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Background and aims: Graph theoretic analysis of structural covariance networks (SCN) provides an assessment of brain organization that has not yet been applied to alcohol dependence (AD). We estimated whether SCN differences are present in adults with AD and heavy‐drinking adolescents at age 19 and age 14, prior to substantial exposure to alcohol. Design Cross‐sectional sample of adults and a cohort of adolescents. Correlation matrices for cortical thicknesses across 68 regions were summarized with graph theoretic metrics. Setting and participants: A total of 745 adults with AD and 979 non‐dependent controls from 24 sites curated by the Enhancing NeuroImaging Genetics through Meta Analysis (ENIGMA)–Addiction consortium, and 297 hazardous drinking adolescents and 594 controls at ages 19 and 14 from the IMAGEN study, all from Europe. Measurements Metrics of network segregation (modularity, clustering coefficient and local efficiency) and integration (average shortest path length and global efficiency). Findings The younger AD adults had lower network segregation and higher integration relative to non‐dependent controls. Compared with controls, the hazardous drinkers at age 19 showed lower modularity [area‐under‐the‐curve (AUC) difference = −0.0142, 95% confidence interval (CI) = −0.1333, 0.0092; P‐value = 0.017], clustering coefficient (AUC difference = −0.0164, 95% CI = −0.1456, 0.0043; P‐value = 0.008) and local efficiency (AUC difference = −0.0141, 95% CI = −0.0097, 0.0034; P‐value = 0.010), as well as lower average shortest path length (AUC difference = −0.0405, 95% CI = −0.0392, 0.0096; P‐value = 0.021) and higher global efficiency (AUC difference = 0.0044, 95% CI = −0.0011, 0.0043; P‐value = 0.023). The same pattern was present at age 14 with lower clustering coefficient (AUC difference = −0.0131, 95% CI = −0.1304, 0.0033; P‐value = 0.024), lower average shortest path length (AUC difference = −0.0362, 95% CI = −0.0334, 0.0118; P‐value = 0.019) and higher global efficiency (AUC difference = 0.0035, 95% CI = −0.0011, 0.0038; P‐value = 0.048). Conclusions: Cross‐sectional analyses indicate that a specific structural covariance network profile is an early marker of alcohol dependence in adults. Similar effects in a cohort of heavy‐drinking adolescents, observed at age 19 and prior to substantial alcohol exposure at age 14, suggest that this pattern may be a pre‐existing risk factor for problematic drinking. [ABSTRACT FROM AUTHOR]

Aims: To test the efficacy of 'MiQuit', a tailored, self‐help, text message stop smoking programme for pregnancy, as an adjunct to usual care (UC) for smoking cessation in pregnancy. Design Multicentre, open, two‐arm, parallel‐group, superiority randomised controlled trial (RCT) and a trial sequential analysis (TSA) meta‐analysis combining trial findings with two previous ones. Setting: Twenty‐four English hospital antenatal clinics. Participants: A total of 1002 pregnant women who were ≥16 years old, were ≤25 weeks gestation and smoked ≥1 daily cigarette and accepted information on cessation with no requirement to set quit dates. Interventions: UC or UC plus 'MiQuit': 12 weeks of tailored, smoking cessation text messages focussed on inducing and aiding cessation. Measurements Primary outcome: biochemically validated cessation between 4 weeks after randomisation and late pregnancy. Secondary outcomes: shorter and non‐validated abstinence periods, pregnancy outcomes and incremental cost‐effectiveness ratios. Findings RCT: cessation was 5.19% (26/501) and 4.59% (23/501) in MiQuit and UC groups (adjusted odds ratio [adj OR] for quitting with MiQuit versus UC, 95% CI = 1.15 [0.65–2.04]); other abstinence findings were similar, with higher point estimates. Primary outcome ascertainment was 61.7% (309) and 67.3% (337) in MiQuit and UC groups with 71.1% (54/76) and 69.5% (41/59) abstinence validation rates, respectively. Pregnancy outcomes were similar and the incremental cost per quality‐adjusted life year was −£1118 (95% CI = −£4806–£1911). More MiQuit group women reported making at least one quit attempt (adj OR [95% CI]) for making an attempt, 1.50 (1.07–2.09). TSA meta‐analysis: this found no significant difference in prolonged abstinence between MiQuit and UC (pooled OR = 1.49, adjusted 95% CI = 0.62–3.60). Conclusions: Irrespective of whether they want to try quitting, when offered a tailored, self‐help, text message stop smoking programme for pregnancy (MiQuit) as an adjunct to usual care, pregnant women are not more likely to stop smoking until childbirth but they report more attempts at stopping smoking. [ABSTRACT FROM AUTHOR]

Aim: To test the association of alcohol consumption with total and cause‐specific mortality risk. Design Prospective observational multi‐centre population‐based study. Setting: Sixteen cohorts (15 from Europe) in the MOnica Risk, Genetics, Archiving and Monograph (MORGAM) Project. Participants: A total of 142 960 individuals (mean age 50 ± 13 years, 53.9% men). Measurements Average alcohol intake by food frequency questionnaire, total and cause‐specific mortality. Findings In comparison with life‐time abstainers, consumption of alcohol less than 10 g/day was associated with an average 11% [95% confidence interval (CI) = 7–14%] reduction in the risk of total mortality, while intake > 20 g/day was associated with a 13% (95% CI = 7–20%) increase in the risk of total mortality. Comparable findings were observed for cardiovascular (CV) deaths. With regard to cancer, drinking up to 10 g/day was not associated with either mortality risk reduction or increase, while alcohol intake > 20 g/day was associated with a 22% (95% CI = 10–35%) increased risk of mortality. The association of alcohol with fatal outcomes was similar in men and women, differed somewhat between countries and was more apparent in individuals preferring wine, suggesting that benefits may not be due to ethanol but other ingredients. Mediation analysis showed that high‐density lipoprotein cholesterol explained 2.9 and 18.7% of the association between low alcohol intake and total as well as CV mortality, respectively. Conclusions: In comparison with life‐time abstainers, consuming less than one drink per day (nadir at 5 g/day) was associated with a reduced risk of total, cardiovascular and other causes mortality, except cancer. Intake of more than two drinks per day was associated with an increased risk of total, cardiovascular and especially cancer mortality. [ABSTRACT FROM AUTHOR]

Background and aims: Culturally relevant and feasible interventions are needed to address limited professional resources in sub‐Saharan Africa for behaviorally treating the dual epidemics of HIV and alcohol use disorder. This study tested the efficacy of a cognitive–behavioral therapy (CBT) intervention to reduce alcohol use among HIV‐infected outpatients in Eldoret, Kenya. Design Randomized clinical trial. Setting: A large HIV outpatient clinic in Eldoret, Kenya, affiliated with the Academic Model Providing Access to Healthcare collaboration. Participants: A total of 614 HIV‐infected outpatients [312 CBT; 302 healthy life‐styles (HL); 48.5% male; mean age: 38.9 years; mean education 7.7 years] who reported a minimum of hazardous or binge drinking. Intervention and comparator: A culturally adapted six‐session gender‐stratified group CBT intervention compared with HL education, each delivered by paraprofessionals over six weekly 90‐minute sessions with a 9‐month follow‐up. Measurements Primary outcome measures were percentage of drinking days (PDD) and mean drinks per drinking day (DDD) computed from retrospective daily number of drinks data obtained by use of the time‐line follow‐back from baseline to 9 months post‐intervention. Exploratory analyses examined unprotected sex and number of partners. Findings Median attendance was six sessions across condition. Retention at 9 months post‐intervention was high and similar by condition: CBT 86% and HL 83%. PDD and DDD marginal means were significantly lower in CBT than HL at all three study phases. Maintenance period, PDD – CBT = 3.64 (0.696), HL = 5.72 (0.71), mean difference 2.08, 95% confidence interval (CI) = 0.13 – 4.04; DDD – CBT = 0.66 (0.96), HL = 0.98 (0.098), mean difference = 0.31, 95% CI = 0.05 – 0.58. Risky sex decreased over time in both conditions, with a temporary effect for CBT at the 1‐month follow‐up. Conclusions: A cognitive–behavioral therapy intervention was more efficacious than healthy lifestyles education in reducing alcohol use among HIV‐infected Kenyan outpatient drinkers. [ABSTRACT FROM AUTHOR]

Background and Aims: Guidelines recommend the 5As model of brief intervention for providing smoking cessation support in clinical settings. This study assessed patient and hospital characteristics associated with self‐reported receipt of the 5As (ask, advise, assess, assist and arrange). Design Multi‐center cross‐sectional study. Setting and participants: Adult inpatients (n = 1047) were randomly selected from 13 hospitals in the Barcelona province of Spain in 2014–2015. Measurements We explored participants' receipt of the 5As through a questionnaire. Given the progressiveness of the 5As, we recoded the fulfillment of the intervention as: A0: no intervention; A1: ask; A2: ask and advise; A3: A2 and assess; A4: A3 and assist; and A5: A4 and arrange a follow‐up. We explored patient (e.g. age, sex, comorbidities) and hospital (e.g. type of hospital, unit) characteristics. We adjusted multi‐level robust Poisson regression models to estimate the adjusted prevalence ratios (aPR) of the association between the recoded 5As intervention received. Findings A total of 60.4% (n = 624) of patients had been asked (A1) about their smoking status. Among smokers, 46.5% (n = 90) were advised (A2), 26.6% (n = 48) assessed (A3) and 4.6% (n = 10) received all the components of the 5As (A5). Middle‐aged smokers [aPR = 3.63; 95% confidence interval (CI) = 1.69–7.79] with a respiratory disease (aPR = 2.19; 95% CI = 1.11–4.34) were most likely to have been asked, advised and assessed (A3). The cessation intervention was most frequently performed by physicians. Conclusions: In the Barcelona province of Spain, it appears that fewer than half of hospitalized patients who smoke were advised to quit and few received the full 'five As' brief intervention for smoking cessation. [ABSTRACT FROM AUTHOR]

Aims: In Iran, injecting drug use has been the major route of human immunodeficiency virus (HIV) transmission. In order to control the HIV epidemic, a harm reduction program was initiated and has been expanded in recent years. The aim of this study was to provide an updated estimate of HIV prevalence among people who inject drugs (PWID) in Iran, investigate prevalence differences over time and assess prevalence correlates. Design A comprehensive systematic review was undertaken in the international, regional and national bibliographic databases in November 2018 and extensive contacts with authors were made. For studies conducted before 2005, we used data from a previous published systematic review. Setting: All studies conducted in Iran were included. Recruitment settings included anywhere except studies conducted in infectious diseases wards or HIV counseling centers. Participants: PWID with any definition utilized in the studies. Thirty‐six studies were included, which were conducted in 24 of 31 provinces with a sample size of 22 160 PWID. Measurements We included studies that had performed HIV testing and had a confirmed diagnosis of HIV through repeating the enzyme‐linked immunosorbent assay (ELISA) or Western immunoblot assay (WB). Pooled prevalence of HIV was calculated for the total sample and for different subgroups, by available socio‐demographic and behavioral factors. For assessing the trend of HIV prevalence over time, a linear meta‐regression model was fitted separately for before 2007 and during 2007 and afterwards. Findings The pooled prevalences of HIV before 2007 and in 2007 and afterwards were 14.3% [95% confidence interval (CI) = 9.8–18.9] and 9.7% (95% CI = 7.6–11.9), respectively. HIV prevalence increased until 2005–06 and then slowly declined until 2009–10, which was not significant. Prevalence of HIV was significantly higher in PWID above age 25 years, and in those with history of imprisonment and history of needle/syringe‐sharing. HIV prevalence was higher in men than in women, but the difference was insignificant. Conclusion: The prevalence of HIV among people who inject drugs in Iran decreased after 2006 which could, at least in part, be attributed to the development of extensive harm reduction programs in the country. [ABSTRACT FROM AUTHOR]

Abstract: Background and aims: Emergency department (ED) alcohol‐related presentation data are not routinely collected in Australia and New Zealand. It is likely that previous research has underestimated the numbers of patients presenting with alcohol‐related conditions. This study aimed to quantify the level of alcohol harm presenting to EDs in Australia and New Zealand [Correction added on 23 Jan 2018, after first online publication: The ‘aims’ section was missing and is updated in this version]. Design: Multi‐centre, prospective study. Patients were screened prospectively for alcohol‐related presentations during a 7‐day period in December 2014. Part 1 involved screening to determine alcohol‐positive ED presentations and data collection of patient demographic and clinical information. Part 2 involved a consent‐based survey conducted with patients aged ≥ 14 years to perform Alcohol Use Disorders Identification Test (AUDIT) scores. Setting: Eight EDs in Australia and New Zealand, representing differing hospital role delineations. Participants: A total of 8652 patients aged ≥ 14 years attended and 8435 (97.5%) were screened. Measurements: The main outcome measure was the proportion of patients who had an alcohol‐related presentation termed ‘alcohol‐positive’, using pre‐defined criteria. It included injuries, intoxication, medical conditions and injuries caused by an alcohol‐affected third party. Secondary outcomes included demographic and clinical information, the type of alcohol‐related presentations and AUDIT scores. Findings: A total of 801 [9.5%; 95% confidence interval (CI) = 8.9–10.1%] presentations were identified as alcohol‐positive, ranging between 4.9 and 15.2% throughout sites. Compared with alcohol‐negative patients, alcohol‐positive patients were more likely to be male [odds ratio (OR) = 1.90, 95% CI = 1.63–2.21], younger (median age 37 versus 46 years, P < 0.0001), arrive by ambulance (OR = 1.94, 95% CI = 1.68–2.25) or police/correctional vehicle (OR = 4.56, 95% CI = 3.05–6.81) and require immediate treatment (OR = 3.20, 95% CI = 2.03–05.06). The median AUDIT score was 16 (interquartile range = 10–24). Conclusions: Almost one in 10 presentations to emergency departments in Australia and New Zealand are alcohol related. [ABSTRACT FROM AUTHOR]

Background and aims Prescription opioid overdose is a leading cause of injury-related morbidity and mortality in the United States. We aimed to identify characteristics associated with clinical severity in emergency department patients with prescription opioid overdose. Design This was a secondary data analysis of adult prescription opioid overdoses from a large prospective cohort of acute overdoses. We examined elements of a typical emergency department evaluation using a multivariable model to determine which characteristics were associated with clinical severity, specifically severe respiratory depression (SRD). Setting This study was conducted at two urban academic emergency departments in New York City, USA. Participants Adult patients who presented with acute prescription opioid overdose between 2009 and 2013 were included in the current study. We analyzed 307 patients (mean age = 44.7, 42% female, 2.0% mortality). Measurements Patient demographics, reported substances ingested, suspected intent for ingesting the substance, vital signs, laboratory data, treatments including antidotes and intubation and outcome of death were recorded by trained research assistants. Intent was categorized into four mutually exclusive categories: suicide, misuse, therapeutic error and undetermined. The primary outcome was SRD, defined as administration of either (a) naloxone or (b) endotracheal intubation (ETI). Findings A total of 109 patients suffered SRD with 90 patients receiving naloxone alone, nine ETI alone and 10 both naloxone and ETI. The most common opioids were oxycodone ( n = 124) and methadone ( n = 116). Mean age was higher in patients with SRD (51.1 versus 41.1, P < 0.001). Opioid misuse was associated with SRD in the multivariable analysis [odds ratio (OR) = 2.07, 95% confidence interval (CI) = 1.21-3.55]. The unadjusted relative risk of SRD was high for fentanyl (83.3% SRD) and lowest for codeine (3.6% SRD). Conclusion In emergency department patients in the United States with prescription opioid overdose, worse clinical severity was associated with opioid misuse, increased with age and was widely variable, depending on the specific opioid medication involved. [ABSTRACT FROM AUTHOR]

Background and aims Anhedonia-a transdiagnostic psychopathological trait indicative of inability to experience pleasure-could lead to and result from adolescent marijuana use, yet this notion has not been tested. This study aimed to estimate the association of: (1) anhedonia at age 14 with rate of change in marijuana use over an 18-month follow-up, and (2) marijuana use at age 14 with rate of change in anhedonia over follow-up. Secondary aims were to test whether gender, baseline marijuana use history and peer marijuana use moderated these associations. Design Observational longitudinal cohort repeated-measures design, with baseline (age 14 years), 6-month, 12-month and 18-month follow-up assessments. Settings Ten public high schools in Los Angeles, CA, USA, 2013-15. Participants Students [ n = 3394; 53.5% female, mean (standard deviation) age at baseline = 14.1 (0.42)]. Measurements Self-report level of anhedonia on the Snaith-Hamilton Pleasure Scale and frequency of marijuana use in the past 30 days. Findings Parallel process latent growth curve models adjusting for confounders showed that baseline anhedonia level was associated positively with the rate of increase in marijuana use frequency across follow-ups [β, 95% confidence interval (CI) = 0.115 (0.022, 0.252), P = 0.03]. Baseline marijuana use frequency was not related significantly to the rate of change in anhedonia across follow-ups [β, 95% CI = −0.015 (−0.350, 0.321), P = 0.93]. The association of baseline anhedonia with faster marijuana use escalation was amplified among adolescents with (versus without) friends who used marijuana at baseline [β, 95% CI = 0.179 (0.043, 0.334) versus 0.064 (−0.071, 0.187), interaction P = 0.04], but did not differ by gender or baseline ever marijuana use. Conclusions In mid-adolescence, anhedonia is associated with subsequent marijuana use escalation, but marijuana use escalation does not appear to be associated with subsequent anhedonia. [ABSTRACT FROM AUTHOR]

Aims To study the effectiveness of intensive counselling by a practice nurse (PN) versus brief advice by a general practitioner (GP), each combined with pharmacotherapy, for 6 months' tobacco abstinence (primary outcome). Secondary outcomes included 12-month abstinence, medication adherence and incremental costs per life-year gained. Design A multi-site ( n = 10), two-group, parallel, pragmatic randomized controlled trial. Setting A network of primary health-care centres in the Netherlands. Participants A total of 295 adult daily smokers (mean age = 48 years; mean cigarettes/day = 19). Intervention and comparator Patients were randomized to receive individual counselling by a practice nurse (PN) ( n = 149) or brief advice by a general practitioner (GP) (146). All patients received 12 weeks of open-label varenicline. Measurements The primary outcome was prolonged biochemically validated abstinence from weeks 9 to 26 after treatment initiation. Secondary outcomes included abstinence from weeks 9 to 52, good dosing adherence (> 80% days taken) and incremental costs per life-year gained. Findings Abstinence rates in the PN versus GP groups were 32.2% ( n = 48) versus 39.0% [ n = 57; odds ratio (OR) = 0.71; 95% confidence interval (CI) = 0.44-1.16] from weeks 9 to 26 and 25.5% ( n = 38) versus 28.8% ( n = 42; OR = 0.84, 95% CI = 0.50-1.43) from weeks 9 to 52, respectively. Values of the Bayes factor indicated that the PN and GP were equally effective. Good dosing adherence was significantly lower in the PN (45.5%, n = 56/123) than in the GP group (62.0%, n = 75/121; OR = 0.45, 95% CI = 0.26-0.77), and the incremental costs per life-year gained were -€416.10. Conclusions Among people seeking help to stop smoking from their general practice, one-off brief advice from a general practitioner appears to be as effective as several sessions of behavioural support from a practice nurse when smoking cessation medication is provided. [ABSTRACT FROM AUTHOR]

Background and Aims Premises licensed for the sale and consumption of alcohol can contribute to levels of assault-related injury through poor operational practices that, if addressed, could reduce violence. We tested the real-world effectiveness of an intervention designed to change premises operation, whether any intervention effect changed over time, and the effect of intervention dose. Design A parallel randomized controlled trial with the unit of allocation and outcomes measured at the level of individual premises. Setting All premises (public houses, nightclubs or hotels with a public bar) in Wales, UK. Participants A randomly selected subsample ( n = 600) of eligible premises (that had one or more violent incidents recorded in police-recorded crime data; n = 837) were randomized into control and intervention groups. Intervention and comparator Intervention premises were audited by Environmental Health Practitioners who identified risks for violence and provided feedback by varying dose (informal, through written advice, follow-up visits) on how risks could be addressed. Control premises received usual practice. Measurements Police data were used to derive a binary variable describing whether, on each day premises were open, one or more violent incidents were evident over a 455-day period following randomization. Findings Due to premises being unavailable at the time of intervention delivery 208 received the intervention and 245 were subject to usual practice in an intention-to-treat analysis. The intervention was associated with an increase in police recorded violence compared to normal practice (hazard ratio = 1.34, 95% confidence interval = 1.20-1.51). Exploratory analyses suggested that reduced violence was associated with greater intervention dose (follow-up visits). Conclusion An Environmental Health Practitioner-led intervention in premises licensed for the sale and on-site consumption of alcohol resulted in an increase in police recorded violence. [ABSTRACT FROM AUTHOR]

Aims To determine (i) whether Australian adolescents' exposure to television alcohol advertisements changed between 1999 and 2011 and (ii) examine the association between television alcohol advertising and adolescent drinking behaviours. Design Cross-sectional surveys conducted every 3 years between 1999 and 2011. Analyses examined associations between advertising exposures and reported drinking. Setting Five Australian major cities. Participants Students aged 12-17 years participating in a triennial nationally representative school-based survey residing in the television advertising markets associated with the major cities (sample size range per survey: 12 644-16 004). Measurements Outcome measures were: drinking in the past month, past week and past-week risky drinking (5+ drinks on a day). The key predictor variable was past-month adolescent-directed alcohol advertising Targeted Rating Points (TRPs, a measure of television advertising exposure). Control measures included student-level characteristics, government alcohol-control advertising TRPs, road safety (drink-driving) TRPs and time of survey. Findings Average monthly adolescent alcohol TRPs increased between 1999 (mean = 2371) to 2005 (mean = 2679) ( P < 0.01) then decreased between 2005 and 2011: (mean = 880) ( P < 0.01). Multi-level logistic regression analyses that adjusted for survey timing, student level factors and alcohol-control advertising variables showed a significant association between past-month alcohol TRPs and past-month drinking [odds ratio (OR) = 1.11, 95% confidence interval (CI) = 1.07-1.15), past-week drinking (OR = 1.10, 95% CI = 1.06-1.14) and past-week risky drinking (OR = 1.15, 95% CI = 1.09-1.22). Past-week risky drinking was associated inversely with road safety TRPs (OR = 0.69, 95% CI = 0.49-0.98). Conclusions While Australian adolescents' exposure to alcohol advertising on television reduced between 1999 and 2011, higher levels of past-month television alcohol advertising were associated with an increased likelihood of adolescents' drinking. The reduction in television alcohol advertising in Australia in the late 2000s may have played a part in reducing adolescents' drinking prevalence. [ABSTRACT FROM AUTHOR]

Background and Aims Criminal justice-involved individuals are highly susceptible to opioid relapse and overdose-related deaths. In a recent randomized trial, we demonstrated the effectiveness of extended-release naltrexone (XR-NTX; Vivitrol®) in preventing opioid relapse among criminal justice-involved US adults with a history of opioid use disorder. The cost of XR-NTX may be a significant barrier to adoption. Thus, it is important to account for improved quality of life and downstream cost-offsets. Our aims were to (1) estimate the incremental cost per quality-adjusted life-year (QALY) gained for XR-NTX versus treatment as usual (TAU) and evaluate it relative to generally accepted value thresholds; and (2) estimate the incremental cost per additional year of opioid abstinence. Design Economic evaluation of the aforementioned trial from the taxpayer perspective. Participants were randomized to 25 weeks of XR-NTX injections or TAU; follow-up occurred at 52 and 78 weeks. Setting Five study sites in the US Northeast corridor. Participants A total of 308 participants were randomized to XR-NTX ( n = 153) or TAU ( n = 155). Measurements Incremental costs relative to incremental economic and clinical effectiveness measures, QALYs and abstinent years, respectively. Findings The 25-week cost per QALY and abstinent-year figures were $162 150 and $46 329, respectively. The 78-week figures were $76 400/QALY and $16 371/abstinent year. At 25 weeks, we can be 10% certain that XR-NTX is cost-effective at a value threshold of $100 000/QALY and 62% certain at $200 000/QALY. At 78 weeks, the cost-effectiveness probabilities are 59% at $100 000/QALY and 76% at $200 000/QALY. We can be 95% confident that the intervention would be considered 'good value' at $90 000/abstinent year at 25 weeks and $500/abstinent year at 78 weeks. Conclusions While extended-release naltrexone appears to be effective in increasing both quality-adjusted life-years (QALYs) and abstinence, it does not appear to be cost-effective using generally accepted value thresholds for QALYs, due to the high price of the injection. [ABSTRACT FROM AUTHOR]

Aim To examine the efficacy and safety of (1) midazolam-droperidol versus droperidol and (2) midazolam-droperidol versus olanzapine for methamphetamine-related acute agitation. Design and setting A multi-centre, randomized, double-blind, controlled, clinical trial was conducted in two Australian emergency departments, between October 2014 and September 2015. Participants Three hundred and sixty-one patients, aged 18-65 years, requiring intravenous medication sedation for acute agitation, were enrolled into this study. We report the results of a subgroup of 92 methamphetamine-affected patients. Intervention and comparator Patients were assigned randomly to receive either an intravenous bolus of midazolam 5 mg-droperidol 5 mg combined, droperidol 10 mg or olanzapine 10 mg. Two additional doses were administered, if required: midazolam 5 mg, droperidol 5 mg or olanzapine 5 mg, respectively. Measurements The primary outcome was the proportion of patients sedated adequately at 10 minutes. Odds ratios with 95% confidence intervals (ORs, 95% CI) were estimated. Findings The baseline characteristics of patients in the three groups were similar. At 10 minutes, significantly more patients in the midazolam-droperidol group [29 of 34 (85.3%)] were sedated adequately compared with the droperidol group [14 of 30 (46.7%), OR = 6.63, 95% CI = 2.02-21.78] or with the olanzapine group [14 of 28 (50.0%), OR 5.80, 95% CI = 1.74-19.33]. The number of patients who experienced an adverse event (AE) in the midazolam-droperidol, droperidol and olanzapine groups was seven of 34, two of 30 and six of 28, respectively. The most common AE was oxygen desaturation. Conclusion A midazolam-droperidol combination appears to provide more rapid sedation of patients with methamphetamine-related acute agitation than droperidol or olanzapine alone. [ABSTRACT FROM AUTHOR]

Background and aims Substance use disorders are associated commonly with comorbid physical illness. There are fewer data on dental disease in these conditions, in spite of high rates of dry mouth (xerostomia), as well as the associated indirect or life-style effects such as poverty and lack of access to care. We compared the oral health of people with substance use disorders (SUDs) with non-using controls. Method This was a systematic search for studies from the last 35 years of the oral health of people reporting SUDs. We used MEDLINE, PsycInfo, OVID, Google Scholar, EMBASE and article bibliographies. Results were compared with the general population. Oral health was assessed in terms of dental caries and periodontal disease using the following standardized measures: the mean number of decayed, missing and filled teeth (DMFT) or surfaces (DMFS) and probing pocket depth. Non-carious tooth loss was assessed clinically. Results We identified 28 studies that had sufficient data for a meta-analysis, comprising 4086 SU patients and 28 031 controls. People with SUD had significantly higher mean scores for DMFT [mean difference = 5.15, 95% confidence interval (CI) = 2.61-7.69 and DMFS (mean difference = 17.83, 95% CI = 6.85-28.8]. They had more decayed teeth but fewer restorations, indicating reduced access to dental care. Patients with SUD also exhibited greater tooth loss, non-carious tooth loss and destructive periodontal disease compared to controls. Conclusion Patients with substance use disorders have greater and more severe dental caries and periodontal disease than the general population, but are less likely to have received dental care. [ABSTRACT FROM AUTHOR]

Aims To conduct a cost-effectiveness analysis (CEA) comparing the delivery of brief intervention (BI) with brief treatment (BT) within Screening, Brief Intervention and Referral to Treatment (SBIRT) programs. Design Quasi-experimental differences in observed baseline characteristics between BI and BT patients were adjusted using propensity score techniques. Incremental comparison of costs and health outcomes associated with BI and BT. Setting Health-care settings in four US states participating in Substance Abuse and Mental Health Services Administration SBIRT grant programs. Participants Ninety patients who received BT and 878 who received BI. Measurements Per-patient cost of SBIRT, patient demographics and six measures of substance use: proportion using alcohol, proportion using alcohol to intoxication, days of alcohol use, days of alcohol use to intoxication, proportion using drugs and days using drugs. Findings BI and BT were associated with better outcomes. The cost of SBIRT was significantly higher for BT patients ($75.54 versus 16.32, 95% confidence interval, P < 0.01). BT would be cost-effective if the decision-maker had a willingness to pay of $8.90 for a 1 percentage point reduction in the probability of using any alcohol. For the other five outcomes, BT was less effective and more costly, and BI would be a better use of resources. Conclusions It might be cost-effective to offer brief treatment if the goal is to abstain from alcohol. However, the higher effectiveness of brief treatment for this outcome is associated with considerable uncertainty and, because both brief intervention and brief treatment improve all outcomes, brief treatment does not appear to be a good use of resources. [ABSTRACT FROM AUTHOR]

Background and Aims It has been suggested that distributing naloxone to people who inject drugs (PWID) will lead to fewer attendances by emergency medical services at opioid-related overdose incidents if peer administration of naloxone was perceived to have resuscitated the overdose victim successfully. This study evaluated the impact of a national naloxone programme (NNP) on ambulance attendance at opioid-related overdose incidents throughout Scotland. Specifically, we aimed to answer the following research questions: is there evidence of an association between ambulance call-outs to opioid-related overdose incidents and the cumulative number of 'take-home naloxone' (THN) kits in issue; and is there evidence of an association between ambulance call-outs to opioid-related overdose incidents in early adopter (pilot) or later adopting (non-pilot) regions and the cumulative number of THN kits issued in those areas? Design Controlled time-series analysis. Setting Scotland, UK, 2008-15. Participants Pre-NNP implementation period for the evaluation was defined as 1 April 2008 to 31 March 2011 and the post-implementation period as 1 April 2011 to 31 March 2015. In total, 3721 ambulance attendances at opioid-related overdose were recorded for the pre-NNP implementation period across 158 weeks (mean 23.6 attendances per week) and 5258 attendances across 212 weeks in the post-implementation period (mean 24.8 attendances per week). Intervention Scotland's NNP; formally implemented on 1 April 2011. Measurements Primary outcome measure was weekly incidence (counts) of call-outs to opioid-related overdoses at national and regional Health Board level. Data were acquired from the Scottish Ambulance Service (SAS). Models were adjusted for opioid replacement therapy using data acquired from the Information Services Division on monthly sums of all dispensed methadone and buprenorphine in the study period. Models were adjusted further for a control group: weekly incidence (counts) of call-outs to heroin-related overdose in the London Borough area acquired from the London Ambulance Service. Findings There was no significant association between SAS call-outs to opioid-related overdose incidents and THN kits in issue for Scotland as a whole (coefficient 0.009, 95% confidence intervals = −0.01, 0.03, P = 0.39). In addition, the magnitude of association between THN kits and SAS call-outs did not differ significantly between pilot and non-pilot regions (interaction test, P = 0.62). Conclusions The supply of take-home naloxone kits through a National Naloxone Programme in Scotland was not associated clearly with a decrease in ambulance attendance at opioid-related overdose incidents in the 4-year period after it was implemented in April 2011. [ABSTRACT FROM AUTHOR]

Aims To compare the use of alternative nicotine products, smoking behavior and tobacco biomarker exposure in smokers unwilling to quit who were assigned randomly to normal nicotine content (NNC) cigarettes or very low nicotine content (VLNC) cigarettes. Design Randomized, parallel-arm 8-week study with assignment to VLNC (VLNC 1, n = 53) or NNC (NNC, n = 27) with access to non-cigarette combusted and non-combusted tobacco/nicotine products or to VLNC with access to only non-combusted products (VLNC2, n = 56). Setting Clinics in Minnesota, USA. Participants Smokers uninterested in quitting smoking with a mean [± standard deviation (SD)] age of 44 (± 14) years and smoking 16 (± seven) cigarettes/day; 51% female, 72% white. Measurements During the experimental period, the measures taken included: rate of alternative products used, amount of and abstinence from combusted tobacco used and tobacco exposure biomarkers. Findings There were higher rates of non-combusted alternative tobacco/nicotine product use in both VLNC conditions versus the NNC condition [rate ratio (RR) = 2.18, 95% confidence interval (CI) = 1.94, 2.46 and RR = 1.64, 95% CI = 1.46, 1.85, respectively] and in VLNC1 versus VLNC2 condition (RR = 1.33, 95% CI = 1.23, 1.44), accompanied by reduced biomarkers of exposure primarily in VLNC2 condition compared to NNC condition ( Ps < 0.05). Fewer combusted products were smoked at almost all visits ( Ps ≤ 0.02) and there were higher rates of abstinence for both VLNC conditions compared with the NNC condition (VLNC1 versus NNC: RR = 9.96, 95% CI = 5.01, 19.81; VLNC2 versus NNC: RR = 11.23, 95% CI = 5.74, 21.97). Conclusion The offer of, and instructions to use, reduced nicotine content cigarettes during an 8-week period led to greater use of alternative tobacco/nicotine products compared with continued use of normal nicotine cigarettes and also reductions in smoking rates. [ABSTRACT FROM AUTHOR]

Background and aims This is the first study to examine the effect of alcohol marketing exposure on adolescents' drinking in a cross-national context. The aim was to examine reciprocal processes between exposure to a wide range of alcohol marketing types and adolescent drinking, controlled for non-alcohol branded media exposure. Design Prospective observational study (11-12- and 14-17-month intervals), using a three-wave autoregressive cross-lagged model. Setting School-based sample in 181 state-funded schools in Germany, Italy, Netherlands, Poland. Participants A total of 9075 eligible respondents participated in the survey (mean age 14 years, 49.5% male. Measurements Adolescents reported their frequency of past-month drinking and binge drinking. Alcohol marketing exposure was measured by a latent variable with 13 items measuring exposure to online alcohol marketing, televised alcohol advertising, alcohol sport sponsorship, music event/festival sponsorship, ownership alcohol-branded promotional items, reception of free samples and exposure to price offers. Confounders were age, gender, education, country, internet use, exposure to non-alcohol sponsored football championships and television programmes without alcohol commercials. Findings The analyses showed one-directional long-term effects of alcohol marketing exposure on drinking (exposure T1 on drinking T2: β = 0.420 (0.058), P < 0.001, 95% confidence interval (CI) = 0.324-0.515; exposure T2 on drinking T3: β = 0.200 (0.044), P < 0.001, 95% CI = 0.127-0.272; drinking T1 and drinking T2 on exposure: P > 0.05). Similar results were found in the binge drinking model (exposure T1 on binge T2: β = 0.409 (0.054), P < 0.001, 95% CI = 0.320-0.499; exposure T2 on binge T3: β = 0.168 (0.050), P = 0.001, 95% CI = 0.086-0.250; binge T1 and binge T2 on exposure: P > 0.05). Conclusions There appears to be a one-way effect of alcohol marketing exposure on adolescents' alcohol use over time, which cannot be explained by either previous drinking or exposure to non-alcohol-branded marketing. [ABSTRACT FROM AUTHOR]

Background and Aims Despite ambiguous evidence for the effectiveness of alcohol screening with brief interventions (BI) in emergency departments (ED), ambition for their widespread implementation continues to grow. To clarify whether such an application of BI is justifiable, we conducted a systematic review and meta-analysis on studies testing the impact of BI on alcohol consumption. Methods We included peer-reviewed, randomized controlled studies investigating the effects of BI on alcohol consumption in injured and/or intoxicated patients, published January 2002-September 2015. Changes from baseline in consumption quantity, intensity and number of heavy drinking episodes were assessed at 3-, 6- and 12-month follow-up, resulting in nine separate random-effects meta-analyses of standardized mean differences (SMD). Moderation effects of intervention mode, length, type of interventionist, intensity of control intervention and study quality were assessed using subgroup comparisons and meta-regression. Results We considered 33 publications (28 separate studies) including 14 456 patients. Six of nine comparisons revealed small significant effects in favour of BI, with the highest SMD at 0.19 [95% confidence interval (CI) = 0.08-0.31]. No significant moderators could be identified, and statistical heterogeneity ( I2) was below 40%. Conclusions In a large meta-analysis of randomized controlled trials in emergency care settings, there was evidence for very small effects of brief interventions on alcohol consumption reductions. More intensive interventions showed no benefit over shorter approaches. Non-face-to-face interventions appear to be comparably effective, but this finding remains tentative due to the low number of non-face-to-face studies. [ABSTRACT FROM AUTHOR]

Background and Aims Supervised injection facilities (legally sanctioned spaces for supervised consumption of illicitly obtained drugs) are controversial public health interventions. We determined the optimal number of facilities in two Canadian cities using health economic methods. Design Dynamic compartmental model of HIV and hepatitis C transmission through sexual contact and sharing of drug use equipment. Setting Toronto and Ottawa, Canada. Participants Simulated population of each city. Interventions Zero to five supervised injection facilities. Measurements Direct health-care costs and quality-adjusted life-years (QALYs) over 20 years, discounted at 5% per year; incremental cost-effectiveness ratios. Findings In Toronto, one facility cost $4.1 million and resulted in a gain of 385 QALYs over 20 years, for an incremental cost-effectiveness ratio (ICER) of $10 763 per QALY [95% credible interval (95CrI): cost-saving to $278 311]. Establishing one facility in Ottawa had an ICER of $6127 per QALY (95CrI: cost-saving to $179 272). At a $50 000 per QALY threshold, three facilities would be cost-effective in Toronto and two in Ottawa. The probability that establishing three, four, or five facilities in Toronto was cost-effective was 17, 21, and 41%, respectively. Establishing one, two, or three facilities in Ottawa was cost-effective with 13, 35, and 41% probability, respectively. Establishing no facility was unlikely to be the most cost-effective option (14% in Toronto and 10% in Ottawa). In both cities, results were robust if the reduction in needle-sharing among clients of the facilities was at least 50% and fixed operating costs were less than $2.0 million. Conclusions Using a $50 000 per quality-adjusted life-years threshold for cost-effectiveness, it is likely to be cost-effective to establish at least three legally sanctioned spaces for supervised injection of illicitly obtained drugs in Toronto, Canada and two in Ottawa, Canada. [ABSTRACT FROM AUTHOR]

Background and Aims Flaws in previous studies mean that findings of J-shaped risk curves for gambling should be disregarded. The current study aims to estimate the shape of risk curves for gambling losses and risk of gambling-related harm (a) for total gambling losses and (b) disaggregated by gambling activity. Design Four cross-sectional surveys. Setting Nationally representative surveys of adults in Australia (1999), Canada (2000), Finland (2011) and Norway (2002). Participants A total of 10 632 Australian adults, 3120 Canadian adults, 4484 people aged 15-74 years in Finland and 5235 people aged 15-74 years in Norway. Measurements Problem gambling risk was measured using the modified South Oaks Gambling Screen, the NORC DSM Screen for Gambling Problems and the Problem Gambling Severity Index. Findings Risk curves for total gambling losses were estimated to be r-shaped in Australia {β losses = 4.7 [95% confidence interval (CI) = 3.8, 6.5], β losses2 = -7.6 (95% CI = -17.5, -4.5)}, Canada [β losses = 2.0 (95% CI = 1.3, 3.9), β losses2 = -3.9 (95% CI = -15.4, -2.2)] and Finland [β losses = 3.6 (95% CI = 2.5, 7.5), β losses2 = -4.4 (95% CI = -34.9, -2.4)] and linear in Norway [β losses = 1.6 (95% CI = 0.6, 3.1), β losses2 = -2.6 (95% CI = -12.6, 1.4)]. Risk curves for different gambling activities showed either linear, r-shaped or non-significant relationships. Conclusions Player loss-risk curves for total gambling losses and for different gambling activities are likely to be linear or r-shaped. For total losses and electronic gaming machines, there is no evidence of a threshold below which increasing losses does not increase the risk of harm. [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]

Aims Most people who quit smoking for a short term will return to smoking again in 12 months. We tested whether self-help booklets can reduce relapse in short-term quitters after receiving behavioural and pharmacological cessation treatment. Design A parallel-arm, pragmatic individually randomized controlled trial. Setting Smoking cessation clinics in England. Participants People who stopped smoking for 4 weeks after receiving cessation treatment in stop smoking clinics. Intervention Participants in the experimental group (n = 703) were mailed eight booklets, each of which taught readers how to resist urges to smoke. Participants in the control group (n = 704) received a leaflet currently used in practice. Measurements The primary outcome was prolonged, carbon monoxide-verified abstinence from months 4 to 12. The secondary outcomes included 7-day self#x02010;reported abstinence at 3 and 12 months. Mixed-effects logistic regression was used to estimate treatment effects and to investigate possible effect modifying variables. Findings There were no statistically significant differences between the groups in prolonged abstinence from months 4 to 12 (36.9% versus 38.6%; odds ratio 0.93, 95% confidence interval 0.75-1.16; P = 0.524). In addition, there were no significant differences between the groups in any secondary outcomes. However, people who reported knowing risky situations for relapse and using strategies to handle urges to smoke were less likely to relapse. Conclusions In people who stop smoking successfully with behavioural support, a comprehensive self-help educational programme to teach people skills to identify and respond to high-risk situations for return to smoking did not reduce relapse. [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 investigate the association between frequency of visiting shops and noticing of tobacco point-of-sale (PoS) displays and the development of susceptibility to smoking, or smoking uptake, in secondary school students. Design Two surveys of a school based cohort study carried out in 2011 and 2012. Settings Nottinghamshire, UK. Participants A total of 2270 children aged 11-16 years from eight schools in Nottinghamshire. Measurements We investigated changes in susceptibility to smoking and smoking status in relation to frequency of visiting shops and noticing PoS displays and number of tobacco brands recognized, controlling for a range of potential confounders. Susceptibility to smoking was defined using a set of three questions covering intentions to try smoking, to smoke within the next year and likelihood of smoking if a best friend offered a cigarette. For the analysis we used multinomial logistic regression. Findings Among non-susceptible never smokers, noticing PoS displays more frequently was associated independently with an increased risk of becoming susceptible to smoking [adjusted relative risk ratio (RRR) = 1.74; 99% confidence interval (CI) = 1.13-2.69], but was not associated with smoking uptake. Recognizing a higher number of brands among non-susceptible never smokers doubled the risk of becoming susceptible to smoking and of becoming a smoker, but this did not have a significant effect on transition to smoking among susceptible never smokers. Frequency of noticing tobacco PoS displays was not associated significantly with smoking uptake among those who were susceptible never smokers at baseline. Conclusions Noticing tobacco point-of-sale displays more often and recognizing a higher number of tobacco brands is associated with an increased risk of becoming susceptible to smoking among adolescents in the United Kingdom, and recognizing a higher number of brands is associated positively with an increased risk of smoking uptake. [ABSTRACT FROM AUTHOR]

Aims The Randomized Injectable Opioid Treatment Trial ( RIOTT) compared supervised injectable heroin ( SIH) and supervised injectable methadone ( SIM) with optimized oral methadone ( OOM) ( ISRCTN0133807). Heroin addicts (previously unresponsive to treatment) made significant reductions in street heroin use at 6 months when treated with SIH. We now examine secondary outcomes. Design Multi-site randomized controlled trial ( RCT) comparing SIH versus OOM and SIM versus OOM. Setting Three supervised injectable opiate clinics in England. Participants Chronic refractory heroin addicts continuing to inject street heroin virtually daily despite oral substitution treatment ( n = 127), randomized to either SIH( n = 43), SIM( n = 42) or OOM( n = 42). All received high levels of medical and psychosocial support. Measurements Secondary outcomes: wider drug use, crime, health and social functioning at 6 months. Findings At 6 months, no significant differences were found between treatment groups in wider drug use (crack/cocaine, benzodiazepines, alcohol), physical and mental health ( SF-36) or social functioning. Within each treatment group, significant reductions were observed in crime [ SIH = odds ratio ( OR) 0.05; P < 0.001; SIM = OR 0.11; P = 0.002; OOM = OR 0.11; P = 0.003] and money spent per week on illicit drugs ( SIH = mean change £-289.43; P < 0.001; SIM = mean change £-183.41; P < 0.001; OOM = mean change £-162.80; P < 0.001), with SIH significantly more likely to have reduced money spent on illicit drugs versus OOM (mean difference £-92.04; P < 0.001). Significant improvements were seen in physical health for SIH and SIM ( SIH = mean change 3.97; P = 0.008; SIM = mean change 4.73; P = 0.002) and mental health for OOM (mean change 6.04; P = 0.013). Conclusions Supervised injectable heroin treatment and supervised injectable methadone treatment showed no clearly identified benefit over optimized oral methadone in terms of wider drug use, crime, physical and mental health within a 6-month period, despite reducing street heroin use to a greater extent. However, all interventions were associated with improvements in these outcomes. [ABSTRACT FROM AUTHOR]

Aim To investigate the characteristics of the different club drugs and associated high-risk sexual behaviours in China. Design Multicentre cross-sectional study. Setting Drug Detoxification and Rehabilitation Centres in six provinces, China. Participants A total of 1434 eligible club drug users were included. Measurements Participants were investigated by trained interviewers using a self-designed structured questionnaire to collect information on club drug use and associated behaviours. Findings Methamphetamine was the most commonly abused drug in participants (73.92%), who used it in their or their friends' homes by non-injection for the purpose of feeling euphoria. Among participants with sexual behaviours after club drug use, 75.21% reported having engaged in sex with multiple partners after club drug use during the past year and 79.84% had unprotected sex after using club drug during the past year. A two-level logistic model showed that male gender [adjusted odds ratio ( AOR) = 7.14; 95% confidence interval ( CI) = 4.17-12.5], unmarried ( AOR = 1.71, 95% CI = 1.04-2.79), long duration of club drug use during their life-time ( AOR = 1.76, 95% CI = 1.28-2.42) and severe acute intoxication after using club drugs during the past year ( AOR = 2.11, 95% CI = 1.07-4.15) were independent risk factors of multiple sex partners during the past year. Another two-level model showed that the club drug users who were female ( AOR = 1.79, 95% CI = 1.03-3.11) and had polydrug use during their lifetime ( AOR = 1.55, 95% CI = 1.01-2.34) had more risk for unprotected sex during the past year than without these characteristics. Conclusion High-risk sexual behaviours are common among club drug users in China. The prevention and intervention of club drug use could decrease the risk of sexual behaviours which further prevent HIV transmission and other sexually transmitted infections in China. [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 determine comorbidity patterns in treatment-seeking substance use disorder ( SUD) patients with and without adult attention deficit hyperactivity disorder ( ADHD), with an emphasis on subgroups defined by ADHD subtype, taking into account differences related to gender and primary substance of abuse. Design Data were obtained from the cross-sectional International ADHD in Substance use disorder Prevalence ( IASP) study. Setting Forty-seven centres of SUD treatment in 10 countries. Participants A total of 1205 treatment-seeking SUD patients. Measurements Structured diagnostic assessments were used for all disorders: presence of ADHD was assessed with the Conners' Adult ADHD Diagnostic Interview for DSM-IV ( CAADID), the presence of antisocial personality disorder ( ASPD), major depression ( MD) and (hypo)manic episode ( HME) was assessed with the Mini International Neuropsychiatric Interview- Plus ( MINI Plus), and the presence of borderline personality disorder ( BPD) was assessed with the Structured Clinical Interview for DSM-IV Axis II ( SCID II). Findings The prevalence of DSM-IV adult ADHD in this SUD sample was 13.9%. ASPD [odds ratio ( OR) = 2.8, 95% confidence interval ( CI) = 1.8-4.2], BPD ( OR = 7.0, 95% CI = 3.1-15.6 for alcohol; OR = 3.4, 95% CI = 1.8-6.4 for drugs), MD in patients with alcohol as primary substance of abuse ( OR = 4.1, 95% CI = 2.1-7.8) and HME ( OR = 4.3, 95% CI = 2.1-8.7) were all more prevalent in ADHD+ compared with ADHD− patients ( P < 0.001). These results also indicate increased levels of BPD and MD for alcohol compared with drugs as primary substance of abuse. Comorbidity patterns differed between ADHD subtypes with increased MD in the inattentive and combined subtype ( P < 0.01), increased HME and ASPD in the hyperactive/impulsive ( P < 0.01) and combined subtypes ( P < 0.001) and increased BPD in all subtypes ( P < 0.001) compared with SUD patients without ADHD. Seventy-five per cent of ADHD patients had at least one additional comorbid disorder compared with 37% of SUD patients without ADHD. Conclusions Treatment-seeking substance use disorder patients with attention deficit hyperactivity disorder are at a very high risk for additional externalizing disorders. [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]

Aim To evaluate smokeless tobacco cessation in communities of South Asian origin. Design Multi-centre prospective cohort study. Setting Three tobacco cessation services offering specialist smokeless tobacco cessation outreach clinic support to South Asians ( Bangladeshi, Indian and Pakistani) resident in England. Participants A total of 239 South Asian participants seeking to stop smokeless tobacco use between November 2010 and December 2011. Measurements Socio-demographics, tobacco use and dependence, self-reported abstinence at 4 weeks and satisfaction measures. Findings Participants' mean age was 45 [standard deviation ( SD) = 13] years, were predominantly female (76%), of Bangladeshi origin (74%), either home carers (53%) or not working (29%). Sixty-three per cent were recruited from community locations, 21% through a clinical contact and 16% through friends and family. Mean daily number of smokeless tobacco intakes was 10 ( SD = 7) and the mean dependence score was 4.5 ( SD = 1.9). Sixty-three per cent of participants achieved continuous abstinence 4 weeks after quitting. Using nicotine replacement therapy ( NRT) versus not using it [ OR = 3.47, 95% confidence interval ( CI): 1.25, 9.62] and below median (≤8) daily smokeless tobacco intakes ( OR = 1.91, 95% CI: 1.07, 3.40) predicted successful abstinence. Conclusion South Asian smokeless tobacco users resident in England accessing services to help them stop appear to have short-term success rates comparable with smokers attending stop-smoking services, with higher success rates being reported by those using nicotine replacement therapy. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims Smokers who lapse during a cessation attempt are at particularly high risk of relapse, so interventions to help smokers recover from lapses are urgently needed. Two recent studies have suggested continuing to use nicotine patches following a lapse may be a beneficial relapse prevention strategy. However, to date no study that uses approved doses of nicotine patches under real-world conditions has tested this hypothesis. Design and setting Clinical trial conducted across eight US study sites. Participants and measurements Using data from 509 subjects (240 active; 269 placebo) who lapsed during weeks 3-5 of treatment in a randomized, double-blind placebo-controlled trial of 21-mg nicotine patches, we examined whether active nicotine patch use improved the chances of recovering abstinence (7-day point-prevalence) at weeks 6 and 10. Findings Active patch use (versus placebo) increased the likelihood of recovery from a lapse both at 6 weeks [8.3% versus 0.8%; relative risk (RR) = 11.0, P < 0.001] and at 10 weeks (9.6% versus 2.6%; RR = 3.7, P < 0.001). Conclusions Continuing treatment to aid smoking cessation with active patches promotes recovery from lapses. Smokers should be encouraged to persist with patch treatment if they lapse to smoking. [ABSTRACT FROM AUTHOR]