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Background and aims: The relationship between alcohol consumption and age-related diseases is inconsistent. Biological age (BA) serves as both a precursor and a predictor of age-related diseases; however, longitudinal associations between alcohol consumption and BA in middle-aged and older people remain unclear. We measured whether there was a longitudinal association between drinking frequency and pure alcohol intake with BA among middle-aged and older people. Design and setting and participants: This study involved two prospective cohort studies, set in Southwestern China and the United Kingdom. A total of 8046 participants from the China Multi-Ethnic Cohort study (CMEC) and 5412 participants from the UK Biobank (UKB), aged 30-79 years, took part, with complete data from two waves of clinical biomarkers. Measurements: BA was calculated by the Klemera Doubal's method. Accelerated BA equalled BA minus chronological age. Drinking frequency and pure alcohol intake were obtained through self-reported questionnaires. Drinking frequency in the past year was classified as current non-drinking, occasional (monthly drinking) and regular (weekly drinking). Findings: Compared with consistent current non-drinkers, more frequent drinkers [CMEC: β = 0.46, 95% confidence interval (CI) = 0.13-0.80; UKB: β = 0.65, 95% CI = 0.01-1.29)], less frequent drinkers (CMEC: β = 0.62, 95% CI = 0.37-0.87; UKB: β = 0.54, 95% CI = -0.01-1.09), consistent occasional drinkers (CMEC: β = 0.51, 95% CI = 0.23-0.79; UKB: β = 0.63, 95% CI = 0.13-1.13) and consistent regular drinkers (CMEC: β = 0.56, 95% CI = 0.17-0.95; UKB: β = 0.46, 95% CI = 0.00-0.91) exhibited increased accelerated BA. A non-linear relationship between pure alcohol intake and accelerated BA was observed among consistent regular drinkers. Conclusions: In middle-aged and older people, any change in drinking frequency and any amount of pure alcohol intake seem to be positively associated with acceleration of biological ageing, compared with maintaining abstinence. [ABSTRACT FROM AUTHOR]

Background and Aim: Drinking alcohol may cause harm to an individual's health and social relationships, while a drinking culture may harm societies as it may increase crime rates and make an area feel less safe. Local councils in Greater Manchester, UK, developed the Communities in Charge of Alcohol (CICA) intervention, in which volunteers were trained to give alcohol‐related advice to the public and taught how to influence policies to restrict when, where and how alcohol is sold. As part of a larger study, the aim of the current project is to measure the impact of CICA on health and crime outcomes at the lower super output (LSOA) geographical aggregation. Design: Quantitative evaluation using four time series analytic methods (stepped‐wedge design, and comparisons to local controls, national controls and synthetic controls) with findings triangulated across these methods. A cost–benefit analysis was carried out alongside the effectiveness analysis. Setting and Participants: The general public in Greater Manchester, UK, between 2010 and 2020. Measurements: The primary outcome of interest was alcohol‐related hospital admissions. Secondary outcomes were accident and emergency (A&E) attendances, ambulance callouts, recorded crimes and anti‐social behaviour incidents. Findings Triangulation of the results did not indicate any consistent effect on area‐level alcohol‐related hospital admissions, A&E attendances, ambulance callouts, reported crimes or anti‐social behaviour associated with the implementation of CICA. The primary stepped‐wedge analysis indicated an increase in alcohol‐related hospital admissions following the implementation of CICA of 13.4% (95% confidence interval −3.3%, +30.1%), which was consistent with analyses based on other methods with point estimates ranging from +3.4% to 16.4%. Conclusion: There is no evidence of a measurable impact of the Communities in Charge of Alcohol (CICA) programme on area‐level health and crime outcomes in Greater Manchester, UK, within 3 years of the programme start. The increase in alcohol‐related hospital admissions was likely the result of other temporal trends rather than the CICA programme. Possible explanations include insufficient follow‐up time, too few volunteers trained, volunteers being unwilling to get involved in licensing decisions or that the intervention has no direct impact on the selected outcomes. [ABSTRACT FROM AUTHOR]

Background and Aims: ABC-training is a new intervention to encourage health behavior change that targets the automatic activation of adaptive beliefs (i.e. automatic inferences). The aim of this proof-of-principle study was to test the effectiveness of web-based ABC-training to change outcome expectancies of alcohol drinking in a sample of hazardous drinkers. Design: One exploratory and one confirmatory experiment with two between-subject conditions (online ABC- and control-training) and assessments at baseline and 1 week later (after three sessions of training). Setting: Participants recruited on Prolific Academic completed the web-based study. Participants: Adults with self-reported hazardous alcohol drinking (Experiment 1: 193 adults, United Kingdom, age mean = 46.7 years; Experiment 2: 282 adults, different nationalities, age mean = 38.3 years). Intervention and Comparator: ABC-training involved completing an online task that required choosing personally relevant alternative behaviors to drinking alcohol in personally relevant antecedent contexts to attain personally important outcomes. Comparator was control-training, in which participants selected both the alternative behaviors and alcohol drinking an equal number of times. Training was completed at baseline, after 3 days and after 1 week. Measurements: Primary outcome was change in automatic and self-reported (negative/positive) outcome expectancies of alcohol drinking from baseline to after 1 week. Secondary outcomes were change in weekly alcohol consumption, self-efficacy, craving and motivation (and approach-alcohol associations in Experiment 1). Moderators were baseline outcome scores, motivation, age and alcohol dependency. Findings: Findings of this study are as follows: stronger increase in negative outcome expectancies after ABC- than control-training (Experiment 1: self-report, 95% confidence interval of difference scores (CIdiff) = [0.04, Inf]; automatic, CIdiff = [0.01, Inf]; Experiment 2: self-report, CIdiff = [0.16, Inf]; automatic, CIdiff = [0.002, Inf]). Stronger reduction in self-reported positive outcome expectancies after ABC- than controltraining (Experiment 1: CIdiff = [-Inf, -0.01]; Experiment 2: CIdiff = [-Inf, -0.21]) but mixed findings on automatic positive outcome expectancies (Experiment 1: CIdiff = [-Inf, 0.02]; Experiment 2: CIdiff = [-Inf, -0.001]). Conclusions: ABC-training may change outcome expectancies of alcohol consumption, but testing of clinically relevant effects in other samples is warranted. [ABSTRACT FROM AUTHOR]

Background and Aims: Tobacco smoking is a risk factor for impaired brain function, but its causal effect on white matter brain aging remains unclear. This study aimed to measure the causal effect of tobacco smoking on white matter brain aging. Design: Mendelian randomization (MR) analysis using two non‐overlapping data sets (with and without neuroimaging data) from UK Biobank (UKB). The group exposed to smoking and control group consisted of current smokers and never smokers, respectively. Our main method was generalized weighted linear regression with other methods also included as sensitivity analysis. Setting: United Kingdom. Participants: The study cohort included 23 624 subjects [10 665 males and 12 959 females with a mean age of 54.18 years, 95% confidence interval (CI) = 54.08, 54.28]. Measurements Genetic variants were selected as instrumental variables under the MR analysis assumptions: (1) associated with the exposure; (2) influenced outcome only via exposure; and (3) not associated with confounders. The exposure smoking status (current versus never smokers) was measured by questionnaires at the initial visit (2006–10). The other exposure, cigarettes per day (CPD), measured the average number of cigarettes smoked per day for current tobacco users over the life‐time. The outcome was the 'brain age gap' (BAG), the difference between predicted brain age and chronological age, computed by training machine learning model on a non‐overlapping set of never smokers. Findings The estimated BAG had a mean of 0.10 (95% CI = 0.06, 0.14) years. The MR analysis showed evidence of positive causal effect of smoking behaviors on BAG: the effect of smoking is 0.21 (in years, 95% CI = 6.5 × 10−3, 0.41; P‐value = 0.04), and the effect of CPD is 0.16 year/cigarette (UKB: 95% CI = 0.06, 0.26; P‐value = 1.3 × 10−3; GSCAN: 95% CI = 0.02, 0.31; P‐value = 0.03). The sensitivity analyses showed consistent results. Conclusions: There appears to be a significant causal effect of smoking on the brain age gap, which suggests that smoking prevention can be an effective intervention for accelerated brain aging and the age‐related decline in cognitive function. [ABSTRACT FROM AUTHOR]

Background and aims: The majority of smokers accessing the current best treatments continue to smoke. We aimed to test if e‐cigarettes (EC) compared with nicotine replacement treatment (NRT) can help such smokers to reduce smoking. Design Randomized controlled trial of EC (n = 68) versus NRT (n = 67) with 6‐month follow‐up. Setting: Stop smoking service in London, UK. Participants: A total of 135 smokers (median age = 40 years, 51% male) previously unable to stop smoking with conventional treatments. Interventions: Participants received either NRT of their choice (8‐week supply) or an EC starter pack and instructions to purchase further e‐liquids of strength and flavours of their choice themselves. Products were accompanied by minimal behavioural support. Measurements Participants who reported that they stopped smoking or reduced their daily cigarette consumption by at least 50% at 6‐month follow‐up were invited to provide a carbon monoxide (CO) reading. The primary outcome was biochemically validated reduction in smoke intake of at least 50% at 6 months and the main secondary outcome was sustained validated abstinence at 6 months. Drop‐outs were included as 'non‐reducers'. Findings Validated smoking reduction (including cessation) was achieved by 26.5 versus 6.0% of participants in the EC and NRT study arms, respectively [relative risk (RR) = 4.4, P = 0.005, 95% confidence interval (CI) = 1.6–12.4]. Sustained validated abstinence rates at 6 months were 19.1 versus 3.0% (RR = 6.4, P = 0.01, 95% CI = 1.5–27.3). Product use was high and equal in both study arms initially, but at 6 months allocated product use was 47% in the EC arm versus 10% in the NRT arm (χ2(1) = 22.0, P < 0.001), respectively. Adverse events were minor and infrequent. Conclusions: In smokers unable to quit using conventional methods, e‐cigarettes were more effective than nicotine replacement therapy in facilitating validated long‐term smoking reduction and smoking cessation when limited other support was provided. [ABSTRACT FROM AUTHOR]

Aim: To identify the main trajectories of alcohol misuse among UK military personnel from 12 years after the start of the Iraq war (2003) and the factors associated with each trajectory. Design Longitudinal cohort study with three phases of data collection (2004–06, 2007–09 and 2014–16). Setting: United Kingdom. Participants: Serving and ex‐serving personnel of the UK Armed Forces (n = 7111) participating at Phase 1 and at least one follow‐up phase of the King's Centre for Military Health Research (KCMHR) cohort study. Measurements Trajectories of alcohol misuse were derived from scores using the Alcohol Use Disorders Identification Test (AUDIT‐10) over three data collection phases. Demographic and military characteristics were collected and, among the key covariates, post‐traumatic stress disorder (PTSD) was measured using the PTSD checklist (PCL‐C) and childhood interpersonal stress and violence was measured using items from the Adverse Childhood Experiences questionnaire. Findings Five trajectories of alcohol misuse were identified, including 'no misuse' (n = 2249, 31.6%) and 'hazardous' (n = 3398, 47.8%), 'harmful' (n = 832, 11.7%), 'severe‐to‐hazardous' (n = 258, 5.3%) and 'severe' (n = 374, 3.6%) drinking. Substantial changes were evident only among severe drinkers, where more than half reduced over the study period. The factors most strongly associated with belonging to harmful/severe drinking classes were young age, male gender and childhood adversities and antisocial behaviour. Severe drinkers at Phase 1 were more likely to report probable PTSD and shorter military careers and were less likely to serve as Officers. Persistent severe drinkers were less likely to serve in the RAF compared to the Army and were more likely to be reserves. Not misusing alcohol was also associated with reserve status and having left service. Conclusions: In a cohort of approximately 7000 UK military personnel, trajectories of alcohol misuse appeared stable between 2004 and 2016. More than half of severe drinkers made substantial improvements over the period, but 68% of the cohort continued to drink hazardously or harmfully. Lack of change for the majority of the sample signals the need for strategies to address alcohol misuse and its cultural and psychosocial drivers. [ABSTRACT FROM AUTHOR]

Background and aims: The Alcohol Use Disorders Identification Test‐Consumption (AUDIT‐C) questionnaire screens for harmful drinking using a 12‐month timeframe. A score of 0 is assigned to individuals who report abstaining from alcohol in the past year. However, many middle‐age individuals reporting current abstinence are former drinkers (FDs). Because FDs may be more genetically prone to harmful alcohol use than lifelong abstainers (LAs) and are often combined with LAs, we evaluated the impact of differentiating them on the identification of genetic association. Design and Setting: The United Kingdom Biobank (UKBB) includes AUDIT‐C and alcohol drinker status. Participants: 131 510 Europeans, including 5135 FDs. Measurements We compared three genome‐wide association (GWAS) analyses to explore the effects of removing FDs: the full AUDIT‐C data, AUDIT‐C data without FDs, and data from a random sample numerically matched to the data without FDs. Because prior studies show a consistent association of the ADH1B polymorphism rs1229984 with both alcohol consumption and alcohol use disorder, we compared allele frequencies for rs1229984 stratified by AUDIT‐C value and FD versus LA status. Additionally, we calculated polygenic risk scores (PRS) of related diseases. Findings The rs1229984 allele frequencies among FDs were numerically comparable to those with high AUDIT‐C scores and very different from those of LAs. Removing FDs from GWAS yielded a stronger association with rs1229984 (P value after removal: 1.9 × 10−70 vs 1.7 × 10−65 and 2.5 × 10−62), more statistically significant single nucleotide polymorphisms (SNPs) (after removal: 11 vs 9 and 8), and genomic loci (after removal: 11 vs 9 and 7). Additional independent SNPs were identified after removal of FDs: rs2817866 (PTGER3), rs7105867 (ANO3), and rs17601612 (DRD2). For PRS of alcohol use disorder and major depressive disorder, there are statistically significant differences between FDs and LAs. Conclusions: Differentiating between former drinkers and lifelong abstainers can improve Alcohol Use Disorders Identification Test‐Consumption (AUDIT‐C) genome‐wide association results. [ABSTRACT FROM AUTHOR]