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This commentary illustrates a recent case study within Ontario, Canada, in which the application of sociodemographic and health data was used by public health to support a legal case to oppose a retail licence application to consume liquor at a corner store located within a neighbourhood that has experienced low socio-economic factors, including low income, high unemployment and low educational attainment levels. Communities in a similar situation may draw from this situation to prevent expansion of alcohol retail availability in neighbourhoods that have low socio-economic status populations and high unemployment and other factors associated with high rates of alcohol-related harms., (© 2024 Australasian Professional Society on Alcohol and other Drugs.)

Background and Aims: Alcohol retail access is associated with alcohol use and related harms. This study measured whether this association differs for people with and without heavy and disordered patterns of alcohol use., Design: The study used a repeated cross-sectional analysis of health administrative databases., Setting, Participants/cases: All residents of Ontario, Canada aged 10-105 years with universal health coverage (n = 10 677 604 in 2013) were included in the analysis., Measurements: Quarterly rates of emergency department (ED) and outpatient visits attributable to alcohol in 464 geographic regions between 2013 and 2019 were measured. Quarterly off-premises alcohol retail access scores were calculated (average drive to the closest seven stores) for each geographic region. Mixed-effect linear regression models adjusted for area-level socio-demographic covariates were used to examine associations between deciles of alcohol retail access and health-care visits attributable to alcohol. Stratified analyses were run for individuals with and without prior alcohol-attributable health-care use in the past 2 years., Findings: We included 437 707 ED visits and 505 271 outpatient visits attributable to alcohol. After adjustment, rates of ED visits were 39% higher [rate ratio (RR) = 1.39, 95% confidence interval (CI) = 1.20-1.61] and rates of outpatient visits were 49% higher (RR = 1.49, 95% CI = 1.26-1.75) in the highest versus lowest decile of alcohol access. There was a positive association between alcohol access and outpatient visits attributable to alcohol for individuals without prior health-care attributable to alcohol (RR = 1.65, 95% CI = 1.39-1.95 for the highest to lowest decile of alcohol access) but not for individuals with prior health-care attributable to alcohol (RR = 1.08, 95% CI = 0.90-1.30). There was a positive association between alcohol access and ED visits attributable to alcohol for individuals with and without prior health-care for alcohol for ED visits., Conclusion: In Ontario, Canada, greater alcohol retail access appears to be associated with higher rates of emergency department (ED) and outpatient health-care visits attributable to alcohol. Individuals without prior health-care for alcohol may be more susceptible to greater alcohol retail access for outpatient but not ED visits attributable to alcohol., (© 2024 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

Issues: Advertising and marketing affect alcohol use; however, no single systematic review has covered all aspects of how they affect alcohol use, and how the alcohol industry views alcohol marketing restrictions., Approach: Two systematic reviews of reviews were performed according to the Preferred Reporting Items on 2 February 2023. Results were analysed using a narrative synthesis approach., Key Findings: Twenty-three reviews were included in the systematic reviews. The first systematic review examined youth and adolescents (11 reviews), digital or internet marketing (3 reviews), alcohol marketing's impact on cognition (3 reviews), and alcohol marketing and policy options (2 reviews). The second systematic review focused on alcohol industry (i.e., importers, producers, distributors, retailers and advertising firms) response to advertising restrictions (four reviews). The reviews indicated that there is evidence that alcohol marketing (including digital marketing) is associated with increased intentions to drink, levels of consumption and harmful drinking among youth and young adults. Studies on cognition indicate that advertisements focusing on appealing contexts and outcomes may be more readily accepted by adolescents, and may be less easily extinguished in this population. The review of the alcohol industry found a strong desire to self-regulate alcohol advertising., Implications: We found alcohol advertising and marketing is associated with increased drinking intentions, consumption and harmful drinking. Thus, policies which restrict advertising may be an effective way to reduce alcohol use., Conclusion: More research is needed to assess all aspects of the observed associations, especially as to how marketing policies impact women and people with alcohol dependence., (© 2024 The Author(s). Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Objective: To systematically assess the Canadian federal government's current alcohol policies in relation to public health best practices., Methods: The 2022 Canadian Alcohol Policy Evaluation (CAPE) Project assessed federal alcohol policies across 10 domains. Policy domains were weighted according to evidence for their relative impact, including effectiveness and scope. A detailed scoring rubric of best practices was developed and externally reviewed by international experts. Policy data were collected between June and December 2022, using official legislation, government websites, and data sources identified from previous iterations of CAPE as sources. Contacts within relevant government departments provided any additional data sources, reviewed the accuracy and completeness of the data, and provided amendments as needed. Data were scored independently by members of the research team. Final policy scores were tabulated and presented as a weighted overall average score and as unweighted domain-specific scores., Results: Compared to public health best practices, the federal government of Canada scored 37% overall. The three most impactful domains-(1) pricing and taxation, (2) marketing and advertising controls, and (3) impaired driving countermeasures-received some of the lowest scores (39%, 10%, and 40%, respectively). Domain-specific scores varied considerably from 0% for minimum legal age policies to 100% for controls on physical availability of alcohol., Conclusion: Many evidence-informed alcohol policies have not been adopted, or been adopted only partially, by the Canadian federal government. Urgent adoption of the recommended policies is needed to prevent and reduce the enormous health, social, and economic costs of alcohol use in Canada., (© 2024. The Author(s).)

Competing Interests: Competing interests:: Normal Giesbrecht is a member of the Alcohol Working Group, Ontario Public Health Association. Daniel Myran was a scientific expert panel member of the recently released Canada’s Guidance on Alcohol and Health.

To reduce deaths, morbidity, and social problems from alcohol in Canada, a multi-dimensional robust response is needed, including a comprehensive alcohol control strategy at the provincial, territorial, and federal levels. Alcohol container labels with health and standard drink information are an essential component of this strategy. This commentary provides a rationale for the mandatory labelling of all alcohol products, summarizes Canadian initiatives to date to legislate alcohol container warning labels, and addresses myths and misconceptions about labels. Canadians deserve direct, accessible information about (1) the inherent health risks associated with alcohol consumption, (2) the number of standard drinks per container and volume of a standard drink, and (3) guidance for preventing or reducing consumption-related health risks. Enhanced health labels on alcohol containers are long overdue., (© 2023. The Author(s).)

Objective: It is reasonable to believe that the alcohol policy environment can impact the suicide mortality rates in a given country, considering the well-known link between alcohol use and death by suicide. The current literature, albeit limited, suggests that an increase in alcohol taxation may result in a decrease in deaths by suicide and that the effect is sex-specific. Therefore, the objective of the current study was to test the impact of three alcohol control policy enactments (in 2008, 2017 and 2018) on suicide mortality among adults 25-74 years of age in Lithuania, by sex., Methods: To estimate the unique impact of three alcohol control policies, we conducted interrupted time-series analyses by employing a generalized additive mixed model on monthly sex-specific age-standardized suicide mortality rates from January 2001 to December 2018., Results: Analyses showed a significant impact of the 2017 ( p  = 0.016) alcohol control policy on suicide mortality for men only. Specifically, we estimated that in the year following the 2017 policy enactment, approximately 57 (95% CI: 9-107) deaths by suicide were prevented among men, 25-74 years of age. The three policy enactments tested were not found to significantly impact the suicide mortality rate among women., Conclusion: Alcohol control policies involving pricing, which result in a notable decrease in alcohol affordability, could be a cost-effective indirect suicide prevention mechanism in not only countries of the former Soviet Union, but in other high-income countries with a comparable health care system to that in Lithuania. HIGHLIGHTSIncreasing excise tax on alcohol was found to have a sex-specific impact on suicide mortalityThe 2017 alcohol policy prevented 57 deaths by suicide among men, 25-74 years of age, in the following yearAlcohol pricing policies may be a cost-effective indirect suicide prevention mechanism.

A rapid review of research on health warning labels located on alcohol containers (AWLs) was conducted. Using five search engines (Embase, Medline, Pubmed, Scopus, Psyinfo), 2975 non-duplicate citations were identified between the inception date of the search engine and April 2021. Of those, 382 articles were examined and retrieved. We selected 122 research papers for analysis and narrative information extraction, focusing on population foci, study design, and main outcomes. Research included public opinion studies, surveys of post-AWL implementation, on-line and in-person experiments and real-world quasi-experiments. Many studies focused on the effects of the 1989 United States Alcoholic Beverage Labeling Act on perceptions, intentions and behavior. Others focused on Australia, Canada, the United Kingdom, England or Scotland, Italy and France. There was substantial variation in the design of the studies, ranging from small-scale focus groups to on-line surveys with large samples. Over time, evidence has been emerging on label design components, such as large size, combination of text and image, and specific health messaging, that is likely to have some desired impact on knowledge, awareness of risk and even the drinking behavior of those who see the AWLs. This body of evidence provides guidance to policy-makers, and national and regional authorities, and recommendations are offered for discussion and consideration.

Even as women's roles have expanded substantially beyond traditional sex stereotypes, women are still commonly portrayed as uncomplaining caregivers, long-suffering intimate partners and in control of family matters, all while maintaining a sexualised femininity. Nowhere are these stereotypes and expectations more apparent than for mothers. However, some social media are exploiting mothers by inappropriately offering alcohol consumption as a solution to the challenges of parenting. This is a very timely topic, given the impacts of COVID-19 on family and home life, and potential for an increase in alcohol-related problems and health harms. We address these issues and offer alternatives to alcohol consumption as an easy solution to countering challenges of parenthood., (© 2021 Australasian Professional Society on Alcohol and other Drugs.)

Introduction: Evidence-based alcohol policies have the potential to reduce a wide range of related harms. Yet, barriers to adoption and implementation within governments often exist. Engaging relevant stakeholders may be an effective way to identify and address potential challenges thereby increasing reach and uptake of policy evaluation research and strengthening jurisdictional responses to alcohol harms., Methods: As part of the 2019 Canadian Alcohol Policy Evaluation project, we conducted interviews with government stakeholders across alcohol-related sectors prior to a second round of researcher-led policy assessments in Canada's 13 provinces and territories. Stakeholders were asked for feedback on the design and impact of an earlier policy assessment in 2013 and for recommendations to improve the design and dissemination strategy for the next iteration. Content analysis was used to identify ways of improving stakeholder engagement., Results: We interviewed 25 stakeholders across 12 of Canada's 13 jurisdictions, including representatives from government health ministries and from alcohol regulation, distribution and finance departments. In providing feedback on our stakeholder engagement strategy, participants highlighted the importance of maintaining ongoing contact; presenting results in accessible online formats; providing advance notice of results; and offering jurisdiction-specific webinars., Discussion and Conclusions: This study offers important insight into the engagement preferences of government stakeholders involved in the health, regulation, distribution and financial aspects of alcohol control policy. Findings suggest that seeking input from stakeholders as part of conducting evaluation research is warranted; increasing the relevance, reach and uptake of results. Specific stakeholder engagement strategies are outlined., (© 2021 Australasian Professional Society on Alcohol and other Drugs.)

Background: Alcohol consumption has been linked to harmful health short and long-term outcomes. An analysis of socio-demographic factors related to binge drinking may help to identify groups at risk and provide primary health care providers an opportunity to assist members of those groups. In this study, we examined socio-demographic factors associated with binge drinking in Ontario, Canada., Methods: This analysis used data from a cross-sectional survey of Ontario adults (ages 19 and older) for the 2015-2017 period. Bivariate and multivariate adjusted analyses examined the association between binge drinking and socio-demographic factors. These analyses were also stratified by sex., Results: Increased alcohol binge drinking was associated with several socio-demographic factors including younger age groups, lower educational attainment, lower household income quintile, having immigrated to Canada within past 10 years, being male, reporting poorer mental health, being single, living in rural areas, and being unemployed. No differences were noted by households with or without children or by sexual orientation. Many of the factors associated with binge drinking remained significant when stratified by sex., Discussion: These findings suggest that several socio-demographic factors are associated with binge drinking. These can be helpful indicators for decision makers responsible for programs and policies aimed at reducing alcohol binge drinking, and for primary care providers, who in a brief intervention can screen for binge drinking and support those individuals by connecting them with local resources to reduce their harmful alcohol consumption habits., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Introduction: Effective alcohol control measures can prevent and reduce alcohol-related harms at the population level. This study aims to evaluate implementation of alcohol policies across 11 evidence-based domains in Canada's 13 jurisdictions., Methods: The Canadian Alcohol Policy Evaluation project assessed all provinces and territories on 11 evidence-based domains weighted for scope and effectiveness. A scoring rubric was developed with policy and practice indicators and peer-reviewed by international experts. The 2017 data were collected from publicly-available regulatory documents, validated by government officials, and independently scored by team members., Results: The average score for alcohol policy implementation across Canadian provinces and territories was 43.8%; Ontario had the highest (63.9%) and Northwest Territories the lowest (38.4%) jurisdictional scores. Only six of 11 policy domains had average scores above 50% with Monitoring and Reporting scoring the highest (62.8%) and Health and Safety Messaging the lowest (25.7%). A 2017 provincial/territorial current best practice score of 86.6% was calculated taking account of the highest scores for any individual policy indicators implemented in at least one jurisdiction across the country., Discussion and Conclusions: Most of the evidence-based alcohol policies assessed by the Canadian Alcohol Policy Evaluation project were not implemented across Canadian provinces and territories as of 2017, and many provinces showed declining scores since 2012. However, the majority of policies assessed have been implemented in at least one jurisdiction. Improved alcohol policies to reduce related harm are therefore achievable and could be implemented consistently across Canada., (© 2021 Australasian Professional Society on Alcohol and other Drugs.)

Evidence for effective government policies to reduce exposure to alcohol's carcinogenic and hepatoxic effects has strengthened in recent decades. Policies with the strongest evidence involve reducing the affordability, availability and cultural acceptability of alcohol. However, policies that reduce population consumption compete with powerful commercial vested interests. This paper draws on the Canadian Alcohol Policy Evaluation (CAPE), a formal assessment of effective government action on alcohol across Canadian jurisdictions. It also draws on alcohol policy case studies elsewhere involving attempts to introduce minimum unit pricing and cancer warning labels on alcohol containers. Canadian governments collectively received a failing grade (F) for alcohol policy implementation during the most recent CAPE assessment in 2017. However, had the best practices observed in any one jurisdiction been implemented consistently, Canada would have received an A grade. Resistance to effective alcohol policies is due to (1) lack of public awareness of both need and effectiveness, (2) a lack of government regulatory mechanisms to implement effective policies, (3) alcohol industry lobbying, and (4) a failure from the public health community to promote specific and feasible actions as opposed to general principles, e.g., 'increased prices' or 'reduced affordability'. There is enormous untapped potential in most countries for the implementation of proven strategies to reduce alcohol-related harm. While alcohol policies have weakened in many countries during the COVID-19 pandemic, societies may now also be more accepting of public health-inspired policies with proven effectiveness and potential economic benefits.

The use of alcohol and other drugs has been identified as a significant factor related to suicide through multiple pathways. This paper highlights current understanding of their contributions to suicide in Canada and identifies opportunities for enhancing monitoring and prevention initiatives. Publications from 1998 to 2018 about suicide in Canada and that referred to alcohol or other drugs were identified using PubMed and Google Scholar. A second literature search restricted to articles including results of toxicology testing was conducted by a librarian. We summarised the literature identified on ecological analyses, attributable fractions and deaths, and research including the results of toxicological analyses. Our literature search yielded 5230 publications, and 164 documents were identified for full-text screening. We summarised the findings from 30 articles. Ecological analyses support the association between alcohol sales, annual per capita alcohol consumption and suicide rates. Based on published estimates, approximately a quarter of suicide deaths in Canada are alcohol-attributable, while the estimated attributable fraction for illegal drugs is more variable. Finally, there is a dearth of literature examining the role of acute alcohol and/or drug consumption prior to suicide based on toxicological findings. The proportion of suicide decedents with drugs or alcohol present at the time of death varies widely. While there is evidence on the role of alcohol and drugs in suicide deaths, there is not a large body of research about the acute use of these substances at the time of death among suicide decedents in Canada. Our understanding of the role of alcohol and other drugs in suicide deaths could be enhanced through systematic documentation, which in turn could provide much needed guidance for clinical practice, prevention strategies and policy initiatives., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Randomized trials of complex interventions are increasingly including qualitative components to further understand factors that contribute to their success. In this paper, we explore the experiences of health care practitioners in a province wide smoking cessation program (the Smoking Treatment for Ontario Patients program) who participated in the COMBAT trial. This trial examined if the addition of an electronic prompt embedded in a Clinical Decision Support System (CDSS)-designed to prompt practitioners to Screen, provide a Brief intervention and Referral to Treatment (SBIRT) to patients who drank alcohol above the amounts recommended by the Canadian Cancer Society guidelines-influenced the proportion of practitioners delivering a brief intervention to their eligible patients. We wanted to understand the factors influencing implementation and acceptability of delivering a brief alcohol intervention for treatment-seeking smokers for health care providers who had access to the CDSS (intervention arm) and those who did not (control arm)., Methods: Twenty-three health care practitioners were selected for a qualitative interview using stratified purposeful sampling (12 from the control arm and 11 from the intervention arm). Interviews were 45 to 90 min in length and conducted by phone using an interview guide that was informed by the National Implementation Research Network's Hexagon tool. Interview recordings were transcribed and coded iteratively between three researchers to achieve consensus on emerging themes. The preliminary coding structure was developed using the National Implementation Research Network's Hexagon Tool framework and data was analyzed using the framework analysis approach., Results: Seventy eight percent (18/23) of the health care practitioners interviewed recognized the need to simultaneously address alcohol and tobacco use. Seventy four percent (17/23), were knowledgeable about the evidence of health risks associated with dual alcohol and tobacco use but 57% (13/23) expressed concerns with using the Canadian Cancer Society guidelines to screen for alcohol use. Practitioners acknowledged the value of adding a validated screening tool to the STOP program's baseline questionnaire (19/23); however, following through with a brief intervention and referral to treatment proved challenging due to lack of training, limited time, and fear of stigmatizing patients. Practitioners in the intervention arm (5/11; 45%) might not follow the recommendations from CDSS if these recommendations are not perceived as beneficial to the patients., Conclusions: The results of the study show that practitioners' beliefs were reflective of the current social norms around alcohol use and this influenced their decision to offer a brief alcohol intervention. Future interventions need to emphasize both organizational and sociocultural factors as part of the design. The results of this study point to the need to change social norms regarding alcohol in order to effectively implement interventions that target both alcohol and tobacco use in primary care clinics. Trial registration ClinicalTrials.gov NCT03108144. Retrospectively registered 11 April 2017, https://www.clinicaltrials.gov/ct2/show/NCT03108144.

Introduction: Policy changes may contribute to increased alcohol-related risks to populations. These include privatisation of alcohol retailing, which influences density of alcohol outlets, location of outlets, hours of sale and prevention of alcohol sales to minors or intoxicated customers. Meta-analyses, reviews and original research indicate enhanced access to alcohol is associated with elevated risk of and actual harm. We assess the 10 Canadian provinces on two alcohol policy domains-type of alcohol control system and physical availability of alcohol-in order to track changes over time, and document shifting changes in alcohol policy., Methods: Our information was based on government documents and websites, archival statistics and key informant interviews. Policy domains were selected and weighted for their degree of effectiveness and population reach based on systematic reviews and epidemiological evidence. Government representatives were asked to validate all the information for their jurisdiction., Results: The province-specific reports based on the 2012 results showed that 9 of 10 provinces had mixed retail systems-a combination of government-run and privately owned alcohol outlets. Recommendations in each provincial report were to not increase privatisation. However, by 2017 the percentage of off-premise private outlets had increased in four of these nine provinces, with new private outlet systems introduced in several., Discussion and Conclusions: Decision-making protocols are oriented to commercial interests and perceived consumer convenience. If public health and safety considerations are not meaningfully included in decision-making protocols on alcohol policy, then it will be challenging to curtail or reduce harms., (© 2020 Australasian Professional Society on Alcohol and other Drugs.)

Introduction: We conducted a pilot assessment of the feasibility of implementing the International Alcohol Control (IAC) Study in Ontario, Canada, to allow for future comparisons on the impacts of alcohol control policies with a number of countries., Methods: The IAC Study questionnaire was adapted for use in the province of Ontario, and a split-sample approach was used to collect data. Data were collected by computer-assisted telephone interviewing of 500 participants, with half the sample each answering a subset of the adapted IAC Study survey., Results: Just over half of the sample (53.6%) reported high frequency drinking (once a week or more frequently), while 6.5% reported heavy typical occasion drinking (8 drinks or more per session). Self-reported rates of alcohol-related harms from one's own and others' drinking were relatively low. Attitudes towards alcohol control varied. A substantial majority supported more police spot checks to detect drinking and driving, while restrictions on the number of alcohol outlets and increases in the price of alcohol were generally opposed., Conclusion: This pilot study demonstrated that the IAC Study survey can be implemented in Canada with some modifications. Future research should assess how to improve participation rates and the feasibility of implementing the longitudinal aspect of the IAC Study. This survey provides additional insight into alcohol-related behaviours and attitudes towards alcohol control policies, which can be used to develop appropriate public health responses in the Canadian context., Competing Interests: No authors declare any conflicts of interest in the publication of this study.

Despite sustained research, application of lead halide perovskites in field-effect transistors (FETs) has substantial concerns in terms of operational instabilities and hysteresis effects which are linked to its ionic nature. Here, we investigate the mechanism behind these instabilities and demonstrate an effective route to suppress them to realize high-performance perovskite FETs with low hysteresis, high threshold voltage stability (ΔV t < 2 V over 10 hours of continuous operation), and high mobility values >1 cm 2 /V·s at room temperature. We show that multiple cation incorporation using strain-relieving cations like Cs and cations such as Rb, which act as passivation/crystallization modifying agents, is an effective strategy for reducing vacancy concentration and ion migration in perovskite FETs. Furthermore, we demonstrate that treatment of perovskite films with positive azeotrope solvents that act as Lewis bases (acids) enables a further reduction in defect density and substantial improvement in performance and stability of n-type (p-type) perovskite devices., (Copyright © 2020 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works. Distributed under a Creative Commons Attribution NonCommercial License 4.0 (CC BY-NC).)

Although brief alcohol intervention can reduce alcohol use for both men and women, health care providers (HCPs) are less likely to discuss alcohol use or deliver brief intervention to women compared to men. This secondary analysis examined whether previously reported outcomes from a cluster randomized trial of a clinical decision support system (CDSS)-prompting delivery of a brief alcohol intervention (an educational alcohol resource) for patients drinking above cancer guidelines-were moderated by patients' sex. Patients ( n = 5702) enrolled in a smoking cessation program at primary care sites across Ontario, Canada, were randomized to either the intervention (CDSS) or control arm (no CDSS). Logistic generalized estimating equations models were fit for the primary and secondary outcome (HCP offer of resource and patient acceptance of resource, respectively). Previously reported results showed no difference between treatment arms in HCP offers of an educational alcohol resource to eligible patients, but there was increased acceptance of the alcohol resource among patients in the intervention arm. The results of this study showed that these CDSS intervention effects were not moderated by sex, and this can help inform the development of a scalable strategy to overcome gender disparities in alcohol intervention seen in other studies., Competing Interests: The authors have no conflict of interest to declare. However, Peter Selby has the following general disclosures to report: grants and/or salary and/or research support from the Centre for Addiction and Mental Health, Health Canada, Ontario Ministry of Health and Long-term care (MOHLTC), Canadian Institutes of Health Research (CIHR) , Canadian Centre on Substance Use and Addiction, Public Health Agency of Canada (PHAC), Ontario Lung Association, Medical Psychiatry Alliance, Extensions for Community Healthcare Outcomes, Canadian Cancer Society Research Institute (CCSRI), Cancer Care Ontario, Ontario Institute for Cancer Research, Ontario Brain Institute, McLaughlin Centre, Academic Health Sciences Centre, Workplace Safety and Insurance Board, National Institutes of Health (NIH), and the Association of Faculties of Medicine of Canada. Peter Selby also reports receiving funding and/or honoraria from the following commercial organizations: Pfizer Inc./Canada, Shoppers Drug Mart, Bhasin Consulting Fund Inc., Patient-Centered Outcomes Research Institute, ABBVie, and Bristol-Myers Squibb. Further, Peter Selby reports receiving consulting fees from Pfizer Inc./Canada, Evidera Inc., Johnson & Johnson Group of Companies, Medcan Clinic, Inflexxion Inc., V-CC Systems Inc., MedPlan Communications, Kataka Medical Communications, Miller Medical Communications, Nvision Insight Group, and Sun Life Financial. Through an open tender process Johnson & Johnson, Novartis, and Pfizer Inc. are vendors of record for providing smoking cessation pharmacotherapy, free or discounted, for research studies in which Peter Selby is the principal investigator or co-investigator. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Background: Among American Indians/Alaskan Natives (AI/ANs), suicides are disproportionately high among those younger than 40 years of age. This paper examines suicide and alcohol intoxication (postmortem BAC ≥ 0.08 g/dl) by age among Whites and AI/ANs to better understand the reasons for the high rate of suicide among AI/ANs for those younger than 40., Methods: Data come from the restricted 2003 to 2016 National Violent Death Reporting System (NVDRS), with postmortem information on 79,150 White and AI/AN suicide decedents of both genders who had a BAC test in 32 states of the United States., Results: Among Whites, 39.3% of decedents legally intoxicated are younger than 40 years of age, while among AI/ANs the proportion is 72.9% (p < 0.001). Multivariable logistic regression with data divided by age shows that in the 18 to 39 age group, AI/ANs are about 2 times more likely than Whites to have a postmortem BAC ≥ 0.08. Veteran status compared to nonveteran, and history of alcohol problems prior to suicide were also associated with BAC ≥ 0.08. Suicide methods other than by firearm and a report of the presence of 2 or more suicide precipitating circumstances were protective against BAC ≥ 0.08. Results for the age group 40 years of age and older mirror those for the younger group with 1 exception: Race/ethnicity was not associated with BAC level., Conclusions: The proportion of suicide decedents with a BAC ≥ 0.08 is higher among AI/ANs than Whites, especially among those 18 to 39 years of age. However, acute alcohol intoxication does not fully explain differences in suicide age structure between AI/ANs and Whites., (© 2019 by the Research Society on Alcoholism.)

Background: Clinical decision support systems (CDSSs) may promote practitioner adherence to evidence-based guidelines. This study examined if the addition of a CDSS influenced practitioner delivery of a brief intervention with treatment-seeking smokers who were drinking above recommended alcohol consumption guidelines, compared with practitioners who do not receive a CDSS prompt., Methods: This was a cluster randomized controlled trial conducted in primary health care clinics across Ontario, Canada, implementing the Smoking Treatment for Ontario Patients (STOP) smoking cessation program. Clinics randomized to the intervention group received a prompt when a patient reported consuming alcohol above the Canadian Cancer Society (CCS) guidelines; the control group did not receive computer alerts. The primary outcome was an offer of an appropriate educational alcohol resource, an alcohol reduction workbook for patients drinking above the CCS guidelines, and an abstinence workbook to patients scoring above 20 points in the AUDIT screening tool; the secondary outcome was patient acceptance of the resource. The tertiary outcome was patient abstinence from smoking, and alcohol consumption within CCS guidelines, at 6-month follow-up. Results were analyzed using a generalized estimation approach for fitting logistic regression using a population-averaged method., Results: Two hundred and twenty-one clinics across Ontario were randomized for this study; 110 to the intervention arm and 111 to the control arm. From the 15,222 patients that enrolled in the smoking cessation program, 15,150 (99.6% of patients) were screened for alcohol use and 5715 patients were identified as drinking above the CCS guidelines. No statistically significant difference between groups was seen in practitioner offer of an educational alcohol resource to appropriate patients (OR = 1.19, 95% CI 0.88-1.64, p = 0.261) or in patient abstinence from smoking and drinking within the CCS guidelines at 6-month follow-up (OR = 0.93, 95% CI 0.71-1.22, p = 0.594). However, a significantly greater proportion of patients in the intervention group accepted the alcohol resource offered to them by their practitioner (OR = 1.48, 95% CI 1.01-2.16, p = 0.045)., Conclusion: A CDSS may not increase the likelihood of practitioners offering an educational alcohol resource, though it may have influenced patients' acceptance of the resource., Trial Registration: This trial is registered with ClinicalTrials.gov, number NCT03108144 , registered on April 11, 2017, "retrospectively registered".

Background and Aims: The availability of alcohol through retail outlets is associated with alcohol-related harms, but few studies have demonstrated a causal relationship. We investigated the association between alcohol availability and alcohol-attributable emergency department (ED) visits in the province of Ontario during a period of deregulation of controls on the number of alcohol outlets., Design: Cross-sectional and pre-post design SETTING AND PARTICIPANTS: The study used data from two time-periods: pre-deregulation (2013-14) and post-deregulation (2016-17), to compare rates of ED visits for 513 defined geographic regions in Ontario Canada, called Forward Sortation Areas (FSAs)., Measurements: The primary outcome was the age-standardized rates of alcohol-attributable ED visits. We compiled a list of all alcohol retail outlets in Ontario during 2014 and 2017 and matched them to their corresponding FSA. We fitted mixed-effects Poisson regression models to assess: (a) the cross-sectional association between number of outlets and hours of operation and ED visits; and (b) the impact of deregulation on ED visits using a difference-in-difference approach., Findings: Alcohol-attributed ED visits increased 17.8% over the study period: more than twice the rate of increase for all ED visits. Increased hours of operation and numbers of alcohol outlets within an FSA were positively associated with higher rates of alcohol-attributable ED visits. The increase in ED visits attributable to alcohol was 6% (incident rate ratio = 1.06; 95% confidence interval = 1.04-1.08) greater in FSAs that introduced alcohol sales in grocery stores following deregulation compared with FSAs that did not., Conclusions: Deregulation of alcohol sales in Ontario, Canada in 2015 was associated with increased emergency department visits attributable to alcohol., (© 2019 Society for the Study of Addiction.)

Perovskite-based thin-film solar cells today reach power conversion efficiencies of more than 22%. Methylammonium lead iodide (MAPI) is prototypical for this material class of hybrid halide perovskite semiconductors and at the focal point of interest for a growing community in research and engineering. Here, a detailed understanding of the charge carrier transport and its limitations by underlying scattering mechanisms is of great interest to the material's optimization and development. In this article, we present an all-optical study of the charge carrier diffusion properties in large-crystal MAPI thin films in the tetragonal crystal phase from 170 K to room temperature. We probe the local material properties of individual crystal grains within a MAPI thin film and find a steady decrease of the charge carrier diffusion constant with increasing temperature. From the resulting charge carrier mobility, we find a power law dependence of μ ∝ T m with m = -(1.8 ± 0.1). We further study the temperature-dependent mobility of the orthorhombic crystal phase from 50 to 140 K and observe a distinctly different exponent of m = -(1.2 ± 0.1).

Objectives. To examine the association between neighborhood socioeconomic status (SES) and alcohol availability before and after deregulation in 2015 of the alcohol market in Ontario, Canada. Methods. We quantified alcohol access by number of alcohol outlets and hours of retail for all 19 964 neighborhoods in Ontario. We used mixed effects regression models to examine the associations between alcohol access and a validated SES index between 2013 and 2017. Results. Following deregulation, the number of alcohol outlets in Ontario increased by 15.0%. Low neighborhood SES was positively associated with increased alcohol access: lower-SES neighborhoods had more alcohol outlets within 1000 meters and were closer to the nearest alcohol outlets. Outlets located in low-SES neighborhoods kept longer hours of operation. Conclusions. We observed a substantial increase in alcohol access in Ontario following deregulation. Access to alcohol was greatest in low-SES neighborhoods and may contribute to established inequities in alcohol harms. Public Health Implications. Placing limits on number of alcohol outlets and the hours of operation in low-SES neighborhoods offers an opportunity to reduce alcohol-related health inequities.

Solution-processed perovskite solar cells reach efficiencies over 23% on lab-scale. However, a reproducible transfer of these established processes to upscaling techniques or different substrate surfaces requires a highly controllable perovskite film formation. Especially, hydrophobic surfaces cause severe dewetting issues. Such surfaces are particularly crucial for the so-called standard n-i-p cell architecture when fullerene-based electron transport layers are employed underneath perovskite absorber films. In this work, a unique and universally applicable method was developed based on the deposition of size-controlled Al 2 O 3 or SiO 2 nanoparticles. By enhancing the surface energy, they act as a universal wetting agent. This allows perovskite precursor solutions to be spread perfectly over various substrates including problematic hydrophobic Si-wafers or fullerene self-assembled monolayers (C 60 -SAMs). Moreover, the results show that the perovskite morphology, solar cell performance, and reproducibility benefit from the presence of the nanoparticles at the interface. When applied to 144 cm 2 C 60 -SAM-coated substrates, homogenous coverage can be realized via spin coating resulting in average efficiencies of 16% (maximum 18%) on individualized cells with 0.1 cm 2 active area. Modules in the same setup reached maximum efficiencies of 11 and 7% on 2.8 and 23.65 cm 2 aperture areas, respectively.

The aim of this analysis is to examine long-term trends in alcohol consumption and associations with lagged data on specific types of cancer mortality, and indicate policy implications. Data on per capita annual sales of pure alcohol; mortality for three alcohol-related cancers - larynx, esophageal, and lip, oral cavity, and pharynx; and per capita consumption of tobacco products were extracted at the country level. The Unobservable Components Model was used for this time-series analysis to examine the temporal association between alcohol consumption and cancer mortality, using lagged data, from 17 countries. Statistically significant associations were observed between alcohol sales and cancer mortality, in the majority of countries examined, which remained after controlling for tobacco use (P<0.05). Significant associations were observed in countries with increasing, decreasing, or stable trends in alcohol consumption and corresponding lagged trends in alcohol-related cancer mortality. Curtailing overall consumption has potential benefits in reducing a number of harms from alcohol, including cancer mortality. Future research and surveillance are needed to investigate, monitor, and quantify the impact of alcohol control policies on trends in cancer mortality.

Micro- and nanocrystalline methylammonium lead iodide (MAPI)-based thin-film solar cells today reach power conversion efficiencies of over 20%. We investigate the impact of grain boundaries on charge carrier transport in large crystal MAPI thin films using time-resolved photoluminescence (PL) microscopy and numerical model calculations. Crystal sizes in the range of several tens of micrometers allow for the spatially and time resolved study of boundary effects. Whereas long-ranged diffusive charge carrier transport is observed within single crystals, no detectable diffusive transport occurs across grain boundaries. The observed PL transients are found to crucially depend on the microscopic geometry of the crystal and the point of observation. In particular, spatially restricted diffusion of charge carriers leads to slower PL decay near crystal edges as compared to the crystal center. In contrast to many reports in the literature, our experimental results show no quenching or additional loss channels due to grain boundaries for the studied material, which thus do not negatively affect the performance of the derived thin-film devices.

The emergent and growing body of research on alcohol's harm to others (AHTO), or secondhand effects of drinking, has important implications for prevention, intervention, and policy. Those victimized by other drinkers tend to favor effective alcohol policies more than their nonvictimized peers, but often a community's impulse will be to combat AHTO by targeting and stigmatizing individual heavy drinkers, rather than taking a public health approach to reducing harm. Here we discuss opportunities and challenges in selecting ways of reducing AHTO. We make a case for adopting joint public health and individual approaches to reduce AHTO., Competing Interests: The authors have no conflict of interest to report.

Plain English Summary: The purpose of this paper is to describe a patient engagement event designed to create an educational workbook with smokers who drink alcohol at harmful levels. The goal was to create a workbook that combined scientific evidence with patients' values, preferences, and needs. Fourteen adult smokers who drink alcohol were invited to the Centre for Addiction and Mental Health (CAMH) to take part in a four-hour event to help design the workbook with the CAMH research team. Participants provided their opinions and ideas to create an outline for the workbook, including activities, images, and titles. The workbook - called Self-Awareness - is currently being offered in a smoking cessation program in 221 primary care clinics across Ontario to help smokers quit or reduce their harmful alcohol use. The patient engagement event was a useful way to co-create educational materials that incorporate both scientific research and patient needs., Abstract: Background Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values. There are few methodologies on how to design evidence-based programs and resources to include patient values. The latter is an important aspect of patient-centered care, and is essential for patients to trust the recommendations and empower them as consumers to make informed choices. This manuscript describes a participatory research approach to design patient-facing educational materials that incorporate both evidence-based and community-sensitive principles. These materials are intended to support smokers to reduce or stop harmful alcohol consumption. Methods Adult smokers who report consuming alcohol were invited to a co-creation meeting at the Centre for Addiction and Mental Health's Nicotine Dependence Service to guide the adaptation of evidence-based materials. The four-hour event consisted of individual reflections, group discussions, and consensus-building interactions. Detailed notes were taken and then incorporated into the material. Results Fourteen individuals participated in the event. The end product was a descriptive outline of an educational resource - entitled Self-Awareness - incorporating material from evidence-based workbooks and patient-driven features. Participants collaboratively selected the resource's content, structure, and titles. Conclusions This model describes a participatory research method that emphasizes the value of the patient perspective; preliminary evidence finds this adaptation approach can increase the adoption of resources. The process described in this article could be replicated in other settings to co-create evidence-based resources, interventions, and programs that reflect the needs of the community. Trial registration ClinicalTrials.gov NCT03108144. Retrospectively registered 11 April 2017., Competing Interests: The study was reviewed by the research ethics board at the Centre for Addiction and Mental Health (approval number: 035–2015). Patient consent for participation was obtained prior to the engagement event.Not Applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Objectives: The purpose of this study was to estimate the proportion and number of cancer cases diagnosed in Ontario in 2012 that are attributable to alcohol consumption and to compare the impact of drinking within two sets of guidelines on alcohol-attributable cancer incidence., Methods: We estimated the proportion of cancers in Ontario attributable to alcohol consumption by calculating population-attributable fractions (PAFs) for six cancer types using drinking prevalence from the 2000/2001 Canadian Community Health Survey and relative risks from a meta-analysis. Each PAF was multiplied by the number of incident cancers in 2012, allowing for a 12-year latency period, to calculate the number of alcohol-attributable cases. We also estimated the number of alcohol-attributable cases under two scenarios: (1) assuming consumption had not exceeded the levels recommended by the Low-Risk Alcohol Drinking Guidelines (LRADG) and (2) assuming consumption had not exceeded the recommended levels by the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) guidelines., Results: One thousand two hundred ninety-five (95% confidence interval 1093-1499) new cases of cancer diagnosed in Ontario during 2012 are estimated to be attributed to alcohol consumption, representing approximately 1.7% (1.4-1.9%) of all new cancer cases. If no Ontario adults had exceeded the LRADG, an estimated 321 fewer cancer cases could have been diagnosed in 2012, whereas an estimated 482 fewer cancer cases could have been diagnosed if no Ontario adults had exceeded the stricter WCRF/AICR guidelines., Conclusion: Strategies to limit alcohol consumption to the levels recommended by drinking guidelines could potentially reduce the cancer burden in Ontario.

Background: In order to reduce harms from alcohol, evidence-based policies are to be introduced and sustained., Objectives: To facilitate the dissemination of policies that reduce alcohol-related harms by documenting, comparing, and sharing information on effective alcohol polices related to restrictions on alcohol marketing and alcohol warning messaging in 10 Canadian provinces., Methods: Team members developed measurable indicators to assess policies on (a) restrictions on alcohol marketing, and (b) alcohol warning messaging. Indicators were peer-reviewed by three alcohol policy experts, refined, and data were collected, submitted for validation by provincial experts, and scored independently by two team members., Results: The national average score was 52% for restrictions on marketing policies and 18% for alcohol warning message policies. Most provinces had marketing regulations that went beyond the federal guidelines with penalties for violating marketing regulations. The provincial liquor boards' web pages focused on product promotion, and there were few restrictions on sponsorship activities. No province has implemented alcohol warning labels, and Ontario was the sole province to have legislated warning signs at all points-of-sale. Most provinces provided a variety of warning signs to be displayed voluntarily at points-of-sale; however, the quality of messages varied. Conclusions/Importance: There is extensive alcohol marketing with comparatively few messages focused on the potential harms associated with alcohol. It is recommended that governments collaborate with multiple stakeholders to maximize the preventive impact of restrictions on alcohol marketing and advertising, and a broader implementation of alcohol warning messages.

Objectives: To examine (1) the harms related to the drinking of others in five Canadian provinces, stratified by socio-demographic variables, and (2) the relationship between these harms and mental well-being., Methods: A telephone survey sampled 375 adults from British Columbia, Saskatchewan, Ontario, Quebec, and Nova Scotia. Harms related to the drinking of others were measured through 16 questions in the domains of psychological, physical, social, and financial harms. Self-perceived mental well-being was measured with his or her mental well-being., Results: In 2012, 40.1% of Canadian adults surveyed experienced harm in the previous year related to the drinking of another person. These harms were more frequent among people who had a higher education level, were widowed, separated, divorced or never married, and were employed. Psychological, physical, and financial harms related to the drinking of others were significantly correlated to a person's mental well-being., Conclusions: Harms related to the drinking of others are prevalent in this Canadian survey. Furthermore, the psychological, physical, and financial harms related to the drinking of others negatively impact the mental well-being of the affected individuals.

Background: Tobacco and alcohol use present multiplicative risk for aerodigestive cancers. Reducing alcohol consumption improves smoking cessation outcomes and reduces cancer risk. Risky alcohol consumption and smoking are often treated separately despite concurrent treatment potentially leading to better outcomes for each. However, no rapidly scalable program exists for combined interventions in primary care clinics spread across wide geographic areas. This cluster randomized trial aims to report on the effects of a novel clinical decision support system (CDSS) on intervention rates by primary care practitioners addressing risky alcohol use in a smoking cessation program., Methods/design: We will be implementing a clinical decision support system (CDSS) in 221 primary care sites participating in the Smoking Treatment for Ontario Patients (STOP) program across Ontario, Canada. Sites will be blindly allocated to one of two clinical decision support systems guiding practitioners to provide a risky alcohol use intervention to smokers attempting to quit using nicotine replacement therapy (NRT). Risky alcohol use is defined as drinking above the Canadian Cancer Society's low-risk drinking guidelines. Primary analysis will measure the proportion of risky drinkers offered an alcohol intervention in each CDSS arm at baseline. Patients will be contacted by phone or email to track smoking cessation and alcohol consumption rates at 6- and 12-month follow-up., Discussion: Upon completion of the trial, the effect of different clinical decision support systems on practitioner behaviour, and on client tobacco and alcohol use, will be discussed. If the CDSS successfully promotes SBIRT for risky alcohol use in a primary care setting and/or improves patient-level outcomes, including smoking cessation rates and alcohol use reduction, this tool can be used as a model for other web-based behaviour change interventions integrated into primary care practice., Trial Registration: ClinicalTrials.gov NCT03108144.

Introduction: Suicide rates and the proportion of alcohol-involved suicides rose during the 2008-2009 recession. Associations between county-level poverty, foreclosures, and unemployment and suicide rates and proportion of alcohol-involved suicides were investigated., Methods: In 2015, National Violent Death Reporting System data from 16 states in 2005-2011 were utilized to calculate suicide rates and a measure of alcohol involvement in suicides at the county level. Panel models with year and state fixed effects included county-level measures of unemployment, foreclosure, and poverty rates., Results: Poverty rates were strongly associated with suicide rates for both genders and all age groups, were positively associated with alcohol involvement in suicides for men aged 45-64 years, and negatively associated for men aged 20-44 years. Foreclosure rates were negatively associated with suicide rates for women and those aged ≥65 years but positively related for those aged 45-64 years. Unemployment rate effects on suicide rates were mediated by poverty rates in all groups., Conclusions: Population risk of suicide was most clearly associated with county-level poverty rates, indicating that programs addressing area poverty should be targeted for reducing suicide risk. Poverty rates were also associated with increased alcohol involvement for men aged 45-64 years, indicating a role for alcohol in suicide for this working-aged group. However, negative associations between economic indicators and alcohol involvement were found for four groups, suggesting that non-economic factors or more general economic effects not captured by these indicators may have played a larger role in alcohol-related suicide increases., (Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

There is an interest globally in using Minimum Unit Pricing (MUP) of alcohol to promote public health. Canada is the only country to have both implemented and evaluated some forms of minimum alcohol prices, albeit in ways that fall short of MUP. To inform these international debates, we describe the degree to which minimum alcohol prices in Canada meet recommended criteria for being an effective public health policy. We collected data on the implementation of minimum pricing with respect to (1) breadth of application, (2) indexation to inflation and (3) adjustments for alcohol content. Some jurisdictions have implemented recommended practices with respect to minimum prices; however, the full harm reduction potential of minimum pricing is not fully realised due to incomplete implementation. Key concerns include the following: (1) the exclusion of minimum prices for several beverage categories, (2) minimum prices below the recommended minima and (3) prices are not regularly adjusted for inflation or alcohol content. We provide recommendations for best practices when implementing minimum pricing policy.