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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]

The author discusses a paper by B. Sornpaisarn and colleagues, which shows that two-chosen-one (2C1) taxation generates higher average tax rate and results in lower alcohol consumption compared individually to the specific tax or the ad valorem tax. The importance of 'tax rate tipping point' for 2C1 is mentioned. In the author's opinion, specific taxation rates should be linked to an inflation index.

ABSTRACT Aim Prevention of drinking initiation is a significant challenge in low- and middle-income countries that have a high prevalence of abstainers, including life-time abstainers. This paper aims to encourage a debate on an alternative alcohol taxation approach used currently in Thailand, which aims specifically to prevent drinking initiation in addition to reduce alcohol-attributable harms. Methods Theoretical evaluation, simulation and empirical analysis. Result The taxation method of Thailand, 'Two-Chosen-One' (2C1) combines specific taxation (as a function of the alcohol content) and ad valorem taxation (as a function of the price), resulting in an effective tax rate that puts a higher tax both on beverages which are preferred by heavy drinkers and on beverages which are preferred by potential alcohol consumption neophytes, compared to either taxation system alone. As a result of these unique properties of the 2C1 taxation system, our simulations indicate that 2C1 taxation leads to a lower overall consumption than ad valorem or specific taxation alone. In addition, it puts a relatively high tax on beverages attractive to young people, the majority of whom are currently abstaining. Currently, the abstention rates in Thailand are higher than expected based on its economic wealth, which could be taken as an indication that the taxation strategy is successful. Conclusion 'Two-chosen-one' (2C1) taxation has the potential to simultaneously reduce alcohol consumption and prevent drinking initiation among youth; however, additional empirical evidence is needed to assess its effectiveness in terms of the public health impact in low- and middle-income countries. [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: On 1 May 2018, Scotland became the first country in the world to introduce minimum unit pricing (MUP), a strength‐based floor price below which alcohol cannot be sold, across all alcoholic beverages. The legislation contains a sunset clause meaning a comprehensive mixed‐methods evaluation of its impact across a range of outcomes will inform whether it will continue beyond its sixth year. In this study, we assessed the impact of MUP on off‐trade alcohol sales (as a proxy for consumption) after its first year. Design, Setting and Participants: Controlled interrupted time–series regression was used to assess the impact of MUP on alcohol sales among off‐trade retailers in Scotland in the year after it was introduced, with England and Wales (EW) being the control group. In adjusted analyses, we included household disposable income, on‐trade alcohol sales and substitution between beverage categories as covariates. Measurements Weekly data on the volume of pure alcohol sold by off‐trade retailers in Scotland and EW between January 2013 and May 2019, expressed as litres of pure alcohol per adult. Findings The introduction of MUP in Scotland was associated with a 3.5% [95% confidence interval (CI) = 2.2–4.9%] reduction in off‐trade alcohol sales per adult after adjustment for the best available geographical control, disposable income and substitution. In unadjusted analysis, the introduction of MUP was associated with a 2.0% (95% CI = 0.4–3.6%) reduction in off‐trade alcohol sales per adult in Scotland. In EW, there was a 2.4% (95% CI = 0.8–4.0%) increase during the same time‐period. The reduction in off‐trade alcohol sales in Scotland was driven by reduced sales of spirits, cider and perry beverage categories. Conclusion: The implementation of minimum unit pricing for alcohol in Scotland in 2018 appears to have been associated with a reduction in off‐trade alcohol sales after its first year. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to examine if there is an interaction between alcohol use and human development in terms of their associations with alcohol‐attributable health harms. Design Statistical modelling of global country‐ and region‐specific data from 2016. Setting: Global. Participants/Cases: The units of the analyses were countries (n = 180) and regions (n = 4) based on their Human Development Index (HDI). Measurements Alcohol‐attributable harms [deaths, years of life lost (YLL), years lived with disability (YLD) and disability‐adjusted life years (DALYs) lost] and risk relations were based on a recent study using World Health Organization (WHO) estimates for 2016. Human development was measured using the HDI, a summary score of life expectancy, education and gross national income from the United Nations Development Programme. Interactions between HDI and adult per‐capita consumption (APC) affecting alcohol‐attributable harms were assessed using likelihood ratio tests. Differences in alcohol‐attributable harms per litre of APC between HDI groups were assessed using regression analyses and a reference group of low HDI. Findings APC is associated with alcohol‐attributable deaths, YLL, YLDs and DALYs lost, while HDI is associated with alcohol‐attributable deaths, YLL and DALYs lost. Statistical analyses indicated there is an interaction between HDI and APC in their associations with alcohol‐attributable deaths, YLL and DALYs lost per 100 000 people. The alcohol‐attributable burden was highest in low HDI countries, with 11.65 [95% confidence interval (CI) = 10.75, 12.40] deaths and 495.61 (95% CI = 461.83, 569.23) DALYs lost per 100 000 people per litre of APC, and lowest in very high HDI countries, with 4.15 (95% CI = 2.46, 5.71) deaths and 200.31 (95% CI = 122.78, 265.10) DALYs lost per 100 000 people per litre of APC. However, no statistical differences between low and very high HDI groupings for these burdens were observed. Conclusions: There appears to be an interaction between the Human Development Index and alcohol use in their associations with alcohol‐attributable deaths, years of life lost and disability‐adjusted life years lost but not with alcohol‐attributable years lived with disability. Alcohol appears to have a stronger harmful impact per litre of alcohol consumed in lesser developed countries than in developed countries. [ABSTRACT FROM AUTHOR]

Aims: To estimate associations between both current‐ and prior‐year medical cannabis dispensary densities and hospitalizations for cannabis use disorder in California, USA between 2013 and 2016. Design Spatial analysis of ZIP code‐level hospitalization discharge data using Bayesian Poisson hierarchical space–time models over 4 years. Setting and cases: California, USA from 2013 to 2016 (6832 space–time ZIP code units). Measurements We assessed associations of annual hospitalizations for cannabis use disorder [assignment of a primary or secondary code for cannabis abuse and/or dependence using ICD‐9‐CM or ICD‐10‐CM (outcome)] with the total number of medical cannabis dispensaries per square mile in a ZIP code as well as dispensary temporal and spatial lags (primary exposures). Other exposure covariates included alcohol outlet densities, manual labor and retail sales densities and ZIP code‐level economic and demographic conditions. Findings One additional dispensary per square mile was associated with a median risk ratio of 1.021 (95% credible interval 1.001, 1.041). Prior‐year dispensary density did not appear to be associated with hospitalizations (median risk ratio = 1.006, 95% CrI = 0.986, 1.026). Higher median household income, higher unemployment, greater off‐premises alcohol outlet density and lower on‐premises alcohol outlet density and poverty were all associated with decreased ZIP code‐level risk of cannabis abuse/dependence hospitalizations. Conclusions: In California, USA, the increasing density of medical cannabis dispensaries appears to be positively associated with same‐year but not next‐year hospitalizations for cannabis use disorder. [ABSTRACT FROM AUTHOR]

Aims: To better understand the longstanding inequalities concerning alcohol and tobacco use, we aimed to quantify the effect of household economic security on alcohol and tobacco consumption and expenditure. Design Longitudinal analysis using data from the Household, Income and Labour Dynamics in Australia survey (2001–2018). Setting: Australia Participants: A nationally representative cohort of 24 134 adults aged 25–64 years (187 378 observations). Measurements Tobacco and alcohol use (Yes/No), frequency of use of each per week, household expenditure on each per week, household weekly income (Consumer Price Index [CPI]‐adjusted), employment security (based on conditions of employment) and housing affordability (housing costs relative to household income). Findings At baseline, one‐quarter of the sample used tobacco and 87% used alcohol. Annual increases in household income were associated with the increased use of both tobacco and alcohol for people in households in the lowest 40% of the national income distribution (OR = 1.13, 95% CI = 1.03–1.23 and OR = 1.12, 95% CI = 1.04–1.20, respectively) with no similar income effect observed for higher‐income households. In relation to smoking, the odds of a resident's tobacco use increased when their household was unemployed (OR = 1.32, 95% CI = 1.07–1.62). In relation to alcohol, the odds of use decreased when households were insecurely employed or unemployed, or housing costs were unaffordable (OR = 0.87, 95% CI = 0.77–0.98, OR = 0.66, 95% CI = 0.55–0.80 and OR = 0.84, 95% CI = 0.75–0.93, respectively). This was also reflected in the reduced odds of risky drinking (defined in accordance with Australian guidelines) when housing became unaffordable or households became unemployed (OR = 0.90, 95% CI = 0.81–0.99; OR = 0.82, 95% CI = 0.69–0.98, respectively). Conclusions: In Australia, smoking and drinking appear to exhibit different socio‐behavioural characteristics and household unemployment appears to be a strong determinant of smoking. [ABSTRACT FROM AUTHOR]

Background and Aims: Income assistance is critical to the health and wellbeing of socio‐economically marginalized people who use illicit drugs (PWUD). However, past literature paradoxically identifies unintended increases in drug‐related harm coinciding with synchronized payments that may magnify signals for drug use. The scope of such harm has not been fully characterized among non‐institutionalized populations. This study examined socio‐demographic, health and drug use‐related correlates of payment‐coincident drug‐related harm. Design This observational study uses data from prospective community‐based longitudinal cohorts of PWUD between December 2013 and May 2018. Setting: Vancouver, British Columbia, Canada. Participants: A total of 1604 PWUD receiving monthly income assistance. Our sample included 586 (36.5%) women, 861 (53.7%) non‐white participants and 685 (42.7%) people living with HIV. Measurements The primary outcome was a self‐reported composite measure of drug‐related harm in the past 6 months coinciding with income assistance, including higher‐frequency substance use, non‐fatal overdose and service barriers or interruptions. Subanalyses disaggregated this outcome. Findings Payment‐coincident drug‐related harm was reported among 77.7% of participants during the study period. In multivariable models, key correlates positively and significantly associated with payment‐coincident harm included: street‐based income generation [adjusted odds ratio (aOR) = 1.48, 95% confidence interval (CI) = 1.26–1.74, P < 0.001], sex work (aOR = 1.66, 95% CI = 1.35–2.04, P < 0.001), illegal income generation (aOR = 1.57, 95% CI = 1.35–1.83 P < 0.001), homelessness (aOR = 1.34, 95% CI = 1.13–1.58, P < 0.001), exposure to violence (aOR = 1.31, 95% CI = 1.03–1.66, P = 0.032), daily crack cocaine use (aOR = 1.99, 95% CI = 1.59–2.50, P < 0.001), heavy alcohol use (aOR = 1.64, 95% CI = 1.37–1.97, P < 0.001) and injection drug use (aOR = 2.55, 95% CI = 2.01–3.23, P < 0.001). In subanalyses, specific harms were more likely among individuals reporting social, structural and health vulnerabilities. Conclusions: In Vancouver, Canada, people who use illicit drugs who receive income assistance report high prevalence of payment‐coincident drug‐related harm, particularly people experiencing socioeconomic and structural marginalization or engaging in high‐intensity drug use. [ABSTRACT FROM AUTHOR]

Background and Aims: Tobacco and alcohol use are major risk factors for premature mortality and morbidity. Tobacco and alcohol expenditure may also exacerbate poverty. This study aimed to estimate the financial impact of tobacco and alcohol consumption in low income households in the United Kingdom. Design We undertook a cross‐sectional study using a secondary dataset. A sample of 5031 households participated in the 2016–17 Living Costs and Food Survey. Measurements We measured the weekly household income and expenditure on tobacco and alcohol, and the proportion of households with expenditure on tobacco and alcohol overall, by income decile and in households in relative poverty (below 60% of the median household income). Estimates were extrapolated using population data to estimate the number of UK households, adults and children that would be classified as living in relative poverty on the basis of net income after subtracting tobacco or alcohol expenditure ('tobacco and alcohol expenditure‐adjusted poverty'). Findings Spending on alcohol was more common in high income groups; 83% of households in the highest and 47% in the lowest income decile purchased alcohol. The reverse was true for tobacco, which was purchased by 8% and 24% of households in the highest and lowest income deciles respectively. Twenty‐three percent of households in relative poverty purchased tobacco and 49% alcohol, with a median expenditure of £12.50 and £9.55 per week, respectively. A total of 320 000 households comprising 590 000 adults and 175 000 children were in alcohol expenditure‐adjusted poverty, and 230 000 households, comprising 400 000 adults and 180 000 children in tobacco‐expenditure adjusted poverty. Conclusions: Tobacco and alcohol expenditure appear to exacerbate poverty in low income households in the United Kingdom. Hundreds of thousands of additional households would be defined as living in relative poverty based on their income after subtracting their tobacco and alcohol expenditure. [ABSTRACT FROM AUTHOR]

Aims: To examine whether norms towards nicotine vaping product (NVP) use varied between Australia, Canada, England and the United States and by socio‐demographics, smoking and NVP status. Design Cross‐sectional data from the 2016 ITC Four Country Smoking and Vaping Survey. Setting: Four countries with distinct regulatory policies relating to the sale and advertising of NVPs: Australia (most restrictive), Canada (restrictive), England and the United States (least restrictive). Participants: A total of 10900 adult (age 18+) current smokers, former smokers, or at least weekly NVP users. Respondents were from Australia (n = 1366), Canada (n = 3309), England (n = 3835) and the United States (n = 2390). Measurements Questions permitted the categorization of respondents as current smokers, former smokers, NVP users and socio‐demographic categories (sex, age, country, ethnicity, income and education). Further questions were asked regarding the frequency of exposure to NVPs in public, whether they had a partner or close friends who vaped and whether they believed society or those considered important to them approved of NVPs. Findings Adjusting for relevant covariates, compared with Australian respondents, those in England, Canada and the United States were more likely to report frequent exposure to NVPs in public (83.1%, 57.3% and 48.3%, respectively, compared to 19.8% in Australia; P < 0.0001), having a partner who vaped (13.8%, 7.1% and 7.7%, respectively, compared to 2.1% in Australia; P < 0.0001) and having close friend(s) who vaped (31.7%, 25.3%, 20.9%, respectively, compared to 10.0% in Australia; P < 0.0001). Compared with Australian respondents, respondents from England were more likely to report that society (27.6% compared to 12.3% in Australia; P < 0.0001) and people important to them approved of NVP use (28.9% compared to 14.3% in Australia; P < 0.0001). Conclusions: Norms towards nicotine vaping product (NVP) use appear to vary among countries with different regulatory contexts regarding sales and advertising. [ABSTRACT FROM AUTHOR]

Background and aims: Young Russians have been drinking less alcohol, and fewer strong spirits in particular, in recent years. This study aimed to disentangle age, period and birth cohort effects for the first time in Russia to improve our understanding of these trends. Design Age, period and cohort analysis of annual nationally representative repeated cross‐sectional surveys [Russian Longitudinal Monitoring Survey– Higher School of Economics (RLMS‐HSE)] using separate logistic models for each gender. Setting: Russia 1994–2016. Participants: A total of 195 234 respondents aged 14–85 years. Measurements Age (14 groups: 14‐17 to 76+ years), period (21 years: 1994–2016) and birth cohorts (17 groups: 1920–24 to 2000–02). Outcome measures were 30‐day overall and beverage‐specific alcohol use prevalence accounting for vodka, moonshine, beer and wine. Controls were per capita income, education, marital status, ethnicity, residence type and regional climate. Findings Controlling for age and period effects, the most recent cohorts had lower rates of participation than older cohorts. Findings were valid for females born in 1995–2002 (P = 0.000) and males born in 1990–94 (P = 0.002) and 1995–2002 (P = 0.000). The period effects were strong in 1994–2003 due to intensive substitution of beer in place of vodka. Period effects were also important in determining a decline of prevalence in 2008–15 due to restrictive alcohol policy. Age effects showed an inverse U‐shaped trend in both genders, except for moonshine and wine. Overall, drinking profiles were beverage‐specific. Models indicated diverse beverage‐specific effects of income, ethnicity, education, marital status and residence on the prevalence of alcohol use. Conclusion: The recent downward trend in alcohol use in Russia appears to be attributable to reduced participation rates among younger cohorts born after 1990. [ABSTRACT FROM AUTHOR]

Background and aims: Mortality from alcohol‐attributable causes is patterned by income. We study the income trajectories 17–19 years prior to death in order to determine: (1) whether income levels and trajectories differ between those who die of alcohol‐attributable causes, survivors with similar socio‐demographic characteristics, all survivors and those dying of other causes; (2) whether the income trajectories of these groups differ by education; and (3) whether there are differences in income trajectories between Finland and Sweden—two countries with differing levels of alcohol‐attributable mortality but similar welfare‐provision systems. Design Retrospective cohort study using individual‐level longitudinal register data including information on income, cause of death and socio‐economic status. Setting: Finland and Sweden. Participants: The subjects comprised an 11% sample of the Finnish population in 2006–07 and the total population of Sweden aged 45–64 years in 2007–08. Measurements Median household income trajectories by educational group were calculated by cause of death and population alive during the respective years. Additionally, propensity score matching was used to match the surviving population to those dying from alcohol‐attributable causes with regard to socio‐demographic characteristics. Findings The median income 17–19 years prior to death from alcohol‐attributable causes was 92% (Finland) and 91% (Sweden) of survivor income: 1 year prior to death, the respective figures were 47% and 57%. The trajectories differed substantially. Those dying of alcohol‐attributable causes had lower and decreasing incomes for substantially longer periods than survivors and people dying from other causes. These differences were more modest among the highly educated individuals. The baseline socio‐demographic characteristics of those dying of alcohol causes did not explain the different trajectories. Conclusions: In Finland and Sweden, income appears to decline substantially before alcohol‐attributable death. Highly educated individuals may be able to buffer the negative effects of extensive alcohol use on their income level. Income trajectories are similar in Finland and Sweden, despite marked differences in the level of alcohol‐attributable mortality. [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]

Abstract: Aims: To assess tobacco dependence treatment guidelines content in accordance with Article 14 of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) and its guidelines, and association between content and country income level. Design: Cross‐sectional study. Setting: On‐line survey from March to July 2016. Participants: Contacts in 77 countries, including 68 FCTC Parties, six Signatories and three non‐Parties which had indicated having guidelines in previous surveys, or had not been surveyed before. Measurements: A nine‐item questionnaire on guidelines content, key recommendations, writing and dissemination. Findings: We received responses from contacts in 63 countries (82%); 61 had guidelines. The majority are for doctors (93%), primary care (92%) and nurses (75%). All recommend brief advice, 82% recording tobacco use in medical notes, 98% nicotine replacement therapy (NRT), 61% quitlines, 31% text messaging and 87% intensive specialist support, and 54% stress the importance of health‐care workers not using tobacco. Only 57% have a dissemination strategy, and 62% have not been updated for 5 or more years. Compared with high‐income countries, quitlines are less likely to be recommended in upper middle‐income countries guidelines [odds ratio (OR) = 0.15, 95% confidence interval (CI) = 0.04–0.61] and intensive specialist support in lower middle‐income countries guidelines (OR = 0.01, 95% CI = 0.00–0.20). Guidelines updating is associated positively with country income level (P = 0.027). Conclusions: Although most tobacco dependence treatment guidelines in the 61 countries assessed in 2016 follow the World Health Organization's Framework Convention on Tobacco Control Article 14 recommendations and do not differ significantly by income level, improvements are needed in keeping guidelines up‐to‐date, applying good writing practices and developing a dissemination strategy. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To examine retrospectively patient and programmatic outcomes following the development and implementation of an ‘open‐access’ model in which prospective patients were enrolled rapidly in methadone maintenance treatment, irrespective of ability to pay, and provided real‐time access to multiple voluntary treatment options. Design: Medical and administrative records were abstracted to compare data for 1 year before and 9 years after initiating the implementation of an open‐access treatment model in May 2007. Setting: Methadone maintenance treatment center in Connecticut, USA. Participants: Individuals with opioid use disorder entering treatment between July 2006 and June 2015. In June 2015, 64% (n = 2594) of the sample were men and 80% (n = 3133) reported that they were white. Intervention: The Network for the Improvement of Addiction Treatment‐informed open‐access treatment model uses process improvement strategies to improve treatment access and capacity. Measurements: Census, waiting time, retention, non‐medical opioid use, patient mortality and financial sustainability (net income and state‐block grants as proportions of revenue). Findings: In the 9 years following the initial implementation of the open‐access model, patient census increased by 183% from 1431 to 4051, and average waiting‐time days decreased from 21 to 0.3 (same day) without apparent deleterious effects on rates of retention, non‐medical opioid use or mortality. Between fiscal years (FY) 06 and FY 15, net operating margin rose from 2 to 10%, while state‐block grant revenues declined 14% and the proportion of total revenue from state‐block grant revenue decreased from 49 to 24%. Conclusions: An open‐access model for rapid enrolment of people with opioid use disorder in methadone treatment appears to improve treatment access, capacity, and financial sustainability without evidence of deleterious effects on treatment outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To test if the degree of change in cannabis use between 2001 and 2013 differed according to socio‐economic status. Design: Repeated cross‐sectional household surveys that were nationally representative. Setting: Australia. Participants: Adult samples from the 2001 and 2013 National Drug Strategy Household Surveys (n = 23 642 in 2001 and n = 21 353 in 2013), the largest nationally representative survey on drug use in Australia. Measurements: Frequency of cannabis use coded as daily use, weekly use, less than weekly use and non‐current use; socio‐economic status (SES) as measured by personal income and educational level. Finding: There were significant differences in changes to levels of cannabis use between SES groups. Among participants who completed high school, the probability of daily use decreased from 0.014 to 0.009 (P < 0.001), and the probability of weekly use decreased from 0.025 to 0.017 (P < 0.001). These probabilities remained stable for participants who did not complete high school. The probability of weekly cannabis use decreased from 0.032 to 0.023 among participants with middle level income (P = 0.004), and from 0.021 to 0.013 among those with high income (P = 0.005). There were no significant changes in these probabilities among those with low income (0.026 in 2001 and 0.032 in 2013; P = 0.203). Conclusion: The decline in cannabis use in Australia from 2001 to 2013 occurred largely among higher socio‐economic status groups. For people with lower income and/or lower education, rates of frequent cannabis use remained unchanged. [ABSTRACT FROM AUTHOR]

Aims To investigate gambling expenditure and its relationship with socio-demographics, health-related correlates and past-year gambling behaviour. Design Cross-sectional population survey. Setting Population-based survey in Finland. Participants Finnish people aged 15-74 years drawn randomly from the Population Information System. The participants in this study were past-year gamblers with gambling expenditure data available ( n = 3251, 1418 women and 1833 men). Measurements Expenditure shares, means of weekly gambling expenditure (WGE, €) and monthly gambling expenditure as a percentage of net income (MGE/NI, %) were calculated. The correlates used were perceived health, smoking, mental health [Mental Health Inventory (MHI)-5], alcohol use [Alcohol Use Disorders Identification Test (AUDIT)-C], game types, gambling frequency, gambling mode and gambling severity [South Oaks Gambling Screen (SOGS)]. Findings Gender (men versus women) was found to be associated significantly with gambling expenditure, with exp(β) = 1.40, 95% confidence interval (CI) = 1.29, 1.52 and P < 0.005 for WGE, and exp(β) = 1.39, 95% CI = 1.27, 1.51 and P < 0.005 for MGE/NI. All gambling behaviour correlates were associated significantly with WGE and MGE/NI: gambling frequency (several times a week versus once a month/less than monthly, exp(β) = 30.75, 95% CI = 26.89, 35.17 and P < 0.005 for WGE, and exp(β) = 31.43, 95% CI = 27.41, 36.03 and P < 0.005 for MGE/NI), gambling severity (probable pathological gamblers versus non-problem gamblers, exp(β) = 2.83, 95% CI = 2.12, 3.77 and P < 0.005 for WGE, and exp(β) = 2.67, 95% CI = 2.00, 3.57 and P < 0.005 for MGE/NI) and on-line gambling (on-line and land-based versus land-based only, exp(β) = 1.35, 95% CI = 1.24, 1.47 and P < 0.005 for WGE, and exp(β) = 1.35, 95% CI = 1.24, 1.47 and P < 0.005 for MGE/NI). Conclusions In Finland, male gender is associated significantly with both weekly gambling expenditure and monthly gambling expenditure related to net income. People in Finland with lower incomes contribute proportionally more of their income to gambling compared with middle- and high-income groups. [ABSTRACT FROM AUTHOR]

Aims This study investigates the link between personal income and smoking among adolescents, and aims to answer the following questions: (i) to what extent is personal income related to smoking, independent of family socio-economic status (SES) and (ii) does the association between personal income and smoking apply to different subpopulations? Design Cross-sectional study. Setting Six cities from European countries (Amersfoort, the Netherlands; Coimbra, Portugal; Hannover, Germany; Latina, Italy; Namur, Belgium; Tampere, Finland) in 2013. Participants A school-based sample of 10 794 adolescents aged 14-17 years. Measurements We modelled smoking experimentation, weekly smoking, daily smoking and (among daily smokers) smoking intensity as function of personal income, adjusting for age, sex, family SES, parental smoking and country. We tested interactions between personal income and covariates. Stratification analyses were performed for the variables for which interactions were significant. Findings Adolescents in the highest income quintile were more likely to be smoking experimenters [odds ratio (OR) = 1.87; P < 0.01], weekly smokers (OR = 3.51; P < 0.01) and daily smokers (OR = 4.55; P < 0.01) than those in the lowest quintile. They also consumed more cigarettes per month (β = 0.79; P < 0.01). Adjusting for family SES did not modify the significance of relationships, and increased the magnitude of the association for daily smoking. None of the interactions between covariates and personal income was significant for smoking measures. For the intensity of smoking, the interaction was significant for SES. The stratified analysis showed a non-significant association between smoking intensity and personal income among the oldest adolescents and those with the lowest SES background, while significant among younger and higher SES backgrounds. Conclusion In the Netherlands, Portugal, Germany, Italy, Belgium and Finland, adolescents' personal income is related positively to smoking behaviours independent of family socio-economic status (SES). However, among low socio-economic status adolescent daily smokers, the association between the intensity of smoking and personal income is weaker. [ABSTRACT FROM AUTHOR]

Background and Aims Previous research indicates that minimum alcohol pricing (MAP) is associated negatively with alcohol-attributable (AA) hospitalizations. Modeling studies predict that this association will be stronger for people on lower incomes. The objective of this study was to test whether the association between MAP and AA hospitalizations is greater in low-income regions. Design Cross-sectional versus time-series analysis using multivariate multi-level effect models. Setting All 89 Local Health Areas in British Columbia (BC), Canada, 2002-13 (48 quarters). Participants BC population. Measurements Quarterly rates of AA hospital admissions, mean consumer price index-adjusted minimum dollars per standard alcoholic drink and socio-demographic covariates. Findings Family income was related inversely to the effect of minimum prices on rates of some types of AA morbidity. A 1% price increase was associated with reductions of 3.547% [95% confidence interval (CI) = -5.719, −1.377; P < 0.01] in low family-income regions and 1.64% (95% CI = -2.765, −0.519; P < 0.01) across all income regions for 100% acute AA hospital admissions. Delayed (lagged) effects on chronic AA morbidity were found 2-3 years after minimum price increases for low income regions and all regions combined; a 1% increase in minimum price was associated with reductions of 2.242% (95% CI = -4.097, −0.388; P < 0.05) for 100% chronic AA and 2.474% (95% CI = −3.937, −1.011; P < 0.01) for partially chronic AA admissions for low-income regions. Conclusion In Canada, minimum price increases for alcohol are associated with reductions in alcohol attributable hospitalizations, especially for populations with lower income, both for immediate effects on acute hospitalizations and delayed effects on chronic hospitalizations. [ABSTRACT FROM AUTHOR]

Aims To examine the transitions in smoking status among non-daily smokers who transitioned to daily or former smokers or remained as non-daily smokers during a 12-month period. We analyzed factors associated with these transitions, including the use of cigars and smokeless tobacco (SLT). Design Secondary data analyses using pooled data from the 2003, 2006/07 and 2010/11 Tobacco Use Supplements to the Current Population Survey (TUS-CPS). Setting United States. Participants Self-respondents aged 18+ who have smoked for more than 5 years and were non-daily smokers 12 months before the interview ( n = 13 673, or 14.5% of current smokers). Measurements Multinomial logistic regression model to determine the correlates of non-daily to daily, stable non-daily and non-daily to former smoking transitions among non-daily smokers at baseline. The model controlled for socio-demographic factors and the use of cigars and SLT. Findings Of the adults in our sample, 2.6% were non-daily smokers at baseline. Among these, 69.7% remained non-daily smokers (stable non-daily smokers), 18.4% became daily smokers (non-daily to daily smokers) and 11.9% quit smoking (non-daily to former smokers) after 12 months. The non-daily to daily versus stable non-daily smoking transition was less likely among those who were aged 65+ ( P = 0.018), male ( P < 0.001), Hispanic ( P < 0.001), with an income of $25 000-49 999 or ≥$75 000 and current users of SLT ( P = 0.003), but more likely among those without a college degree compared with the appropriate reference group. The non-daily to former versus stable non-daily smoking transition was less likely among those aged 25+, male ( P = 0.013), non-Hispanic Asian ( P = 0.032), without a college degree, widowed/divorced/separated ( P = 0.013) or never married ( P = 0.011) and current users of cigars ( P = 0.003) compared with the appropriate reference group. Conclusions While more than two-thirds of non-daily smokers in the United States remain as such after 12 months, others become daily smokers or quit. The likelihood of remaining stable non-daily smokers and of transition from non-daily to daily and non-daily to former smokers is associated with socio-demographic factors and current use of cigars and smokeless tobacco. [ABSTRACT FROM AUTHOR]

Aims To examine gradual change in debt problems, divorce and income among men in Finland before and after a first conviction for driving under the influence ( DUI). Design and Setting A register-based longitudinal study conducted in Finland between 1999 and 2013. Participants A nationally representative sample of 70 659 Finnish males born between 1918 and 1983, and a subsample of males ( n = 1782) who had their first DUI conviction during 2005-2012. Measurements Descriptive statistics showing the socio-demographic and economic determinants of DUI. The main analysis was based on a longitudinal, within-individual setting. The impact of DUI on debt problems, divorce and income was analysed using random effects regression models. Findings DUI offenders were more likely to be younger and to have lower education and income than the non- DUI group. Criminal convictions were also more common among DUI offenders. Debt problems, divorce and loss of income were more likely after the DUI incident than before. The already increasing level of debt problems accelerated after the incident and divorce rates increased after the DUI incident, whereas the decrease in income was gradual over the whole observation period. Conclusions Among men in Finland, DUI offences are more common among vulnerable social groups. The first drunk-driving conviction among men in Finland constitutes a significant life event that appears to increase the likelihood of financial problems and divorce. [ABSTRACT FROM AUTHOR]

Aims To examine the relationships between income, income inequality and current smoking among youth in low- and middle-income countries. Design Pooled cross-sectional data from the Global Youth Tobacco Surveys, conducted in low- and middle-income countries, were used to conduct multi-level logistic analyses that accounted for the nesting of students in schools and of schools in countries. Participants A total of 169 283 students aged 13-15 from 63 low- and middle-income countries. Measurements Current smoking was defined as having smoked at least one cigarette in the past 30 days. Gross domestic product ( GDP) per capita was our measure of absolute income. Contemporaneous and lagged (10-year) Gini coefficients, as well as the income share ratio of the top decile of incomes to the bottom decile, were our measures of income inequality. Findings Our analyses reveal a significant positive association between levels of income and youth smoking. We find that a 10% increase in GDP per capita increases the odds of being a current smoker by at least 2.5%, and potentially considerably more. Our analyses also suggest a relationship between the distribution of incomes and youth smoking: youth from countries with more unequal distributions of income tend to have higher odds of currently smoking. Conclusions There is a positive association between gross domestic product and the odds of a young person in a low- and middle-income country being a current smoker. Given the causal links between smoking and a wide range of youth morbidities, the association between smoking and income inequality may underlie a substantial portion of the health disparities observed that are currently experiencing rapid economic growth. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims Marital dissolution is associated with increased risk of problematic drinking. However, marriage to a problem drinker also increases this risk, and ending this type of relationship may actually decrease risk of problematic drinking. This study tested whether women ending their marriage to a problem drinker exhibited improvements in drinking. Design National Epidemiologic Survey on Alcohol and Related Conditions, a two-wave nationally representative survey of the US adult population. Setting In-person interviews conducted in US households. Participants Females married or living as if married at wave 1 at least 18 years of age. Measurements Socio-demographics, drinking frequency, drinking quantity, alcohol use disorders, problem drinking, partner problem drinking and relationship dissolution. Findings Ending marriage to a non-problem drinker predicted increased frequency of drinking [risk ratio (RR) = 1.55; 95% confidence interval (CI) = 1.43, 1.67], heavier drinking (RR = 1.30; 95% CI = 1.71, 1.45), more problematic drinking (RR = 2.45; 95% CI = 2.17, 2.77) and a greater likelihood of use disorder diagnosis [odds ratio (OR) = 2.2; 95% CI = 1.67, 2.91]. Ending a relationship with a problem drinker predicted less frequent drinking (RR = 0.94; 95% CI = 0.90, 0.98), less heavy drinking (RR = 0.84; 95% CI = 0.78, 0.90) and fewer alcohol-related problems (RR = 0.77; 95% CI = 0.62, 0.95). Conclusions Ending a marriage with a husband who drinks problematically may decrease risk of alcohol-related problems among women, substantiating the need for alcohol treatments to address a problem drinking partner. [ABSTRACT FROM AUTHOR]

Few studies have examined the statistical association between methamphetamine/amphetamine use and acquisitive crime. Both methamphetamine/amphetamine and cannabis use have been implicated by New Zealand Police as factors in acquisitive offending among active criminal populations. The aim of our study was to examine the statistical association between spending on methamphetamine/amphetamine and cannabis and earnings from acquisitive crime among police detainees in New Zealand. Four police stations in different regions. A sample of 2125 police detainees were interviewed about their drug use and acquisitive crime. Statistical models were developed to predict involvement in acquisitive crime using spending on methamphetamine/amphetamine and cannabis for personal use, and to examine associations between the level of spending on methamphetamine/amphetamine and cannabis for personal use and level of dollar earnings from acquisitive crime. Self-reported spending on drug use and self-reported earnings from acquisitive crime in the past 30 days. Spending on cannabis and methamphetamine/amphetamine could predict involvement in acquisitive crime. Level of spending on methamphetamine/amphetamine and cannabis was associated positively with the level of earnings from property crime. Level of spending on methamphetamine/amphetamine was also associated positively with level of earnings from drug dealing. There was a largely negative association between level of spending on cannabis and level of earnings from drug dealing. High spending on methamphetamine/amphetamine is associated statistically with higher earnings from acquisitive crime among police detainees. Further research into this association, and in particular the causal nature of the association, is required to obtain clear policy recommendations. [ABSTRACT FROM AUTHOR]

To examine the role of abstinence from gambling versus controlled gambling in recovery from pathological gambling (PG) in a community-based survey. Individuals with a life-time history of PG identified in a community-based survey were divided into three groups based on their current levels of PG symptoms. These three groups were compared to each other on their past-year gambling involvement. National general population twin survey conducted in Australia. Overall, there were 4764 participants in the community-based survey (mean age 37.7 years, 57.2% women). Among these were 104 participants with a life-time history of PG; of the 104 with a life-time diagnosis of PG, 28 had a past-year diagnosis of PG, 32 had past-year problem gambling and 44 had no symptoms of PG in the past year ('recovery'). The measure of PG was based on the NODS (NORC DSM-IV Screen for Gambling Problems). Past-year participation in 11 different gambling activities was assessed, as well as the following composite indicators: any gambling, gambling versatility, the number of days and hours spent gambling and the proportion of household income spent on gambling. Ninety per cent of those in the recovery group participated in some form of gambling in the past year. In this general population survey, nearly all the PG recoveries were achieved in the absence of abstinence. Controlled gambling appears to be a popular road to recovery in the community. [ABSTRACT FROM AUTHOR]

Abstract Aims. To assess how income affects hypothetical drug and non-drug purchasing decisions. Participants and setting. Ninety-four subjects (26 heroin abusers, 28 cocaine abusers, 15 alcohol abusers and 25 non-drug using controls) were recruited from advertisements. Intervention. Subjects were exposed to six conditions in which they “purchased” drugs as well as food, housing, and entertainment as income rose from $30 to $560 per day. Findings. Heroin abusers selected significantly more hypothetical heroin and cocaine as income rose and demand for these two drugs was income elastic, with purchases rising in greater proportion than income. Cocaine abusers significantly increased purchases of, and showed income elastic demand for, cocaine and alcohol. Among alcohol abusers, significant increases in purchases and income elastic demand were found for alcohol and cigarettes, but not for other drugs. Across all four groups, demand for rent and food were income inelastic, such that purchases did not rise in proportion to the changes in income, while demand for entertainment was income elastic. Hypothetical choices were reliable between and within subjects, and drug choices were correlated with urinalysis results and life-time years of drug use. Conclusions. Income is an important variable in understanding choices for drug and non-drug commodities across a variety of substance-abusing populations. [ABSTRACT FROM AUTHOR]

The author discusses a study by B. Sornpaisarn and colleagues, which provide analyses of the alcohol-taxation scheme, established by the Thai government and compare it to schemes instituted in the United States. They state that in high-income western nations, moderation tends to work effectively in alcohol-control measures rather than abstention. In their opinion, even though there is a difference between Thailand and United States, each country can learn from the different aspects.