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Background and aims: The ability to regulate emotions effectively has been associated with resilience to psychopathology. Individuals with substance use disorders (SUDs) have been shown to have higher levels of negative emotionality, with some evidence suggesting impairment in emotion regulation compared with individuals without SUDs. However, no previous attempt has been made to systematically review the literature to assess the magnitude of this difference. We aimed to assess the association between SUD diagnosis and emotion regulation as measured by the Difficulties in Emotion Regulation Scale (DERS) and Emotion Regulation Questionnaire (ERQ) through a systematic review and meta‐analysis of existing findings. Methods: The systematic review was conducted using PubMed, PsycINFO and Embase. We examined cross‐sectional studies that compared a SUD group with a control group and measured emotion regulation using the DERS or the ERQ. The primary analysis focused on papers using the DERS, as this was the predominant instrument in the literature. Results: Twenty‐two studies met our primary analysis criteria, representing 1936 individuals with a SUD and 1567 controls. Individuals with SUDs relative to controls had significantly greater DERS scores, with a mean difference of 21.44 [95% confidence interval (CI) = 16.49–26.40, P < 0.001] and Hedges' g = 1.05 (95% CI = 0.86–1.24, P < 0.001). The difference was robust, remaining significant after removing outliers and studies with high risk of bias. Individuals with SUDs demonstrated poorer emotion regulation on each subscale of the DERS, with the largest deficits in the Strategies and Impulse subscales. The ERQ analysis revealed greater use of expressive suppression in those with SUDs relative to controls (Hedges' g = 0.76, 95% CI = 0.25–1.28, P = 0.004). Conclusions: People with substance use disorders appear to have greater difficulties in emotion regulation than people without substance use disorders. [ABSTRACT FROM AUTHOR]

Background and aims: There are concerns that availability of recreational cannabis dispensaries (RCDs) and point‐of‐sale marketing may lead to increased cannabis use in jurisdictions where cannabis retail sale is legal. This paper examined whether the availability RCDs and the presence of storefront signage indicative of cannabis and signs promoting health benefits in RCDs were associated with cannabis use and risk perceptions. Design: Cross‐sectional, secondary data analysis. Setting: California, USA. Participants: A representative sample of 3385 adults in California who participated in the 2020 probability‐based Marijuana Use and Environment Survey. Measurements Binary outcomes included past‐month overall cannabis use, perceiving cannabis smoking as harmful and past‐month cannabis use by purpose (medical only, recreational only and dual). The objectively assessed predictors included proximity and density of RCDs and presence of storefront signage indicative of cannabis and signs promoting health benefits in RCDs. Findings In terms of proximity, thepresence of storefront signage in the nearest RCD was associated with smaller odds of perceiving cannabis smoking as harmful [odds ratio (OR) = 0.63, 95% confidence interval (CI) = 0.39, 0.99] if the RCD was located within 2 miles of home. Presence of health benefit signs in the nearest RCD was associated with greater odds of overall cannabis use (OR = 2.45, 95% CI = 1.17, 5.16) and recreational use (OR = 3.50, 95% CI = 1.027, 11.91) if the RCD was located within 2–4 miles of home. In terms of density, count of RCDs, count of RCDs with storefront signage and count of RCDs with health benefit signs within 2 miles of home were each separately associated with greater odds of overall cannabis use and cannabis use for dual purposes. Conclusions: The availability of recreational cannabis dispensaries within 2 miles of one's home and the presence of storefront signage indicating the availability of cannabis and signs promoting health benefits of cannabis appear to be associated with increased cannabis use and reduced risk perceptions among adults in California, USA. [ABSTRACT FROM AUTHOR]

Background and aims: Among European countries, France is particularly concerned by adolescent tobacco smoking, especially in disadvantaged socio‐economic backgrounds (SES). We measured the respective contributions of parental smoking and family living arrangement to social disparities in smoking during adolescence. Design: Secondary analysis of survey data. Setting: A cross‐sectional nation‐wide exhaustive 12‐day survey in March 2017 of French youth aged 17–18.5 years participating in the national mandatory civic information day. Participants: A total of 13 314 adolescents answering a pen‐and‐paper questionnaire about their own tobacco consumption and the smoking of their parents. Measurements Risk ratios (RRs) were computed using modified Poisson regressions, and population‐attributable fraction (PAF) was used as a measure of the explanatory roles of the different factors as mediators of SES. Findings Adolescents living within very privileged and privileged SES were significantly less likely to report daily tobacco smoking (20.4 and 22.7%, respectively) than those within modest and disadvantaged ones (26.0 and 28.6%, respectively). Parental smoking and family living arrangement independently explained the smoking inequalities among adolescents. After adjusting for schooling factors, the risks associated with parental smoking ranged between RR = 1.64 [95% confidence interval (CI) = 1.50–1.79] when the father only smoked and RR = 2.17 (95% CI = 1.99–2.36) when both parents smoked, compared with non‐smoking parents; the risk associated with living in a non‐intact family was 1.35 (95% CI = 1.26–1.43) and that of living outside the parental home was 1.20 (95% CI = 1.10–1.30). Apprentices and adolescents out of school had higher risks than those at school (RR = 1.82, 95% CI = 1.68–1.98) and RR = 2.10, 95% CI = 1.92–2.29). The contribution of parental smoking to adolescent smoking (PAF = 32%) was greater than that of SES (PAF = 9%), family living arrangement (PAF = 17%) or schooling factors (14%). The share of SES decreased from 18 to 9% when considering these mediating factors. Conclusion: In France, parental smoking appears to be the factor that most influences adolescent smoking, followed by family living arrangement; the role of family socio‐economic status is small in comparison. [ABSTRACT FROM AUTHOR]

Background and Aims: The pathways model is a highly cited etiological model of problem gambling. In the past two decades, a number of studies have found support for the model's utility in classifying gambling subtypes. The aims of this paper were to refine empirically the model subtypes and to revise and update the model based on those findings. Design and Measurement: Observational study using data collected from treatment‐seeking problem gamblers using the Problem Gambling Severity Index (PGSI) and the Gambling Pathways Questionnaire (GPQ). Setting: Treatment clinics in Canada, Australia and the United States. Participants: A convenience sample of 1168 treatment‐seeking problem gamblers, aged 18 years or older. Findings Empirically validated risk factors were analyzed using latent class analyses, identifying a three‐class solution as the best‐fitting model. Those in the largest class (class 1: 44.3%, n = 517) reported the lowest levels of all etiological risk factors. Participants in class 2 (39.5%, n = 461) reported the highest rates of anxiety and depression, both before and after gambling became a problem, as well as childhood maltreatment, and a high level of gambling for stress‐coping. Those in class 3 (16.3%, n = 190) reported high levels of impulsivity; risk‐taking, including sexual risk‐taking; antisocial traits; and coping to provide meaning in life and to alleviate stress. Conclusions: The revised pathways model of problem gambling includes three classes of gamblers similar to the three subtypes in the original pathways model, but class 3 in the revised pathways model is distinct from class 2, showing higher levels of risk‐taking and antisocial traits and gambling motivated by a desire for meaning/purpose and/or to alleviate stress. Class 2 in the revised pathways model demonstrates high levels of childhood maltreatment as well as gambling for stress‐coping. [ABSTRACT FROM AUTHOR]

Background and aims: Recent reports have highlighted the emergence of 'wasp dope' as an issue of concern, but epidemiological evidence is lacking. Wasp dope is a crystalline substance created by electrifying pyrethroid‐containing insecticides (e.g. wasp sprays) that may give users a methamphetamine‐like 'rush'. This paper describes wasp dope use and correlates of use in a sample of people who use drugs (PWUD) in Appalachian Kentucky, a region that has been an epicenter of opioid use and related harms in the United States. Methods: Respondent‐driven sampling and targeted street outreach were used to recruit PWUD. Eligibility criteria included being aged at least 18 years, residing in one of five Appalachian Kentucky counties, and having either used opioids or injected any drug to get high in the prior 30 days. Interviewer‐administered surveys queried participants' (n = 278) recent (past 6 months) wasp dope use, other substance use and demographic characteristics. Prevalence ratios (PR) were estimated using generalized estimating equations assuming a Poisson outcome distribution in a cross‐sectional analysis. Results: Recent wasp dope use was reported by 16.1% of participants. Men and people who recently experienced homelessness and transportation difficulties were twice or more as likely to have used wasp dope compared with their counterparts [PR = 2.08, 95% confidence interval (CI) = 1.11, 3.87, PR = 2.78, 95% CI = 1.64, 4.72 and PR = 2.01, 95% CI = 1.06–3.81, respectively]. While wasp dope use was associated with injection drug use and using opioids and other substances to get high in unadjusted analyses, the factor most strongly associated with wasp dope use was methamphetamine use (PR = 17.23, 95% CI = 2.57, 115.61), specifically methamphetamine injection (PR = 4.47, 95% CI = 1.56, 12.78). Conclusions: Among people who use drugs in rural Kentucky, USA, more than one in six people surveyed reported using wasp dope in the past 6 months, nearing the percentage using cocaine/crack (20%) and fentanyl/carfentanil (25%). Wasp dope use was higher among men and strongly associated with homelessness, transportation access, methamphetamine use and injection drug use. [ABSTRACT FROM AUTHOR]

Aims: This paper presents updated prevalence estimates of awareness, ever‐use, and current use of nicotine vaping products (NVPs) from 14 International Tobacco Control Policy Evaluation Project (ITC Project) countries that have varying regulations governing NVP sales and marketing. Design, Setting, Participants and Measurements: A cross‐sectional analysis of adult (≥ 18 years) current smokers and ex‐smokers from 14 countries participating in the ITC Project. Data from the most recent survey questionnaire for each country were included, which spanned the period 2013–17. Countries were categorized into four groups based on regulations governing NVP sales and marketing (allowable or not), and level of enforcement (strict or weak where NVPs are not permitted to be sold): (1) most restrictive policies (MRPs), not legal to be sold or marketed with strict enforcement: Australia, Brazil, Uruguay; (2) restrictive policies (RPs), not approved for sale or marketing with weak enforcement: Canada, Malaysia, Mexico, New Zealand; (3) less restrictive policies (LRPs), legal to be sold and marketed with regulations: England, the Netherlands, Republic of Korea, United States; and (4) no regulatory policies (NRPs), Bangladesh, China, Zambia. Countries were also grouped by World Bank Income Classifications. Country‐specific weighted logistic regression models estimated adjusted NVP prevalence estimates for: awareness, ever/current use, and frequency of use (daily versus non‐daily). Findings NVP awareness and use were lowest in NRP countries. Generally, ever‐ and current use of NVPs were lower in MRP countries (ever‐use = 7.1–48.9%; current use = 0.3–3.5%) relative to LRP countries (ever‐use = 38.9–66.6%; current use = 5.5–17.2%) and RP countries (ever‐use = 10.0–62.4%; current use = 1.4–15.5%). NVP use was highest among high‐income countries, followed by upper–middle‐income countries, and then by lower–middle‐income countries. Conclusions: With a few exceptions, awareness and use of nicotine vaping products varied by the strength of national regulations governing nicotine vaping product sales/marketing, and by country income. In countries with no regulatory policies, use rates were very low, suggesting that there was little availability, marketing and/or interest in nicotine vaping products in these countries where smoking populations are predominantly poorer. The higher awareness and use of nicotine vaping products in high income countries with moderately (e.g. Canada, New Zealand) and less (e.g. England, United States) restrictive policies, is likely due to the greater availability and affordability of nicotine vaping products. [ABSTRACT FROM AUTHOR]

Aims Although prenatal screening for problem drinking during pregnancy has been recommended, guidance on screening instruments is lacking. We investigated the sensitivity, specificity and predictive value of brief alcohol screening questionnaires to identify problem drinking in pregnant women. Methods Electronic databases from their inception to June 2008 were searched, as well as reference lists of eligible papers and related review papers. We sought cohort or cross-sectional studies that compared one or more brief alcohol screening questionnaire(s) with reference criteria obtained using structured interviews to detect ‘at-risk’ drinking, alcohol abuse or dependency in pregnant women receiving prenatal care. Results Five studies (6724 participants) were included. In total, seven instruments were evaluated: TWEAK (Tolerance, Worried, Eye-opener, Amnesia, Kut down), T-ACE [Take (number of drinks), Annoyed, Cut down, Eye-opener], CAGE (Cut down, Annoyed, Guilt, Eye-opener], NET (Normal drinker, Eye-opener, Tolerance), AUDIT (Alcohol Use Disorder Identification Test), AUDIT-C (AUDIT-consumption) and SMAST (Short Michigan Alcohol Screening Test). Study quality was generally good, but lack of blinding was a common weakness. For risk drinking sensitivity was highest for T-ACE (69-88%), TWEAK (71–91%) and AUDIT-C (95%), with high specificity (71–89%, 73–83% and 85%, respectively). CAGE and SMAST performed poorly. Sensitivity of AUDIT-C at score ≥3 was high for past year alcohol dependence (100%) or alcohol use disorder (96%) with moderate specificity (71% each). For life-time alcohol dependency the AUDIT at score ≥8 performed poorly. Conclusion T-ACE, TWEAK and AUDIT-C show promise for screening for risk drinking, and AUDIT-C may also be useful for identifying alcohol dependency or abuse. However, their performance as stand-alone tools is uncertain, and further evaluation of questionnaires for prenatal alcohol use is warranted. [ABSTRACT FROM AUTHOR]

Aims The Framework Convention on Tobacco Control (FCTC) asks countries to develop and disseminate comprehensive evidence-based guidelines and promote adequate treatment for tobacco dependence, yet to date no summary of the content of existing guidelines exists. This paper describes the national tobacco dependence treatment guidelines of 31 countries. Design, setting, participants A questionnaire on tobacco dependence treatment guidelines was sent by e-mail to a convenience sample of contacts working in tobacco control in 31 countries in 2007. Completed questionnaires were received from respondents in all 31 countries. During the course of these enquiries we also made contact with people in 14 countries that did not have treatment guidelines and sent them a short questionnaire asking about their plans to produce guidelines. Measurements The survey instrument was a 17-item questionnaire asking the following key questions: do the guidelines recommend brief interventions, intensive behavioural support, medications; which medications; do the guidelines apply to the whole health-care system and all professionals; do they refer explicitly to the Cochrane database; are they based on another country's guidelines; are they national or more local; are they endorsed formally by government; did they undergo peer review; who funded them; where were they published; do they include evidence on cost effectiveness of treatment? Findings According to respondents, all their countries' guidelines recommended brief advice, intensive behavioural support and nicotine replacement therapy (NRT); 84% recommended bupropion; 19% recommended varenicline; and 35% recommended telephone quitlines. Nearly half (48%) included cost-effectiveness evidence. Seventy-one per cent were supported formally by their government and 65% were supported financially by the government. Most (84%) used the Cochrane reviews as a source of evidence, 84% underwent a peer review process and 55% were based on the guidelines of other countries, most often the United States and England. Conclusion Overall, the guidelines reviewed followed the evidence base closely, recommending brief interventions, intensive behavioural support and NRT, and most recommended bupropion. Varenicline was not on the market in most of the countries in this survey when their guidelines were written, illustrating the need for guidelines to be updated periodically. None recommended interventions not proven to be effective, and some recommended explicitly against specific interventions (for lack of evidence). Most were peer-reviewed, many through lengthy and rigorous procedures, and most were endorsed or supported formally by their governments. Some countries that did not have guidelines expressed a need for technical support, emphasizing the need for countries to share experience, something the FCTC process is well placed to support. [ABSTRACT FROM AUTHOR]

Background and aims Prohibitions on producing, distributing and selling cannabis are loosening in various jurisdictions around the world. This paper describes the diversification of cannabis supply laws and discusses the challenges to and opportunities for learning from these changes. Methods We document changes in cannabis supply laws that de jure legalized cannabis production for medical and/or non-medical purposes (excluding industrial hemp) in Australasia, Europe, North America and South America. We also highlight challenges to evaluating these legal changes based on our experiences studying cannabis laws and policies in the United States. Findings As of August 2016, two countries have passed laws to legalize large-scale cannabis production for non-medical purposes at the national (Uruguay) or subnational level (four US states). At least nine other countries legally allow (or will soon allow) cannabis to be supplied for medicinal purposes. Most of the changes in cannabis supply laws have occurred since 2010. The data available in most countries are inadequate for rigorously evaluating the changes in cannabis supply laws. Conclusion The evidence base for assessing changes in cannabis supply laws remains weak. Efforts should focus upon collecting information about quantities consumed and market transactions as well as validating self-report surveys. [ABSTRACT FROM AUTHOR]

Background and Aims If socio-economic disadvantage is associated with more adolescent smoking, but less participation in tertiary education, and smoking and tertiary education are both associated with heavier drinking, these may represent opposing pathways to heavy drinking. This paper examines contextual variation in the magnitude and direction of these associations. Design Comparing cohort studies. Setting United Kingdom. Participants Participants were from the 1958 National Child Development Study (NCDS58; n = 15 672), the British birth cohort study (BCS70; n = 12 735) and the West of Scotland Twenty-07 1970s cohort (T07; n = 1515). Measurements Participants self-reported daily smoking and weekly drinking in adolescence (age 16 years) and heavy drinking (> 14/21 units in past week) in early adulthood (ages 22-26 years). Parental occupational class (manual versus non-manual) indicated socio-economic background. Education beyond age 18 was coded as tertiary. Models were adjusted for parental smoking and drinking, family structure and adolescent psychiatric distress. Findings Respondents from a manual class were more likely to smoke and less likely to enter tertiary education (e.g. in NCDS58, probit coefficients were 0.201 and -0.765, respectively; P < 0.001 for both) than respondents from a non-manual class. Adolescent smokers were more likely to drink weekly in adolescence (0.346; P < 0.001) and more likely to drink heavily in early adulthood (0.178; P < 0.001) than adolescent non-smokers. Respondents who participated in tertiary education were more likely to drink heavily in early adulthood (0.110 for males, 0.182 for females; P < 0.001 for both) than respondents with no tertiary education. With some variation in magnitude, these associations were consistent across all three cohorts. Conclusions In Britain, young adults are more likely to drink heavily both if they smoke and participate in tertiary education (college and university) despite socio-economic background being associated in opposite directions with these risk factors. [ABSTRACT FROM AUTHOR]

Aims U.S. studies contribute heavily to the literature about the tax elasticity of demand for alcohol, and most U.S. studies have relied upon specific excise (volume-based) taxes for beer as a proxy for alcohol taxes. The purpose of this paper was to compare this conventional alcohol tax measure with more comprehensive tax measures (incorporating multiple tax and beverage types) in analyses of the relationship between alcohol taxes and adult binge drinking prevalence in U.S. states. Design Data on U.S. state excise, ad valorem and sales taxes from 2001 to 2010 were obtained from the Alcohol Policy Information System and other sources. For 510 state-year strata, we developed a series of weighted tax-per-drink measures that incorporated various combinations of tax and beverage types, and related these measures to state-level adult binge drinking prevalence data from the Behavioral Risk Factor Surveillance System surveys. Findings In analyses pooled across all years, models using the combined tax measure explained approximately 20% of state binge drinking prevalence, and documented more negative tax elasticity (-0.09, P = 0.02 versus -0.005, P = 0.63) and price elasticity (-1.40, P < 0.01 versus −0.76, P = 0.15) compared with models using only the volume-based tax. In analyses stratified by year, the R-squares for models using the beer combined tax measure were stable across the study period ( P = 0.11), while the R-squares for models rely only on volume-based tax declined ( P < 0.01). Conclusions Compared with volume-based tax measures, combined tax measures (i.e. those incorporating volume-based tax and value-based taxes) yield substantial improvement in model fit and find more negative tax elasticity and price elasticity predicting adult binge drinking prevalence in U.S. states. [ABSTRACT FROM AUTHOR]

Background and aims: Models of alcohol use risk suggest that drinking motives represent the most proximal risk factors on which more distal factors converge. However, little is known about how distinct risk factors influence each other and alcohol use on different temporal scales (within a given moment versus over time). We aimed to estimate the dynamic associations of distal (personality and life stressors) and proximal (drinking motives) risk factors, and their relationship to alcohol use in adolescence and early adulthood using a novel graphical vector autoregressive (GVAR) panel network approach. Design, setting and cases: We estimated panel networks on data from the IMAGEN study, a longitudinal European cohort study following adolescents across three waves (aged 16, 19 and 22 years). Our sample consisted of 1829 adolescents (51% females) who reported alcohol use on at least one assessment wave. Measurements: Risk factors included personality traits (NEO‐FFI: neuroticism, extraversion, openness, agreeableness and conscientiousness; SURPS: impulsivity and sensation‐seeking), stressful life events (LEQ: sum scores of stressful life events), and drinking motives [drinking motives questionnaire (DMQ): social, enhancement, conformity, coping anxiety and coping depression]. We assessed alcohol use [alcohol use disorders identification test (AUDIT): quantity and frequency] and alcohol‐related problems (AUDIT: related problems). Findings Within a given moment, social [partial correlation (pcor) = 0.17] and enhancement motives (pcor = 0.15) co‐occurred most strongly with drinking quantity and frequency, while coping depression motives (pcor = 0.13), openness (pcor = 0.05) and impulsivity (pcor = 0.09) were related to alcohol‐related problems. The temporal network showed no predictive associations between distal risk factors and drinking motives. Social motives (beta = 0.21), previous alcohol use (beta = 0.11) and openness (beta = 0.10) predicted alcohol‐related problems over time (all P < 0.01). Conclusions: Heavy and frequent alcohol use, along with social drinking motives, appear to be key targets for preventing the development of alcohol‐related problems throughout late adolescence. We found no evidence for personality traits and life stressors predisposing towards distinct drinking motives over time. [ABSTRACT FROM AUTHOR]

Background and Aims: The prevalence of cannabis use based on self‐reports is likely to be underestimated in population surveys, especially in contexts where its use is a criminal offence. Indirect survey methods ask sensitive questions ensuring that answers cannot be identified with an individual respondent, therefore potentially resulting in more reliable estimates. We aimed to measure whether the indirect survey method 'randomized response technique' (RRT) increased response rate and/or increased disclosure of cannabis use among young adults compared with a traditional survey. Design: We conducted two parallel nation‐wide surveys during the spring and the summer of 2021. The first survey was a traditional questionnaire‐based one (focusing on substance use and gambling). The second survey applied an indirect survey method known as 'the cross‐wise model' to questions related to cannabis use. The two surveys employed identical procedures (e.g. invitations, reminders and wording of the questions) Setting and Participants: The participants were young adults (aged 18–29 years) living in Sweden. The traditional survey had 1200 respondents (56.9% women) and the indirect survey had 2951 respondents (53.6% women). Measurements In both surveys, cannabis use was assessed according to three time‐frames: life‐time use; use during the past year; and use during the past 30 days. Findings The estimated prevalence of cannabis use was two‐ to threefold higher on all measures when estimated using the indirect survey method compared with the traditional survey: use during life‐time (43.2 versus 27.3%); during the past year (19.2 versus 10.4%); and during the past 30 days (13.2 versus 3.7%). The discrepancy was larger among males and individuals with an education shorter than 10 years, who were unemployed, and who were born in non‐European countries. Conclusions: Indirect survey methods may provide more accurate estimates than traditional surveys on prevalence of self‐reported cannabis use. [ABSTRACT FROM AUTHOR]

Background and aim: Patients with opioid use disorder (OUD) may experience inadequate pain management especially during childbirth. This study assessed and compared patient and provider perspectives on analgesia during and after delivery in women with OUD. Design: Prospective cohort, mixed method design including semi‐structured interviews and structured surveys with pregnant or recently pregnant patients (n = 17) and provider (n = 15) groups. Setting: Prenatal clinics and hospital postpartum units. Participants: Patients were pregnant women with OUD currently treated with methadone (n = 1) or buprenorphine (n = 16). Providers were obstetricians (n = 5), obstetric nurses (n = 5) and anesthesiologists (n = 5). Measurements: Validated questionnaires were completed by both groups; patient interviews were conducted during the third trimester and at 5 days post‐delivery. Patient topics included pain management preferences, analgesia satisfaction and attitudes toward pain. Provider topics included labor and postpartum pain management perspectives. Interviews were independently coded and qualitatively analyzed for major themes. Findings: Five major themes emerged from patient interviews: (1) neuraxial blockade was endorsed for labor pain; (2) otherwise, limited pain control options were perceived; (3) no consensus around use of opioids for pain; (4) non‐opioid options should be available; and (5) provider communication and health‐care system issues act as barriers to adequate pain management. Provider perspective themes included the following: (1) unique challenges in pain management for patients with OUD; (2) confusion on how to plan for and make perinatal adjustments to medication for OUD; (3) discrepant views on use of opioids for pain management; (4) endorsement of non‐pharmacological and non‐opioid options; and (5) need for improved provider collaboration in developing pain management plans. Conclusions: Patients with opioid use disorder and health‐care providers prioritize pain management during and after childbirth, but have discrepant views on use of opioids and other pain management options. Inadequate care coordination and discrepancies in opinions need to be addressed both within care teams and between patients and providers. Clinicians would benefit from better evidence to guide clinical care of patients with OUD for patient‐centered pain management. [ABSTRACT FROM AUTHOR]

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

Aims: Role models around the adolescent, including parents, peers, best friends and older siblings, all act in ways to socialize the adolescent into alcohol use. This study aims to examine the effect of exposure to siblings' drinking alongside the more traditionally examined role models on alcohol use among adolescents. Design: A longitudinal study followed adolescents (45.6% male) who completed a questionnaire every 6 months over 3 years (seven in total). Setting: Netherlands Participants: This resulted in 5112 observations clustered in 765 participants aged between 10 and 16 years. Measurements: We examined three alcohol use measures: alcohol use in the last 6 months, in the last 4 weeks and binge drinking in the last 4 weeks—both cross‐sectionally at each time‐point and their change from one time‐point to the next in a series of multi‐level logistic regression models. Findings Results revealed a non‐significant difference in any of the exposure or alcohol use variables between those with or without older siblings. Higher exposure to sibling drinking was significantly associated with all alcohol use outcomes: use in the last 6 months, odds ratio (OR) = 1.54, 95% confidence interval (CI) = 1.25–1.91; last 4 weeks, OR = 2.04, 95% CI = 1.60–2.60; and binge drinking, OR = 2.35, 95% CI = 1.82–3.05. When adding the other role models (i.e. peers, mothers, fathers and best friends), the significant association between siblings' exposure and adolescents' alcohol use remains. Conclusions: It would appear that, after adjustment for the effect of role models, adolescents who are exposed to more sibling drinking are more likely to have drunk alcohol during the past 6 months and past 4 weeks and also to binge drink. [ABSTRACT FROM AUTHOR]

Background and aims: Alcohol use disorder (AUD) is a chronic disorder with high relapse rates. There are currently few clinical trials of high frequency repetitive transcranial magnetic stimulation (HF‐rTMS) to reduce alcohol use among AUD patients, and results are mixed. The current study tested the effect of 10 add‐on sessions of HF‐rTMS over the right dorsolateral pre‐frontal cortex (DLPFC) on alcohol use and craving. Design: Single‐center, single blind sham‐controlled parallel‐group RCT (n = 80), with 3 and 6 months follow‐up. Setting: Clinical treatment center in Amsterdam, the Netherlands. Participants: Eighty detoxified and abstinent AUD inpatients in clinical treatment (20 females, average age = 44.35 years). Intervention: Ten sessions of active or sham HF‐rTMS (60 10 Hz trains of 5 sec at 110% motor threshold) over the right DLPFC on 10 consecutive work‐days. Measurements The primary outcome measure is the number of abstinent days over 6‐month follow‐up (FU). Secondary outcome measures are craving over 6‐month FU (alcohol urge questionnaire and obsessive‐compulsive drinking scale), time to first relapse over 6‐month FU and grams of alcohol consumed over 6‐month FU. Additional outcome measures: full abstinence over 6‐month FU and treatment success over 12‐month FU. Findings HF‐rTMS did not affect the number of abstinent days over 6 months FU [sham = 124 ± 65.9 days, active = 115 ± 69.8 days, difference: 9 days, 95% confidence interval (CI) = Poisson model: 0.578–3.547]. Moreover, HF‐rTMS did not affect craving (AUQ/OCDS) (sham = 15.38/5.28, active = 17.48/4.75, differences = 2.1/−0.53, 95% CI mixed‐effects model = −9.14 to 2.07/−1.44 to 2.40). Conclusions: There was no clear evidence that high‐frequency repetitive transcranial magnetic stimulation over the right dorsolateral pre‐frontal cortex treatment has a long‐term positive effect on alcohol use or craving as add‐on treatment for alcohol use disorder. High treatment response at 6‐month follow‐up could have limited the possibility to find an effect. [ABSTRACT FROM AUTHOR]

Aims: To estimate the prevalence of family members affected by addictive disorders (FMA) with regard to various types of addictive disorders, and self‐rated health and depression in the general population. Design: Cross‐sectional general population survey. Setting: The German Health Update study (GEDA) 2014/2015, a nationally representative panel of German residents aged 15 years or older. Participants: A total of 24 824 residents aged 15 years or older. Measurements Participants were asked if they had a family member with current or past addictive disorder, the type of addiction and the relationship status. In addition, self‐rated health and depression were assessed using standardized questionnaires. Findings Of the respondents, 9.5% [95% confidence interval (CI) = 9.0–10.0] reported being affected by a current addictive disorder of a relative (cFMA), with a further 4.5% (95% CI = 4.2–4.9) reported having been affected by the addictive disorders of a relative in the past but not within the last 12 months (pFMA). Most FMAs reported having been affected by disorders due to alcohol, followed by cannabis and other drugs. Compared with life‐time non‐FMAs, FMAs reported significantly (P < 0.001) higher odds ratios for depression (cFM = 2.437; 95% CI = 2.082–2.853; pFMA = 1.850; 95% CI = 1.519–2.253) and ill‐health (cFMA = 1.574; 95% CI = 1.374–1.805; pFMA = 1.297; 95% CI = 1.082–1.555). Conclusions: In Germany, family members affected by addictive disorder are a substantial group within the general population. This group is characterized by ill‐health and has not yet been adequately addressed by the addiction treatment system. [ABSTRACT FROM AUTHOR]

Aims: To estimate incidence of post‐release injecting drug use (IDU) among men who injected drugs before imprisonment and determine factors associated with post‐release IDU frequency. Design, setting, participants: Prospective cohort study of men reporting monthly IDU before a period of sentenced imprisonment in Victoria, Australia, recruited between September 2014 and May 2016 (n = 195). Measurements: Any post‐release IDU and IDU frequency was measured via self‐report at 3‐month follow‐up interview. IDU frequency, measured over the preceding month, was categorised as no IDU, irregular IDU (1–4 days IDU) and regular IDU (≥5 days IDU). Incidence of any IDU was calculated at 3 months post‐release. Factors associated with IDU frequency were estimated using ordinal logistic regression. Findings Most (83%) participants reported post‐release IDU (265 per 100 person‐years, 95% CI, 227–309); with half (48%) reporting regular IDU, 23% irregular IDU and 29% no IDU in the month preceding follow‐up. Poorer psychological well‐being at follow‐up (General Health Questionnaire [GHQ‐12] score; adjusted odds ratio [AOR], 1.18; 95% CI, 1.07–1.29) and post‐release unemployment (AOR, 4.57; 95% CI, 1.67–12.49) were associated with increased IDU frequency. Retention in opioid agonist treatment (AOR, 0.49; 95% CI, 0.24–0.98) was associated with reduced IDU frequency. Non‐linear (inverted‐u) associations between IDU frequency and age (age: AOR, 1.51; 95% CI, 1.17–1.96; age‐squared: AOR, 0.99; 95% CI, 0.99–0.99) and pre‐imprisonment IDU frequency (pre‐imprisonment IDU frequency: AOR, 1.36; 95% CI, 1.15–1.61; pre‐imprisonment IDU frequency‐squared: AOR, 0.99; 95% CI, 0.99–0.99) were found, with odds peaking at age 39 and 19 days IDU, respectively. Longer baseline sentence length was associated with reduced odds of irregular and regular IDU (AOR, 0.99; 95% CI, 0.99–0.99). Conclusion: Among Australian men who inject drugs before imprisonment, resumption of injecting drug use after release from prison appears to be common, with imprisonment seeming to have little impact on reducing injecting drug use behaviour. [ABSTRACT FROM AUTHOR]

Aims: To estimate the associations between high‐risk alcohol consumption and (1) severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) seroconversion, (2) self‐reported new SARS‐CoV‐2 infection and (3) symptomatic COVID‐19. Design Prospective cohort study. Setting: Indiana University Bloomington (IUB), IN, USA. Participants: A total of 1027 IUB undergraduate students (64% female), aged 18 years or older, residing in Monroe County, Indiana, seronegative for SARS‐CoV‐2 at study baseline. Measurements Primary exposure was high‐risk alcohol consumption measured with an Alcohol Use Disorders Identification Test (AUDIT) questionnaire score of 8 or more. Primary outcome was SARS‐CoV‐2 seroconversion since baseline, assessed with two SARS‐CoV‐2 antibody tests, at baseline (September 2020) and end‐line (November 2020). Secondary outcomes were (a) self‐reported new SARS‐CoV‐2 infection at the study end‐line and (b) self‐reported symptomatic COVID‐19 at baseline. Findings Prevalence of high‐risk alcohol consumption was 32 %. In models adjusted for demographics, students with high‐risk alcohol consumption status had 2.44 [95% confidence interval (CI) = 1.35, 4.25] times the risk of SARS‐CoV‐2 seroconversion and 1.84 (95% CI = 1.04, 3.28) times the risk of self‐reporting a positive SARS‐CoV‐2 infection, compared with students with no such risk. We did not identify any association between high‐risk alcohol consumption and symptomatic COVID‐19 (prevalence ratio = 1.17, 95% CI = 0.93, 1.47). Findings from sensitivity analyses corroborated these results and suggested potential for a dose–response relationship. Conclusions: Among American college students, high‐risk alcohol consumption appears to be associated with higher risk for severe acute respiratory syndrome coronavirus 2 seroconversion/infection. [ABSTRACT FROM AUTHOR]

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

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]

Aims: To investigate whether reduction in opioid use differs when treated by either buprenorphine–naloxone (BUP) or methadone (MET) among adults with comorbid opioid use disorder (OUD) and mental disorders. Design, Setting and Participants: In a randomized controlled trial, adults with OUD were randomized to 24 weeks of either BUP or MET treatment and were followed up in 3‐yearly assessments. The present secondary analyses were based on 597 participants who completed all assessments. Measurements The outcome measure was the number of days of using opioids per month during the follow‐up period. The Mini‐International Neuropsychiatric Interview (MINI) was used to classify participants into three groups: life‐time mood disorder (n = 302), life‐time mental disorder other than mood disorder (n = 114) and no mental disorder (n = 181). Medication treatment (BUP, MET, no treatment) during the follow‐up period was a time‐varying predictor. Findings Based on zero‐inflated Poisson (ZIP) mixed regression analysis, it was found that relative to no treatment, opioid use during the follow‐up was significantly reduced by BUP [odds ratio (OR) = 0.12, 95% confidence interval (CI) = 0.07–0.21 for any use; risk ratio (RR) = 0.77, 95% CI =0.66–0.89 for days of use] and by MET [OR = 0.33, 95% CI = 0.25–0.45 for any use; RR = 0.78, 95% CI = 0.72–0.84 for days of use]. Relative to MET, BUP was associated with a lower likelihood of any opioid use among participants with mood disorders (OR = 0.52, 95% CI = 0.36–0.74) and for participants without mental disorder (OR = 0.37, 95% CI = 0.21–0.66) and fewer number of days using opioids (RR = 0.37, 95% CI = 0.25–0.56) among participants with other mental disorders. Conclusions: Among adults with comorbid opioid use disorder and mental disorders, treatment with buprenorphine–naloxone produced greater reductions in opioid use than treatment with methadone. [ABSTRACT FROM AUTHOR]

Background and Aims: College students report high levels of alcohol use, which can be exacerbated by interpersonal trauma exposure (IPT). Romantic relationships may represent salient contexts for moderating associations between IPT and alcohol use. We examined whether relationship status, partner alcohol use and relationship satisfaction moderated associations between IPT and alcohol use, and whether these associations varied in a sex‐specific manner. Design University‐wide longitudinal survey of college students. Setting Large, urban public university in mid‐Atlantic United States. Participants: We used two subsets of participants (n = 5673 and 3195) from the Spit for Science project, a longitudinal study of college students. Participants completed baseline assessments during the autumn of their freshman year and were invited to complete follow‐up assessments every spring thereafter. Participants were included in the present study if they completed surveys at baseline and at least one follow‐up assessment (meanfollow‐ups = 1.70, range = 1–4). Measurements Predictors included precollege and college‐onset IPT, relationship status, partner alcohol use, relationship satisfaction and sex. Alcohol consumption was the primary outcome of interest. Pre‐college IPT was measured at baseline and all other measures were assessed at each follow‐up. Findings Individuals with pre‐college IPT consumed more alcohol than those without IPT, but this was mitigated for those in relationships (β = −0.15, P = 0.046, 95% confidence interval (CI) = −0.29, 0.00). Individuals with college‐onset IPT consumed more alcohol than those without IPT, and this was more pronounced for those with higher partner alcohol use (β = −0.18, P = 0.001, 95% CI = −0.29, −0.07). Relationship satisfaction was not a significant moderator of the associations between IPT and alcohol use (Ps > 0.05 and 95% CIs include 0). Conclusions: Involvement in relationships, but not relationship satisfaction, appears to reduce the effects of interpersonal trauma exposure (IPT) on alcohol use among US college students, while high partner alcohol use appears to exacerbate it. The moderating effects of relationship characteristics depend on the developmental timing of IPT. [ABSTRACT FROM AUTHOR]

Background and aims: There has been little empirical evidence to show the 'real‐world' impact of scaling‐up direct‐acting anti‐viral (DAA) treatment among people who inject drugs (PWID) on hepatitis C virus (HCV) viraemia at a population level. We aimed to assess the population impact of rapid DAA scale‐up to PWID delivered through community services—including drug treatment, pharmacies, needle exchanges and prisons—in the Tayside region of Scotland, compared with Greater Glasgow and Clyde (GGC) and the Rest of Scotland (RoS). Design, setting and participants: Natural experiment, evaluated using data from national biennial surveys of PWID and national clinical data. Services providing injecting equipment (2010–18) and HCV treatment clinics (2017–18) across Scotland. A total of 12 492 PWID who completed a questionnaire and provided a blood spot (tested for HCV‐antibodies and RNA); 4105 individuals who initiated HCV treatment. Intervention and comparator, measurements: The intervention was rapid DAA scale‐up among PWID, which occurred in Tayside. The comparator was GGC/RoS. Trends in HCV viraemia and uptake of HCV therapy over time; sustained viral response (SVR) rates to therapy by region and treatment setting. Findings Uptake of HCV therapy (last year) among PWID between 2013–14 and 2017–18 increased from 15 to 43% in Tayside, 6 to 16% in GGC and 11 to 23% in RoS. Between 2010 and 2017–18, the prevalence of HCV viraemia (among antibody‐positives) declined from 73 to 44% in Tayside, 67 to 58% in GGC and 64 to 55% in RoS. The decline in viraemia was greater in Tayside [2017–18 adjusted odds ratio (aOR) = 0.47, 95% confidence interval (CI) = 0.30–0.75, P = 0.001] than elsewhere in Scotland (2017–18 aOR = 0.89, 95% CI = 0.74–1.07, P = 0.220) relative to the baseline of 2013–14 in RoS (including GGC). Per‐protocol SVR rates among PWID treated in community sites did not differ from those treated in hospital sites in Tayside (97.4 versus 100.0%, P = 0.099). Conclusions: Scale‐up of direct‐acting anti‐viral treatment among people who inject drugs can be achieved through hepatitis C virus (HCV) testing and treatment in community drug services while maintaining high sustained viral response rates and, in the Tayside region of Scotland, has led to a substantial reduction in chronic HCV in the population. [ABSTRACT FROM AUTHOR]

Background and Aims: Unhealthy alcohol consumption is a key concern for Aboriginal and Torres Strait Islander ('Indigenous') communities. It is important to identify and treat at‐risk drinkers, to prevent harms to physical or social wellbeing. We aimed to test whether training and support for Aboriginal Community Controlled Health Service (ACCHS) staff would increase rates of alcohol screening and brief intervention. Design Cluster randomized trial. Setting: Australia. Cases/Intervention/Measurements Twenty‐two ACCHSs that see at least 1000 clients per year and use Communicare as practice management software. The study included data on 70 419 clients, training, regular data feedback, collaborative support and funding for resources ($9000). Blinding was not used. The comparator was waiting‐list control (equal allocation). Alcohol Use Disorder Identification Test (AUDIT‐C) screening and records of brief interventions were extracted from practice management software at 2‐monthly intervals. Observations described the clinical actions taken for clients over each 2‐month interval. The baseline period (28 August 2016–28 August 2017) was compared with the post‐implementation period (29 August 2017–28 August 2018). We used multi‐level logistic regression to test the hypotheses that clients attending a service receiving active support would be more likely to be screened with AUDIT‐C (primary outcome) or to receive a brief intervention (secondary outcome). Findings We observed an increase in the odds of screening with AUDIT‐C for both groups, but the increase was 5.52 [95% confidence interval (CI) = 4.31, 7.07] times larger at services receiving support. We found little evidence that the support programme increased the odds of a recorded brief intervention relative to control services (odds ratio = 2.06; 95% CI = 0.90, 4.69). Differences in baseline screening activity between treatment and control reduce the certainty of our findings. Conclusions: Providing Aboriginal Community Controlled Health Services with training and support can improve alcohol (AUDIT‐C) screening rates. [ABSTRACT FROM AUTHOR]

Background and aims: Following the recognition of 'internet gaming disorder' (IGD) as a condition requiring further study by the DSM‐5, 'gaming disorder' (GD) was officially included as a diagnostic entity by the World Health Organization (WHO) in the 11th revision of the International Classification of Diseases (ICD‐11). However, the proposed diagnostic criteria for gaming disorder remain the subject of debate, and there has been no systematic attempt to integrate the views of different groups of experts. To achieve a more systematic agreement on this new disorder, this study employed the Delphi expert consensus method to obtain expert agreement on the diagnostic validity, clinical utility and prognostic value of the DSM‐5 criteria and ICD‐11 clinical guidelines for GD. Methods: A total of 29 international experts with clinical and/or research experience in GD completed three iterative rounds of a Delphi survey. Experts rated proposed criteria in progressive rounds until a pre‐determined level of agreement was achieved. Results: For DSM‐5 IGD criteria, there was an agreement both that a subset had high diagnostic validity, clinical utility and prognostic value and that some (e.g. tolerance, deception) had low diagnostic validity, clinical utility and prognostic value. Crucially, some DSM‐5 criteria (e.g. escapism/mood regulation, tolerance) were regarded as incapable of distinguishing between problematic and non‐problematic gaming. In contrast, ICD‐11 diagnostic guidelines for GD (except for the criterion relating to diminished non‐gaming interests) were judged as presenting high diagnostic validity, clinical utility and prognostic value. Conclusions: This Delphi survey provides a foundation for identifying the most diagnostically valid and clinically useful criteria for GD. There was expert agreement that some DSM‐5 criteria were not clinically relevant and may pathologize non‐problematic patterns of gaming, whereas ICD‐11 diagnostic guidelines are likely to diagnose GD adequately and avoid pathologizing. [ABSTRACT FROM AUTHOR]

Aims: To establish the number of smokers in England who would be targeted by increasing the age of sale of cigarettes from 18 to 21 years and to assess the smoking and socio‐demographic profile of those smokers. Design and setting: Nationally representative cross‐sectional survey of adults in England conducted between January 2009 and July 2019. Participants: A total of 219 720 adults. Measurements All participants reported their current smoking status and socio‐demographic characteristics (i.e. age, gender, home ownership, social grade and ethnicity). Smokers reported motivation to quit, urges to smoke and the Heaviness of Smoking Index (HIS). Weighted prevalence statistics were calculated. Multinomial regression and logistic regression were used to assess differences in smoking characteristics among smokers and socio‐demographic characteristics relative to non‐smokers. Findings The prevalence of smoking between January 2009 and July 2019 was highest among those aged 21–30. In 2019, 15.6% [95% confidence interval (CI) = 12.8–18.8%] of 18–20‐year‐olds reported smoking, which is estimated to represent 364 000 individuals in England. Relative to smokers aged 18–20, older smokers (aged 21+) had a higher motivation to quit smoking [odds ratios (ORs) = 1.40–1.45 range] and higher nicotine dependency as measured by urges to smoke (ORs = 1.06–1.24 range) and HSI (ORs = 1.05–2.85 range). Compared with non‐smokers aged 18–20, smokers in this age group had lower odds of being female (OR = 0.89) and higher odds of being of white ethnicity (OR = 2.78) and from social grades C1–E (lower social grades) compared with AB (higher social grades) (OR = 1.19–1.83 range). Conclusion: Increasing the age of sale of cigarettes to 21 years in England would currently target approximately 364 000 lower dependent smokers from more disadvantaged backgrounds aged 18–20, who have less motivation to quit. [ABSTRACT FROM AUTHOR]

Background and aims: Evidence for efficacy of brief alcohol interventions (BAIs) is mainly limited to primary care and at‐risk drinkers. The aim was to test the efficacy of a BAI addressing the full spectrum of alcohol use in a general population sample and across alcohol risk groups. Design Two‐parallel‐group randomized controlled trial (allocation ratio 1:1) with post‐baseline assessments at months 3, 6 and 12. Setting: One municipal registry office in Germany responsible for registration, passport and vehicle admission issues. Participants: A total of 1646 proactively recruited 18–64‐year‐old adults with past year alcohol use (56% women, 66% low‐risk drinkers) were randomized to intervention (n = 815) or control (n = 831). Intervention and comparator: The intervention consisted of assessment plus computer‐generated individualized feedback letters at baseline and months 3 and 6. Comparator was assessment only. Measurements Primary outcome was change in the self‐reported number of drinks/week from baseline to 12 months. Changes at 3 and 6 months were secondary outcomes. Moderator was alcohol risk group (low‐risk versus at‐risk drinking) according to the Alcohol Use Disorders Identification Test–Consumption, with scores from 1‐3 (women) and from 1‐4 (men) indicating low‐risk drinking. Findings For the whole sample, significant group differences were observed neither at 12‐month follow‐up [incidence rate ratio (IRR) = 1.01, 95% confidence interval (CI) = 0.87–1.17, Bayes factor (BE) = 0.52] nor at previous assessments (month 3: IRR = 1.01, 95% CI = 0.92–1.12, BE = 0.41; month 6: IRR = 0.93, 95% CI = 0.81–1.07, BE = 1.10). Moderator analyses revealed that low‐risk drinkers were more likely to benefit from BAI only at month 6 than at‐risk drinkers (IRR = 0.77, 95% CI = 0.70–0.86). Conclusions: In a randomized controlled trial, there was no clear evidence for efficacy of a computer‐based brief alcohol intervention in a general population sample, but there was some evidence of medium‐term benefits in the large but understudied group of low‐risk drinkers. [ABSTRACT FROM AUTHOR]

Background and aims: In susceptible individuals, cues associated with drug use are theorized to take on incentive–motivational properties, including the ability to reinforce higher‐order, drug‐related associative learning. This study aimed to test this prediction among people varying in risk for alcohol use disorder. Design, setting and participants: Repeated‐measures experiment with a measured individual difference variable at a University psychology laboratory in Missouri, USA. One hundred and six young adults (96 contributed complete data) were pre‐selected to represent the upper and lower quartiles of self‐reported sensitivity to alcohol's acute effects. Measurements Participants completed a second‐order Pavlovian conditioning paradigm in which an initially neutral visual cue (second‐order conditional stimulus; CS2) predicted onset of an olfactory cue (first‐order conditional stimulus; CS1). Olfactory cues were isolated from alcoholic beverages, sweets and non‐comestible substances, each presumed to have a natural history of first‐order conditioning. Event‐related potential responses to the CS2 across its conditioning and extinction, and to the CS1, provided neurophysiological indices of incentive salience (IS). Findings The IS of the alcohol CS1 was higher among participants low in alcohol sensitivity (LS), relative to their higher‐sensitivity (HS) peers. The IS of the CS2 paired with the alcohol CS1 increased across the CS2 conditioning phase among LS but not HS participants. Also, LS (but not HS) individuals also experienced increases in alcohol craving following alcohol CS1 exposure, and this change was correlated with increases in the IS of the CS2 paired with the alcohol CS1. Conclusions: Alcoholic beverage odor, a proximal cue for alcohol consumption, appears to reinforce conditioning of neurophysiological responses to a novel cue among low alcohol sensitivity (LS) individuals but not high alcohol sensitivity individuals, providing the first evidence that the LS phenotype may be associated with differences in the conditioned reinforcing properties of alcohol‐related cues. These findings support the idea that the LS phenotype may increase alcohol use disorder risk via susceptibility to incentive salience sensitization. [ABSTRACT FROM AUTHOR]

Aim: This study examined factors associated with severity, incidence and/or persistence of internet gaming disorder (IGD) in children and adolescents. Design, Setting, Participants: Prospective cohort study with 2‐year follow‐up study in South Korea. A total of 2319 3rd‐, 4th‐ and 7th‐graders enrolled into the internet user cohort for unbiased recognition of gaming disorder in early adolescence [intramural Continuing Umbrella of Research Experiences (iCURE)] and analyzed for the current study. Measurements Severity of the IGD features was assessed by the Internet Game Use‐Elicited Symptom Screen (IGUESS), a self‐reported questionnaire based on the DSM‐5 IGD criteria. Participants with IGUESS scores ≥ 10 were considered to be at high risk for IGD (HIGD). Time spent playing on‐line games, game types, depressive symptoms, trait anxiety, attention deficit hyperactivity disorder (ADHD) symptoms, social support, openness of communication with parents, attachment to parents and potential confounders were assessed by self‐report. Findings A total of 175 (7.5%) students were classified as HIGD cases upon initial assessment. The independent risk factors of incidence of HIGD included playing on‐line games for ≥ 240 minutes/day, playing multi‐player games, depressive symptoms and ADHD symptoms [adjusted rate ratios (aRRs) = 2.03, 1.63, 2.04, 2.53, respectively; all P < 0.05]. Factors related to changing IGD severity scores were playing on‐line games for 60–239 minutes/day, playing single‐player on‐line games, higher attachment and social support [adjusted incidence rate ratio (aIRRs) = 1.38, 1.22, 0.86, 0.87, respectively; all P < 0.05]. Independent predictors of persistence of HIGD were playing on‐line games for ≥ 240 minutes/day and ADHD symptoms (aRRs = 2.63, 2.14, respectively; all P < 0.05). Conclusions: Among adolescents in South Korea, the existence of ADHD symptoms and spending more than 4 hours per day playing on‐line games were associated with the occurrence or persistence of high risk for internet gaming disorder. [ABSTRACT FROM AUTHOR]

Background and Aims: Disbursement of income assistance has been temporally associated with intensified drug use and related harms (coined the 'cheque effect'). However, relationships to injection drug use (IDU) remain understudied. We examined short‐term 'cheque effects' and associated factors among people who inject drugs (PWID). Design Cross‐sectional analysis nested within a cohort study. Setting: Montreal, Quebec, Canada. Participants: PWID receiving income assistance, with no employment income. A total of 613 PWID (median age 41, 83% male) contributed 3269 observations from 2011 to 2017. Measurements and Methods: At each cohort visit, an interviewer‐administered questionnaire captured retrospective reports of injection‐related behaviour during the 2‐day periods (i) before and (ii) including/after receiving last month's income assistance payment (number of injections; drugs injected; any receptive syringe‐sharing). The relative likelihood (odds) and magnitude (rate) of an increase in injection frequency ('cheque effect') were estimated in relation to social and behavioural factors using logistic and negative binomial regression in a covariate‐adjusted two‐part model. Findings Prevalence of IDU and syringe‐sharing were, respectively, 1.80 and 2.50 times higher in the days following versus preceding cheque receipt (P < 0.001). Among people with past‐month IDU, most observations showed increased injection frequency (52%) or no change in injection frequency (44%). The likelihood of a 'cheque effect' was positively associated with cocaine injection [versus injection of other substances, odds ratio (OR) = 2.639, 95% confidence interval (CI) = 2.04–3.41], unstable housing (OR = 1.272, 95% CI = 1.03–1.57) and receiving opioid agonist therapy (OR =1.597, 95% CI = 1.27–2.00) during the same month. Magnitude of the 'cheque effect' was positively associated with cocaine injection [rate ratio (RR) = 1.795, 95% CI = 1.43–2.16], unstable housing (RR = 1.198, 95% CI = 1.02–1.38) and frequent injection (RR = 2.938, 95% CI = 2.43–3.44), but inversely associated with opioid agonist therapy (RR = 0.817, 95% CI = 0.68–0.95) and prescription opioid injection (RR = 0.794, 95% CI = 0.66–0.93). Conclusion: Among people who inject drugs in Montreal, Canada, injection drug use and receptive syringe‐sharing appear to be more prevalent in the 2 days after versus before receiving income assistance. The odds and rate of individual‐level increases in injection frequency appear to be positively associated with cocaine injection (versus injection of other substances) and unstable housing. [ABSTRACT FROM AUTHOR]

Background and Aims: Between 2007 and 2016, pregnancy‐associated mortality resulting from overdose more than doubled in the United States. This study explored the circumstances surrounding maternal opioid‐related morbidity and mortality, using the life‐course theory as a sensitizing framework to examine how each participant's life‐course contributed to her substance use, relapse, recovery or overdose. Design A mixed‐methods study using semi‐structured, in‐depth face‐to‐face interviews and focus groups were conducted. Setting: Texas, United States. Participants: Women who had relapsed into opioid use or experienced a 'near‐miss' overdose and family members of women who had died during the maternal period due to opioid overdose were interviewed (n = 99). Measurements A socio‐demographic questionnaire captured participants' ethnicity, age, marital status, medical and mental health history and employment status. The Stressful Life Events Screening Questionnaire—revised (SLESQ‐R) assessed life‐time exposure to trauma. Findings Women reported histories of abuse and loss of a loved one through homicide or suicide. Participants indicated that limited social support, interpersonal conflict with their partner and unaddressed mental illness made recovery more challenging. Additionally, losing their children through the child welfare system was described as punitive and placed them at greater risk for relapse and overdose. Conclusions: A life‐course theory approach to examining maternal opioid‐related morbidity and mortality in Texas, United States reveals the complex needs of women at risk for opioid use relapse and overdose and the significant role of previous traumatic experiences. [ABSTRACT FROM AUTHOR]

Background and aims: Nearly all the research conducted on high‐intensity drinking has focused on college and school‐based samples, with recent calls for research to understand this risky drinking pattern in non‐school‐based samples and across time. This study aimed to characterize predictors and consequences of non‐binge drinking, age‐ and gender‐adjusted binge drinking (level I) and drinking at levels representing two or more times (level II) and three or more times the level I binge threshold (level III) in a clinical sample of adolescents followed into young adulthood. Design Cross‐sectional associations between non‐binge drinking, binge levels, and negative alcohol‐related consequences were examined during adolescence; prospective analyses tested whether adolescent non‐binge drinking and binge levels predicted alcohol use disorder (AUD) symptoms in young adulthood and whether changes in drinking motives over time were associated with binge levels in young adulthood. Setting: US clinical settings. Participants: A total of 432 adolescents (aged 12–18 years) with alcohol‐related problems followed into young adulthood (aged 19–25 years). Measurements Life‐time drinking history, Structured Clinical Interview for DSM AUDs, and Inventory of Drinking Situations. Findings Results were generally consistent with a distinction between binge level I versus levels II–III on various negative alcohol‐related consequences in adolescence (Ps < 0.05) that were maintained in young adulthood (Ps < 0.01). The maintenance of relatively high endorsement of enhancement and social motives over time was associated with binge levels II–III in young adulthood (Ps < 0.001); decreases in coping motives were associated with less risky drinking in adulthood (P = 0.003). Conclusions: Among US adolescents with alcohol‐related problems who were followed‐up in young adulthood (aged 19–25 years), standard threshold binge drinking (five or more drinks per occasion; level I) was generally associated with fewer alcohol‐related consequences and problem behaviors than binge drinking at two or more times (level II) or three or more times (level III) the standard binge threshold. [ABSTRACT FROM AUTHOR]

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Aim: To describe systemic nicotine exposure and subjective effects of electronic cigarettes (e‐cigarettes) in people who use both e‐cigarettes and cigarettes (dual users), including within‐subject comparisons of e‐cigarette and cigarette use. Design Two‐arm, counterbalanced cross‐over study. Participants used their usual brand of e‐cigarette or cigarette during a standardized session in a 2‐week study. Setting: Hospital research ward, San Francisco, CA, USA. Participants: Thirty‐six healthy (eight women, 28 men) participants. Measurements Plasma nicotine was analyzed by gas chromatography–tandem mass spectrometry; nicotine withdrawal, urge to smoke and vape, affective states, craving, satisfaction and psychological reward were measured by standardized questionnaires. Findings Compared with cigarettes, average maximum plasma nicotine concentration (Cmax) was lower with e‐cigarettes [6.1 ± 5.5 ng/ml, mean ± standard deviation (SD) versus 20.2 ± 11.1 ng/ml, P < 0.001] and time of maximal concentration (Tmax) was longer (6.5 ± 5.4 versus 2.7 ± 2.4 minutes, P < 0.001). Use of both products resulted in a reduction in the severity of withdrawal symptoms, negative affect and urge to use either product. E‐cigarettes were less rewarding and satisfying and reduced craving to a lesser degree than cigarettes. We were not able to detect any differences in withdrawal symptoms, affective states and urge to smoke cigarettes between e‐cigarette and cigarette use. Conclusion: Systemic nicotine exposure was, on average, lower with single use of e‐cigarettes compared with cigarettes, and e‐cigarettes were judged to be less satisfying and rewarding and reduced craving less than cigarettes. [ABSTRACT FROM AUTHOR]

Aims: To perform an economic evaluation of a work‐place smoking cessation group training programme with incentives compared with a training programme without incentives. Design A trial‐based cost‐effectiveness analysis (CEA) and cost–utility analysis (CUA) from a societal perspective and an employer's perspective. Setting: Sixty‐one companies in the Netherlands. Participants: A total of 604 tobacco‐smoking employees. Intervention and comparator: A 7‐week work‐place smoking cessation group training programme. The intervention group earned gift vouchers of €350 for 12 months' continuous abstinence. The comparator group received no incentives. Measurements Online questionnaires were administered to assess quality of life (EQ‐5D‐5 L) and resource use during the 14‐month follow‐up period (2‐month training period plus 12‐month abstinence period). For the CEA the primary outcome measure was carbon monoxide (CO)‐validated continuous abstinence; for the CUA the primary outcome was quality‐adjusted life years (QALY). Bootstrapping and sensitivity analyses were performed to account for uncertainty. Incremental cost‐effectiveness ratio (ICER) tables were used to determine cost‐effectiveness from a life‐time perspective. Findings Of the participants in the intervention group, 41.1% had quit smoking compared with 26.4% in the control group. From a societal perspective with a 14‐month follow‐up period, the ICER per quitter for an intervention with financial incentives compared with no incentives was €11 546. From an employer's perspective, the ICER was €5686. There was no significant difference in QALYs between the intervention and control group within the 14‐month follow‐up period. The intervention was dominated by the comparator in the primary analysis at a threshold of €20 000 per QALY. In the sensitivity analysis, these results were uncertain. A life‐time perspective showed an ICER of €1249 (95% confidence interval = €850–2387) per QALY. Conclusions: Financial incentives may be cost‐effective in increasing quitting smoking, particularly from a life‐time perspective. [ABSTRACT FROM AUTHOR]

Background and aims: The 21‐item Brief Marijuana Consequences Questionnaire (B‐MACQ) has been shown to be a valid measure to assess negative marijuana‐related consequences among US college students. The present study aimed to: (a) examine measurement invariance of the B‐MACQ among college student marijuana users in five countries, (b) evaluate latent mean differences on the B‐MACQ as a function of sex and country if invariance is met and (c) compare criterion‐related validity across different countries and sex. Design Instrumental study. Setting: Argentina, the Netherlands, Spain, Uruguay and United States. Participants: A subsample of last‐month marijuana users who completed the B‐MACQ (n = 1145; 62.9% female). Measurements The B‐MACQ, several dimensions of marijuana use and perceptions of marijuana use. Findings Results supported configural and scalar invariance (all ΔCFI/TLI ≤ 0.01; ΔRMSEA ≤ 0.015) of a 20‐item B‐MACQ across sex and four countries (the Netherlands being the exception). In examining latent mean differences, Spanish students reported a higher number of consequences than US (P < 0.001) and Argentinian students (P = 0.003). In examining criterion‐related validity, marijuana use indicators (0.01 < rs < 0.64), descriptive norms (0.04 < rs < 0.49) and injunctive norms for best friend (0.06 < rs < 0.28) largely had small‐to‐moderate positive correlations with negative marijuana‐related consequences. Conclusions: The 20‐item B‐MACQ accurately assesses marijuana‐related negative consequences among male and female college student marijuana users across the United States, Argentina, Spain and Uruguay. The B‐MACQ could be used effectively to identify marijuana‐related consequences in college students from different countries or cultures. [ABSTRACT FROM AUTHOR]

Background and Aims: To determine whether transdiagnostic risk, represented as elevations in one high‐risk personality trait, interacts with behavior‐specific risk, represented as elevated expectancies for reinforcement from either drinking or smoking, to account partly for early adolescent drinking and smoking behavior. Design Multiple regression analysis. Setting: Twenty‐three public schools in two school systems in the United States. Participants: A sample of 1897 adolescents tested in the spring of 5th, 6th, 7th, 8th and 9th grades. Measurements Transdiagnostic risk was measured as negative urgency, the tendency to act rashly when distressed, using the UPPS‐P child version. Drinking‐specific and smoking‐specific risk were measured as expectancies for reinforcement from drinking and smoking, using the Memory Model‐Based Expectancy Questionnaire (alcohol) and the Adolescent Smoking Consequences Questionnaire (smoking). Findings There was consistent concurrent prediction from the interactions of (a) negative urgency and alcohol reinforcement expectancies to early adolescent drinking and (b) negative urgency and smoking reinforcement expectancies to early adolescent smoking, above and beyond prediction from the main effects of those variables. In each case, expectancies were more predictive at higher levels of negative urgency. Incremental R2 values for main effects ranged from 0.07 to 0.26, and for interactions ranged from 0.01 to 0.03. Prospectively, the main effects predicted subsequent behavior but the interaction effects did not, except in one case. Conclusions: Among elementary and high school students in the United States, the joint effects of negative urgency and behavior‐specific expectancies help to explain drinking and smoking behavior. Joint elevations on the trait and the learning variable account for drinking and smoking behavior beyond the main effects of each predictor. However, there is reason to doubt whether the joint effects predict subsequent increases in drinking and smoking beyond the main effects of those variables. [ABSTRACT FROM AUTHOR]

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

Abstract: Background and aims: Although generally prohibited by national regulations, underage gambling has become popular in Europe, with relevant cross‐country prevalence variability. This study aimed to estimate the prevalence of underage gambling in Europe stratified by type of game and on‐/off‐line mode and to examine the association with individual and family characteristics and substance use. Design: Our study used data from the 2015 European School Survey Project on Alcohol and Other Drugs (ESPAD) cross‐sectional study, a survey using self‐administered anonymous questionnaires. Setting: Thirty‐three European countries. Participants: Sixteen‐year‐old‐year‐old students (n = 93 875; F = 50.8%). Measurements: The primary outcome measure was prevalence of past‐year gambling activity. Key predictors comprised individual behaviours, substance use and parenting (regulation, monitoring and caring). Findings: A total of 22.6% of 16‐year‐old students in Europe gambled in the past year: 16.2% on‐line, 18.5% off‐line. High prevalence variability was observed throughout countries both for mode and types of game. With the exception of cannabis, substance use shows a higher association with gambling, particularly binge drinking [odds ratio (OR) = 1.46, 95% confidence interval (CI) = 1.39–1.53), life‐time use of inhalants (OR = 1.57, 95% CI = 1.47–1.68) and other substances (OR = 1.78, 95% CI = 1.65–1.92)]. Among life habits, the following showed a positive association: truancy at school (OR = 1.26, 95% CI = 1.18–1.35), going out at night (OR = 1.32, 95% CI = 1.26–1.38), participating in sports (OR = 1.30, 95% CI = 1.24–1.37). A negative association was found with reading books for leisure (OR = 0.82%, 95% CI = 0.79–0.86), parents’ monitoring of Saturday night activities (OR = 0.81, 95% CI = 0.77–0.86) and restrictions on money provided by parents as a gift (OR = 0.89, 95% CI = 0.84–0.94). Conclusions: Underage gambling in Europe appears to be associated positively with alcohol, tobacco and other substance use (but not cannabis), as well as with other individual behaviours such as truancy, going out at night and active participation in sports, and is associated negatively with reading for pleasure, parental monitoring of evening activities and parental restriction of money. [ABSTRACT FROM AUTHOR]

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

Abstract: Aims: To determine (i) whether the strength of Australian alcohol control policy in three domains (youth access, trading hours and drink driving) changed during the 2000s; and (ii) estimate associations between these policies and adolescent drinking after adjusting for television alcohol advertising exposures, alcohol outlet density, alcohol price changes, exposure to negative articles about alcohol in daily newspapers and adult drinking prevalence. Design: Repeated cross‐sectional surveys conducted triennially from 2002 to 2011. Multi‐level modelling examined the association between alcohol control policies and drinking prevalence after adjusting for covariates. Setting: Four Australian capital cities between 2002 and 2011. Participants: Students aged 12–17 years participating in a triennial national representative school‐based survey (sample size range/survey: 9805–13 119). Measurements: Outcome measures were: past month drinking and risky drinking (5+ drinks on a day) in the past 7 days. Policy strength in each of three domains (youth access, trading hours, drink‐driving) were the key predictor variables. Covariates included: past 3‐month television alcohol and alcohol‐control advertising, alcohol outlet density, alcohol price change, negatively framed newspaper alcohol articles, adult drinking prevalence and student demographic characteristics. Findings: During the study period, the strength of youth access policies increased by 10%, trading hours policies by 14% and drink‐driving policies by 58%. Past‐month and risky drinking prevalence decreased (e.g. past‐month: 2002: 47.4% to 2011: 26.3%). Multivariable analyses that included all policy variables and adjusted for year, student and other covariates showed past‐month drinking to be associated inversely with stronger trading hours policies [odds ratio (OR) = 0.80, 95% confidence interval (CI) = 0.69, 0.94], but not youth access (OR = 0.92 95% CI = 0.81, 1.04) or drink‐driving (OR = 1.00, 95% CI = 0.93, 1.09). Risky drinking was associated inversely with stronger youth access policies (OR = 0.82, 95% CI = 0.69, 0.98), but not trading hours (OR = 0.85, 95% CI = 0.66, 1.09) or drink‐driving (OR = 1.02, 95% CI = 0.90, 1.14) policies. Conclusions: Population‐directed policies designed to reduce alcohol availability and promotion may reduce adolescents’ alcohol use. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To determine whether diminished alternative reinforcement (i.e. engagement and enjoyment from substance‐free activities) mediated the longitudinal association of conduct problems with substance use in early–mid‐adolescence. Design: Structural equation modeling tested whether the association between wave 1 (baseline) conduct problems and wave 3 (24‐month follow‐up) substance use outcomes was mediated by diminished alternative reinforcement at wave 2 (12‐month follow‐up). Additional analyses tested whether sex and socio‐economic status moderated this association. Setting: Ten high schools in Los Angeles, CA, USA, 2013–15. Participants: Students (n = 3396, 53.5% female, mean [standard deviation (SD)] age at wave 1 baseline = 14.1 (0.42) years). Measurements: Self‐reported conduct problems (11‐item questionnaire), alternative reinforcement (44‐item questionnaire) and use of alcohol, marijuana and combustible cigarettes during the past 6 months (yes/no) and the past 30 days (nine‐level ordinal response based on days used in past 30 days). Results: Significant associations of wave 1 conduct problems with wave 3 marijuana use during the past 6 months (β = 0.25) and past 30 days (β = 0.26) were mediated by wave 2 diminished alternative reinforcement (βindirect effect: 6 months = 0.013, 30 days = 0.017, Ps < 0.001). Associations of conduct problems with alcohol or combustible cigarette use were not mediated by alternative reinforcement. All associations did not differ by sex and socio‐economic status. Conclusions: Diminished alternative reinforcement may be a modifiable mechanism linking early adolescent conduct problems and subsequent marijuana use that could be targeted in prevention programs to offset the adverse health and social sequelae associated with comorbid conduct problems and marijuana use in early‐mid adolescence. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To investigate socio‐economic disparities in smoking in pregnancy (SIP) by the mother's education, occupational class and current economic conditions. Design: Cross‐sectional analysis with linked survey and register data. Setting: South‐western Finland. Participants: A total of 2667 pregnant women [70% of the original sample (n = 3808)] from FinnBrain, a prospective pregnancy cohort study. Measurements: The outcome was smoking during the first pregnancy trimester, measured from the Finnish Medical Birth Register. Education and occupational class were linked from population registers. Income support recipiency and subjective economic wellbeing were questionnaire‐based measures of current economic conditions. These were adjusted for age, partnership status, residential area type, parental separation, parity, childhood socio‐economic background, childhood adversities (the Trauma and Distressing Events During Childhood scale) and antenatal stress (Edinburgh Postnatal Depression Scale). Logistic regressions and attributable fractions (AF) were estimated. Findings: Mother's education was the strongest socio‐economic predictor of SIP. Compared with university education, adjusted odds ratios (aORs) of SIP were: 2.2 [95% confidence interval (CI) = 1.2–3.9; P = 0.011] for tertiary vocational education, 4.4 (95% CI = 2.1–9.0; P < 0.001) for combined general and vocational secondary education, 2.9 (95% CI = 1.4–6.1; P = 0.006) for general secondary education, 9.5 (95% CI 5.0–18.2; P < 0.001) for vocational secondary education and 14.4 (95% CI = 6.3–33.0; P < 0.001) for compulsory schooling. The total AF of education was 0.5. Adjusted for the other variables, occupational class and subjective economic wellbeing did not predict SIP. Income support recipiency was associated positively with SIP (aOR = 1.8; 95% CI = 1.1–3.1; P = 0.022). Antenatal stress predicted SIP (aOR = 2.0; 95% CI = 1.4–2.8; P < 0.001), but did not attenuate its socio‐economic disparities. Conclusions: In Finland, socio‐economic disparities in smoking in pregnancy are attributable primarily to differences in the mother's educational level (low versus high) and orientation (vocational versus general). [ABSTRACT FROM AUTHOR]

Abstract: Background and aims: Despite the over‐representation of people with gambling problems in mental health populations, there is limited information available to guide the selection of brief screening instruments within mental health services. The primary aim was to compare the classification accuracy of nine brief problem gambling screening instruments (two to five items) with a reference standard among patients accessing mental health services. Design: The classification accuracy of nine brief screening instruments was compared with multiple cut‐off scores on a reference standard. Setting: Eight mental health services in Victoria, Australia. Participants: A total of 837 patients were recruited consecutively between June 2015 and January 2016. Measurements: The brief screening instruments were the Lie/Bet Questionnaire, Brief Problem Gambling Screen (BPGS) (two‐ to five‐item versions), NODS‐CLiP, NODS‐CLiP2, Brief Biosocial Gambling Screen (BBGS) and NODS‐PERC. The Problem Gambling Severity Index (PGSI) was the reference standard. Findings: The five‐item BPGS was the only instrument displaying satisfactory classification accuracy in detecting any level of gambling problem (low‐risk, moderate‐risk or problem gambling) (sensitivity = 0.803, specificity = 0.982, diagnostic efficiency = 0.943). Several shorter instruments adequately detected both problem and moderate‐risk, but not low‐risk, gambling: two three‐item instruments (NODS‐CLiP, three‐item BPGS) and two four‐item instruments (NODS‐PERC, four‐item BPGS) (sensitivity = 0.854–0.966, specificity = 0.901–0.954, diagnostic efficiency = 0.908–0.941). The four‐item instruments, however, did not provide any considerable advantage over the three‐item instruments. Similarly, the very brief (two‐item) instruments (Lie/Bet and two‐item BPGS) adequately detected problem gambling (sensitivity = 0.811–0.868, specificity = 0.938–0.943, diagnostic efficiency = 0.933–0.934), but not moderate‐risk or low‐risk gambling. Conclusions: The optimal brief screening instrument for mental health services wanting to screen for any level of gambling problem is the five‐item Brief Problem Gambling Screen (BPGS). Services wanting to employ a shorter instrument or to screen only for more severe gambling problems (moderate‐risk/problem gambling) can employ the NODS‐CLiP or the three‐item BPGS. Services that are only able to accommodate a very brief instrument can employ the Lie/Bet Questionnaire or the two‐item BPGS. [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]

Abstract: Aims: To assess the cost‐effectiveness of a two‐component intervention designed to increase attendance at the NHS Stop Smoking Services (SSSs) in England. Design: Cost‐effectiveness analysis alongside a randomized controlled trial (Start2quit). Setting: NHS SSS and general practices in England. Participants: The study comprised 4384 smokers aged 16 years or more identified from medical records in 99 participating practices, who were motivated to quit and had not attended the SSS in the previous 12 months. Intervention and comparator: Intervention was a personalized and tailored letter sent from the general practitioner (GP) and a personal invitation and appointment to attend a taster session providing information about SSS. Control was a standard generic letter from the GP advertising SSS and asking smokers to contact the service to make an appointment. Measurements: Costs measured from an NHS/personal social services perspective, estimated health gains in quality‐adjusted life‐years (QALYs) measured with EQ‐5D and incremental cost per QALY gained during both 6 months and a life‐time horizon. Findings: During the trial period, the adjusted mean difference in costs was £92 [95% confidence interval (CI) = –£32 to –£216) and the adjusted mean difference in QALY gains was 0.002 (95% CI = –0.001 to 0.004). This generates an incremental cost per QALY gained of £59 401. The probability that the tailored letter and taster session is more cost‐effective than the generic letter at 6 months is never above 50%. In contrast, the discounted life‐time health‐care cost was lower in the intervention group, while the life‐time QALY gains were significantly higher. The probability that the intervention is more cost‐effective is more than 83% using a £20 000–30 000 per QALY‐gained decision‐making threshold. Conclusions: An intervention designed to increase attendance at the NHS Stop Smoking Services (tailored letter and taster session in the services) appears less likely to be cost‐effective than a generic letter in the short term, but is likely to become more cost‐effective than the generic letter during the long term. [ABSTRACT FROM AUTHOR]

Background and Aims Both high alcohol intake and alcohol dependence increase mortality, and both are associated with smoking. We aimed to compare the associations of quantity of alcohol, number of alcohol-related symptoms and smoking history with all-cause mortality, and to assess symptom count and smoking history as confounders or mediators of the effects of high alcohol intake. Design Survival was analysed by Cox regression with sex, body mass index, alcohol intake (overall and by beverage), maximum drinks on any day, alcohol symptom count and smoking status as potential predictors of age at death. Setting Australia. Participants Participants were apparently healthy volunteers consisting of 33 593 Australian adult twins and their relatives who completed questionnaires or interviews between 1979 and 2005. Measurements Data on alcohol use, smoking and occurrence of symptoms related to alcohol use disorders and death records from the Australian National Death Index. Findings A total of 3764 participants were matched with deaths occurring within Australia up to July 2014. Individually, alcohol intake [hazard ratio (HR) = 1.0082, 95% confidence interval (CI) = 1.0063-1.0102, per drink per week], beer intake (HR = 1.0159, 95% CI = 1.0123-1.0195, per drink per week), life-time maximum number of drinks in 1 day (HR = 1.0176, 95% CI = 1.0130-1.0221, per drink), symptom count (HR = 1.0867, 95% CI = 1.0633-1.1106, per symptom) and smoking status (HR = 2.82, 95% CI = 2.52-3.16 for smokers of 10+ cigarettes/day versus never-smokers) were each significant predictors of all-cause mortality. After adjustment for the independently significant predictors alcohol symptom count and smoking status, alcohol intake was no longer significant (adjusted HR = 1.0012 per drink per week, 95% CI = 0.9979-1.0145). Conclusions Number of symptoms related to high alcohol intake and tobacco smoking appear to account for the positive association between alcohol consumption and premature mortality. [ABSTRACT FROM AUTHOR]

Background and aims In Scotland, hepatitis B virus (HBV) vaccination for all prisoners was introduced in 1999; here, we examine the impact of this programme among people who inject drugs (PWID) in the community. This study aimed to compare rates of HBV vaccine uptake before and after implementation of the prison programme and to estimate the determinants of vaccine uptake, the levels of ever/current HBV infection and the associations between vaccine uptake and ever/current HBV infection. Design Data collected via serial cross-sectional surveys were used to compare the proportion who reported being vaccinated over time. For the 2013-14 survey, rates of ever/current HBV infection were calculated and the associations between vaccine uptake and ever/current HBV infection were examined using logistic regression. Setting Services providing injecting equipment and drug treatment and street sites in Glasgow (1993-2002) and throughout Scotland (2008-14). Participants More than 10 000 PWID in total were recruited in the surveys. Measurements Participants completed a questionnaire (all years) to ascertain self-reported vaccine uptake and provided a blood spot (in 2013-14), tested for HBV core antibodies (anti-HBc) and surface antigen (HBsAg). Findings Among recent-onset PWID in Glasgow, vaccine uptake increased from 16% in 1993 to 59% in 2008-14 ( P < 0.001). Among all PWID in Scotland, uptake increased further from 71% in 2008-09 to 77% in 2013-14 ( P < 0.001) and was associated with incarceration [adjusted odds ratio (aOR) = 2.91, 95% confidence interval (CI) = 2.23-3.79]. The prevalence of anti-HBc and HBsAg in Scotland was 2.6 and 0.3%, respectively, among PWID who had commenced injecting in the decade since the programme's introduction. Vaccination was associated with reduced odds of ever (aOR = 0.60, CI = 0.37-0.97) and current (aOR = 0.40, CI = 0.16-0.97) HBV infection. Conclusions In Scotland, uptake of hepatitis B virus (HBV) vaccination among people who inject drugs (PWID) in the community has increased since the 1999 introduction of universal prison vaccination, and current levels of HBV infection among PWID are low compared with other European countries. [ABSTRACT FROM AUTHOR]