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

Aims This study examines the preliminary outcomes of an intervention targeting service providers in methadone maintenance therapy ( MMT) clinics in China. The intervention effects on both service providers and clients are reported. Design The MMT CARE intervention pilot was developed and implemented collaboratively with local health educators. After three group intervention sessions, trained providers in intervention clinics delivered two individual motivational interviewing sessions with their clients. Settings Six clinics in Sichuan, China, were randomized to either the MMT CARE intervention condition or a standard care condition. Participants A total of 41 providers and 179 clients were sampled from the six clinics. Measurements At baseline and three-, six-, and nine-month assessments, providers completed self-administrated paper/pencil questionnaires regarding provider-client interaction, MMT knowledge, perceived job-related stigma and clinic support. Clients completed a face-to-face survey about their concurrent drug use and drug avoidance self-efficacy. Mixed-effects regression models with clinic-level random effect were used to assess the intervention effects. Findings Significant intervention effects for providers were found in improved MMT knowledge, provider-client interaction and perceived clinic support. For clients, better improvements in drug avoidance self-efficacy and reduced concurrent drug use were observed for the intervention compared with the standard care group. Conclusions The MMT CARE intervention targeting providers in methadone maintenance clinics can improve providers' treatment knowledge and their interaction with clients. The intervention can also reduce clients' drug-using behavior through motivational interviewing sessions conducted by trained providers. [ABSTRACT FROM AUTHOR]

Aims Nicotine dependence is a highly heritable disorder associated with severe medical morbidity and mortality. Recent meta-analyses have found novel genetic loci associated with cigarettes per day ( CPD), a proxy for nicotine dependence. The aim of this paper is to evaluate the importance of phenotype definition (i.e. CPD versus Fagerström Test for Cigarette Dependence ( FTCD) score as a measure of nicotine dependence) on genome-wide association studies of nicotine dependence. Design Genome-wide association study. Setting Community sample. Participants A total of 3365 subjects who had smoked at least one cigarette were selected from the Study of Addiction: Genetics and Environment ( SAGE). Of the participants, 2267 were European Americans, 999 were African Americans. Measurements Nicotine dependence defined by FTCD score ≥4, CPD. Findings The genetic locus most strongly associated with nicotine dependence was rs1451240 on chromosome 8 in the region of CHRNB3 [odds ratio ( OR) = 0.65, P = 2.4 × 10−8]. This association was further strengthened in a meta-analysis with a previously published data set (combined P = 6.7 × 10−16, total n = 4200). When CPD was used as an alternate phenotype, the association no longer reached genome-wide significance ( β = −0.08, P = 0.0004). Conclusions Daily cigarette consumption and the Fagerstrom Test for Cigarette Dependence show different associations with polymorphisms in genetic loci. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims This paper examined whether or not: (a) care-giver 'alcohol abuse' is associated with recurrent child maltreatment; (b) other 'risk factors' affect this relationship; and (c) which of alcohol abuse or other drug abuse plays a stronger role. It also examined (d) how children and families where alcohol-related child abuse was identified were managed by child protection services (CPS) in Victoria, Australia. Design, setting and participants Using anonymized data from Victorian CPS, repeat cases were examined involving 29 455 children identified between 2001 and 2005. Measurements Carer alcohol abuse, other drug abuse, mental ill-health, carer experience of abuse as a child, child age and gender, family type, socio-economic variables and level of child protection service intervention as recorded in the CPS electronic database were examined as risk factors for recurrence, using bivariate and multivariate techniques. Findings Almost one-quarter of children in CPS experienced a recurrent incident of child maltreatment in a 5-year period. Where carer alcohol abuse was identified children were significantly more likely to experience multiple incidents compared with children where this was not identified ( P < 0.001), as were children where other family risk factors (including markers of socio-economic disadvantage) were identified. The majority of children whose carers were identified with alcohol abuse experienced either repeat incidents or interventions (84%), although almost three-quarters of these children were managed without resort to the most serious outcome, involving court orders. Conclusions Alcohol and drug abuse in carers are important risk-factors for recurrent child maltreatment after accounting for other known risk factors; the increased risk appears to be similar between alcohol and drug abuse. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims There is a growing interest in very low rate [fewer than one cigarette per day (CPD)] and light (one to nine CPD) smokers and in some parts of the world their numbers appear to be increasing. This paper examined changes in prevalence over the past 5 years, cessation patterns, and smoking and demographic characteristics of very low rate, light and moderate-to-heavy (10+ CPD) smokers in England. Design Cross-sectional and longitudinal data from aggregated monthly waves of a household survey: the Smoking Toolkit Study. Setting England. Participants A total of 23 245 smokers interviewed between November 2006 and May 2011 and 4147 who provided data at 6-month follow-up. Measurements We compared the demographic and smoking characteristics between the three groups of smokers at baseline, and the rate of attempts to quit, use of aids to cessation and success of quit attempts at follow-up. Findings Very low rate smoking remained extremely rare (1.9% of smokers in 2006 to 2.8% in 2011), but light smoking became increasingly common (23.9-32.8%). Compared with moderate-to-heavy smokers, very low rate and light smokers were younger, more often female and from a higher socio-economic background. They were more motivated to quit and enjoyed smoking less. During the 6-month follow-up period, light smokers, but not very low rate smokers, were more likely to attempt to quit than moderate-to-heavy smokers. When they tried to quit, very low rate and light smokers used aids to cessation less than moderate-to-heavy smokers but still used them to a substantial degree: 18%, 31% and 44% used over-the-counter nicotine replacement therapy in their most recent quit attempt for the three types of smoker, respectively. Even very low rate smokers had a substantial failure rate: 65% failed in their most recent quit attempt within 6 months. Conclusions Very low rate (fewer than one cigarette per day) and light (one to nine cigarettes per day) smokers in England are at least as motivated to quit as heavier smokers. Although they use cessation medication less than heavier smokers and are more likely to succeed, they still use such medication and fail in quit attempts to a substantial degree. [ABSTRACT FROM AUTHOR]

Aims The Ethnic Minority Meta-Analysis ( EMMA) aims to assess racial/ethnic disparities in HIV infection among people who inject drugs ( PWID) across various countries. This is the first report of the data. Methods Standard systematic review/meta-analysis methods were utilized, including searching for, screening and coding published and unpublished reports and meta-analytical statistics. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines for reporting methods. Disparities were measured with the odds ratio (OR) for HIV prevalence among ethnic minority PWID compared to ethnic majority PWID; an OR >1.0 indicated higher prevalence among ethnic minorities. Results Racial/ethnic disparities in HIV prevalence among PWID were examined in 131 prevalence reports, with 214 racial/ethnic minority to majority comparisons, comprising 106 715 PWID. Overall, the pooled OR indicates an increased likelihood of higher HIV prevalence among racial/ethnic minority compared to racial/ethnic majority PWID [ OR = 2.09, 95% confidence interval ( CI): 1.92-2.28]. Among 214 comparisons, 106 produced a statistically significant higher OR for minorities; in 102 comparisons the OR was not significantly different from 1.0; six comparisons produced a statistically significant higher OR for majority group members. Disparities were particularly large in the United States, pooled OR = 2.22 (95% CI: 2.03-2.44). There was substantial variation in ORs- I2 = 75.3%: interquartile range = 1.38-3.56-and an approximate Gaussian distribution of the log ORs. Conclusions Among people who inject drugs, ethnic minorities are approximately twice as likely to be HIV seropositive than ethnic majorities. The great heterogeneity and Gaussian distribution suggest multiple causal factors and a need to tailor interventions to local conditions. [ABSTRACT FROM AUTHOR]

Aim To test whether an incentive-based intervention that increased adherence to naltrexone also increased opiate abstinence. Design Post-hoc combined analysis of three earlier randomized controlled trials that showed individually that incentives for adherence to oral and to extended-release injection naltrexone dosing schedules increased naltrexone adherence, but not opiate abstinence. Setting Out-patient therapeutic work-place in Baltimore, MD, USA. Participants One hundred and forty unemployed heroin-dependent adults participating from 2006 to 2010. Interventions Participants were hired in a model work-place for 26 weeks and randomized to a contingency ( n = 72) or prescription ( n = 68) group. Both groups were offered naltrexone. Contingency participants were required to take scheduled doses of naltrexone in order to work and earn wages. Prescription participants could earn wages independent of naltrexone adherence. Measures Thrice-weekly and monthly urine samples tested for opiates and cocaine and measures of naltrexone adherence (percentage of monthly urine samples positive for naltrexone or percentage of scheduled injections received). All analyses included pre-randomization attendance, opiate use and cocaine use as covariates. Additional analyses controlled for cocaine use and naltrexone adherence during the intervention. Findings Contingency participants had more opiate abstinence than prescription participants (68.1 versus 52.9% opiate-negative thrice-weekly urine samples, respectively; and 71.9 versus 61.7% opiate-negative monthly urine samples, respectively) based on initial analyses [thrice-weekly samples, odds ratio (OR) = 3.3, 95% confidence interval (CI) = 1.7-6.5, P < 0.01; monthly samples, OR = 2.6, 95% CI = 1.0-7.1, P = 0.06] and on analyses that controlled for cocaine use (thrice-weekly samples, OR = 3.9, 95% CI = 3.3-4.5, P < 0.01; monthly samples, OR = 3.4, 95% CI = 1.1-11.1, P = 0.04), which was high and associated with opiate use. The difference in opiate abstinence rates between contingency and prescription participants was reduced when controlling for naltrexone adherence (monthly samples, OR = 1.1, 95% CI = 0.7-1.7, P = 0.84). Conclusions Incentives for naltrexone adherence increase opiate abstinence in heroin-dependent adults, an effect that appears to be due to increased naltrexone adherence produced by the incentives. [ABSTRACT FROM AUTHOR]

Aims To investigate how gender composition of the drinking group affects young adults' alcohol consumption on weekend evenings over and above the effect of drinking-group size. Design Using the internet-based cellphone-optimized assessment technique (ICAT), participants completed online questionnaires on their cell phones every hour from 8 p.m. to midnight on Thursday, Friday and Saturday evenings during five consecutive weekends. Setting French-speaking Switzerland. Participants Convenience sample of 183 young adults (53.0% female, mean age = 23.1) who completed a total of 4141 hourly assessments. Measurements Alcohol consumption and number of male and female friends present assessed at 8 p.m., 9 p.m., 10 p.m., 11 p.m. and midnight. Findings Results of three-level negative binomial regression analyses showed that women consumed significantly more drinks per hour when drinking in mixed-gender groups ( Z-values ranging from 2.9 to 5.3, all P < 0.01) and significantly fewer drinks when drinking with men only ( Z = −2.7, P < 0.01), compared with drinking with women only. Men reported consuming more drinks per hour in mixed-gender groups of equal gender composition ( Z = 2.4, P < 0.05) or mixed-gender groups with men in the majority ( Z = 2.2, P < 0.05) and fewer hourly drinks when drinking with women only ( Z = −4.9, P < 0.001), compared with drinking with men only. Drinking-group size predicted the hourly number of drinks for women ( Z = 6.0, P < 0.001) and men ( Z = 5.5, P < 0.001). Conclusions Drinking-group gender composition is associated with number of drinks consumed per hour, over and above the impact of the drinking-group size. Young adults report consuming more drinks per hour when drinking with mixed-gender groups than with same-gender groups. [ABSTRACT FROM AUTHOR]

Aims To test whether exposure to party-related alcohol advertising is associated with drinking behavior in a national US sample of adolescents and young adults, independently of exposure to other alcohol advertising. Design Longitudinal telephone- and web-based surveys conducted in 2011 and 2013. Setting All regions of the United States, participants selected via mixed-mode random-digit-dial landline and cellphone frames. Participants A sample of 705 respondents who never had a whole drink of alcohol at baseline (mean age 16.9 years, 53.3% female) and a sample of 1036 who never had six or more drinks during one drinking occasion (mean age 17.4 years, 55.8% female). Measurements Outcome measures were onset of alcohol use and binge drinking during the study interval. Primary predictor was exposure to television alcohol advertising, operationalized as contact frequency and brand recall for 20 randomly selected alcohol advertisements. Independent post-hoc analyses classified all advertisements as 'party' or 'non-party' advertisements. Socio-demographics, sensation-seeking, alcohol expectancies and alcohol use of friends and family were assessed as covariates. Findings Onset rates for having the first whole drink of alcohol and for first binge drinking were 49.2% and 29.5%, respectively. On average, approximately half (median = 10.2) of the 20 alcohol advertisements in each individual survey were 'party' advertisements. If both types of exposures ('party' and 'non-party') were included in the regression model, only 'party' exposure remained a significant predictor of alcohol use onset [adjusted odds ratio (AOR) = 19.17; 95% confidence interval (CI) = 3.72-98.79] and binge drinking onset (AOR = 3.87; 95% CI = 1.07-13.99) after covariate control. Conclusions Adolescents and young adults in the United States appear to have higher rates of alcohol use and binge drinking onset if they have higher exposure to alcohol advertisements using a partying theme, independently of the amount of exposure to alcohol advertisements with non-party themes. [ABSTRACT FROM AUTHOR]

Aims We compared the risk of mental health episodes requiring hospitalization (primary aim) or out-patient clinic visits (secondary aim) associated with varenicline versus the nicotine patch (NP) in an era prior to psychiatric boxed warnings. Design Retrospective cohort. Setting Department of Veterans Affairs (VA), USA. Participants VA patients with or without psychiatric comorbidities and a new prescription for varenicline (15 255) were propensity score-matched (1 : 2) to new users of NP (123 054) between 1 May 2006 and 30 September 2007, resulting in 11 774 and 23 548 patients in the varenicline and NP groups, respectively. Measurements The primary outcomes were hospitalizations with a primary discharge diagnosis of a range of mental health disorders: depression, schizophrenia, bipolar disorder, suicide attempt, post-traumatic stress disorder, other psychosis and drug-induced mental disorders. Secondary outcomes were out-patient clinic visits with a primary diagnosis of the above list of mental health disorders. Findings Background characteristics of the treatment groups were similar after matching. There was no statistically significant difference in risk of hospitalization for any of the studied mental health disorders with varenicline compared with NP. Among secondary outcomes there was an increased risk of out-patient clinic visits for schizophrenia among patients who received varenicline [hazard ratio (HR) = 1.27; 95% confidence interval (CI) = 1.07, 1.51], this increase being evident only in those with a pre-existing mental health disorder. Conclusion In US VA patients studied prior to the boxed warning being implemented, use of varenicline for smoking cessation was not associated with a detectable increase compared with nicotine patches in hospitalization for any mental health outcomes. There was an increased rate of out-patient attendances with a primary diagnosis of schizophrenia amounting to five per 100 person years of treatment. This increase was found only in patients with a pre-existing mental health disorder. [ABSTRACT FROM AUTHOR]

Background and Aims Current pharmacotherapies for tobacco dependence are generally well tolerated, but have relatively high rates of relapse. They target primarily the brains' mesocorticolimbic 'reward' pathway. However, recent evidence suggests that the insular cortex, a central cerebral hemispheric region historically overlooked in addiction models, may also play an important role in cognitive and emotional processes that facilitate drug use. We examined whether insular versus non-insular damage from ischemic stroke attenuated acute withdrawal from cigarette smoking and reduced the likelihood of nicotine replacement therapy (NRT) use during hospitalization. Design Data were derived from a longitudinal study with 3 months' follow-up, beginning June 2013 and ending May 2014. Setting Three acute care hospitals in Rochester, NY, USA. Participants One-hundred and fifty-six current smokers hospitalized for acute ischemic stroke (38 with insular infarctions and 118 with non-insular infarctions, assessed by three neuroradiologists). Measurements The Wisconsin Smoking Withdrawal Scale (WSWS) and Minnesota Nicotine Withdrawal Scale (MNWS) were administered during hospitalization (a period of forced abstinence) to assess the frequency and severity of withdrawal symptoms. NRT use was also assessed during hospitalization. Findings On average, smokers with insular damage had a lower WSWS score during admission [mean = 5.89, standard deviation (SD) = 4.72] compared with those with non-insular damage (mean = 9.20, SD = 4.71; P < 0.001) [covariate-adjusted difference in means of -3.12, 95% confidence interval (CI) = -4.97, -1.27]. A similar difference was also noted when the MNWS was used ( P = 0.02). Furthermore, participants with insular lesions appeared to be less likely to use NRT during admission compared with those with non-insular lesions [odds ratio (OR) = 0.72, 95% CI = 0.32, 1.64]. Conclusions Current smokers with damage to their insular cortex brain region appear to experience fewer and less severe tobacco withdrawal symptoms, and appear to be less likely to require nicotine replacement therapy during hospitalization, compared with smokers with non-insular damage. These findings support the potential role of the insular cortex in regulating withdrawal during abstinence, a motivator responsible for the maintenance of addictive behaviors. [ABSTRACT FROM AUTHOR]

Background and aims Retrospective measures of alcohol intake are becoming increasingly popular; however, the reliability of such measures remains uncertain. This study assessed the reliability of a retrospective decade-based life-course alcohol consumption questionnaire, based on the standardized Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) administered in older age in a well-characterized cohort study. Design, setting, participants and measurements A retrospective alcohol life-grid was administered to 5980 participants (72% male, mean age 70 years) in the Whitehall II study covering frequency of drinking, number of drinks in a typical drinking day and frequency of consuming six or more drinks in a single drinking occasion in the teens (16-19 years) through to the 80s. A subsample of 385 individuals completed a repeat survey to determine test-retest reliability. Retrospective measures were also compared with prospectively ascertained information and used to predict objectively measured systolic blood pressure to test their predictive validity. Findings Across all decades of life, test-retest reliability was generally good (κ range = 0.62-0.78 for frequency, 0.55-0.62 for usual number of drinks and 0.57-0.65 for frequency of consuming six or more drinks in a single occasion). The concordance between prospective and retrospective measures was consistently moderate to high. The life-grid method performed better than a single question in identifying life-time abstainers. Retrospective measures were also related to systolic blood pressure in the manner anticipated. Conclusion A retrospective decade-based AUDIT-C grid administered in older age provides a relatively reliable measure of alcohol consumption across the life-course. [ABSTRACT FROM AUTHOR]

Background and Aims A broadly mandated reduction of the nicotine content (RNC) of cigarettes has been proposed in the United States to reduce the addictiveness of cigarettes, to prevent new smokers from becoming addicted and to facilitate quitting in established smokers. The primary aim of this study was to determine whether following 7 months of smoking very low nicotine content cigarettes (VLNC), and then returning to their own cigarettes, smokers would demonstrate persistently reduced nicotine intake compared with baseline or quit smoking. Methods In a community-based clinic 135 smokers not interested in quitting were randomized to one of two groups. A research group smoked their usual brand of cigarettes, followed by five types of research cigarettes with progressively lower nicotine content, each for 1 month, followed by 6 months at the lowest nicotine level (0.5 mg/cigarette) (53 subjects) and then 12 months with no intervention (30 subjects completed). A control group smoked their usual brand for the same period of time (50 subjects at 6 months, 38 completed). Smoking behavior, biomarkers of nicotine intake and smoke toxicant exposure were measured. Results After 7 months smoking VLNC, nicotine intake remained below baseline (plasma cotinine 149 versus 250 ng/ml, P<0.005) with no significant change in cigarettes per day or expired carbon monoxide (CO). During the 12-month follow-up, cotinine levels in RNC smokers rose to baseline levels and to those of control smokers. Quit rates among RNC smokers were very low [7.5 versus 2% in controls, not significant). Conclusions In smokers not interested in quitting, reducing the nicotine content in cigarettes over 12 months does not appear to result in extinction of nicotine dependence, assessed by persistently reduced nicotine intake or quitting smoking over the subsequent 12 months. [ABSTRACT FROM AUTHOR]

Aims Ecological Momentary Assessment (EMA) captures real-time reports in subjects' natural environments. This experiment manipulated EMA frequency to estimate effects on abstinence and peri-cessation subjective experiences. Design In this randomized trial, subjects had an equal chance of being assigned to low-frequency (once) or high-frequency (six times) daily EMA for 4 weeks (1 week pre- and 3 weeks post-cessation). Participants completed six office visits over 5 weeks and 6- and 12-week follow-up telephone interviews. Setting Community participants were recruited from central New Jersey, USA. Participants One hundred and ten adult daily smokers seeking to quit smoking were included in intent-to-treat analyses of tobacco abstinence; 94 were available for secondary analyses of peri-cessation subjective ratings. Measurements Primary outcomes were cessation (abstaining at least 24 hours within 2 weeks of attempting to quit) and prolonged abstinence (no relapse between weeks 2 and 12 post-quit). Secondary outcomes were mean levels and growth in ratings of cigarette craving, affect and quitting motivation and self-efficacy. Findings EMA frequency was unrelated to cessation (odds ratio = 1.367, 95% confidence interval = 0.603-3.098) or prolonged abstinence (odds ratio = 1.040, 95% confidence interval = 0.453-2.388) in intent-to-treat analyses. High-frequency EMA was associated with lower craving (B = -0.544, standard error (SE) = 0.183, P = 0.004, anxiety ( B = -0.424, SE = 0.170, P = 0.015), anger (B = -0.474, SE = 0.139, P = 0.001), hunger (B = -0.388, SE = 0.170, P = 0.025) and positive affect (B = -0.430, SE = 0.196, P = 0.03). Conclusions In smokers trying to quit, more frequent ecological momentary assessment self-monitoring results in lower craving, anxiety, anger, hunger and positive affect. It is not clear whether this translates into higher rates of smoking abstinence. [ABSTRACT FROM AUTHOR]

Aim The effectiveness of Preventure was tested on drinking behaviour of young adolescents in secondary education in the Netherlands. Design A cluster randomized controlled trial was carried out, with participants assigned randomly to a two-session coping skills intervention or a control no-intervention condition. Setting Fifteen secondary schools throughout the Netherlands; seven schools in the intervention and eight schools in the control condition. Participants A total of 699 adolescents aged 13-15 years participated, 343 allocated to the intervention and 356 to the control condition, with drinking experience and elevated scores in either negative thinking, anxiety sensitivity, impulsivity or sensation-seeking. Intervention and comparator Preventure is a selective school-based alcohol prevention programme targeting personality risk factors. The comparator was a no-intervention control. Measurements The effects of the intervention on the primary outcome past-month binge drinking, and the secondary outcomes binge drinking frequency, alcohol use, alcohol frequency and problem drinking, were examined. The primary analyses of interest were intervention main effects at 12 months post-intervention. In addition, intervention effects on the linear development of binge drinking using a latent-growth curve approach were examined. Findings Binge drinking rates were not significantly different between the intervention (42.9%) and control group (49.2%) at 12 months follow-up [odds ratio (OR) = 1.05, confidence interval (CI) = 0.99, 1.11]. Intention-to-treat analyses revealed no significant intervention effects on alcohol use (53.9 versus 61.5%; OR = 0.99, CI = 0.86, 1.14) and problem drinking (37.0 versus 44.7%; OR = 1.03, CI = 0.92, 1.10) at 12 months follow-up. The post-hoc latent-growth analyses revealed significant effects on the development of binge drinking ( β = -0.16, P = 0.05), and binge drinking frequency ( β = -0.14, P = 0.05). Conclusion The alcohol prevention programme, Preventure, appears to have little or no effect on overall prevalence of binge drinking in adolescents in the Netherlands but may reduce the development of binge drinking over time. [ABSTRACT FROM AUTHOR]

Aims Within a parent study examining ovarian hormone effects on smoking cessation in women, we conducted an exploratory short-term trial of varenicline versus transdermal nicotine patch. Design Double-blind double-dummy randomized trial. Setting Single-site out-patient research clinic in the United States. Participants Female smokers, ages 18-45 years and averaging ≥10 cigarettes per day for at least 6 months ( n = 140). Interventions Participants were randomized to receive a 4-week course of (a) varenicline tablets and placebo patches ( n = 67) or (b) placebo tablets and nicotine patches ( n = 73). Two brief cessation counseling sessions were provided for all participants. Measurements The outcome of primary clinical interest was 2-week end-of-treatment abstinence. Secondary outcomes included 1- and 4-week end-of treatment abstinence and abstinence at a post-treatment follow-up visit occurring 4 weeks after treatment conclusion. Breath carbon monoxide (≤ 10 parts per million) was used to confirm biochemically self-reported abstinence. Findings Two-week end-of-treatment abstinence was achieved by 37.3% (25 of 67) of varenicline participants and by 17.8% (13 of 73) of nicotine patch participants [odds ratio (OR) = 2.7, 95% confidence interval (CI) = 1.3-6.0, P = 0.011]. One-week (44.8 versus 20.6%, OR = 3.1, 95% CI = 1.5-6.6, P = 0.003) and 4-week (22.4 versus 9.6%, OR = 2.7, 95% CI = 1.0-7.2, P = 0.043) end-of-treatment abstinence similarly favored varenicline, although post-treatment follow-up Russell Standard abstinence was not significantly different between groups (23.9 versus 13.7%, OR = 2.0, 95% CI = 0.8-4.7, P = 0.126). Conclusion In an exploratory 4-week head-to-head trial in female smokers, varenicline, compared with nicotine patch, more than doubled the odds of end-of-treatment abstinence, although this diminished somewhat at post-treatment follow-up. [ABSTRACT FROM AUTHOR]

Aims To compare three missing data strategies: (i) the latent growth model that assumes the data are missing at random ( MAR) model; (ii) the Diggle- Kenward missing not at random ( MNAR) model, where dropout is a function of previous/concurrent urinalysis ( UA) submissions; and (iii) the Wu- Carroll MNAR model where dropout is a function of the growth factors. Design Secondary data analysis of a National Drug Abuse Treatment Clinical Trials Network trial that examined a 7-day versus 28-day taper (i.e. stepwise decrease in buprenorphine/naloxone) on the likelihood of submitting an opioid-positive UA during treatment. Setting 11 out-patient treatment settings in 10 US cities. Participants A total of 516 opioid-dependent participants. Measurements Opioid UAs provided across the 4-week treatment period. Findings The MAR model showed a significant effect ( B = −0.45, P < 0.05) of trial arm on the opioid-positive UA slope (i.e. 28-day taper participants were less likely to submit a positive UA over time) with a small effect size ( d = 0.20). The MNAR Diggle- Kenward model demonstrated a significant ( B = −0.64, P < 0.01) effect of trial arm on the slope with a large effect size ( d = 0.82). The MNAR Wu- Carroll model showed a significant ( B = −0.41, P < 0.05) effect of trial arm on the UA slope that was relatively small ( d = 0.31). Conclusions This performance comparison of three missing data strategies (latent growth model, Diggle- Kenward selection model, Wu- Carrol selection model) on sample data indicates a need for increased use of sensitivity analyses in clinical trial research. Given the potential sensitivity of the trial arm effect to missing data assumptions, it is critical for researchers to consider whether the assumptions associated with each model are defensible. [ABSTRACT FROM AUTHOR]

Aims To test the effectiveness of tailored quitline (telephone) counselling among smoking parents recruited into cessation support through their children's primary schools. Design Two-arm randomized controlled trial with 3- and 12-month follow-up. Setting Proactive telephone counselling was administered by the Dutch national quitline. Participants Smoking parents were recruited through their children's primary schools and received either intensive quitline support in combination with tailored supplementary materials ( n = 256) or a standard self-help brochure ( n = 256). Measurements The primary outcome was 7-day point-prevalence abstinence at 12-month follow-up. Also measured were baseline characteristics, use of and adherence to nicotine replacement therapy and pharmacotherapy, smoking characteristics and implementation of a home smoking ban. Findings Parents who received quitline counselling were more likely to report 7-day point-prevalence abstinence at 12-month assessment [34.0 versus 18.0%, odds ratio ( OR) = 2.35, confidence interval ( CI) = 1.56-3.54] than those who received a standard self-help brochure. Parents who received quitline counselling were more likely to use nicotine replacement therapy ( P < 0.001) than those who received a standard self-help brochure. Among parents who did not achieve abstinence, those who received quitline counselling smoked fewer cigarettes at 3-month ( P < 0.001) and 12-month assessment ( P < 0.001), were more likely to make a quit attempt ( P < 0.001), to achieve 24 hours' abstinence ( P < 0.001) and to implement a complete home smoking ban ( P < 0.01). Conclusions Intensive quitline support tailored to smoking parents is an effective method for helping parents quit smoking and promoting parenting practices that protect their children from adverse effects of smoking. [ABSTRACT FROM AUTHOR]

Background and Aims Alcohol and nicotine dependence are associated with considerable morbidity and mortality, especially when cases are persistent. The risk for alcohol and nicotine dependence is increased by childhood maltreatment. However, the influence of childhood maltreatment on dependence course is unknown, and is evaluated in the current study. Design Physical, sexual and emotional abuse, and physical and emotional neglect, were evaluated as predictors of persistent alcohol and nicotine dependence over 3 years of follow-up, with and without control for other childhood adversities. Setting National Epidemiologic Survey on Alcohol and Related Conditions ( NESARC). Participants NESARC participants completing baseline and follow-up who met criteria at baseline for past-year alcohol dependence ( n = 1172) and nicotine dependence ( n = 4017). Measurements Alcohol Use Disorder and Associated Disabilities Interview Schedule ( AUDADIS) measures of alcohol/nicotine dependence, childhood maltreatment and other adverse childhood experiences (e.g. parental divorce). Findings Controlling for demographics only, physical, sexual and emotional abuse and physical neglect predicted 3-year persistence of alcohol dependence [adjusted odds ratio ( AOR) = 1.50-2.99; 95% CI = 1.04-4.68] and nicotine dependence ( AOR = 1.37-1.74; 95% CI = 1.13-2.11). With other childhood adversities also controlled, maltreatment types remained predictive for alcohol persistence ( AOR = 1.53-3.02; 95% CI = 1.07-4.71) and nicotine persistence ( AOR = 1.35-1.72; 95% CI = 1.11-2.09). Further, a greater number of maltreatment types incrementally influenced persistence risk ( AOR = 1.19-1.36; 95% CI = 1.11-1.56). Conclusions A history of childhood maltreatment predicts persistent adult alcohol and nicotine dependence. This association, robust to control for other childhood adversities, suggests that maltreatment (rather than a generally difficult childhood) affects the course of dependence. [ABSTRACT FROM AUTHOR]

Aims To examine differences between early-onset versus later-onset pathological gamblers in socio-demographic characteristics, rates of Axis I and II disorders, preferred type of gambling and rates of treatment-seeking in a large nationally representative survey of adults in the United States. Design Data were collected from face-to-face interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule DSM- IV version IV ( AUDADIS- IV). Setting and Measurement The study drew on data from the United States' National Epidemiologic Survey on Alcohol and Related Conditions ( NESARC). Participants All individuals with a DSM- IV diagnosis of pathological gambling ( PG). To be consistent with prior studies, age of onset of PG was dichotomized as 25 years and younger (early-onset) versus 26 years and older (later-onset). Findings Individuals with early-onset PG were more likely than individuals with later-onset PG to be male [odds ratio ( OR) = 2.86; 95% confidence interval ( CI) = 1.20, 6.82], never married ( OR = 3.51; 95% CI = 1.39, 8.84), to have income below US$70 000 ( OR = 0.09; 95% CI = 0.01, 0.61), to belong to younger cohorts ( OR = 0.93; 95% CI = 0.89, 0.97) and to have a cluster B personality disorder ( OR = 4.11; 95% CI = 1.77, 9.55), but less likely to have a mood disorder ( OR = 0.42; 95% CI = 0.19, 0.94). There were no differences between individuals with early- and later-onset PG regarding rates of treatment-seeking ( OR = 0.71; 95% CI = 0.20, 2.43) or preferred type of gambling ( OR = 2.00; 95% CI = 0.55, 7.3). All results remained significant after adjusting for age, sex and race, except the difference in the prevalence for mood disorders, which was no longer significant. Conclusions Individuals with early-onset versus later-onset pathological gambling differ in several socio-demographic and clinical characteristics, but not in their preferred types of game. Individuals from more recent cohorts appear to be at significantly increased risk for developing early-onset pathological gambling. [ABSTRACT FROM AUTHOR]

Background and aims There is a need for more evidence on the 'real-world' effectiveness of commonly used aids to smoking cessation from population-level studies. This study assessed the association between abstinence and use of different smoking cessation treatments after adjusting for key potential confounding factors. Design Cross-sectional data from aggregated monthly waves of a household survey: the Smoking Toolkit Study. Setting England. Participants A total of 10 335 adults who smoked within the previous 12 months and had made at least one quit attempt during that time. Measurements Participants were classified according to their use of cessation aids in their most recent quit attempt: (i) medication (nicotine replacement therapy, bupropion or varenicline) in combination with specialist behavioural support delivered by a National Health Service Stop Smoking Service; (ii) medication provided by the prescribing health-care professional without specialist behavioural support; (iii) nicotine replacement therapy ( NRT) bought over the counter; and (iv) none of these. The main outcome measure was self-reported abstinence up to the time of the survey, adjusted for key potential confounders including tobacco dependence. Findings Compared with smokers using none of the cessation aids, the adjusted odds of remaining abstinent up to the time of the survey were 3.25 [95% confidence interval ( CI) = 2.05-5.15] greater in users of prescription medication in combination with specialist behavioural support, 1.61 (95% CI = 1.33-1.94) greater in users of prescription medication combined with brief advice and 0.96 (95% CI = 0.81-1.13) in users of NRT bought over the counter. Conclusions After adjusting for major confounding variables such as tobacco dependence, smokers in England who use a combination of behavioural support and pharmacotherapy in their quit attempts have almost three times the odds of success than those who use neither pharmacotherapy nor behavioural support. Smokers who buy nicotine replacement therapy over the counter with no behavioural support have similar odds of success in stopping as those who stop without any aid. [ABSTRACT FROM AUTHOR]

Aims We examined the cost-effectiveness of extended smoking cessation treatment in older smokers. Design Participants who completed a 12-week smoking cessation program were factorial randomized to extended cognitive behavioral treatment and extended nicotine replacement therapy. Setting A free-standing smoking cessation clinic. Participants A total of 402 smokers aged 50 years and older were recruited from the community. Measurements The trial measured biochemically verified abstinence from cigarettes after 2 years and the quantity of smoking cessation services utilized. Trial findings were combined with literature on changes in smoking status and the age- and gender-adjusted effect of smoking on health-care cost, mortality and quality of life over the long term in a Markov model of cost-effectiveness over a lifetime horizon. Findings The addition of extended cognitive behavioral therapy added $83 in smoking cessation services cost [ P = 0.012, confidence interval ( CI) = $22-212]. At the end of follow-up, cigarette abstinence rates were 50.0% with extended cognitive behavioral therapy and 37.2% without this therapy ( P < 0.05, odds ratio 1.69, CI 1.18-2.54). The model-based incremental cost-effectiveness ratio was $6324 per quality-adjusted life year ( QALY). Probabilistic sensitivity analysis found that the additional $947 in lifetime cost of the intervention had a 95% confidence interval of −$331 to 2081; the 0.15 additional QALYs had a confidence interval of 0.035-0.280, and that the intervention was cost-effective against a $50 000/ QALY acceptance criterion in 99.6% of the replicates. Extended nicotine replacement therapy was not cost-effective. Conclusions Adding extended cognitive behavior therapy to standard cessation treatment was cost-effective. Further intensification of treatment may be warranted. [ABSTRACT FROM AUTHOR]

Background and aims British alcohol consumption and abstinence rates have increased substantially in the last 3 decades. This study aims to disentangle age, period and birth cohort effects to improve our understanding of these trends and suggest groups for targeted interventions to reduce resultant harms. Design Age, period, cohort analysis of repeated cross-sectional surveys using separate logistic and negative binomial models for each gender. Setting Great Britain 1984-2009. Participants Annual nationally representative samples of approximately 20 000 adults (16+) within 13 000 households. Measurements Age (eight groups: 16-17 to 75+ years), period (six groups: 1980-84 to 2005-09) and birth cohorts (19 groups: 1900-04 to 1990-94). Outcome measures were abstinence and average weekly alcohol consumption. Controls were income, education, ethnicity and country. Findings After accounting for period and cohort trends, 18-24-year-olds have the highest consumption levels (incident rate ratio = 1.18-1.15) and lower abstention rates (odds ratio = 0.67-0.87). Consumption generally decreases and abstention rates increase in later life. Until recently, successive birth cohorts' consumption levels were also increasing. However, for those born post-1985, abstention rates are increasing and male consumption is falling relative to preceding cohorts. In contrast, female drinking behaviours have polarized over the study period, with increasing abstention rates accompanying increases in drinkers' consumption levels. Conclusions Rising female consumption of alcohol and progression of higher-consuming birth cohorts through the life course are key drivers of increased per capita alcohol consumption in the United Kingdom. Recent declines in alcohol consumption appear to be attributable to reduced consumption and increased abstinence rates among the most recent birth cohorts, especially males, and general increased rates of abstention across the study period. [ABSTRACT FROM AUTHOR]

Aims To compare a brief versus a brief plus intensive self-help version of 'Balance', a fully automated online alcohol intervention, on self-reported alcohol consumption. Design A pragmatic randomized controlled trial. Participants in both conditions received an online single session screening procedure including personalized normative feedback. The control group also received an online booklet about the effects of alcohol. The treatment group received the online multi-session follow-up program, Balance. Setting Online study in Norway. Participants At-risk drinkers were recruited by internet advertisements and assigned randomly to one of the two conditions ( n = 244). Measurements The primary outcome was self-reported alcohol consumption the previous week measured 6 months after screening. Findings Regression analysis, using baseline carried forward imputation (intent-to-treat), with baseline variables as covariates, showed that intervention significantly affected alcohol consumption at 6 months (B = 2.96; 95% confidence interval = 0.02-5.90; P = 0.049). Participants in the intensive self-help group drank an average of three fewer standard alcohol units compared with participants in the brief self-help group. Conclusions The online Balance intervention, added to a brief online screening intervention, may aid reduction in alcohol consumption compared with the screening intervention and an educational booklet. [ABSTRACT FROM AUTHOR]

Aims To examine patient and medication characteristics associated with retention and continued illicit opioid use in methadone ( MET) versus buprenorphine/naloxone ( BUP) treatment for opioid dependence. Design, settings and participants This secondary analysis included 1267 opioid-dependent individuals participating in nine opioid treatment programs between 2006 and 2009 and randomized to receive open-label BUP or MET for 24 weeks. Measurements The analyses included measures of patient characteristics at baseline (demographics; use of alcohol, cigarettes and illicit drugs; self-rated mental and physical health), medication dose and urine drug screens during treatment, and treatment completion and days in treatment during the 24-week trial. Findings The treatment completion rate was 74% for MET versus 46% for BUP ( P < 0.01); the rate among MET participants increased to 80% when the maximum MET dose reached or exceeded 60 mg/day. With BUP, the completion rate increased linearly with higher doses, reaching 60% with doses of 30-32 mg/day. Of those remaining in treatment, positive opioid urine results were significantly lower [odds ratio ( OR) = 0.63, 95% confidence interval ( CI) = 0.52-0.76, P < 0.01] among BUP relative to MET participants during the first 9 weeks of treatment. Higher medication dose was related to lower opiate use, more so among BUP patients. A Cox proportional hazards model revealed factors associated with dropout: (i) BUP [versus MET, hazard ratio ( HR) = 1.61, CI = 1.20-2.15], (ii) lower medication dose (<16 mg for BUP, <60 mg for MET; HR = 3.09, CI = 2.19-4.37), (iii) the interaction of dose and treatment condition (those with higher BUP dose were 1.04 times more likely to drop out than those with lower MET dose, and (iv) being younger, Hispanic and using heroin or other substances during treatment. Conclusions Provision of methadone appears to be associated with better retention in treatment for opioid dependence than buprenorphine, as does use of provision of higher doses of both medications. Provision of buprenorphine is associated with lower continued use of illicit opioids. [ABSTRACT FROM AUTHOR]

Aims To examine non-medical use of prescription opioids ( NMUPO) patterns during the transition from adolescence to adulthood, and assess individual characteristics and other substance use behaviors associated with longitudinal patterns of NMUPO. Design Nationally representative samples of high school seniors in the United States (wave 1: modal age 18 years) were followed longitudinally across three biennial follow-up waves (waves 2, 3 and 4: modal ages 19/20, 21/22 and 23/24 years). Setting Data were collected via self-administered questionnaires to high school seniors and young adults. Participants The longitudinal sample consisted of 27 268 individuals in 30 cohorts (high school senior years 1976-2005) who participated in all four waves. Measurements Self-reports of NMUPO and other substance use behaviors. Findings Approximately 11.6% [95% confidence interval ( CI) = 11.2%, 12.0%] of the sample reported past-year NMUPO in at least one of the four waves. Among those who reported past-year NMUPO in at least one wave, 69.0% (67.6%, 70.4%), 20.5% (19.3%, 21.7%), 7.8% (7.1%, 8.6%) and 2.7% (2.3%, 3.1%) reported NMUPO at one, two, three and four waves, respectively. Several wave 1 variables were associated with greater odds of multiple waves of NMUPO and individuals who reported more waves of NMUPO had greater odds of other substance use behaviors. Conclusions Although most non-medical use of prescription opioids among 18-year-olds in the United States appears to be non-continuing, approximately one-third of the sample reporting non-medical use of prescription opioids appear to continue use beyond age 18 and have elevated odds of other substance use behaviors at ages 23/24. [ABSTRACT FROM AUTHOR]

Aims To evaluate the associations of treatment and an additive genetic efficacy score ( AGES) based on dopamine functional polymorphisms with time to first smoking lapse and point prevalence abstinence at end of treatment among participants enrolled into two randomized clinical trials of smoking cessation therapies. Design Double-blind pharmacogenetic efficacy trials randomizing participants to active or placebo bupropion. Study 1 also randomized participants to cognitive-behavioral smoking cessation treatment ( CBT) or this treatment with CBT for depression. Study 2 provided standardized behavioural support. Setting Two hospital-affiliated clinics (study 1), and two university-affiliated clinics (study 2). Participants A total of 792 self-identified white treatment-seeking smokers aged ≥18 years smoking ≥10 cigarettes per day over the last year. Measurements Age, gender, Fagerström Test for Nicotine Dependence, dopamine pathway genotypes (rs1800497 [ ANKK1 E713 K], rs4680 [ COMT V158 M], DRD4 exon 3 variable number of tandem repeats polymorphism [ DRD4 VNTR], SLC6 A3,3′ VNTR) analyzed both separately and as part of an AGES, time to first lapse and point prevalence abstinence at end of treatment. Findings Significant associations of the AGES (hazard ratio [HR] = 1.10, 95% confidence interval [ CI] = 1.06-1.14, P = 0.009) and of the DRD4 VNTR ( HR = 1.29, 95% CI = 1.17-1.41, P = 0.0073) were observed with time to first lapse. A significant AGES by pharmacotherapy interaction was observed (β standard error = −0.18 [0.07], P = 0.016), such that AGES predicted risk for time to first lapse only for individuals randomized to placebo. Conclusions A score based on functional polymorphisms relating to dopamine pathways appears to predict lapse to smoking following a quit attempt, and the association is mitigated in smokers using bupropion. [ABSTRACT FROM AUTHOR]

Aims Studies of offending among people who use drugs typically focus upon small and potentially unrepresentative samples. We examined an entire population of opioid-dependent clients' contact with the criminal justice system to develop more accurate population-wide measures of offending among opioid-dependent people in Australia. Design Retrospective data linkage study. Setting All entrants to opioid substitution therapy ( OST) for opioid dependence in New South Wales, Australia, between 1985 and 2010, with data on court appearances from 1 December 1993 to 31 March 2011. Participants All 48 069 valid cohort members who received OST between 1985 and 2010. Measurements Person-years ( PY) of observation and charge rates for major crime categories estimated by sex, age and time. Findings A total of 638 545 charges were laid against cohort members between 1993 and 2011. Eight in 10 males (79.7%) and 67.9% of females had at least one charge; rates were 94.15 per 100 PY [95% confidence interval ( CI) = 93.89-94.41] among males, and 53.19 per 100 PY (95% CI = 52.91-53.46) among females, and highest at 15-19 years [175.74/100 PY males (95% CI = 174.45-177.03), 75.60/100 PY females (95% CI = 74.46-76.76)] and 20-24 years [144.61/100 PY males (95% CI = 143.70-145.53), 84.50/100 PY females (95% CI = 83.53-85.48)]. The most frequent charges were theft (24.5% of charges), traffic/vehicle (16.3%), offences against justice (10.5%), illicit drug (10.0%), intentional injury (9.9%) and public order offences (8.9%). Overall, 20.8% of the cohort accounted for 67.4% of charges. The most frequently appearing 5.6% of the cohort accounted for 24.3% of costs ($75.5 million). Conclusions Among opioid-dependent people in Australia, a minority account for the majority of the criminal justice contact and levels of offending are not consistent over time, sex or age. [ABSTRACT FROM AUTHOR]

Aim To examine the association between alcohol in school environments and adolescent alcohol use over the previous 6 months. Design A multi-level logistic regression analysis was performed of cross-sectional surveys conducted in 2004, 2005 and 2006. Participants and setting A total of 52 214 students aged 11-19 years from 387 middle or high schools were selected from a nationally representative, multi-stage, stratified probability sampling across Taiwan. Measurements Information on socio-demographic features and substance use experiences was collected using self-administered questionnaires. The alcohol in the environment was measured using the availability of convenience stores surrounding the schools. Using geographical information systems, the weighted numbers of convenience stores within 1 km, a 12-15-minute walk, of a school were calculated. The schools were later categorized into three subgroups via the tertile of nearby convenience stores. Findings Considering the compositional characteristics, the availability of convenience stores was found to account for 1.5% of the school-level variance of youthful drinking. The odds ratios (95% confidence interval) of alcohol use over the previous 6 months among youth attending schools with medium and high availability were 1.04 (0.96-1.13) and 1.08 (1.00-1.17), respectively, with a P-value of 0.04 in the trend test. Conclusion The greater availability of convenience stores near a school is associated with an increased risk of alcohol use among adolescents over the previous 6 months. [ABSTRACT FROM AUTHOR]

Aims To establish the 3-year persistency rate of alcohol use disorder ( AUD) and its predictors, and to examine drinking patterns of recently remitted individuals. Design and Setting The Netherlands Mental Health Survey and Incidence Study-2 ( NEMESIS-2) surveyed a nationally representative sample of adults (aged 18-64 years) at baseline (response = 65.1%) and 3-year follow-up (response = 80.4%). Participants People with AUD at baseline, as defined by DSM-5 ( n = 198). Measurements AUD, drinking patterns and mental disorders were assessed using the Composite International Diagnostic Interview 3.0. Other predictors were assessed with an additional questionnaire. Predictors of persistency were examined with univariable and multivariable logistic regression analyses. Results The AUD persistency rate was 29.5% [95% confidence intervals ( CI) = 20.0-39.0]. In the multivariable model, the older (25-34 and 35-44) age groups had lower AUD persistency [odds ratio ( OR) = 0.05; 95% CI = 0.00-0.49 and OR = 0.14; 95% CI = 0.02-0.79, respectively] than the youngest age group (18-24). A higher number of weekly drinks and a comorbid anxiety disorder predicted AUD persistency ( OR = 1.03; 95% CI = 1.00-1.07 and OR = 4.56; 95% CI = 1.04-20.06, respectively). Furthermore, remission was associated with a reduction of six drinks per week between T0 and T1. It should be noted, however, that 35.8% (95% CI = 22.4-49.2) of people in diagnostic remission still drank more than the recommended maximum (more than seven/14 drinks weekly for women/men). Conclusions Only a minority of people in the Netherlands with alcohol use disorder as defined by DSM-5 still have the disorder 3 years later. Factors that help to identify people at risk of alcohol use disorder persistence are: younger age, a higher number of weekly drinks and a comorbid anxiety disorder. A substantial number of people recently in diagnostic remission still drink above the maximum recommended level. [ABSTRACT FROM AUTHOR]

Aims To investigate the prevalence of cannabis use and problem use in boys and girls at age 16 years, and to investigate the role of adversity in early life and of conduct disorder between the ages of 4 and 13 years as risk factors for these outcomes. Design Birth cohort study. Setting England. Participants A total of 4159 (2393 girls) participants in the Avon Longitudinal Study of Parents and Children ( ALSPAC) birth cohort providing information on cannabis use at age 16. Measurements Cannabis use and problem cannabis use at age 16 were assessed by postal questionnaire. Material adversity, maternal substance use, maternal mental health and child conduct disorder were all assessed by maternal report. Findings Cannabis use was more common among girls than boys (21.4% versus 18.3%, P = 0.005). Problem cannabis use was more common in boys than girls (3.6% versus 2.8%, P = 0.007). Early-onset persistent conduct problems were associated strongly with problem cannabis use [odds ratio ( OR) = 6.46, 95% confidence interval ( CI) = 4.06-10.28]. Residence in subsidized housing ( OR = 3.10, 95% CI = 1.95, 4.92); maternal cannabis use ( OR 8.84, 95% CI 5.64-13.9) and any maternal smoking in the postnatal period ( OR = 2.69, 95% CI = 1.90-3.81) all predicted problem cannabis use. Attributable risks for adolescent problem cannabis use associated with the above factors were 25, 13, 17 and 24%, respectively. Conclusions Maternal smoking and cannabis use, early material disadvantage and early-onset persistent conduct problems are important risk factors for adolescent problem cannabis use. This may have implications for prevention. [ABSTRACT FROM AUTHOR]

Aims This study examined how family, peer and school factors are related to different trajectories of adolescent alcohol use at key developmental periods. Design Latent class growth analysis was used to identify trajectories based on five waves of data (from grade 6, age 12 to grade 11, age 17), with predictors at grades 5, 7 and 9 included as covariates. Setting Adolescents completed surveys during school hours. Participants A total of 808 students in Victoria, Australia. Measurements Alcohol use trajectories were based on self-reports of 30-day frequency of alcohol use. Predictors included sibling alcohol use, attachment to parents, parental supervision, parental attitudes favourable to adolescent alcohol use, peer alcohol use and school commitment. Findings A total of 8.2% showed steep escalation in alcohol use. Relative to non-users, steep escalators were predicted by age-specific effects for low school commitment at grade 7 ( P = 0.031) and parental attitudes at grade 5 ( P = 0.003), and age-generalized effects for sibling alcohol use ( Ps = 0.001, 0.012, 0.033 at grades 5, 7 and 9, respectively) and peer alcohol use ( Ps = 0.041, < 0.001, < 0.001 at grades 5, 7 and 9, respectively). Poor parental supervision was associated with steep escalators at grade 9 ( P < 0.001) but not the other grades. Attachment to parents was unrelated to alcohol trajectories. Conclusions Parental disapproval of alcohol use before transition to high school, low school commitment at transition to high school, and sibling and peer alcohol use during adolescence are associated with a higher risk of steep escalations in alcohol use. [ABSTRACT FROM AUTHOR]

Aims We determined whether or not homelessness is associated with cigarette smoking independent of other socio-economic measures and behavioral health factors, and whether homeless smokers differ from non-homeless smokers in their desire to quit. Design, setting and participants We analyzed data from 2678 adult respondents to the 2009 Health Center Patient Survey, a nationally representative cross-sectional survey of homeless and non-homeless individuals using US federally funded community health centers. Measurements We used multivariable logistic regression to examine the association between homelessness and (i) current cigarette smoking among all adults, and (ii) past-year desire to quit among current smokers, adjusting for demographic, socio-economic and behavioral health characteristics. Findings Adults with any history of homelessness were more likely than never homeless respondents to be current smokers (57 versus 27%, P < 0.001). In multivariable models, a history of homelessness was associated independently with current smoking [adjusted odds ratio ( AOR) 2.09; 95% confidence interval ( CI) = 1.49-2.93], even after adjusting for age, sex, race, veteran status, insurance, education, employment, income, mental illness and alcohol and drug abuse. Housing status was not associated significantly with past-year desire to stop smoking in unadjusted ( P = 0.26) or adjusted ( P = 0.60) analyses; 84% of currently homeless, 89% of formerly homeless and 82% of never homeless smokers reported wanting to quit. Conclusions Among patients of US health centers, a history of homelessness doubles the odds of being a current smoker independent of other socio-economic factors and behavioral health conditions. However, homeless smokers do not differ from non-homeless smokers in their desire to quit and should be offered effective interventions. [ABSTRACT FROM AUTHOR]

Aims To assess the reliability and validity of self-reported cannabis dose and potency measures. Design Cross-sectional study comparing self-reports with objective measures of amount of cannabis and delta-9-tetrahydrocannabinol ( THC) concentration. Setting Ecological study with assessments at participants' homes or in a coffee shop. Participants Young adult frequent cannabis users ( n = 106) from the Dutch Cannabis Dependence ( Can Dep) study. Measurements The objectively measured amount of cannabis per joint (dose in grams) was compared with self-reported estimates using a prompt card and average number of joints made from 1 g of cannabis. In addition, objectively assessed THC concentration in the participant's cannabis was compared with self-reported level of intoxication, subjective estimate of cannabis potency and price per gram of cannabis. Findings Objective estimates of doses per joint (0.07-0.88 g/joint) and cannabis potency (1.1-24.7%) varied widely. Self-reported measures of dose were imprecise, but at group level, average dose per joint was estimated accurately with the number of joints made from 1 g [limit of agreement (LOA) = −0.02 g, 95% confidence interval ( CI) = −0.29; 0.26], whereas the prompt card resulted in serious underestimation (LOA = 0.14 g, 95% CI = −0.10; 0.37). THC concentration in cannabis was associated with subjective potency ['average' 3.77% ( P = 0.002) and '(very) strong' 5.13% more THC ( P < 0.001) than '(very) mild' cannabis] and with cannabis price (about 1% increase in THC concentration per euro spent on 1 g of cannabis, P < 0.001), but not with level of intoxication. Conclusions Self-report measures relating to cannabis use appear at best to be associated weakly with objective measures. Of the self-report measures, number of joints per gram, cannabis price and subjective potency have at least some validity. [ABSTRACT FROM AUTHOR]

Aims Animal models show that a single dose of 3,4-methylenedioxymethamhetamine ( MDMA; 'ecstasy') can result in long-term disruption of sleep. We evaluated the relationship between ecstasy consumption and the use of sleep medications in humans after controlling for key factors. Design The Personality and Total Health Through Life project uses a longitudinal cohort with follow-up every 4 years. This study reports data from waves 2 and 3. Setting Participants were recruited from the electoral roll in the Australian Capital Territory and Queanbeyan, New South Wales, Australia. Participants Participants were aged 20-24 years at wave 1 (1999-2000). Measures The study collected self-reported data on ecstasy, meth/amphetamine, cannabis, alcohol, tobacco and use of sleeping medications (pharmaceutical or other substances). Depression was categorized using the Brief Patient Health Questionnaire ( BPHQ). Other psychosocial measures included life-time traumas. We used generalized estimating equations to model outcomes. Findings Ecstasy data were available from 2128 people at wave 2 and 1977 at wave 3: sleeping medication use was reported by 227 (10.7%) respondents at wave 2 and 239 (12.1%) at wave 3. Increased odds ratios ( OR) for sleeping medication use was found for those with depression [ OR = 1.88, 95% confidence interval ( CI): 1.39, 2.53], women ( OR = 1.44, 95% CI : 1.13, 1.84), and increased by 19% for each life-time trauma. Ecstasy use was not a significant predictor, but ≥monthly versus never meth/amphetamine use increased the odds ( OR = 3.03, 95% CI 1.30, 7.03). Conclusion The use of ecstasy appears to be associated with the use of sleeping medications but this association can be accounted for by other factors. [ABSTRACT FROM AUTHOR]

Aims To assess the performance of a range of biomarkers of alcohol consumption in a heavy-drinking population of working-aged Russian men. Design Cross-sectional study of men originally sampled at random from a population register. Setting Izhevsk, a Russian city with a population of 650 000 people. Participants A total of 1023 men aged 27-59 years living in Izhevsk who took part in a health check examination in 2008-2009. Measurements Self-reported alcohol consumption, hazardous drinking behaviours, socio-economic position, anthropometric measurements plus blood levels of alcohol biomarkers [carbohydrate-deficient transferrin ( CDT, gamma-glutamyl transferase (GGT), alanine aminotransferase ( ALT), aspartate aminotransferase ( AST) and mean cell volume of erythrocytes ( MCV)] and hepatitis B and C status. Findings In the year before interview there was a high prevalence of high-risk alcohol consumption indicated by consumption of non-beverage alcohols (5%), problem drinking behaviours (4.4%) and alcohol consumption exceeding an average 40 g per day (12.6%). All biomarkers were associated strongly with total beverage alcohol consumption even after adjustment for confounders. CDT performed best as an alcohol biomarker, with a sensitivity of 67% and specificity of 71% for detecting an average consumption of more than 40 g per day versus less. For all biomarkers sensitivity was considerably lower than specificity. Hazardous drinking patterns per se were not well detected by any of the biomarkers, all with sensitivity below 60%. Conclusions In a Russian population with high levels of alcohol consumption, carbohydrate-deficient transferrin ( CDT) might be the most sensitive and specific biomarker for detecting ethanol consumption above 40 g/day. A biomarker reflecting hazardous drinking patterns has yet to be established. [ABSTRACT FROM AUTHOR]

Aims To investigate the competing effects of increased anti-drink driving legislation and the recent elimination of excise taxes on wine and beer. Design Serial cross-sectional telephone surveys were conducted in 2006 ( n = 9860) and 2011 ( n = 4800). Setting Hong Kong, China. Participants Chinese adults (≥18 years of age). Measurements Respondents were asked about their drinking patterns, past-year experience of driving within 2 hours of drinking, drinking-related attitudes and reported deterrents to drink driving. Findings Following the legislative changes, the age-standardized past-year prevalence of drink driving decreased significantly from 5.2 to 2.8% ( P < 0.001) among all males, from 9.0 to 4.4% ( P < 0.001) among male past-year drinkers and from 13.7 to 8.5% ( P < 0.01) among male weekly drinkers. The past-year prevalence of drink driving in 2011 among all females (0.08%), female past-year drinkers (1.6%), male binge drinkers (12.5%), female weekly drinkers (4.7%) and female binge drinkers (7.9%) were not significantly different from 2006. Drink driving was associated independently with business sector employment [odds ratio ( OR) = 2.47], past-month binge drinking ( OR = 6.08) and beliefs in the benefits to one's wellbeing of drinking ( OR = 2.62) among males and past-month binge drinking ( OR = 5.57), belief in the social benefits of drinking ( OR = 5.66) and being unmarried ( OR = 3.00) in females ( P < 0.05). The most commonly reported drink driving deterrents were concerns about random breath tests (93.8%) and the potential legal consequences of conviction (93.6-96.5%). Conclusions Despite greater alcohol consumption in Hong Kong, the current anti-drink driving strategy appears to reduce drink driving in males and prevent increased levels among females. Binge drinkers, however, remain a high-risk group that should be monitored continually. [ABSTRACT FROM AUTHOR]

Aims To assess the efficacy of methylphenidate as a substitution therapy for amphetamine/methamphetamine dependence in Finland and New Zealand. Design Parallel-group, double-blind, randomized placebo-controlled trial. Setting Out-patient care. Participants Amphetamine-/methamphetamine-dependent, aged 16-65 years. Measurements The primary outcome measure was presence/absence of amphetamine/methamphetamine in urine samples collected twice weekly. Secondary measures included treatment adherence, alterations in craving scores and self-reported use. Primary analysis was by intention-to-treat ( ITT). The study drug, methylphenidate (as Concerta®), was up-titrated over 2 weeks to a maximum dose of 54 mg daily and continued for a further 20 weeks. Doses were given under daily supervision at the clinics. Findings Seventy-nine participants were randomized (40 methylphenidate; 39 placebo); 76 received allocated treatment and 27 completed the trial. ITT analysis ( n = 78) showed no statistically significant difference in the percentage of positive urines between the methylphenidate and placebo arms (odds ratio: 0.95, 95% confidence interval: 0.83-1.08). However, there was a significant difference ( P < 0.05) between the active and placebo arms in retention, the placebo arm displaying a significantly lower retention from 6 weeks that persisted until the end of the trial. Conclusions The trial failed to replicate earlier findings suggesting that methylphenidate was superior to placebo. The low retention rate confounded the ability to draw firm conclusions about efficacy. The higher retention rate was observed in the methylphenidate arm. Any replication of this work would need to consider alternatives to the rigid clinic attendance criteria, and consider an increased dose. [ABSTRACT FROM AUTHOR]

Aims To test whether psychological factors predict male smokeless tobacco ( SLT) initiation and cessation longitudinally. Design Sixteen-year longitudinal design with 95% retention at year 6 and 82% at year 16. Setting Forty Washington State school districts. Participants SLT use data were gathered on a cohort of adolescents (91% Caucasian). For SLT initiation, the sample size was 2468. For SLT cessation, sample sizes were 219 (age 20 outcome) and 192 (age 28 outcome). Measurements Self-reported psychological measures of parental disobedience ('parent non-compliance'), peer influence ('friend compliance'), rebelliousness and thrill-seeking were taken at ages 12 and 18. SLT use was measured at ages 12, 18, 20 and 28 years. Findings For SLT initiation, scoring highly on the following psychological factors at age 12 at least doubled the odds of daily SLT use at age 18 ( P < 0.001): friend compliance [odds ratio ( OR): 2.56, 95% confidence interval ( CI): 1.78-3.68), rebelliousness ( OR: 2.16, 95% CI: 1.46-3.19) and thrill-seeking ( OR: 2.33, 95% CI: 1.45-3.75). For SLT cessation, none of the psychological factors at age 18 predicted SLT cessation at age 20 or 28 ( P value range: 0.06-0.84). Conclusion Peer influence, rebelliousness, and thrill-seeking appear to predict smokeless tobacco initiation strongly among male youth in the United States. [ABSTRACT FROM AUTHOR]

Aim To test the effectiveness of motivational interviewing ( MI) to reduce the risk of an alcohol exposed pregnancy ( AEP) in a high-risk population. Design Randomized controlled trial. Setting Rural population in the Western Cape, South Africa. Participants A total of 165 women aged 18-44 years at risk of AEP. Intervention Five-session MI intervention. Measurements Structured questionnaires were administered pre-intervention and at 3 and 12 months follow-up. The primary outcome measure was AEP at 12 months. Secondary outcomes were AEP at 3 months, and alcohol use and effective contraception at 3 and 12 months. Findings There was a significant difference in the decline in the proportion of women at risk for an AEP in the MI group at 3 months (50 versus 24.59%; P = 0.004), maintained at 12 months (50.82 versus 28.12%; P = 0.009). In an intention-to-treat analysis these differences were also significant (32.93 versus 18.07%; P = 0.029; and 37.80 versus 21.69%; P = 0.024, respectively). The odds ratio for no longer being at risk of an AEP ( MI versus control) at 12 months was 2.64 [95% confidence interval ( CI): 1.18-5.94]. In the intention-to-treat analysis this ratio was 2.19 (95% CI: 1.05-4.65). Conclusions A five-session motivational interviewing intervention was found to be effective with women at risk of an alcohol-exposed pregnancy, and could be implemented as part of routine primary care clinic services in similar populations. The message of 'no alcohol in pregnancy' should be adapted to include better family planning and early recognition of pregnancy. [ABSTRACT FROM AUTHOR]

Aims To test aripiprazole for efficacy in decreasing use in methamphetamine-dependent adults, compared to placebo. Design Participants were randomized to receive 12 weeks of aripiprazole or placebo, with a 3-month follow-up and a platform of weekly 30-minute substance abuse counseling. Setting The trial was conducted from January 2009 to March 2012 at the San Francisco Department of Public Health. Participants Ninety actively using, methamphetamine-dependent, sexually active adults were recruited from community venues. Measurements The primary outcome was regression estimated reductions in weekly methamphetamine-positive urines. Secondary outcomes were study medication adherence [by self-report and medication event monitoring systems ( MEMS)], sexual risk behavior and abstinence from methamphetamine. Findings Participant mean age was 38.7 years, 87.8% were male, 50.0% white, 18.9% African American, and 16.7% Latino. Eighty-three per cent of follow-up visits and final visits were completed. By intent-to-treat, participants assigned to aripiprazole had similar reductions in methamphetamine-positive urines as participants assigned to placebo [risk ratio ( RR) 0.88, 95% confidence interval ( CI): 0.66-1.19, P = 0.41]. Urine positivity declined from 73% (33 of 45 participants) to 45% (18 of 40) in the placebo arm and from 77% (34 of 44) to 44% (20 of 35) in the aripiprazole arm. Adherence by MEMS and self-report was 42 and 74%, respectively, with no significant difference between arms ( MEMS P = 0.31; self-report P = 0.17). Most sexual risk behaviors declined similarly among participants in both arms (all P > 0.05). There were no serious adverse events related to study drug, although participants randomized to aripiprazole reported more akathisia, fatigue and drowsiness ( P < 0.05). Conclusion Compared with placebo, aripiprazole did not reduce methamphetamine use significantly among actively using, dependent adults. [ABSTRACT FROM AUTHOR]

Aims To assess the incidence or prevalence of opioid dependence syndrome in adults (with and without previous history of substance abuse) following treatment with opioid analgesics for pain relief. Methods Medline, Embase, CINHAL and the Cochrane Library were searched up to January 2011. Systematic reviews and primary studies were included if they reported data about incidence or prevalence of opioid dependence syndrome (as defined by DSM-IV or ICD-10) in patients receiving strong opioids (or opioid-type analgesics) for treatment of acute or chronic pain due to any physical condition. The data were abstracted, and the methodological quality was assessed using validated checklists. Results Data were extracted from 17 studies involving a total of 88 235 participants. The studies included three systematic reviews, one randomized controlled trial, eight cross-sectional studies and four uncontrolled case series. Most studies included adult patients with chronic non-malignant pain; two also included patients with cancer pain; only one included patients with a previous history of dependence. Incidence ranged from 0 to 24% (median 0.5%); prevalence ranged from 0 to 31% (median 4.5%). Conclusions The available evidence suggests that opioid analgesics for chronic pain conditions are not associated with a major risk for developing dependence. [ABSTRACT FROM AUTHOR]

Aims To assess age variation in correlates of drinking cessation. Design Prospective study of a US general population sample. Setting Face-to-face household interviews. Participants Past-year ≥ monthly drinkers interviewed at baseline and 3-year follow-up ( n = 14 885). Measurements Baseline values and selected changes over follow-up in alcohol consumption, alcohol use disorder ( AUD), socio-demographic and health characteristics, other substance use and psychiatric comorbidity were used to predict drinking cessation in three age groups. Findings Correlates of drinking cessation varied over the life-course, with pregnancy/presence of an infant, nicotine or drug use disorder, incident AUD, cluster A personality disorder, liver disease and incident retirement being important at younger ages and high-school graduation, family income ≥ $70 000, volume of ethanol intake, Asian race/ethnicity, mood disorder and incident cardiovascular disease being significant at older ages. Age-invariant correlates included smoking cessation over follow-up, odds ratio ( OR) = 2.82 [95% confidence interval ( CI): 1.62-4.92] to 3.45 (2.20-5.39); college education, OR = 0.42 (0.27-0.65) to 0.54 (0.36-0.83); black and Hispanic race/ethnicity, OR = 1.74 (1.18-2.29) to 1.88 (1.21-2.93) and 1.58 (1.11-1.25) to 1.73 (0.83-3.63), respectively, and months since last drink, OR = 1.24 (1.13-1.36) to 1.29 (1.19-1.39). Conclusions Factors associated with ceasing alcohol use in US adults appear to differ over the life-course, reflecting age variation in both their prevalence and impact and supporting the importance of role transitions and health problems (the 'sick quitter' effect). The most consistent correlates of drinking cessation included factors reflecting ability/inability to give up potentially addictive substances and factors associated with perceived acceptability of drinking and subgroup-specific drinking contexts that might facilitate/impede continued drinking. [ABSTRACT FROM AUTHOR]

Aims This study aimed to compare emotion perception and social inference in opioid maintenance patients with abstinent ex-users and non-heroin-using controls, and determine whether any deficits in could be accounted for by cognitive deficits and/or risk factors for brain damage. Design Case-control. Setting Sydney, Australia. Participants A total of 125 maintenance patients ( MAIN), 50 abstinent opiate users ( ABST) and 50 matched controls ( CON). Measurements The Awareness of Social Inference Test ( TASIT) was used to measure emotion perception and social inference. Measures were also taken of executive function, working memory, information processing speed, verbal/non-verbal learning and psychological distress. Findings After adjusting for age, sex, pre-morbid IQ and psychological distress, the MAIN group was impaired relative to CON (β = −0.19, P < 0.05) and ABST (β = −0.19, P < 0.05) on emotion perception and relative to CON (β = −0.25, P < 0.001) and ABST (β = −0.24, P < 0.01) on social inference. In neither case did the CON and ABST groups differ. For both emotion perception ( P < 0.001) and social inference ( P < 0.001), pre-morbid IQ was a significant independent predictor. Cognitive function was a major predictor of poor emotion perception (β = −0.44, P < 0.001) and social inference (β = −0.48, P < 0.001). Poor emotion recognition was also predicted by number of heroin overdoses (β = −0.14, P < 0.05). Neither time in treatment or type of maintenance medication (methadone or buprenorphine) were related to performance. Conclusions People in opioid maintenance treatment may have an impaired capacity for emotion perception and ability to make inferences about social situations. [ABSTRACT FROM AUTHOR]

Aims To test the population impact of offering automated smoking cessation interventions via the internet and/or by mobile phone. Design Pragmatic randomized controlled trial with five conditions: offer of (i) minimal intervention control; (ii) QuitCoach personalized tailored internet-delivered advice program; (iii) on Q, an interactive automated text-messaging program; (iv) an integration of both QuitCoach and on Q; and (v) a choice of either alone or the combined program. Setting Australia, via a mix of internet and telephone contacts. Participants A total of 3530 smokers or recent quitters recruited from those interested in quitting, and seeking self-help resources ( n = 1335) or cold-contacted from internet panels ( n = 2195). Measurements The primary outcome was self-report of 6 months sustained abstinence at 7 months post-recruitment. Findings Only 42.5% of those offered one of the interventions took it up to a minimal level. The intervention groups combined had a non-significantly higher 6-month sustained abstinence rate than the control [odds ratio ( OR) = 1.48; 95% confidence interval (CI): 0.98-2.24] (missing cases treated as smokers), with no differences between the interventions. Among those who used an intervention, there was a significant overall increase in abstinence ( OR = 1.95; CI: 1.04-3.67), but not clearly so when analysing only cases with reported outcomes. Success rates were greater among those recruited after seeking information compared to those cold-contacted. Conclusions Smokers interested in quitting who were assigned randomly to an offer of either the QuitCoach internet-based support program and/or the interactive automated text-messaging program had non-significantly greater odds of quitting for at least 6 months than those randomized to an offer of a simple information website. [ABSTRACT FROM AUTHOR]

Aims To investigate the relationships between tobacco dependence, biomarkers of nicotine and carcinogen exposure and biomarkers of nicotine and carcinogen exposure per cigarette in back and white smokers. Design, setting and participants A total of 204 healthy black ( n = 69) and white ( n = 135) smokers were enrolled into two clinical studies. Measurement Nicotine equivalents (nicotine and its metabolites), 4-(methylnitrosamino)-1-(3)pyridyl-1-butanol ( NNAL) and polycyclic aromatic hydrocarbon ( PAH) metabolites were measured in urine. The Fagerström Test for Nicotine Dependence ( FTND) and time to first cigarette ( TFC) measured tobacco dependence. Findings Average TFC and FTND for blacks and whites were not significantly different. Urine NNAL and nicotine equivalents increased with increasing FTND in whites but did not increase in blacks (race × FTND interaction, both P < 0.031). The interaction term was not significant for PAHs. An inverse relationship was seen between FTND and nicotine equivalents, NNAL and PAH metabolites per cigarette in blacks but remained flat in whites (race × FTND interaction, all P ≤ 0.039). Regardless of dependence (low dependence, TFC >15 minutes; high dependence, TFC ≤15 minutes), FTND and TFC were not correlated significantly with urine nicotine equivalents and carcinogen exposure in blacks. We found moderate correlations between FTND and TFC and nicotine equivalents and carcinogen exposure among whites of low dependence and non-significant correlations among whites of high dependence. Conclusion In the United States, tobacco dependence measures were related linearly to nicotine intake and carcinogen exposure in white but not in black smokers. The relationship between dependence measures and tobacco biomarkers in black smokers regardless of level of dependence resembled highly dependent white smokers. [ABSTRACT FROM AUTHOR]

Aims To investigate associations between socio-economic position in early life and later alcohol use and problem use among male and female adolescents. Design Birth cohort study. Setting South West England. Participants A total of 2711 girls and 2379 boys with one or more measures of alcohol use or problem use at age 15 years. Measurements Exposure measures were highest parental social class, maternal education and household disposable income (all maternal self-report before school-age); outcome measures were heavy typical drinking, frequent drinking, regular binge drinking, alcohol-related psychosocial problems and alcohol-related behavioural problems. Findings Alcohol use and related problems were relatively common amongst adolescent girls and boys. Boys were slightly more likely to report frequent drinking and girls were slightly more likely to drink heavily and to experience alcohol-related psychosocial problems. Higher maternal education appeared protective in relation to alcohol-related problems, particularly among boys. Higher household income was associated with greater risk of alcohol use and problem use, most apparently among girls. Conclusions Children from higher-income households in England appear to be at greater risk of some types of adolescent alcohol problems, and these risks appear different in girls compared to boys. Childhood social advantage may not generally be associated with healthier behaviour in adolescence. [ABSTRACT FROM AUTHOR]

Aims The aim of the current study was to examine the mediating role of alcohol-related memory associations in the relation between perceived parental drinking and the onset of adolescents' alcohol use. Gender and grade were also included in the analyses. Design We tested a mediation model within a structural path modelling framework using longitudinal data (two waves). Setting and Participants The sample consisted of 608 Canadian adolescents (42.9% boys), who did not have any alcohol experiences at the first measurement. The adolescents were recruited from all grades 7-9 classes in a large school district in western Canada. Measurements Alcohol-related memory associations were tested with the Word Association Test. We used adolescent self-reports of alcohol use and parental drinking. Findings Results clearly showed a mediation effect of alcohol-related memory associations [estimate = 0.023, 95% confidence interval ( CI): 0.002-0.044). That is, parental drinking as perceived by the adolescent was related positively to alcohol-related memory associations, which in turn predicted adolescents' alcohol use a year later. Gender and grade were related to alcohol-related memory associations. That is, boys and adolescents of higher grades had more memory associations. Conclusions Children appear to form memory associations related to alcohol before they ever drink alcohol themselves, and these associations appear to mediate the link between their perceptions of their parents' drinking and their own initial alcohol use. [ABSTRACT FROM AUTHOR]

Aims To investigate differences in the presence of drugs, by gender, when considering deaths attributable to homicides and suicides. Design Logistic regression analysis of mortality data collected by the Colorado Violent Death Reporting System. Participants and setting A total of 5791 Colorado decedents who died of violent causes from 2004 to 2009. Measurement Forensic pathologist autopsy data on drug presence at time of death, coded as present, not present or missing. Findings Postmortem presence of drugs is associated strongly with the specific cause of violent death. Compared with suicide decedents, homicide decedents are significantly more likely to test positive for amphetamines [odds ratio ( OR): 1.79; confidence interval ( CI): 1.34, 2.39], marijuana ( OR: 2.03; CI: 1.60, 2.58) and cocaine ( OR: 2.60; CI: 2.04, 3.31), and are less likely to test positive for opiates ( OR: 0.27; CI: 0.18, 0.39) and antidepressants ( OR: 0.17; CI: 0.10, 0.28). When other drugs are controlled for the influence of alcohol is abated dramatically. The patterns of drug prevalence associated with homicide (particularly marijuana) are stronger among males; the patterns of drug prevalence associated with suicide are stronger among females. Conclusions Suicide and homicide decedents are characterized by varying patterns of licit and illicit drug use that differ by gender. Drugs associated with homicide (marijuana, cocaine and amphetamines) are stronger among males, while drugs associated with suicide are stronger among females (antidepressants and opiates). Taking these differences into consideration may allow for targeted interventions to reduce violent deaths. [ABSTRACT FROM AUTHOR]

Aims This study aimed to assess the association between smoking and absenteeism in working adults. Methods A systematic review and meta-analysis was performed by electronic database searches in MEDLINE, EMBASE, CAB Abstracts, Pub Med, Science Direct and National Health Service Economic Evaluation Database ( February 2012). Longitudinal, prospective cohorts or retrospective cohorts were included in the review. Summary effect estimates were calculated using random-effects meta-analysis. Heterogeneity was assessed by I2 and publication bias was investigated. Results A total of 29 longitudinal or cohort studies were included. Compared with non-smokers, current smokers had a 33% increase in risk of absenteeism [95% confidence interval ( CI): 1.25-1.41; I2 = 62.7%; 17 studies]. Current smokers were absent for an average of 2.74 more days per year compared with non-smokers (95% CI: 1.54-3.95; I2 = 89.6%; 13 studies). Compared with never smokers, ex-smokers had a 14% increase in risk of absenteeism (95% CI: 1.08-1.21; I2 = 62.4%; eight studies); however, no increase in duration of absence could be detected. Current smokers also had a 19% increase in risk of absenteeism compared with ex-smokers (95% CI: 1.09-1.32, P < 0.01, eight studies). There was no evidence of publication bias. The total cost of absenteeism due to smoking in the United Kingdom was estimated to be £1.4 billion in 2011. Conclusions Quitting smoking appears to reduce absenteeism and result in substantial cost-savings for employers. [ABSTRACT FROM AUTHOR]