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Background and Aims: Alcohol consumption is increasing among older adults. Rethink My Drink is a brief internet-delivered intervention to reduce alcohol consumption and related harms, adapted specifically for older adults. This protocol for a large-scale randomised controlled trial will evaluate whether Rethink My Drink is effective in reducing alcohol consumption and cognitive decline in a sample of older risky drinkers, compared with an active control. Design: 1:1 parallel group, randomised controlled trial. Setting: Online trial in Australia. Participants: Hazardous or harmful drinkers (defined as those scoring =5 on the Alcohol Use Disorders Identification Test [AUDIT]) age 60 to 75 years old (n = 842). Participants will be recruited from August 2021 to August 2022 through online social media advertisements and community networks. Intervention and Comparator: Participants will be randomly allocated to receive access to Rethink My Drink (intervention) or Alcohol: The Facts (comparator), an online patient information booklet provided by New South Wales (NSW) Health. Measurements: Primary outcomes include (i) average weekly standard drinks and (ii) rate of cognitive decline. Secondary outcomes include (i) typical quantity of drinks per drinking day; (ii) heavy episodic drinking; (iii) age-specific risky drinking; (iv) alcoholrelated harms; (v) subjective cognitive complaints; and (vi) quality of life. All primary and secondary outcomes will be assessed at baseline, post-intervention (4 weeks) and 12 months. Effectiveness will be evaluated using multilevel linear regression, adjusting for baseline demographic differences. Bonferroni adjustments will be used to control for multiple comparisons. Multiple imputation, regression weighting and sensitivity analyses will assess the effect of attrition. Comments: This will be the first large-scale trial, internationally, to examine whether a brief internet-delivered intervention is effective in reducing alcohol consumption and cognitive decline among older adults. If successful, the intervention will provide an accessible and highly scalable treatment to reduce risky alcohol consumption in older adulthood. [ABSTRACT FROM AUTHOR]

Background and Aims: Changes in cannabis legalization and availability in Australia necessitate monitoring use and attitudes. We estimated age–period–cohort effects of past‐year cannabis use and attitudes toward criminalization and legalization. Design Analysis of six waves of the Australian National Drug Strategy Household Survey (NDSHS) every 3 years (2001–2016). Setting and participants: The study was nationally representative of Australian households using multistage random sampling, totaling 145 168 respondents 18–79 years old. Data were collected using telephone, face‐to‐face, and drop‐and‐collect. Sample sizes per analysis varied based on data availability (~107 000–127 000 per model). Measurements Six waves of data for past‐year cannabis use (by sex and education), attitudes toward criminalization and legalization. Findings Past‐year cannabis use decreased in young adults ages 18–35 from 2001–2016 (25.1%–18.6%) and increased in middle adults ages 36–55 (8.6%–10.1%) and older adults ages 56–79 (0.6%–3.0%). We observed a positive period effect and negative cohort effect for recent cohorts for past‐year use (e.g. 1955 cohort had 1.41 (95% CI: [1.11, 1.70]) increased log odds vs. 1998 cohort had −2.86 (95% CI: [−3.17, −2.55]) increased log odds) compared with the mean across years. Results were consistent by sex and varied by education. We observed a negative period effect for criminalization favorability (0.14 (95% CI: [0.003, 0.28]) increased log odds in 2001 vs. ‐0.31 (95% CI: [−0.45, −0.17]) increased log odds in 2016) and positive cohort effect for recent cohorts. Last, we observed a positive period effect for legalization support (−0.03 (95% CI: [−0.20, 0.14]) increased log odds in 2001 vs. 0.38 (95% CI: [0.22, 0.55]) increased log odds in 2016) and negative cohort effect for recent cohorts. Conclusion: Cannabis use appears to be increasing in Australia among adults over 35, while decreasing among adolescents and young adults. Legalization support also appears to have been increasing since 2007, signaling discordance between use and attitudes among adolescents and young adults, and potentially predicting increases in use over time. [ABSTRACT FROM AUTHOR]

Aims: (1) To classify Australian adolescents according to their alcohol consumption trajectories; and (2) to assess the direct and interactive effects of perceived peer drinking (PPD) and personality on adolescent drinking. Design Prospective cohort study comprising secondary analysis of six waves of prospective data (collected between 2014 and 2016) from the control arm of the Climate Schools Combined Study. Setting: Nineteen schools across three Australian states. Participants: A total of 1492 socio‐demographically diverse students (mean age at baseline: 13.47; 68% female; 82% born in Australia). Measurements Alcohol consumption trajectories were assessed using self‐reported sipping of alcohol, full standard drink consumption, binge drinking and quantity and frequency of alcohol consumption. One item assessed PPD and personality was assessed using the Substance Use Risk Profile Scale. Findings Eight hundred and sixty‐four (58%) adolescents consumed alcohol across the study period. Four drinking trajectories were identified: abstaining (n = 513; reference group); onset (n = 361; initiated after baseline); persistent (n = 531; initiated prior to baseline); and decreasing (n = 50; consumed alcohol at baseline but ceased or decreased thereafter). A significant PPD × anxiety sensitivity (AS) interaction affected probability of belonging to the onset (P < 0.001) and persistent (P = 0.003) trajectories. The effect of PPD on probability of belonging to the onset trajectory was only significant when adolescents reported low [95% confidence interval (CI) = 1.464–2.646, P < 0.001], but not high AS. The effect of PPD on probability of belonging to the persistent drinking trajectory was stronger at low (95% CI = 2.144–3.283, P < 0.001), compared with high (95% CI = 1.440–2.308, P < 0.001) AS. Conclusions: In Australian adolescents, self‐reported drinking onset and persistent drinking appear to be more strongly associated with perceived peer drinking in those with low anxiety sensitivity than those with high anxiety sensitivity. [ABSTRACT FROM AUTHOR]