a health system which currently provides behavioural support and an offer of nicotine replacement therapy as standard stop smoking support for pregnant women, the greatest economic gains would be provided by operating an abstinent‐contingent financial incentives scheme alongside this. [ABSTRACT FROM AUTHOR]

Background and Aims: Loot boxes are purchasable randomised rewards in video games that share structural and psychological similarities with gambling. Systematic review evidence has established reproducible associations between loot box purchasing and both problem gambling and problem video gaming. We aimed to measure the association between loot box engagement and socioeconomic correlates. Design The study was a cross‐sectional online survey using the recruitment platform, Prolific. Setting: United Kingdom (UK). Participants: A cohort of 16 196 UK adults (18 + years) self‐reporting as video gamers. Measurements Respondents were asked about their game‐related purchasing behaviour (including loot boxes), recent monthly spend on loot boxes and gambling engagement (gambling in any form; gambling online; playing 'social casino' games). A range of demographic variables were simultaneously captured, including age, sex, ethnicity, earnings, employment and educational attainment. Findings Overall, 17.16% of gamers in our cohort purchased loot boxes, with a mean self‐reported monthly spend of £29.12. These loot box purchasers are more likely to gamble (45.97% gamble) than people who make other types of game‐related purchases (on aggregate, 28.13% of non‐loot box purchasers gamble), and even greater still than those who do not make any game related purchases (24.38% gamble P < 0.001). Loot box engagement (as binary yes/no or as monthly spend normalised to earnings) was significantly associated with younger age (P < 0.001 and P < 0.001; respectively, for binary yes/no and monthly spend, adjusted for false discovery rate correction), male sex (P < 0.001 and P = 0.025), non‐university educational attainment (P < 0.001 and P < 0.001) and unemployment (P = 0.003 and P = < 0.001). Lower earners spent a higher proportion of monthly earnings on loot boxes (P < 0.001). Conclusions: The demographic associations of video game loot box engagement (younger age, male sex, non‐university educational attainment and unemployment) mirror those of other addictive and problematic behaviours, including disordered gambling, drug and alcohol misuse. [ABSTRACT FROM AUTHOR]

Background and Aims: The three-question Alcohol Use Disorders Identification Test (AUDIT-C) is frequently used in healthcare for screening and brief advice about levels of alcohol consumption. AUDIT-C scores (0-12) provide feedback as categories of risk rather than estimates of actual alcohol intake, an important metric for behaviour change. The study aimed to (i) develop a continuous metric from the Extended AUDIT-C expressed in United Kingdom (UK) units (8 g pure ethanol), offering equivalent accuracy, and providing a direct estimator of weekly alcohol consumption (EWAC) and (ii) evaluate the EWAC's bias and error using the graduated-frequency (GF) questionnaire as a reference standard of alcohol consumption. Design: Cross-sectional diagnostic study based on a nationally-representative survey. Settings: Community dwelling households in England. Participants: A total of 22 404 household residents aged =16 years reporting drinking alcohol at least occasionally. Measurements: Computer-assisted personal interviews consisting of (i) AUDIT questionnaire with extended response items (the 'Extended AUDIT') and (ii) GF. Primary outcomes were: mean deviation <1 UK unit (metric of bias); root-mean-square deviation <2 UK units (metric of total error) between EWAC and GF. The secondary outcome was the receiver operating characteristic area under the curve for predicting alcohol consumption in excess of 14 and 35 UK units. Findings: EWAC had a positive bias of 0.2 UK units (95% CI = 0.08, 0.4) compared with GF. Deviations were skewed: whereas the mean error was 11 UK units/week [9.5, 11.9], in half of participants the deviation between EWAC and GF was between 0 and 2.1 UK units/week. EWAC predicted consumption in excess of 14 UK units/week with a significantly greater area under the curve (0.918 [0.914, 0.923]) than AUDIT-C (0.870 [0.864, 0.876]) or the full AUDIT (0.854 [0.847, 0.860]). Conclusions: A new estimator of weekly alcohol consumption, which uses answers to the Extended AUDIT-C, meets the targeted bias tolerance. It is superior in accuracy to AUDIT-C and the full 10-item AUDIT when predicting consumption thresholds, making it a reliable complement to the Extended AUDIT-C for health promotion interventions. [ABSTRACT FROM AUTHOR]

Background and Aims: Given the decline in alcohol consumption and rise in technological use among young people, there is a need to investigate whether technology use might influence how young people drink. This study explores how social media use and changes in social media use over time could affect alcohol use among youths. Design The UK Household Longitudinal Study (Understanding Society). Setting: United Kingdom. Participants: Participants aged 10–15 (n = 4093) and 16–19 (n = 2689) from the youth and main survey interviewed in 2011–13, and followed‐up in 2014–16 (aged 10–15 n = 2588, aged 16–19 n = 1057). Measurements Self‐reported social media usage on an average day (no profile/non‐daily/less than an hour/1–3/4+ hours use), drinking frequency (never/one to three times/weekly) and binge drinking frequency (never/one to two/three/more than three times) in the past month. Covariates included sex, age, educational status, household income, urban/rural, number of friends and life satisfaction. Findings Among 10–15‐year‐olds, compared with those who used social media for less than an hour, those with no profile [odds ratio (OR) = 0.41, 95% confidence interval (CI) = 0.25–0.67] and non‐daily users (OR = 0.49, 95% CI = 0.33–0.72) had a lower risk of drinking at least monthly, whereas those with 1–3 hours' use (OR = 1.44, 95% CI = 1.14–1.81) and 4+ hours' use (OR = 2.08, 1.47–2.95) had a greater risk. Among participants aged 16–19, a lower risk of binge drinking three or more times per month was found for those with no profile [relative risk ratios (RRR) = 0.29, 95% CI = 0.17–0.48] and a higher risk for those with 4+ hours' use (RRR = 1.47, 95% CI = 1.03–2.09). Longitudinally, among 10–15‐year‐olds, those who had increased their social media usage versus no change were more likely to have increased their drinking frequency (OR = 1.89, 95% CI = 1.45–2.46). Some social media use at baseline (rather than none) was predictive of increased drink and binge drinking frequency over time among youths and young adults. Conclusions: Heavier social media use was associated with more frequent alcohol consumption among young people in the United Kingdom. [ABSTRACT FROM AUTHOR]

Background and aims: Evidence on the effectiveness of electronic cigarettes (ECs) to facilitate abstinence from smoking is limited. The current study aimed to estimate the relative effectiveness of ECs and smoking cessation medication compared with using no help, accounting for frequency of use of ECs. Design Four consecutive wave‐to‐wave transitions (waves 1–2, 2–3, 3–4 or 4–5) of a longitudinal online survey collected between 2012 and 2017 were analysed. Time between waves ranged between 12 and 17 months. Cigarette smokers at the baseline wave who attempted to quit smoking between waves were included. Setting: United Kingdom Participants: A total of 1155 respondents (aged 18–81, 56.1% male, 64.6% in social grade C2DE, 93.8% white) provided 1580 pairs of observations for the primary analysis. Measurements Primary outcome: abstinence from smoking for at least 1 month at follow‐up; secondary outcome: at least 1 month's abstinence from smoking between baseline and follow‐up. The main predictor was stop smoking aid used (No help, nicotine replacement therapy only, smoking cessation medication only, disposable/cartridge EC, refill/modular EC, combination), adjusted for demographics. Findings: Primary Compared with using no help, the odds of abstinence were increased by daily use of disposable/cartridge ECs (OR = 3.31 (1.32, 8.26), P =.010) and daily use of refill/modular ECs (OR = 5.47 (2.70, 11.11), P <.001). Odds were reduced by non‐daily use of disposable/cartridge ECs (OR = 0.23 (0.08–0.63), P =.005), and by use of disposable/cartridge ECs to quit and no longer using at follow‐up (OR = 0.10 (0.16–0.62), P <.013). Secondary Results were similar to the primary outcome; however, odds of abstinence were also increased by use of smoking cessation medication (OR = 4.15 (1.79, 9.62), P =.001). Conclusions: When used daily, electronic cigarettes appear to facilitate abstinence from smoking when compared with using no help. [ABSTRACT FROM AUTHOR]

Background and Aims: Past research has found that young smokers are more likely to make quit attempts; however, there are conflicting findings regarding age and quit success. This study examined the degree to which smoker age is related to making quit attempts and quit success. Design Ten waves of the International Tobacco Control Policy Cohort survey (ITC‐4C) collected between 2002 and 2014, with nine wave‐to‐wave transitions with predictors at the first wave predicting quit attempts and success by the next wave. Setting: Canada, the United States, the United Kingdom and Australia. Participants: Data from 15 874 smokers categorized into four age groups at baseline (18–24, 25–39, 40–54 and 55+ years). Measurements Age, quit attempts and success (defined as ≥ 30 days abstinence confirmed, if possible, on a third wave for recent attempts). Findings Older smokers were more likely to smoke daily (χ2 = 1557.86, r = 0.136, P < 0.001) than younger smokers. Daily smokers were less likely to report quit attempts (38.1 versus 58.2%) and to achieve 30 days of abstinence (22.9 versus 34.3%) than non‐daily smokers. Older daily smokers were less likely to make quit attempts [0.61, confidence interval (CI) = 0.54–0.70, P < 0.001], even after controlling for indicators of nicotine dependence, country, sex, education, income, relationship status and household composition, than younger smokers. Younger smokers (< 25) were more likely to succeed for at least 30 days of abstinence, but only when compared with those aged 40–54 (OR = 0.83, 95% CI = 0.68–0.99). However, when controlling for heaviness of smoking the age effect disappeared. Significant interactions with age were found between age and intention when predicting quit attempts, and age and heaviness of smoking when predicting quit success. Conclusions: An international cohort study indicates that young smokers are more likely to attempt to quit and appear to have similar levels of success in abstaining from smoking compared with older smokers when controlling for dependence. Quit success in all ages is most predicted by lower levels of nicotine dependence. [ABSTRACT FROM AUTHOR]

Background and Aims: The same information may be perceived differently, depending on how it is described. The risk information given on many gambling warning labels tends to accentuate what a gambler might expect to win, e.g. 'This game has an average percentage payout of 90%' (return‐to‐player), rather than what a gambler might expect to lose, e.g. 'This game keeps 10% of all money bet on average' (house‐edge). We compared gamblers' perceived chances of winning and levels of warning label understanding under factually equivalent return‐to‐player and house‐edge formats. Design Online surveys: experiment 1 was designed to test how gamblers' perceived chances of winning would vary under equivalent warning labels, and experiment 2 explored how often equivalent warning labels were correctly understood by gamblers. Setting: United Kingdom. Participants: UK nationals, aged 18 years and over and with experience of virtual on‐line gambling games, such as on‐line roulette, were recruited from an on‐line crowd‐sourcing panel (experiment 1, n = 399; experiment 2, n = 407). Measurements The main dependent variables were a gambler's perceived chances of winning on a seven‐point Likert scale (experiment 1) and a multiple‐choice measure of warning label understanding (experiment 2). Findings The house‐edge label led to lower perceived chances of winning in experiment 1, F(1, 388) = 19.03, P < 0.001. In experiment 2, the house‐edge warning label was understood by more gamblers [66.5, 95% confidence interval (CI) = 60.0%, 73.0%] than the return‐to‐player warning label (45.6%, 95% CI = 38.8%, 52.4%, z = 4.22, P < 0.001). Conclusions: House‐edge warning labels on electronic gambling machines and on‐line casino games, which explain what a gambler might expect to lose, could help gamblers to pay greater attention to product risk and would be better understood by gamblers than equivalent return‐to‐player labels. [ABSTRACT FROM AUTHOR]

Aim: To assess (1) how far smoking patterns, depression and smoking‐related beliefs and intentions predict vaping uptake, current vaping and vaping frequency among daily smokers; and (2) how far the aforementioned predictors and baseline vaping frequency predict current vaping among those who reported ever vaped. Design Analysis of data from six waves of a longitudinal survey over 8 years. Longitudinal associations between predictors and outcomes were examined using multi‐level models. Setting: United Kingdom, United States, Canada and Australia. Participants: A total of 6296 daily smokers (53% females) who contributed data to at least two consecutive survey waves. Measurements The outcome variables were vaping uptake, vaping frequency and current vaping at follow‐up. The key predictor variables, measured in previous waves, were time to first cigarette, cigarettes smoked per day, depressive symptoms, intention to quit smoking, quitting self‐efficacy and worry about adverse health effects of smoking. Findings Number of cigarettes smoked daily was associated with (1) subsequent vaping uptake [odds ratio (OR) = 1.69, 95% confidence interval (CI) = 1.19, 2.39 for 30+ cigarette per day; reference category: 0–10 cigarettes] and (2) a higher frequency of current vaping (OR = 1.97, 95% CI = 1.36, 2.85 for 30+ cigarettes). Intention to quit was associated with a higher frequency of current vaping (OR = 1.48, 95% CI = 1.21, 1.82). Among those who reported ever vaped, higher baseline vaping frequency (OR = 11.98, 95% CI = 6.00, 23.93 for daily vaping at baseline; reference category: vaped less than monthly) predicted current vaping. Conclusion: Among daily smokers, amount smoked and intention to quit smoking appear to predict subsequent vaping uptake. Vaping frequency at baseline appears to predict current vaping at follow‐up. [ABSTRACT FROM AUTHOR]

Background and aims: E‐cigarettes (EC) and nicotine replacement therapy (NRT) are less harmful than smoking, but misperceptions of relative harm are common. Aims were to (1) assess nicotine knowledge and perceptions of: harm of EC and NRT relative to smoking, addictiveness of EC relative to smoking, and change in harm to user if smoking replaced with EC; (2) define associations of these perceptions with respondent characteristics including nicotine knowledge; and (3) explore perceived main harms of EC and whether these differ by vaping status. Design Analyses were: (1) frequencies; (2) logistic regressions of perceptions of relative harm, addictiveness and change in harm onto demographics, smoking and vaping status and nicotine knowledge (attributing cancer or health risks of smoking to nicotine); and (3) frequencies and χ2 statistics. Setting and participants: Participants were smokers and recent ex‐smokers from one wave (September 2017) of a longitudinal online survey in the United Kingdom (n = 1720). Measurements Demographics included gender, age, smoking status, vaping status and income. Survey questions collected data on nicotine knowledge and harm perceptions of different products; the relative harm perceptions of NRT, EC and tobacco cigarettes; and perceived main harms of EC. Findings Relative to smoking, 57.3% perceived EC and 63.4% NRT to be less harmful; 25.4% perceived EC to be less addictive; and 32.2% thought replacing smoking with EC reduced health harms a great deal. Participants were less likely to endorse these beliefs if they had never vaped, and participants who had inaccurate nicotine knowledge were less likely to endorse all these beliefs apart from the addictiveness of EC. The main concerns about EC were a lack of research (48.3%), regulation or quality control (37.8%) and harmfulness of chemicals (41.6%). Conclusions: Large proportions of UK smokers and ex‐smokers overestimate the relative harmfulness of e‐cigarettes and nicotine replacement therapy compared with smoking; misattributing smoking harms to nicotine is associated with increased misperceptions. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the cost‐effectiveness of needle and syringe programmes (NSPs) compared with no NSPs on hepatitis C virus (HCV) transmission in the United Kingdom. Design Cost‐effectiveness analysis from a National Health Service (NHS)/health‐provider perspective, utilizing a dynamic transmission model of HCV infection and disease progression, calibrated using city‐specific surveillance and survey data, and primary data collection on NSP costs. The effectiveness of NSPs preventing HCV acquisition was based on empirical evidence. Setting and participants: UK settings with different chronic HCV prevalence among people who inject drugs (PWID): Dundee (26%), Walsall (18%) and Bristol (45%) Interventions: Current NSP provision is compared with a counterfactual scenario where NSPs are removed for 10 years and then returned to existing levels with effects collected for 40 years. Measurements HCV infections and cost per quality‐adjusted life year (QALY) gained through NSPs over 50 years. Findings Compared with a willingness‐to‐pay threshold of £20 000 per QALY gained, NSPs were highly cost‐effective over a time‐horizon of 50 years and decreased the number of HCV incident infections. The mean incremental cost‐effectiveness ratio was cost‐saving in Dundee and Bristol, and £596 per QALY gained in Walsall, with 78, 46 and 40% of simulations being cost‐saving in each city, respectively, with differences driven by coverage of NSP and HCV prevalence (lowest in Walsall). More than 90% of simulations were cost‐effective at the willingness‐to‐pay threshold. Results were robust to sensitivity analyses, including varying the time‐horizon, HCV treatment cost and numbers of HCV treatments per year. Conclusions: Needle and syringe programmes are a highly effective low‐cost intervention to reduce hepatitis C virus transmission, and in some settings they are cost‐saving. Needle and syringe programmes are likely to remain cost‐effective irrespective of changes in hepatitis C virus treatment cost and scale‐up. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To estimate differences in the strength and shape of associations between alcohol use and diagnosis‐specific sickness absence. Design: A multi‐cohort study. Participants (n = 47 520) responded to a survey on alcohol use at two time‐points, and were linked to records of sickness absence. Diagnosis‐specific sickness absence was followed for 4–7 years from the latter survey. Setting and participants: From Finland, we had population cohort survey data from 1998 and 2003 and employee cohort survey data from 2000–02 and 2004. From France and the United Kingdom, we had employee cohort survey data from 1993 and 1997, and 1985–88 and 1991–94, respectively. Measurements: We used standard questionnaires to assess alcohol intake categorized into 0, 1–11 and > 11 units per week in women and 0, 1–34 and > 34 units per week in men. We identified groups with stable and changing alcohol use over time. We linked participants to records from sickness absence registers. Diagnoses of sickness absence were coded according to the International Classification of Diseases. Estimates were adjusted for sex, age, socio‐economic status, smoking and body mass index. Findings: Women who reported drinking 1–11 units and men who reported drinking 1–34 units of alcohol per week in both surveys were the reference group. Compared with them, women and men who reported no alcohol use in either survey had a higher risk of sickness absence due to mental disorders [rate ratio = 1.51, 95% confidence interval (CI) = 1.22–1.88], musculoskeletal disorders (1.22, 95% CI = 1.06–1.41), diseases of the digestive system (1.35, 95% CI = 1.02–1.77) and diseases of the respiratory system (1.49, 95% CI = 1.29–1.72). Women who reported alcohol consumption of > 11 weekly units and men who reported alcohol consumption of > 34 units per week in both surveys were at increased risk of absence due to injury or poisoning (1.44, 95% CI = 1.13–1.83). Conclusions: In Finland, France and the United Kingdom, people who report not drinking any alcohol on two occasions several years apart appear to have a higher prevalence of sickness absence from work with chronic somatic and mental illness diagnoses than those drinking below a risk threshold of 11 units per week for women and 34 units per week for men. Persistent at‐risk drinking in Finland, France and the United Kingdom appears to be related to increased absence due to injury or poisoning. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To estimate the association between implementation of a community‐based multi‐component intervention (Drink Less Enjoy More) and sales of alcohol to pseudo‐intoxicated patrons and nightlife patron awareness of associated legislation. Design: Cross‐sectional pre‐intervention and follow‐up measurements, including alcohol test purchases (using pseudo‐intoxicated patrons) in licensed premises (stratified random sample; 2013, 2015) and a survey with nightlife patrons (convenience sample; 2014, 2015). Setting: One UK municipality with a large night‐time economy. Participants: Licensed premises (pre = 73; follow‐up = 100); nightlife patrons (pre = 214; follow‐up = 202). Intervention: The Drink Less Enjoy More intervention included three interacting components: community mobilization and awareness‐raising; responsible bar server training; and active law enforcement of existing legislation prohibiting sales of alcohol to, and purchasing of alcohol for, a person who appears to be alcohol intoxicated: ‘intoxicated’, herein for economy. Measurements: The primary outcomes were alcohol service refusal to pseudo‐intoxicated patrons and nightlife patron knowledge of alcohol legislation (illegal to sell alcohol to, and purchase alcohol for, intoxicated people), adjusted for potential confounders including characteristics of the area, venue, test purchase and nightlife patron. Findings: Pre‐intervention, 16.4% of alcohol sales were refused, compared with 74.0% at follow‐up (P < 0.001). In adjusted analyses, the odds of service refusal were higher at follow‐up [adjusted odds ratio (aOR) = 14.63, P < 0.001]. Service refusal was also associated with server gender and patron drunkenness within the venue. Among drinkers, accurate awareness of alcohol legislation was higher at follow‐up (sales: pre = 44.5%; follow‐up = 66.0%; P < 0.001/purchase: pre = 32.5%; follow‐up = 56.0%; P < 0.001). In adjusted analyses, knowledge of legislation was higher at follow‐up (sales: aOR = 2.73, P < 0.001; purchasing: aOR = 2.73, P < 0.001). Knowledge of legislation was also associated with participant age (purchasing) and expectations of intoxication (sales). Conclusion: A community‐based multi‐component intervention concerning alcohol sales legislation in the United Kingdom (UK) was associated with a reduction in sales of alcohol to pseudo‐intoxicated patrons in on‐licensed premises in a UK nightlife setting and an improvement in nightlife patron awareness of associated legislation. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To estimate predictors of time to smoking relapse and test if prediction varied by quit duration. Design: Longitudinal cohort data from the International Tobacco Control Four‐Country survey with annual follow up collected between 2002 and 2015. Setting: Canada, United States, United Kingdom and Australia. Participants: A total of 9171 eligible adult smokers who had made at least one quit attempt during the study period. Measurements: Time to relapse was the main outcome. Predictor variables included pre‐quit baseline measures of nicotine dependence, smoking and quitting‐related motivations, quitting capacity and social influence, and also two post‐quit measures, use of stop‐smoking medications and quit duration (1–7 days, 8–14 days, 15–31 days, 1–3 months, 3–6 months, 6–12 months, 1–2 years and 2+ years), along with socio‐demographics. Findings: All factors were predictive of relapse within the first 6 months of quitting but only wanting to quit, quit intentions and number of friends who smoke were still predictive of relapse in the 6–12‐month period of quitting [hazard ratios (HR) = 1.20, P < 0.05; 1.13, P < 0.05; and 1.21, P < 0.001, respectively]. Number of friends smoking was the only remaining predictor of relapse in the 1–2 years quit period (HR = 1.19, P = 0.001) with none predictive beyond the 2‐year quit period. Use of stop‐smoking medications during quit attempts was related negatively to relapse during the first 2 weeks of quitting (HR = 0.71–0.84), but related positively to relapse in the 1–6‐month quit period (HR = 1.29–1.54). Predictive effects of all factors showed significant interaction with quit duration except for perceiving smoking as an important part of life, prematurely stubbing out a cigarette and wanting to quit. Conclusions: Among adult smokers in the United States, Canada, United Kingdom and Australia, factors associated with smoking relapse differ between the early and later stages of a quit attempt, suggesting that the determinants of relapse change as a function of abstinence duration. [ABSTRACT FROM AUTHOR]

Background and Aims The Cochrane Tobacco Addiction Group (TAG) conducts systematic reviews of the evidence for tobacco cessation and prevention interventions. In 2016 TAG conducted a priority-setting, stakeholder engagement project to identify where further research is needed in the areas of tobacco control and smoking cessation. Design The project comprised two surveys and a workshop. A range of stakeholders participated, including members of the public (smokers and ex-smokers), clinicians, researchers, research funders, health-care commissioners and public health organizations. The first survey phase identified unanswered research questions in the field of tobacco control. The second phase asked participants to rank these, with overall rankings calculated by combining scores across participants. The workshop allowed attendees to discuss prioritization of topics and questions in more depth. Workshop discussions were transcribed and analysed thematically, and a final voting activity at the close of the workshop allowed participants to choose topics to prioritize and to de-prioritize. Findings A total of 304 stakeholders (researchers, health professionals, smokers and ex-smokers, guideline developers, research funders and policymakers, representing 28 countries) identified 183 unanswered research questions. These were categorized into 15 research categories. A total of 175 participants prioritized categories and questions in the second survey phase, with 'electronic cigarettes'; 'addressing inequalities'; and 'mental health and other substance abuse' prioritized as the top three categories. Forty-three stakeholders attended the workshop and discussed reasons for and against category prioritization. Prioritized research categories largely mirrored those in the survey stage, although 'treatment delivery' also emerged as a key category. Five cross-cutting themes emerged: efficacy; relative efficacy; cost effectiveness; addressing inequalities; and different types of evidence. Conclusions There are many unanswered questions in the field of tobacco control. Stakeholders highlighted electronic cigarettes, addressing inequalities and mental health and other substance abuse as key areas for further research, and efficacy, relative efficacy, cost-effectiveness and use of non-randomized studies as important themes cutting across research areas. Future prioritization work would benefit from targeting non-US and non-UK stakeholders explicitly and from examining where priorities may differ based on stakeholder group. [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]

The authors comment on consultation that the British government is undergoing via population surveys to reform the UK 2005 Gambling Act. Topics covered include the methodological limitations of the telephone surveys carried out by the Gambling Commission (GC) as well as the British Gambling Prevalence Survey (BGPS) and Health Survey England (HSE), the proneness to error of prevalence surveys, and the ability of the surveys to capture the true nature of the extent of gambling-related harm.

Background and aims Analytical approaches to addressing survey non-participation bias typically use only demographic information to improve estimates. We applied a novel methodology which uses health information from data linkage to adjust for non-representativeness. We illustrate the method by presenting adjusted alcohol consumption estimates for Scotland. Design Data on consenting respondents to the Scottish Health Surveys (SHeSs) 1995-2010 were linked confidentially to routinely collected hospital admission and mortality records. Synthetic observations representing non-respondents were created using general population data. Multiple imputation was performed to compute adjusted alcohol estimates given a range of assumptions about the missing data. Adjusted estimates of mean weekly consumption were additionally calibrated to per-capita alcohol sales data. Setting Scotland. Participants 13 936 male and 18 021 female respondents to the SHeSs 1995-2010, aged 20-64 years. Measurements Weekly alcohol consumption, non-, binge- and problem-drinking. Findings Initial adjustment for non-response resulted in estimates of mean weekly consumption that were elevated by up to 17.8% [26.5 units (18.6-34.4)] compared with corrections based solely on socio-demographic data [22.5 (17.7-27.3)]; other drinking behaviour estimates were little changed. Under more extreme assumptions the overall difference was up to 53%, and calibrating to sales estimates resulted in up to 88% difference. Increases were especially pronounced among males in deprived areas. Conclusions The use of routinely collected health data to reduce bias arising from survey non-response resulted in higher alcohol consumption estimates among working-age males in Scotland, with less impact for females. This new method of bias reduction can be generalized to other surveys to improve estimates of alternative harmful behaviours. [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]

Aims To determine whether signs of current depression predict attempts to quit smoking, and short-term abstinence among those who try, and to test moderating effects of gender and cessation support (pharmacological and behavioural). Design Prospective cohort with approximately annual waves. Among smokers at one wave we assessed outcomes at the next wave using mixed-effects logistic regressions. Setting Waves 5-8 of the Four Country International Tobacco Control Study: a quasi-experimental cohort study of smokers from Canada, USA, UK and Australia. Participants A total of 6811 tobacco smokers who participated in telephone surveys. Measurements Three-level depression index: (1) neither low positive affect (LPA) nor negative affect (NA) in the last 4 weeks; (2) LPA and/or NA but not diagnosed with depression in the last 12 months; and (3) diagnosed with depression. Outcomes were quit attempts and 1-month abstinence among attempters. Findings Depression positively predicted quit attempts, but not after controlling for quitting history and motivational variables. Controlling for all covariates, depression consistently negatively predicted abstinence. Cessation support did not moderate this effect. There was a significant interaction with gender for quit attempts ( P = 0.018) and abstinence ( P = 0.049) after controlling for demographics, but not after all covariates. Depression did not predict abstinence among men. Among women, depressive symptoms [odds ratio (OR) = 0.63, 95% confidence interval (CI) = 0.49-0.81] and diagnosis (OR = 0.46, 95% CI = 0.34-0.63) negatively predicted abstinence. Conclusions Smokers with depressive symptoms or diagnosis make more quit attempts than their non-depressed counterparts, which may be explained by higher motivation to quit, but they are also more likely to relapse in the first month. These findings are stronger in women than men. [ABSTRACT FROM AUTHOR]

Aims To determine whether abstinence or relapse on a quit attempt in the previous year is associated with current depressive symptoms. Design Prospective cohort with approximately annual waves. Mixed-effect logistic regressions tested whether time 2 (T2) quitting status was associated with reporting symptoms at T2, and whether time 1 (T1) symptoms moderated this relationship. Setting Waves 5-8 of the Four-Country International Tobacco Control Study: a quasi-experimental cohort study of smokers from Canada, the United States, the United Kingdom and Australia. Participants A total of 6978 smokers who participated in telephone surveys. Measurements T1 and T2 depressive symptoms in the last 4 weeks were assessed with two screening items from the PRIME-MD questionnaire. Quitting status at T2: (1) no attempt since T1; (2) attempted and relapsed; and (3) attempted and abstinent at T2. Findings Compared with no attempt, relapse was associated with reporting T2 symptoms [odds ratio (OR) = 1.46, 95% confidence interval (CI) = 1.33, 1.59]). Associations between T2 quitting status and T2 symptoms were moderated by T1 symptoms. Relapse was associated positively with T2 symptoms for those without T1 symptoms (OR = 1.71, 95% CI = 1.45, 2.03) and those with T1 symptoms (OR = 1.45, 95% CI = 1.23, 1.70). Abstinence was associated positively for those without T1 symptoms (OR = 1.37, 95% CI = 1.10, 1.71) and negatively for those with T1 symptoms (OR = 0.74, 95% CI = 0.59, 0.94). Age moderated these associations significantly. Relapse did not predict T2 symptoms for those aged 18-39 irrespective of T1 symptoms. The negative effect of abstinence on T2 symptoms for those with T1 symptoms was significant only for those aged 18-39 (OR = 0.61, 95% CI = 0.40, 0.94) and 40-55 (OR = 0.58, 95% CI = 0.40, 0.84). The positive effect of abstinence on T2 symptoms for those without T1 symptoms was significant only for those aged more than 55 (OR =1.97, 95% CI = 1.35, 2.87). Conclusions Most people who stop smoking appear to be at no greater risk of developing symptoms of depression than if they had continued smoking. However, people aged more than 55 who stop smoking may be at greater risk of developing symptoms of depression than if they had continued smoking. [ABSTRACT FROM AUTHOR]

Aims To estimate associations between smoking initiation, smoking persistence and smoking heaviness and caffeine consumption in two population-based samples from the Netherlands and the United Kingdom. Design Observational study employing data on self-reported smoking behaviour and caffeine consumption. Setting Adults from the general population in the Netherlands and the United Kingdom. Participants Participants from the Netherlands Twin Register [NTR: n = 21 939, mean age 40.8, standard deviation (SD) = 16.9, 62.6% female] and the Avon Longitudinal Study of Parents and Children (ALSPAC: n = 9086, mean age 33.2, SD = 4.7, 100% female). Measurements Smoking initiation (ever versus never smoking), smoking persistence (current versus former smoking), smoking heaviness (number of cigarettes smoked) and caffeine consumption in mg per day through coffee, tea, cola and energy drinks. Findings After correction for age, gender (NTR), education and social class (ALSPAC), smoking initiation was associated with consuming on average 52.8 [95% confidence interval (CI) = 45.6-60.0; NTR] and 59.5 (95% CI = 51.8-67.2; ALSPAC) mg more caffeine per day. Smoking persistence was also associated with consuming more caffeine [+57.9 (95% CI = 45.2-70.5) and +83.2 (95% CI = 70.2-96.3) mg, respectively]. Each additional cigarette smoked per day was associated with 3.7 (95% CI = 1.9-5.5; NTR) and 8.4 (95% CI = 6.9-10.0; ALSPAC) mg higher daily caffeine consumption in current smokers. Smoking was associated positively with coffee consumption and less strongly with cola and energy drinks. For tea, associations were positive in ALSPAC and negative in NTR. Conclusions There appears to be a positive association between smoking and caffeine consumption in the Netherlands and the United Kingdom. [ABSTRACT FROM AUTHOR]

Commentary to: How can we conceptualize behavioural addiction without pathologizing common behaviours? [ABSTRACT FROM AUTHOR]