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BACKGROUND: In February, 2005, the canton of Geneva in Switzerland prohibited the off-premise sale of alcoholic beverages between 9pm and 7am, and banned their sale in gas stations and video stores. The aim of this study is to assess the impact of this policy change on hospital admission rates for alcoholic intoxication. METHODS: An interrupted time series analysis of this natural experiment was performed with data on hospitalisations for acute alcoholic intoxication during the 2002-2007 period. The canton of Geneva was treated as the experimental group, while all other Swiss cantons were used as the control group. RESULTS: In the experimental site, the policy change was found to have a significant effect on admission rates among adolescents and young adults. Depending on the age group, hospitalisation rates for alcoholic intoxication fell by an estimated 25-40% as the result of restricted alcohol availability. CONCLUSIONS: Modest restrictions on opening hours and the density of off-premise outlets were found to be of relevance for public health in the canton of Geneva. In light of this finding, policy makers should consider such action as a promising approach to alcohol prevention. [ABSTRACT FROM AUTHOR]

Background: Alcohol consumption has been causally related to the incidence of coronary heart disease, but the role of alcohol before the event has not been explored in depth. This study tested the hypothesis that heavy drinking (binge drinking) increases the risk of subsequent acute myocardial infarctions (AMI), whereas light to moderate drinking occasions decrease the risk. Methods: Case-crossover design of 250 incident AMI cases in Switzerland, with main hypotheses tested by conditional logistic regression. Results: Alcohol consumption 12 h before the event significantly increased the risk of AMI (OR 3.1; 95% CI 1.4–6.9). Separately, the effects of moderate and binge drinking before the event on AMI were of similar size but did not reach significance. In addition, AMI patients showed more binge drinking than comparable control subjects from the Swiss general population. Conclusions: We found no evidence that alcohol consumption before the event had protective effects on AMI. Instead, alcohol consumption increased the risk. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background/Aims: Cannabis use is a growing challenge for public health, calling for adequate instruments to identify problematic consumption patterns. The Cannabis Use Disorders Identification Test (CUDIT) is a 10-item questionnaire used for screening cannabis abuse and dependency. The present study evaluated that screening instrument. Methods: In a representative population sample of 5,025 Swiss adolescents and young adults, 593 current cannabis users replied to the CUDIT. Internal consistency was examined by means of Cronbach’s alpha and confirmatory factor analysis. In addition, the CUDIT was compared to accepted concepts of problematic cannabis use (e.g. using cannabis and driving). ROC analyses were used to test the CUDIT’s discriminative ability and to determine an appropriate cut-off. Results: Two items (‘injuries’ and ‘hours being stoned’) had loadings below 0.5 on the unidimensional construct and correlated lower than 0.4 with the total CUDIT score. All concepts of problematic cannabis use were related to CUDIT scores. An ideal cut-off between six and eight points was found. Conclusions: Although the CUDIT seems to be a promising instrument to identify problematic cannabis use, there is a need to revise some of its items. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Summary Objective. To examine the association between drinking patterns and alcohol- related traffic casualties. Study design. Data Linkage of cross-sectional survey data on alcohol consumption with official traffic casualty records. Methods. Alcohol consumption measures for usual heavy drinking and risky single occasion drinking were derived for different time segments of the day from a 7-day drinking diary study of 747 current drinkers. Measures were correlated with official records of alcohol-related traffic casualties. Results. There was a high correlation between alcohol-related traffic casualties and the number of risky single occasion drinkers that consumed alcohol outside their homes (r=O.92). On average, about 50% of these drinking occasions were attributed to usual moderate drinkers. The proportion of usual heavy drinkers was Lowest in the time segments with the most alcohol-related casualties. Conclusion. Preventive countermeasures should be targeted at the general population, enforced particularly during specific periods of the week. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic impacted daily life worldwide. It may also have had a psychological impact, especially on those with less resources already before the crisis and those who reported substantial changes to their work situation. Objectives: To investigate whether socioeconomic status before the crisis and changes in work situation during the crisis (unemployment, home-office) are associated with psychological impact in a cohort of young Swiss men. Methods: A total of 2345 young Swiss men (mean age = 29) completed assessments shortly before (April 2019 to February 2020) and early during the COVID-19 crisis (May to June 2020). Assessments covered psychological outcomes assessed before and during COVID-19 crisis (depression, perceived stress and sleep quality), and assessed during the crisis (fear, isolation and COVID-19 psychological trauma), socioeconomic status (relative financial status and difficulty to pay bills) before the crisis and changes in work situation (unemployment, home-office). Results: About a fifth of the sample were in partial unemployment or lost their job during COVID-19 crisis. Those in partial or full unemployment, those mostly working from home and those with a lower socioeconomic status already prior to the crisis showed overall higher levels of depression, stress, psychological trauma, fear and isolation. Conclusions: Even in a country with high social security such as Switzerland, the COVID-19 crisis had a higher psychological impact on those who were already disadvantaged before the crisis or experienced deteriorations in their work situation. Supporting disadvantaged subpopulations during the crisis may help to prevent an amplification of pre-existing inequalities. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the risk of alcohol consumption after acute coronary syndromes (ACS)., Methods and Results: A total of 6557 patients hospitalized for ACS at four Swiss centres were followed over 12 months. Weekly alcohol consumption was collected at baseline and 12 months. Binge drinking was defined as consumption of ≥6 units of alcohol on one occasion. Major adverse cardiovascular events (MACE) were defined as a composite of cardiac death, myocardial infarction, stroke, or clinically indicated target vessel coronary revascularization. Cox regression analysis was performed to assess the risk of MACE in patients with heavy (>14 standard units/week), moderate (7-14 standard units per week), light consumption (<1 standard unit/week), or abstinence, and with binge drinking episodes, adjusted for baseline differences. At baseline, 817 (13.4%) patients reported heavy weekly alcohol consumption. At 1-year follow-up, 695/1667 (41.6%) patients reported having at least one or more episodes of binge drinking per month. The risk for MACE was not significantly higher in those with heavy weekly consumption compared to abstinence [8.6% vs. 10.2%, hazard ratio (HR) 0.97, 95% confidence interval (CI) 0.69-1.36] or light consumption (8.6% vs. 8.5%, HR 1.41, 95% CI 0.97-2.06). Compared to patients with no binge drinking, the risk of MACE was dose-dependently higher in those with binge drinking with less than one episode per month (9.2% vs. 7.8%, HR 1.61, 95% CI 1.23-2.11) or one or more episodes per month (13.6% vs. 7.8%, HR 2.17, 95% CI 1.66-2.83)., Conclusion: Binge drinking during the year following an ACS, even less than once per month, is associated with worse clinical outcomes., Competing Interests: Conflict of interest: Conflicts of interest are detailed in the Declarations Form, and all authors have filled out the ICJME disclosure form., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background and Aims: OAT is a well developed and successful treatment strategy for opioid dependent patients in Europe. It has significantly contributed to the fight against the HIV and HCV pandemics, leading to an increased life expectancy in this population. Building on the OAT experiences in Austria, Germany, and Switzerland and their models of care, the objective of this study is to analyse experiences and changes in patient structures to identify necessary adaptations for the system of care., Methods: We analysed national register-based data from patients receiving OAT during the period spanning from 2010 to 2020 in Austria, Germany (cases), and Switzerland. We examined and compared OAT policies and practice at national levels through a review of literature and publicly available policy documents., Results: Across these three countries, the life expectancy of OAT patients increased substantially. The mean age increased from 33.0 in 2010 to 39.1 in 2020 in Austria, from 35.6 years to 41.5 years in Germany (cases), and from 39.6 to 47.1 in Switzerland, respectively. In all three countries, the percentage of patients/cases aged 60 years and older increased more than tenfold between 2010 and 2020., Conclusions: Integrated support models, reliable care structures, internationally comparable high treatment coverage, flexible prescribing practices, and a wide range of available OAT medications are successful strategies. The experiences in these countries indicate that it is possible to address the complex and chronic nature of opioid dependence and its concurrent mental and physical health challenges, resulting in an increasing life expectancy of OAT patients., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Single-measurement-point data collection to assess change has increased with studies assessing the impact of the Covid-19 pandemic and of its containment, despite evidence of its lack of validity. Retrospective change is not equivalent to change in repeated self-reported measures giving raise to questions about the validity of the former. This paper purports to investigate inconsistencies between change measures by confronting retrospective change to information from longitudinally self-reported measures from the C-SURF cohort study. The study sample consists of 2,279 young men who participated in C-SURF between 2020 and 2021, and completed between May and June 2021 a survey covering change in alcohol, cigarette, cannabis and other addictive behaviors related to the pandemic. The aforementioned behaviors were assessed longitudinally at two time points using self-reports, and retrospective change since the onset of the Covid-19 crisis was also assessed at the second measurement time. Information from both prospective and retrospective change measures were confronted to identify inconsistent information for each behavior. Additionally, multiple logistic regressions were performed to assess associations between socioeconomic status, impulsivity, depression, and different indicators of motivation to complete the study and inconsistency between both measures for each behavior of interest. Importantly, inconsistent information in at least one of the investigated behaviors was found in about 90% of the participants. Small associations were found between inconsistency and different factors with a consistent effect of impulsivity. In the absence of evidence of the validity of retrospective change measures, studies relying on retrospective change should be interpreted with caution., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Dupuis et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: To investigate the risk factors for and the consequences (ie, substance use disorders (SUD), depression, personality traits) of traumatic brain injury (TBI) in young Swiss men., Design: This is a three-wave cohort study. Risk factors were measured at baseline (2010-2012) and at follow-up 1 (FU1; 2012-2014), while the consequences and TBI were measured at follow-up 2 (FU2; 2016-2018)., Setting: Switzerland., Participants: All participants at FU2 (Mage=25.43, SD=1.25) of the Cohort Study on Substance Use Risk Factors (N=4881 young Swiss men after listwise deletion)., Measures: The outcomes measured were TBI, SUD (ie, alcohol, nicotine, cannabis, other illicit drugs), depression and personality traits (ie, sensation seeking, anxiety-neuroticism, sociability, aggression-hostility) at FU2. The predictors were previous TBI (lifetime TBI but not in the past 12 months at FU2), SUD, personality traits and sociodemographics (highest level of achieved education, age, linguistic region) measured at FU1., Results: At FU2, 3919 (80.3%) participants reported to never have had TBI, 102 (2.1%) have had TBI in the last 12 months (TBI new cases), and 860 (17.6%) have had TBI during their lifetime but not in the 12 months preceding FU2 (previous TBI). Low educational attainment (OR=3.93, 95% CI 2.10 to 7.36), depression (OR=2.87, 95% CI 1.35 to 6.11), nicotine dependence (OR=1.72, 95% CI 1.09 to 2.71), high sociability (OR=1.18, 95% CI 1.07 to 1.30), high aggression-hostility (OR=1.15, 95% CI 1.06 to 1.26) and high sensation seeking (OR=1.33, 95% CI 1.04 to 1.68) at FU1 were significantly associated with TBI new cases at FU2. Previous TBI was significantly associated with nicotine dependence (OR=1.46, 95% CI 1.16 to 1.83), depression (OR=2.16, 95% CI 1.56 to 2.99) and aggression-hostility (B=0.14, 95% CI >0.00 to 0.28) at FU2., Conclusion: Low educational attainment and depression are the most significant risk factors associated with increased odds of future TBI, while depression, nicotine dependence and high aggression-hostility are the main consequences of previous TBI. TBI should be considered an underlying factor in the treatment of depression, SUD or unfavourable personality profiles., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Previous research has demonstrated a preventive effect of the alcohol policy environment on alcohol consumption. However, little is known about the heterogeneity of this effect. Our aim was to examine the extent of heterogeneity in the relationship between the strictness of alcohol policy environments and heavy drinking and to identify potential moderators of the relationship., Methods: Cross-sectional data from 5986 young Swiss men participating in the cohort study on substance use risk factors (C-SURF) were analysed. The primary outcome was self-reported risky single-occasion drinking in the past 12 months (RSOD, defined as 6 standard drinks or more on a single occasion at least monthly). A previously-used index of alcohol policy environment strictness across Swiss cantons was analysed in conjunction with 21 potential moderator variables. Random forest machine learning captured high-dimensional interaction effects, while individual conditional expectations captured the heterogeneity induced by the interaction effects and identified moderators., Results: Predicted subject-specific absolute risk reductions in RSOD risk ranged from 16.8% to - 4.2%, indicating considerable heterogeneity. Sensation seeking and antisocial personality disorder (ASPD) were major moderators that reduced the preventive relationship between stricter alcohol policy environments and RSOD risk. They also were associated with the paradoxical observation that some individuals displayed increased RSOD risk in stricter alcohol policy environments., Conclusion: Whereas stricter alcohol policy environments were associated with reduced average RSOD risk, additionally addressing the risk conveyed by sensation seeking and ASPD would deliver an interlocking prevention mix against young Swiss men's RSOD., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Aims of the Study: In Switzerland, there has been a boom in the market for cannabidiol (CBD) products in recent years. However, little is known on the prevalence, modes of administration and motives for use of CBD products. The aim of the present study was to fill this gap using recent (2019) data from the Cohort Study on Substance Use Risk Factors (C-SURF)., Methods: Between April and December 2019, an unselected sample of 5233 Swiss young men from the French- and German-speaking regions (mean age 28.2 years, standard deviation 1.3) completed a self-report questionnaire covering measures of use of CBD products, modes of administration and motives to use of CBD, tetrahydrocannabinol (THC) and cigarettes. Descriptive statistics were used to estimate prevalence of self-reported use, modes of administration and motives to use CBD, whereas logistic regression models were used to test the associations of linguistic region, THC and tobacco use with use of CBD., Results: Lifetime and 12-month prevalence of self-reported use of CBD were 32.4% and 18.5%, respectively. Among past 12-month CBD users, 79.4% used CBD once a month or less often, whereas 20.6% used it more than once a month. The most often reported modes of administration of CBD were in association with tobacco: flowers mixed with tobacco (67.5%), and CBD cigarettes with tobacco (37.1%), while 18.6% used flowers without tobacco. The three most reported reasons for using CBD were: out of curiosity (74.0%), to feel the effects of THC (38.1%) and for well-being and health (37.5%). In multivariable models, CBD use was associated with use of THC (odds ratio [OR] 9.85, 95% confidence interval [CI] 8.28-11.73), cigarettes (OR 2.74, 95% CI 2.28-3.29) or e-cigarettes (OR 1.5795% CI 1.27-1.95), as well as for the linguistic region (French-speaking vs German-speaking region OR 1.3895% CI 1.15-1.65)., Conclusions: Self-reported use of CBD is common among young Swiss men: about one third used CBD in their life and about one in five in the previous 12 months. However, the vast majority of CBD users used it infrequently and out of curiosity. CBD use was particularly prevalent among users of THC and cigarette smokers. CBD was most often used in combination with tobacco, thus exposing users to risks associated with smoking tobacco products.

The prevalence of different routes of administration (ROAs) of illicit drugs other than cannabis was examined in young Swiss men, in addition to the association between socio-demographics and adverse outcomes and particular ROAs. Our sample consisted of 754 men (mean age = 25.4 ± 1.2 years) who participated in the Cohort Study on Substance Use Risk Factors and reported using any of 18 illicit drugs over the last 12 months. Prevalence estimates were calculated for oral use, nasal use, smoking, injecting, and other ROAs. Associations between ROAs and socio-demographics and adverse outcomes (i.e., alcohol use disorder (AUD), suicidal ideations, and health and social consequences) were calculated for using single versus multiple ROAs. The most prevalent ROA was oral use (71.8%), followed by nasal use (59.2%), smoking (22.1%), injecting (1.1%), and other ROAs (1.7%). Subjects' education, financial autonomy, and civil status were associated with specific ROAs. Smoking was associated with suicidal ideations and adverse health consequences and multiple ROAs with AUD, suicidal ideations, and health and social consequences. The most problematic pattern of drug use among young adults appears to be using multiple ROAs, followed by smoking. Strategies to prevent and reduce the use of such practices are needed to avoid adverse outcomes at this young age.

Background: The COVID-19 pandemic and its countermeasures may have had a significant impact on the psychological well-being of specific population subgroups. The present study investigated whether sexual minority men (defined here as attracted partly or exclusively to men) from an ongoing cohort study of young Swiss men experienced different psychological impacts, levels of substance use and addictive behaviors, and to which degree pre-existing vulnerabilities and participants experiences during the crisis might explain these differences. Methods: An ongoing cohort sample based on the general population of young Swiss men (mean age = 29.07 years; SD = 1.27) was assessed before and during the COVID-19 crisis for depression, stress, sleep quality, substance use and addictive behaviors. Additionally, during the crisis, we assessed its impact in form of fear, isolation and traumatic experiences. Potential associations between these outcomes and sexual orientation (sexual minority vs. heterosexual) were tested using linear regression models. It was additionally estimated to which degree these associations were attenuated if adjusted for differences in mental health, personality and socioeconomic status before the crisis, as well as the experience of the COVID-19 crisis (infection with the virus and changes to work situation). Results: Compared to heterosexual men, sexual minority men showed higher levels of psychological trauma ( b = 0.37 [0.25, 0.49]), fear ( b = 0.18 [0.06, 0.30]) and isolation ( b = 0.32 [0.20, 0.44]) due to the COVID-19 pandemic as well as higher levels of depression ( b = 0.31 [0.20, 0.41]) and lower sleep quality ( b = -0.13 [-0.24, -0.02]) during the crisis. These differences were to a large degree explained by higher pre-crisis levels of mental health problems and the personality dimension of neuroticism-anxiety. Sexual minority men showed higher overall levels of substance use and addictive behaviors, but these differences were already present before the crisis. Conclusion: The COVID-19 crisis may have worsened pre-existing vulnerabilities in sexual minority men, leading to its greater psychological impact on them than on heterosexual men. Reducing minority stress due to sexual orientation may help not only to improve mental health among important proportions of the population but also to reduce their vulnerability to crises. Services offering psychological support to sexual minorities may need to be reinforced during crises., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Marmet, Wicki, Gmel, Gachoud, Bertholet and Studer.)

Aims: The COVID-19 pandemic caused many disturbances to daily life worldwide and may also have significantly affected people's psychological well-being. The present study aimed to describe the psychological impact of the crisis on our sample of young Swiss men and to examine differences due to their linguistic region, experiencing COVID-19 symptoms and living arrangements., Methods: Based on an ongoing cohort study, we assessed a general-population sample of young Swiss men (n = 2345; average 29 years old) shortly before (from April 2019) and early on during the COVID-19 crisis (between 13 May and 8 June 2020). This was a unique opportunity to estimate the crisis' psychological impact in the form of depression, perceived stress and sleep quality (assessed before and during COVID-19), and any crisis-induced fears, isolation or psychological trauma. Associations of psychological impact with living arrangements, experiencing COVID-19 symptoms and linguistic region (German-speaking vs French-speaking) were investigated using linear regression models., Findings: By the time participants responded to our questionnaire, less than 1% had been tested positive for COVID-19, 2.6% had been tested negative and 14.7% had had some COVID-19 symptoms but had not been tested. About 8.2% of the sample reported at least some symptoms of psychological trauma (≥24 points on the Impact of Event Scale). On average, participants reported higher levels of fear for others (43.6% at least moderate) and economic fear (12.7% at least moderate) than fear for themselves (5.8% at least moderate). Those living alone and those who reported having COVID-19 symptoms themselves, or knowing someone with symptoms, reported higher overall psychological impact in the form of depression, perceived stress, sleep quality, psychological trauma, fear and isolation. Associations with linguistic region varied by outcome, with higher levels of depression and fear in French-speaking regions and higher levels of perceived stress and isolation in German-speaking regions., Interpretation: The crisis had a considerable impact on the psychological well-being of our sample of young Swiss men, and some groups were more affected than others: those living alone and those who had shown COVID-19 symptoms themselves or had known someone with symptoms may have felt a greater psychological impact from the crisis. Supporting those at a higher risk of psychological consequences in such crises, whether through structural measures or via individual support, should be an important aspect of crisis management and could help reduce the overall impact of the current pandemic on Switzerland's population.

Objective: Change talk has been proposed as a mechanism of change in motivational interviewing (MI) by mediating the link between MI technical skills and behavioral outcomes. We tested the influence of therapists' relational skills on this mediation model. Method: Secondary analysis of a randomized controlled trial of individual brief MI for heavy drinking among 20-year-old-Swiss young men, where the MI group (n = 179) significantly reduced drinking compared to an assessment-only control. We coded MI sessions and derived: therapists' MI technical skills, clients' change talk (CT) and sustain talk (ST), and global relational ratings (empathy and MI spirit). We tested moderated mediation models with technical skills as the independent variable, CT and ST as parallel mediators, predicting drinking at 3-month follow-up (controlling for baseline drinking), and relational skills as moderators of the path from technical skills to client mediators. Results: Conditional indirect effects were significant for overall MI technical skills, open questions, and simple reflections (i.e., more of these behaviors related to more ST, which was related to more drinking) when relational skills were low. In contrast, there was a significant conditional indirect effect for complex reflections when relational skills were high (i.e., more complex reflections related to less ST). Conclusions: This study provides partial support for the MI technical and relational process models. Interestingly, support was found regarding the negative side of client ambivalence (ST) in this highly precontemplative sample. Accordingly, MI therapists should work cautiously with ST when clients are at early stages of motivational readiness. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Aims: The present study aimed to investigate whether the psychological impact of the COVID-19 crisis varied with regards to young Swiss men's pre-crisis level of education and socioeconomic status and to changes in their work situation due to it., Methods: A cohort of 2345 young Swiss men (from 21 out of 26 Swiss cantons; mean age = 29) completed survey-based assessments shortly before (April 2019 to February 2020) and early on during the COVID-19 crisis (May to June 2020). Outcomes measured were psychological outcomes before and during the COVID-19 crisis (depression, perceived stress and sleep quality), and the fear, isolation and psychological trauma induced by it. We investigated associations between these outcomes and their predictors: pre-crisis socioeconomic status (relative financial status, difficulty paying bills, level of education), changes in work situation during the crisis (job loss, partial unemployment, working from home, change in workload) and working in contact with potentially infected people, both inside and outside the healthcare sector. For outcomes measured before and during the crisis, the analyses were adjusted for their pre-crisis levels., Results: About 21% of participants changed their employment status (job loss, partial unemployment or lost money if self-employed) and more than 40% worked predominantly from home during the COVID-19 crisis. Participants with a lower relative socioeconomic status already before the crisis experienced a higher psychological impact due to the COVID-19 crisis, compared to participants with an average socioeconomic status (major depression (b = 0.12 [0.03, 0.22]), perceived stress (b = 0.15 [0.05, 0.25]), psychological trauma (b = 0.15 [0.04, 0.26]), fear (b = 0.20 [0.10, 0.30]) and isolation (b = 0.19 [0.08, 0.29])). A higher impact was also felt by participants who lost their job due to the COVID-19 crisis, the partially unemployed, those with an increased workload or those who worked mainly from home (e.g. depression b = 0.25 [0.16, 0.34] for those working 90%+ at home, compared to those not working at home)., Conclusions: Even in a country like Switzerland, with relatively high social security benefits and universal healthcare, the COVID-19 crisis had a considerable psychological impact, especially among those with a lower socioeconomic status and those who experienced deteriorations in their work situation due to the COVID-19 crisis. Supporting these populations during the crisis may help to prevent an amplification of inequalities in mental health and social status. Such support could help to lower the overall impact of the crisis on the mental well-being of Switzerland's population., Competing Interests: The authors have declared that no competing interests exist.

Background: Information about correlates of cannabis vaping in Europe is scarce., Methods: In a cohort of 1613 Swiss young males currently using cannabis, we used logistic regression, adjusting for age, linguistic region and education to assess the association between sensation seeking, substance use and sociodemographic variables with cannabis vaping., Results: Mean age was 25.38 years, 60.4% had post-secondary education and 57.3% lived in French-speaking cantons; 26.3% met criteria for nicotine dependence, 16.0% met criteria for alcohol use disorder and 34.9% used illicit drugs other than cannabis; 27.4% used cannabis at least twice a week and 27.8% met criteria for cannabis use disorder (CUD). Ninety-four participants (5.8%) reported cannabis vaping (of them 87.4% reported infrequent cannabis vaping). In the adjusted analysis, using joints with no tobacco {adjusted odds ratio (aOR) [95% confidence interval (CI)] = 1.45 (1.02-1.76)}, water pipe with [aOR (95% CI) = 1.70 (1.29-2.24)] and without tobacco [aOR (95% CI) = 2.15 (1.60-2.87)], cannabis mixed with food [aOR (95% CI) = 1.61 (1.29-2.02)], using cannabis >2 times a week [aOR (95% CI) = 3.73 (2.40-5.81)], meeting criteria for CUD [aOR (95% CI) = 4.19 (2.70-6.50)], using illicit drugs other than cannabis [aOR (95% CI) = 1.88 (1.23-2.87)], weekly number of alcohol drinks [aOR (95% CI) = 1.01 (1.00-1.03)] and living in the German-speaking area of Switzerland [aOR (95% CI) = 2.70 (1.71-4.25)] were associated with higher odds of cannabis vaping; post-secondary schooling [aOR (95% CI) = 0.37 (0.16-0.86)] and vocational training [aOR (95% CI) = 0.41 (0.17-0.99)] (as opposed to primary schooling) were associated with lower odds of cannabis vaping., Conclusion: Cannabis vaping might be a marker of riskier behaviours among cannabis users., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Importance: There are concerns that the use of water pipes to consume cannabis is associated with increased risks of engaging in more addictive behaviors., Objective: To examine whether consuming cannabis with a water pipe was associated with later consumption of other illicit drugs compared with not using a water pipe., Design, Setting, and Participants: The Cohort Study on Substance Use Risk Factors (C-SURF) was a population-based study, recruiting 5987 Swiss men aged 18 to 25 years from 3 of 6 Swiss Armed Forces recruitment centers (response rate: 79.2%). The baseline assessment (t0) was done from 2010 to 2012, first follow-up (t1) from 2012 to 2014, and second follow-up (t2) from 2016 to 2018. Our sample included men who participated in both t0 and t2 assessments and used cannabis but no other illicit drugs at t0. Data analysis was performed from July 2020 to January 2021., Exposures: Cannabis use frequency and route of administration from self-administered questionnaires completed at t0 and t2., Main Outcomes and Measures: Outcome measures were initiation of illicit drug use and cannabis use disorder, identified by the Cannabis Use Disorder Identification Test. To examine whether water pipe use at t0 was associated with illicit drug use at t2, multivariable logistic regression analysis was performed., Results: Among 1108 Swiss male cannabis users who did not use other illicit drugs at t0, the mean (SD) age was 20 (1.2) years, 617 (55.7%) were from Switzerland's French-speaking region, and 343 (30%) used water pipes to consume cannabis. Water pipe users at t0 were more likely to use other illicit drugs at t2 compared with water pipe nonusers (adjusted odds ratio [aOR], 1.54; 95% CI, 1.10-2.16). The odds of using middle-stage drugs (including stimulants, hallucinogens, and inhaled drugs) at t2 were increased for water pipe users (aOR, 1.61; 95% CI, 1.13-2.29). Water pipe use at t0 was not associated with cannabis use disorder at t2 after adjusting for cannabis use frequency., Conclusions and Relevance: This cohort study's results suggest that, among Swiss young men, water pipe use is associated with other illicit drug use later in life, particularly middle-stage illicit drugs. Preventive programs must focus on the potential of later harm to cannabis users who use water pipes but have not yet started taking other illicit drugs.

Background and Aims: Cannabis use disorder (CUD) is frequent in adolescence and often goes into remission towards adulthood. This study aimed to estimate trajectories of CUD severity (CUDS) in Swiss men aged from 20 to 25 years and to identify prospective predictors of these trajectories., Design: Latent class growth analysis of self-reported CUDS in a cohort study with three data collection waves., Setting: A general population sample of young Swiss men., Participants: A total of 5987 Swiss men assessed longitudinally at the mean ages of 20, 21.5 and 25 years., Measurements: Latent CUDS in the last 12 months was measured at each wave with the Cannabis Use Disorders Identification Test-Revised (CUDIT-R). Predictors of CUDS trajectories, measured at age 20, were from six domains: factors related to cannabis use, family, peers, other substance use, mental health and personality., Findings: We distinguished four CUDS trajectories: stable-low (88.2%), decreasing (5.2%), stable-high (2.6%) and increasing (4.0%). Predictors were generally associated with higher odds of membership in the decreasing and stable-high trajectory (versus the stable-low), and to a lesser degree with higher odds of membership in the increasing trajectory. Bivariate predictors of persistent high CUDS (stable-high versus decreasing trajectory) were major depression severity [odds ratio (OR) = 1.19, 95% confidence interval (CI) = 1.01, 1.40], attention deficit hyperactivity disorder severity (OR = 1.25, 95% CI = 1.04, 1.51), antisocial personality disorder severity (OR = 1.18, 95 % CI = 1.04, 1.34), relationship with parents (OR = 0.74, 95% CI = 0.63, 0.88), number of friends with drug problems (OR = 1.33, 95% CI = 1.11, 1.60) and the personality dimensions neuroticism-anxiety (OR = 1.35, 95% CI = 1.11, 1.65) and sociability (OR = 0.78, 95% CI = 0.62, 0.97)., Conclusions: Factors associated with persistent cannabis use disorder in young Swiss men include cannabis use, cannabis use disorder severity, mental health problem severity, relationship with parents (before the age of 18), peers with drug problems and the personality dimensions neuroticism-anxiety and sociability at or before age 20. Effect sizes may be small, and predictors are mainly associated with persistence via higher severity at age 20 years., (© 2020 Society for the Study of Addiction.)

Background and Aims: It is well documented that individuals with a minority sexual orientation face greater risks of problematic substance use (e.g. heavy episodic drinking, alcohol use disorder) and mental health problems. Far less is known about how that risk varies within this population and their risk of behavioural addictions. This study estimated the risks of problematic substance use, behavioural addiction and poor mental health across the spectrum of sexual orientation., Sample and Method: A sample of young Swiss men (N = 5294; mean age = 25.5, SD = 1.25; representative of 21 of Switzerland's 26 cantons) completed a self-reporting questionnaire on sexual orientation (attraction, 5-point scale) and criterion variables: problematic substance use (e.g. alcohol, cigarettes, cannabis and other illegal drugs), behavioural addictions (gambling, gaming, cybersex, internet, smartphone, work, exercise) and indicators of mental health (e.g. depression, stress). Curvilinear associations between sexual orientation (heterosexual, mostly-heterosexual, bisexual, mostly-homosexual or homosexual individuals) and criterion variables were explored using fractional polynomial regressions., Results: Although there were differences across criterion variables, in general, the highest risks of problematic substance use, behavioural addictions and mental health problems were estimated for mostly-heterosexual, bisexual or mostly-homosexual men, followed by homosexual men, and with heterosexual men facing the lowest risk., Discussion and Conclusion: Aggregating the spectrum of sexual orientations into two or three distinct groups blurs important internal group differences. Outcome-specific explanations beyond minority stress and biphobia are necessary to understand the pathways between sexual orientation and risky behaviours. Considering sexual orientation is important to provide targeted healthcare prevention and interventions., (Copyright © 2020. Published by Elsevier Ltd.)

Background: There is a need for empirical studies assessing the psychometric properties of self-reported alcohol use as measures of excessive chronic drinking (ECD) compared to those of objective measures, such as ethyl glucuronide (EtG)., Objectives: To test the quality of self-reported measures of alcohol use and of risky single-occasion drinking (RSOD) to detect ECD assessed by EtG., Methods: A total of 227 samples of hair from young Swiss men were used for the determination of EtG. Self-reported measures of alcohol use (previous twelve-month and previous-week alcohol use) and RSOD were assessed. Using EtG (<30 pg/mg) as the gold standard of ECD assessment, the sensitivity and specificity were computed, and the AUROC were compared for alcohol use measures and RSOD. Logistic regressions were used to test the contribution of RSOD to the understanding of ECD after controlling for alcohol use., Results: A total of 23.3% of participants presented with ECD. Previous twelve-month alcohol use with a cut-off of >15 drinks per week (sensitivity = 75.5%, specificity = 78.7%) and weekly RSOD (sensitivity = 75.5%, specificity = 70.1%) yielded acceptable psychometric properties. No cut-off for previous-week alcohol use gave acceptable results. In the multivariate logistic regression, after controlling for the previous twelve months of alcohol use, RSOD was still significantly associated with EtG (p = .016)., Conclusion: Self-reported measures of the previous twelve months of alcohol use and RSOD were acceptable measures of ECD for population-based screening. Self-reported RSOD appeared to be an interesting screening measure, in addition to the previous twelve months of alcohol use, to understand ECD among young people., Competing Interests: The authors have declared that no competing interests exist.

The objective of this study was to assess the association between tobacco/nicotine use and type and intensity of sport. Data were drawn from the second follow-up of the Cohort Study on Substance Use Risk Factors. Young Swiss men completed a questionnaire about tobacco/nicotine use (cigarette, vaping, snus, snuff), type and intensity of sport and other demographic and medical variables. Among the 5414 included participants (mean age 25.5), 3434 (63.4%) reported regularly practicing a sport. They had a lower rate of cigarette smoking (32.3%) compared with participants not practicing a sport (44.6%) but a higher rate of snus use (15.0% vs. 10.0%). In adjusted models, individual-sport participants were less likely to use snus and snuff (OR = 0.63, 95% CI = 0.51-0.77 and OR = 0.73, 95% CI = 0.61-0.88), compared with team-sport participants. The association was inversed for vaping users (OR = 1.54, 95% CI = 1.03-2.30). Furthermore, participants who practiced high-intensity sports had a lower likelihood to smoke cigarettes (OR = 0.63, 95% CI = 0.52-0.78) compared with low-intensity sports. Our findings suggest that type and intensity of sport are associated with tobacco/nicotine use. Youth who practice an individual sport are less likely to use snus or snuff and more likely to vape compared with a team sport. This could help better target smoking prevention in young people.

Introduction: Social cohesion, depression, and problematic substance use are intertwined and poorly understood.This study aimed to examine cross-sectional and longitudinal associations between social cohesion, depression and problematic substance use amongyoung men, age 21-25., Methods: We used 2nd wave (t 1 , 2012-2014, N = 6020) and 3rd wave (t 2 , 2016-2018) data from the on-going Swiss CohortStudy on Substance Use Risk Factors (C-SURF), assessing social cohesion, depression, and severity of alcohol, nicotine and cannabis use during both waves. Structural Equation Models (SEMs) were employed to examine pathways in both waves under the framework of longitudinal analysis., Results: Social cohesion was directly associated with depression and problem nicotine and cannabis use and indirectly associated with problem alcohol, nicotine and cannabis use through depression at both t1 and t2. Social cohesion exerted direct effects on nicotine use and cannabis use severity, but not on alcohol use severity. Social cohesion had indirect effects on problem use of all three substances, mediated via depression. The predictive direction was from depression to substance use, rather than vice versa., Conclusions: Higher social cohesion at an early age appears to protect young males from depression and problematic substance use later in life. However, once problematic substance use is established, the direct effect of social cohesion diminishes and is mediated through personal depression. Therefore, promoting a more cohesiveneighborhood in childhood or adolescenthood could play an important role preventing depression and more severe substance use behaviors., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aims: To estimate age-specific changes in hospital admissions for alcohol intoxication following two consecutive restrictions on off-premises alcohol sales introduced in the canton of Vaud, Switzerland., Design: Primary analyses used interrupted autoregressive integrated moving average (ARIMA) time-series analyses (repeated cross-sectional), with Lausanne and Vaud as experimental sites and the rest of Switzerland as the control. Secondary analyses used, for example, a different control site (other French-speaking cantons only) or a different statistical model., Setting: Switzerland between 2010 and 2016., Participants: In-patients (i.e. patients assigned a bed overnight) hospitalized between 8 p.m. and 6 a.m. (n = 1 261 564), as documented in the Swiss Hospital Statistics., Interventions: Ban 1, only effective in the canton's capital, Lausanne, prohibited off-premises sales of all alcoholic beverages after 8 p.m. on Fridays and Saturdays from September 2013 to June 2015. In July 2015, Ban 2 replaced this, covered the whole canton and affected off-premises sales of beer and spirits (but not wine) after 9 p.m. (8 p.m. in Lausanne) every night of the week., Measurements: Proportions of monthly hospital admissions for alcohol intoxication (ICD-10 diagnoses F10.0/F10.1, T51.0) per 1000 monthly overall admissions., Findings: Proportions of overall hospitalizations for alcohol intoxication declined after both bans in Lausanne [ω Ban1  = -0.017, 95% confidence interval (CI) = -0.025, -0.008; ω Ban2  = -0.021, 95% CI = -0.030, -0.013] but only after Ban 2 in the remainder of the canton of Vaud (ω Ban2  = -0.008, 95% CI = -0.014, -0.002). Estimated changes in % were largest among 16-19-year-olds. However, as admission rates for alcohol intoxication were more frequent in adulthood than adolescence, the estimated change in number of cases was also relevant to public health among 20-69-year-olds. Secondary analyses supported the findings of the primary analyses., Conclusion: Even partial restrictions of off-premises sales of alcohol in Switzerland (only 2 days per week or only for beer and spirits) appeared to reduce hospital admissions for alcohol intoxication across a wide age range (ages 16-69 years)., (© 2020 Society for the Study of Addiction.)

Alcohol use disorder (AUD) is frequently comorbid with other psychiatric disorders. However, few studies investigated the psychometric properties of AUD screening tools in presence of co-occurring disorders. This study examined the diagnostic accuracy of a short AUD screening tool among young adults, in the presence of high vs. low or moderate symptomatology of other common psychiatric disorders. Data were collected among young Swiss men (n = 233) between 2016 and 2018. Measures included a diagnostic interview for AUD and screening tools for AUD and other psychiatric disorders (attention deficit hyperactivity disorder, antisocial personality disorder, bipolar disorder, borderline personality disorder, major depressive disorder, and social anxiety disorder). We computed receiver operating characteristic curves to test whether the AUD screening tool was an accurate indicator of AUD for groups with high vs. low or moderate symptomatology of each psychiatric disorder. The results showed that the optimal cut-off score was ≥3 (the original cut-off of the scale) for participants with a low or moderate symptomatology and ≥4 for participants with a high symptomatology. Our findings highlighted the urgent need for an integrated approach to screening. Psychiatric comorbidities should be included in the screen for AUD to obtain accurate results., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background and Aims: Short screenings for alcohol use disorder (AUD) are crucial for public health purposes, but current self-reported measures have several pitfalls and may be unreliable. The main aim of our study was to provide empirical evidence on the psychometric performance of self-reports currently used. Our research questions were: compared with a gold standard clinical interview, how accurate are (1) self-reported AUD, (2) self-reported alcohol use over time and (3) biomarkers of alcohol use among Swiss men? Finally, we aimed to identify an alternative screening tool., Design: A single-center study with a cross-sectional design and a stratified sample selection., Setting: Lausanne University Hospital (Switzerland) from October 2017 to June 2018., Participants: We selected participants from the French-speaking participants of the ongoing Cohort Study on Substance Use and Risk Factors (n = 233). The sample included young men aged on average 27.0 years., Measurements: We used the Diagnostic Interview for Genetic Studies as the gold standard for DSM-5 AUD. The self-reported measures included 11 criteria for AUD, nine alcohol-related consequences, and previous 12 months' alcohol use. We also assessed biomarkers of chronic excessive drinking (ethyl glucuronide and phosphatidylethanol)., Findings: None of the self-reported measures/biomarkers taken alone displayed both sensitivity and specificity close to 100% with respect to the gold standard (e.g. self-reported AUD: sensitivity = 92.3%, specificity = 45.8%). The best model combined eight self-reported criteria of AUD and four alcohol-related consequences. Using a cut-off of three, this screening tool yielded acceptable sensitivity (83.3%) and specificity (78.7%)., Conclusions: Neither self-reported alcohol use disorder nor heavy alcohol use appear to be adequate to screen for alcohol use disorder among young men from the Swiss population. The best screening alternative for alcohol use disorder among young Swiss men appears to be a combination of eight symptoms of alcohol use disorder and four alcohol-related consequences., (© 2019 Society for the Study of Addiction.)

Background: Unhealthy alcohol use is a leading cause of morbidity and mortality among young people, including university students. Delivering secondary prevention interventions against unhealthy alcohol use is challenging. Information technology has the potential to reach large parts of the general population. The present study is proposed to test a proactive secondary prevention smartphone-based intervention against unhealthy alcohol use., Methods: This is a parallel-group, randomized controlled trial (1:1 allocation ratio) among 1696 university students with unhealthy alcohol use, identified by screening and followed up at 3, 6, and 12 months. Participants will be randomized to receive access to a smartphone-based intervention or to a no intervention control condition. The primary outcome will be self-reported volume of alcohol drunk over the past 30 days, reported as the mean number of standard drinks per week over the past 30 days, measured at 6 months. Secondary outcomes will be number of heavy drinking days over the past 30 days, at 6 months. Additional outcomes will be maximum number of drinks on any day over the past 30 days, alcohol-related consequences (measured using the Short Inventory of Problems (SIP-2R), and academic performance., Discussion: The aim of this trial is to close the evidence gap on the efficacy of smartphone-based secondary prevention interventions. If proven effective, smartphone-based interventions have the potential to reach a large portion of the population, completing what is available on the Internet., Trial Registration: ISRCTN, 10007691. Registered on 2 December 2019. Recruitment will start in April 2020.

(a) Objective: This study aimed to identify trajectories of alcohol use (AU) and their associations with the development of alcohol use disorder (AUD) among young men with different weekly drinking patterns., (b) Method: A longitudinal latent class analysis integrating several aspects of AU, such as drinking quantity and frequency on weekends vs workweek days, involving 4719 young Swiss men at ages 20, 21, and 25, and collected by the Cohort Study on Substance Use Risk Factors, was used to identify different AU trajectories over time. The development of AUD scores in these trajectories was investigated using generalized linear mixed models., (c) Results: Six AU trajectory classes, similar to those described in the literature, were identified: 'abstainers-light drinkers', 'light workweek increasers', 'light decreasers', 'moderate weekend decreasers', 'moderate workweek increasers', and 'heavy drinkers'. Only 12% of participants were assigned to a trajectory class with decreasing AU associated with a decline in their AUD score. AUD scores increased in trajectory classes exhibiting increasing AU on workweek days, despite low and moderate general AU. Finally, more than 59% of participants were on an AU trajectory presenting no change in their mean AUD score over time., (d) Conclusions: Maturing out of problematic AU in emerging adulthood is not the norm in Switzerland, and the AUD score developed in late adolescence remains until at least emerging adulthood. AU on workweek days is a more practical marker of potentially problematic AU. This calls for timely interventions in adolescence and concerning regular drinking on workweek days in emerging adulthood., Competing Interests: The authors have declared that no competing interests exist.

Background: Attention deficit/hyperactivity disorder (ADHD), conduct disorder (CD), and sensation seeking (SS) have been consistently related to a higher risk of substance use (SU) and substance use disorder (SUD)., Objectives: To investigate the relationship between ADHD and prevalence rates in males at age 20 and age 25, the initiation of SU and SUD after age 20, and the escalation of SU from age 20 to age 25, and to explore the role of CD and SS in the relation of ADHD with SU and SUD initiation and escalation., Method: Data were obtained as part of the Cohort Study on Substance Use Risk Factors (C-SURF), which focused on young Swiss men aged 20 years at baseline and 25 years at follow-up., Results: Participants who screened positive for ADHD at baseline exhibited a higher rate of SU and SUD than participants who screened negative. The presence of ADHD symptoms at age 20 predicted initiation of all SU between age 20 and age 25, except for alcohol and smoking. After controlling for self-reported CD and SS, ADHD still predicted this late initiation of use of hallucinogens, meth-/amphetamines, and ecstasy/MDMA; non-medical use of ADHD medication and sedatives, and alcohol use disorder (AUD). No escalation of weekly drinking and smoking or annual cannabis use was observed from age 20 to age 25., Conclusion: Screened-positive ADHD is an independent predictor of late SU and AUD, along with self-reported CD and SS. From a public health perspective, identifying ADHD is not only important in childhood and adolescence but also in early adulthood to guide specific interventions to lower risks of drug use initiation and the development of AUD in early adulthood., (© 2020 The Author(s). Published by S. Karger AG, Basel.)

Background and Aims: Cybersex use (CU) is highly prevalent in Switzerland's population, particularly among young men. CU may have negative consequences if it gets out of control. This study estimated prevalence of CU, frequency of CU (FCU), and problematic CU (PCU) and their correlates., Methods: A non-selective sample of young Swiss men ( N  = 5,332, mean age = 25.45) completed a questionnaire assessing FCU and PCU, sociodemographics (age, linguistic region, and education), sexuality (being in a relationship, number of sexual partners, and sexual orientation), dysfunctional coping (denial, self-distraction, behavioral disengagement, and self-blame), and personality traits (aggression/hostility, sociability, anxiety/neuroticism, and sensation seeking). Associations were tested using hurdle and negative binomial regression models., Results: At least monthly CU was reported by 78.6% of participants. CU was associated positively with post-secondary schooling (vs. primary schooling), German-speaking (vs. French-speaking), homosexuality, bisexuality (vs. heterosexuality), more than one sexual partner (vs. one), dysfunctional coping (except denial), and all personality traits except sociability, but negatively with being in a relationship (vs. not), age, and sociability. FCU was associated positively with homosexuality, bisexuality, no or more than one sexual partner, dysfunctional coping (except denial), and all personality traits except sociability, but negatively with age, being in a relationship, and sociability. PCU was associated positively with bisexuality, four or more sexual partners, dysfunctional coping, and all personality traits except sociability, but negatively with German-speaking and sociability., Discussion and Conclusions: CU should be viewed in light of its associations with sociodemographic, sexual, and psychological factors. Healthcare professionals should consider these aspects to adapt their interventions to patients' needs.

Background and Aims: Behavioral addictions (BAs) and substance use disorders (SUDs) tend to co-occur; both are associated with mental health problems (MHPs). This study aimed to estimate the proportion of variance in the severity of MHPs explained by BAs and SUDs, individually and shared between addictions., Methods: A sample of 5,516 young Swiss men (mean = 25.47 years old; SD  = 1.26) completed a self-reporting questionnaire assessing alcohol, cannabis, and tobacco use disorders, illicit drug use other than cannabis, six BAs (Internet, gaming, smartphone, Internet sex, gambling, and work) and four MHPs (major depression, attention-deficit hyperactivity disorder, social anxiety disorder, and borderline personality disorder). Commonality analysis was used to decompose the variance in the severity of MHPs explained ( R 2 ) by BAs and SUDs into independent commonality coefficients. These were calculated for unique BA and SUD contributions and for all types of shared contributions., Results: BAs and SUDs explained between a fifth and a quarter of the variance in severity of MHPs, but individual addictions explained only about half of this explained variance uniquely; the other half was shared between addictions. A greater proportion of variance was explained uniquely or shared within BAs compared to SUDs, especially for social anxiety disorder., Conclusions: The interactions of a broad range of addictions should be considered when investigating their associations with MHPs. BAs explain a larger part of the variance in MHPs than do SUDs and therefore play an important role in their interaction with MHPs.

Background: Alcohol use disorder (AUD) is known to co-occur with other addictions, as well as with mental health problems. However, the effects of other addictions co-occurring with AUD on mental health problems were rarely studied and not considering them may bias estimates of the association between AUD and mental health problems. This study investigated which role co-occurring addictions play for the cross-sectional associations between self-reported AUD and mental health problems., Method: Participants were 5516 young Swiss men (73.0% of those that gave written informed consent) who completed a self-report questionnaire. Using short screening questionnaires, we assessed three substance use disorders (alcohol, cannabis and tobacco), seven behavioural addictions (internet, gaming, smartphone, internet sex, gambling, work, exercise) and four mental health problems (major depression, bipolar disorder, attention deficit hyperactivity disorder (ADHD) and social anxiety disorder). Differences in the proportions of mental health problems were tested using logistic regressions between (1) participants with no AUD and AUD, (2) participants with no AUD and AUD alone and (3) participants with no AUD and AUD plus at least one co-occurring addiction., Results: Overall, (1) participants with AUD had higher proportions of major depression (Odds ratio (OR [95% confidence interval]) = 3.51 [2.73, 4.52]; ADHD (OR = 3.12 [2.41, 4.03]); bipolar disorder (OR = 4.94 [3.38, 7.21]) and social anxiety (OR = 2.21 [1.79, 2.73])) compared to participants with no AUD. Considering only participants with AUD alone compared to participants with no AUD (2), differences in proportions were no longer significant for major depression (OR = 0.83 [0.42, 1.64]), bipolar disorder (OR = 1.69 [0.67, 4.22]), social anxiety (OR = 1.15 [0.77, 1.73]) and ADHD (OR = 1.65 [1.00, 2.72]) compared to participants with no AUD. In contrast, (3) proportions of mental health problems were considerably higher for participants with AUD plus at least one other addiction when compared to participants with no AUD, with OR's ranging from 2.90 [2.27, 3.70] for social anxiety, 4.03 [3.02, 5.38] for ADHD, 5.29 [4.02, 6.97] for major depression to 6.64 [4.44, 9.94] for bipolar disorder., Conclusions: AUD was associated with all four measured mental health problems. However, these associations were mainly due to the high proportions of these mental health problems in participants with AUD plus at least one co-occurring addiction and only to a lesser degree due to participants with AUD alone (i.e. without any other co-occurring addictions). Hence, estimates of the association between AUD and mental health problems that do not consider other addictions may be biased (i.e. overestimated). These findings imply that considering addictions co-occurring with AUD, including behavioural addictions, is important when investigating associations between AUD and mental health problems, and for the treatment of AUD and co-morbid disorders., Competing Interests: The authors have declared that no competing interests exist.

Background and Aims: Alcohol-induced blackout (AIB) is a common alcohol-related adverse event occurring during teenage years. Although research provides evidence that AIB predicts acute negative consequences, less is known about the associations of AIB with chronic consequences, such as alcohol dependence (AD). This study estimated the associations between an experience of AIB at age 20 and the incidence, maintenance and severity of AD at age 25 among Swiss men., Design: Prospective cohort study with 5.5 years separating baseline and follow-up., Setting: Switzerland., Participants: Swiss male drinkers (n = 5469, age 20 at baseline) drawn from the Cohort Study on Substance Use Risk Factors (C-SURF)., Measurements: Self-report questionnaires assessing AIB, AD, alcohol (drinking volume, binge drinking), cigarette and cannabis use, several risk factors (sensation-seeking, family history of problematic alcohol use, age of first alcohol intoxication) and socio-demographic variables., Findings: Generalized estimating equation models with and without adjustment for risk factors, including alcohol use and socio-demographics, showed that AIB at age 20 significantly predicted the incidence of AD at age 25 in men without AD at age 20 [odds ratio (OR) = 2.52, 95% confidence interval (CI), unadjusted = 2.04, 3.11, P < 0.001; fully adjusted, OR = 1.47, 95% CI = 1.13, 1.91, P = 0.004], maintenance of AD in men with AD at age 20 (unadjusted, OR = 1.82, 95% CI = 1.12, 2.95, P = 0.015; fully adjusted, OR = 1.66, 95% CI = 1.00, 2.76, P = 0.048] and AD severity [unadjusted incidence rate ratio (IRR) = 1.89, 95% CI = 1.69, 2.11, P < 0.001; fully adjusted, IRR = 1.20, 95% CI = 1.10, 1.31, P < 0.001]., Conclusions: Among Swiss men, alcohol-induced blackout at age 20 predicts the development, maintenance and severity of alcohol dependence at age 25., (© 2019 Society for the Study of Addiction.)

Objective: The Protective Behavioral Strategies Scale (PBSS-20) is one of the most commonly used measures of engagement in protective behavioral strategies (PBS). This research aimed to examine the psychometric properties of a French and German version of the PBSS-20 in a large sample of young males in Switzerland., Method: The sample included 5,017 young males (mean age = 25.44) participating in the Cohort Study on Substance Use Risk Factors in Switzerland. Measures of PBS use, total drinks per week, and alcohol-related consequences were used from a second follow-up assessment., Results: Confirmatory factor analysis testing different models previously documented in the literature provided initial support for a four-factor model. Fit statistics indicated that this model adequately reflects the structure of data. Further findings also provided support for adequate internal consistency and for convergent validity of this four-factor model, whereas metric-but not scalar-measurement invariance across linguistic regions was demonstrated., Conclusion: Although further research testing measurement invariance across linguistic regions and gender is warranted, results of the current study suggest that the French and German PBSS-20 is reliable and that it may represent a promising research and clinical tool that can be used in both French- and German-speaking countries., (© 2019 John Wiley & Sons, Ltd.)

Differences in mental health (MH) of users of distinct psychoactive substances have been shown. Both substance use (SU) and MH in users are influenced by stressful life events. This study compared MH parameters in distinct groups of substance users and evaluated the impact of stress factors on these outcomes. Data stem from the longitudinal Swiss Cohort Study on Substance Use Risk Factors (C-SURF) involving 4,475 young adult men. Distinct groups were created for the past 12 months' use of psychedelics, MDMA, psychostimulants, and cannabis. MH measurements (depressive symptoms, overall MH, perceived stress, life satisfaction) were used as outcome variables, while indicators of past family functioning and stressful life events served as covariates. The MH of psychedelics users was not significantly different from the no-drug-use group, whereas poorer MH was found in the other SU groups. Observed effects were influenced by the tested stress factors. The absence of association between use of psychedelics and worsening of MH deserves further investigation in male and female samples. Stressful life experiences must be considered when assessing the MH of users of illicit substances. These findings suggest that some men practice SU as self-medication to cope with life adversity.

Background and Aims: This study aimed to examine associations between risk factors suggested in the pathway model proposed by Billieux et al., demographic and substance use variables, and problematic smartphone use (PSU)., Methods: The analytical sample consisted of 5,096 Swiss men (mean age = 25.5 years, SD  = 1.26). Multiple linear regression analyses were conducted with PSU as dependent and the following as independent variables: (a) Billieux's pathway model variables (depression, social anxiety, ADHD, aggression-hostility, and sensation seeking); (b) substance use variables [alcohol: at-risk risky single-occasion drinking (RSOD); at-risk volume drinking; tobacco use: daily smoking; illicit drug use: more than weekly cannabis use; having used at least one other illicit drug besides cannabis over the preceding 12 months]; and (c) sociodemographic variables (age, language region, and education)., Results: All pathway-model variables except sensation seeking were significant predictors of PSU, especially symptoms of social anxiety (β = 0.196) and ADHD (β = 0.184). At-risk RSOD was positively (β = 0.071) associated with PSU, whereas both frequent cannabis use (β = -0.060) and daily cigarette smoking (β = -0.035) were negatively associated with PSU. Higher-achieved educational levels and being from the German-speaking part of Switzerland predicted PSU., Discussion and Conclusions: The findings of this study can be used to develop tailored interventional programs that address the co-occurrence of certain risky behaviors (e.g., at-risk RSOD and PSU) and target individuals who might be particularly prone to PSU. Such interventions would need to ensure that addressing one problem (e.g., decreasing PSU) does not lead to some other compensatory behavior (e.g., frequent cigarette smoking).

Motivations for cannabis use may include coping with negative well-being. Life satisfaction, a hallmark of subjective well-being, could play a role in cannabis use among young adults. This study aims to assess whether life satisfaction (SWLS) at age 21 is associated with cannabis initiation and cessation between the ages of 21 and 25, and with cannabis use severity (CUDIT) at age 25. Data were drawn from a cohort of young Swiss males. Associations of life satisfaction with initiation, cessation, and severity were assessed with logistic and zero-truncated negative binomial regressions. Age, family income, education, alcohol, and tobacco use at age 21 were used as adjustment variables. From a sample of 4778 males, 1477 (30.9%) reported cannabis use at age 21, 456 (9.5%) initiated use between age 21 and 25, and 515 (10.8%) ceased by age 25. Mean (SD) SWLS was significantly higher among non-users at age 21: 27.22 (5.35) vs. 26.28 (5.80), p < 0.001. Negative associations between life satisfaction at age 21 and cannabis use initiation (OR = 0.98, p = 0.029) and severity at age 25 (IRR = 0.97, p < 0.001) were no more significant in adjusted analyses (OR = 0.98, p = 0.059 and IRR = 0.99, p = 0.090). Life satisfaction at age 21 was not associated with cannabis cessation (OR = 0.99, p = 0.296). Results suggest that the predictive value of life satisfaction in cannabis use is questionable and may be accounted for by other behaviors, such as tobacco and alcohol use., Competing Interests: The authors declare no conflict of interest.

Objectives: Transition into adulthood is a risky period for young people with attention deficit-hyperactivity disorder (ADHD), but empirical studies on this topic are scarce. This study investigated the association between the level of ADHD symptoms and transition into adulthood., Methods: Data were collected in the Cohort Study of Substance Use and Risk Factors among a representative sample of young Swiss men (n = 4681) over three waves. Measures included the level of ADHD symptoms and emerging adulthood assessed with the Inventory of the Dimensions of Emerging Adulthood and indicators of successful transition into adulthood., Results: The level of ADHD symptoms was associated with a lower success in the transition into adulthood. Young people with high level of ADHD symptoms had a reduced increase in indicators of successful transition over time. Inattention symptoms were more strongly associated with emerging adulthood measures in comparison with hyperactive symptoms., Conclusions: The level of ADHD symptoms may delay the transition into adulthood, especially inattentive symptoms. Providing tailored interventions to emerging adults with ADHD symptoms may decrease the substantial impairments adults with ADHD experience in life.

Objectives: The study aims to develop a short form of the compulsive internet use scale (CIUS), which can be used in multitopic and general population health surveys and is invariant across different sexes, linguistic regions, and ages., Methods: Two general population surveys from 2013 and 2015 were used as learning (n = 1,371) and validation samples (n = 1,550), respectively. Reducing items from the original CIUS was based on the following: (a) correlated errors between items, (b) differential item functioning, and (c) measurement invariance. Methods used item response theory and latent confirmatory factor analysis for ordinal variables., Results: The eight-item short form maintained the five dimensions of the original scale and was metric and mostly scale invariant for sex, region, and age. It fell marginally short of scale invariance (ΔCFI < 0.01) for regions in the learning sample and for sexes in the validation sample (both ΔCFI = 0.013, p < 0.01). Root mean square error of approximation was 0.045 and 0.036, and comparative fit index was 0.989 and 0.995, in the learning and validation samples, respectively, showing excellent fit of the model to data. Correlations with the full scale were r = 0.966 (learning) and r = 0.969 (validation)., Conclusion: If the full 14-item CIUS is a valid, reliable screening instrument, then the short eight-item form is too, and can be used in multitopic, general population health surveys., (© 2019 John Wiley & Sons, Ltd.)

Background: A basic, yet untested tenet underlying alcohol control policies is that they should affect both light and heavy drinking, thereby shifting the entire population in a favourable direction. The aim of this study was to test this assumption in young Swiss men., Methods: Cross-sectional self-reported data - from 5755 young Swiss men participating in the Cohort Study on Substance Use Risk Factors (C-SURF), a large cohort study on young men living within 21 jurisdictions across Switzerland - were analysed via nested logistic regression. With this approach, a set of increasingly-heavy drinking patterns was broken down into a set of nested regression models, each one estimating the probability of heavier drinking, conditional on the lighter drinking pattern. Drinking patterns relating to heavy episodic drinking (HED), heavy volume drinking (HVD) on weekends, and workweek drinking, as well as alcohol use disorder (AUD) were examined. The explanatory variable was a previously-used alcohol policy environment index (APEI) reflecting the number of alcohol control policies implemented in each jurisdiction. Conventional and multilevel logistic regression models were tested, adjusted for age, education, linguistic region, urban/rural status, attention-deficit/hyperactivity disorder, depression, sensation seeking, antisocial personality disorder, and unobserved heterogeneity between jurisdictions., Results: For HED, weekend HVD, and AUD, negative relationships with the APEI were found, such that with a higher APEI the probability of lighter drinking patterns was increased while the probability of heavier patterns was reduced, including a reduced probability of the heaviest patterns. These relationships were non-linear, however, and tapered off towards the heavy end of the drinking spectrum. No relationship was identified between the APEI and workweek drinking patterns., Conclusion: Among young Swiss men, stricter alcohol policy environments were associated with a global shift towards lighter drinking, consistent with the basic tenet behind the universal prevention approach., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Research into comorbidity of alcohol and cannabis use disorders has resulted in inconsistent findings, especially among simultaneous users, who used alcohol and cannabis together on a single occasion. This study investigated the association of alcohol and cannabis use disorders among simultaneous users using a network perspective, which considers direct relationships between symptoms. We used a subset of simultaneous alcohol and cannabis users driven from the representative population-based sample of young Swiss men cohort study on substance use risk factors (C-SURF) ( n = 1559 at baseline and n = 991 at follow-up). Self-reported symptoms of alcohol and cannabis use disorders were collected. Network analyses included network estimation, visualization, and community detection tests. Alcohol and cannabis use symptoms were separated in two distinct clusters, with few paths between them (eleven positive edges at baseline, three at follow-up). Withdrawal symptoms were likely to connect the two disorders at baseline, but not at follow-up. Alcohol and cannabis use disorders appeared as separate disorders among simultaneous users. Our findings mitigated previous findings on the detrimental association between alcohol and cannabis use. Future studies should incorporate network analyses as a means to study comorbidity in other community and clinical samples to confirm our preliminary findings.

Introduction: There are few recent longitudinal studies on smokeless tobacco (SLT) products and smoking outside the United States or European Nordic countries. The present longitudinal study tests whether Swedish-type snus and nasal snuff use decreases smoking incidence and prevalence in a central European country., Methods: The sample consisted of 5198 Swiss men (around 20 years of age). Retention rate was 91.5% over 15 months. Regression models, adjusting for a variety of psychosocial, smoking-related, and other risk factors, assessed whether no, low (less than weekly), and high (weekly or more) use baseline groups showed changes or maintenance in snus and snuff use related to smoking initiation, cessation, and reduction., Results: Among baseline nonsmokers, snus initiators (OR = 1.90, p = .003) and low baseline maintainers (OR = 4.51, p < .001) were more likely to start smoking (reference: persistent nonusers of snus). Among baseline smokers, initiators (OR = 2.79, p < .001) and low baseline maintainers (OR = 2.71, p = .005) more often continued smoking, whereas snus quitters less frequently continued smoking (OR = 0.57, p = .009). High baseline maintainers were non-significantly less likely to continue smoking (OR = 0.71, p = .315). Among continuing smokers, only snus quitters significantly reduced the number of cigarettes smoked per day (b = -1.61, p = .002) compared with persistent nonusers of snus. Results were similar for snuff., Conclusions: SLT use did not have any significant beneficial effects on young men in Switzerland but significantly increased the likelihood of smoking initiation and continuation, independent of whether the substance is legally sold (snuff) or not (snus). This does not exclude that there may be beneficial effects at older ages., Implications: Our research provides evidence that SLT use has no benefits for cigarette smoking initiation, cessation, or reduction among young men in a central European country, where SLT is not highly promoted or receives tax incentives. This is true for both legally sold nasal snuff and Swedish-type snus that cannot be legally sold. Results indicate that without incentives for using it, among young people shifts from smoking to SLT use are questionable and confirms the need for country-specific studies before the global public health community engages in promoting SLT.

An important ongoing debate in the addiction field is whether certain technology-mediated behaviors constitute tenable and independent constructs. This study investigated whether problematic technology-mediated behaviors could be conceptualized as a spectrum of related, yet distinct disorders (spectrum hypothesis), using the network approach, which considers disorders as networks of symptoms. We used data from the Cohort Study on Substance Use and Risk Factors (C-SURF; Swiss National Science Foundation), with a representative sample of young Swiss men (subsample of participants engaged in technology-mediated behaviors, n = 3,404). Four technology-mediated addictive behaviors were investigated using symptoms derived from the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) and the component model of addiction: Internet, smartphone, gaming, and cybersex. Network analyses included network estimation and visualization, community detection tests, and centrality indices. The network analysis identified four distinct clusters corresponding to each condition, but only Internet addiction had numerous relationships with the other behaviors. This finding, along with the finding that there were few relationships between the other behaviors, suggests that smartphone addiction, gaming addiction, and cybersex addiction are relatively independent constructs. Internet Addiction was often connected with other conditions through the same symptoms, suggesting that it could be conceptualized as an "umbrella construct," that is, a common vector that mediates specific online behaviors. The network analysis thus provides a preliminary support to the spectrum hypothesis and the focus on the specific activities performed online, while showing that the construct of Internet addiction is inadequate. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

Aim: To estimate the long-term efficacy of an internet-based brief intervention (IBI) in decreasing alcohol use among men on (1) number of drinks/week and (2) monthly or more binge drinking prevalence. In addition, overall changes in alcohol use were assessed., Design: Participants in a cohort study were recruited in a two parallel-group randomized controlled trial of an IBI versus no-intervention control condition, showing a positive intervention effect at 6 months. As part of the regular cohort assessments, participants were re-assessed 47 months after the initial trial, offering an opportunity to determine long-term efficacy., Setting: Young Swiss men from the general population., Participants: Of 737 randomized trial participants with unhealthy alcohol use (> 14 drinks/week or ≥ 6 drinks/occasion at least monthly, or Alcohol Use Disorders Identification Test (AUDIT) ≥ 8), 626 completed a cohort assessment at mean ± standard deviation (SD) = 47.4 ± 2.6) months after their randomized trial baseline assessment., Intervention: IBI included normative and personalized feedback on alcohol use, risk indicators, information about alcohol and health and recommendations; controls: assessment only., Measurements: Self-reported number of drinks/week and monthly or more binge drinking prevalence., Findings: Comparisons at follow-up were adjusted for baseline drinking. Missing values were replaced with the last observation carried forward. There was no evidence of differences between the IBI and control group on either the number of drinks/week [IBI: 10.8 (14.2); control: 10.7 (14.1), P = 0.8] or monthly or more binge drinking prevalence (IBI: 65.1%; control: 63.5%, P = 0.5). Although there was no evidence of overall change from baseline in number of drinks/week [9.8 (7.9) at baseline, 10.8 (14.1) at 47 months, P = 0.051], there was evidence that monthly or more binge drinking prevalence had decreased during the follow-up time (84.9% at baseline, 64.3% at 47 months, P < 0.001)., Conclusions: An internet-based brief intervention directed at unhealthy alcohol use among young men does not appear to reduce drinking over the long-term., (© 2018 Society for the Study of Addiction.)

Background: Recent theories suggest that behavioural addictions and substance use disorders may be the result of the same underlying vulnerability. The present study investigates profiles of family background, personality and mental health factors and their associations with seven behavioural addictions (to the internet, gaming, smartphones, internet sex, gambling, exercise and work) and three substance use disorder scales (for alcohol, cannabis and tobacco)., Methods: The sample consisted of 5287 young Swiss men (mean age = 25.42) from the Cohort Study on Substance Use Risk Factors (C-SURF). A latent profile analysis was performed on family background, personality and mental health factors. The derived profiles were compared with regards to means and prevalence rates of the behavioural addiction and substance use disorder scales., Results: Seven latent profiles were identified, ranging from profiles with a positive family background, favourable personality patterns and low values on mental health scales to profiles with a negative family background, unfavourable personality pattern and high values on mental health scales. Addiction scale means, corresponding prevalence rates and the number of concurrent addictions were highest in profiles with high values on mental health scales and a personality pattern dominated by neuroticism. Overall, behavioural addictions and substance use disorders showed similar patterns across latent profiles., Conclusion: Patterns of family background, personality and mental health factors were associated with different levels of vulnerability to addictions. Behavioural addictions and substance use disorders may thus be the result of the same underlying vulnerabilities., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Introduction: Short screenings of alcohol-related dependence are needed for population-based assessments. A clinical interview constitutes a reliable diagnosis often seen as gold standard, but it is costly and time consuming and as such, not suitable for population-based assessments. Therefore, self-reported questionnaires are needed (eg, alcohol use disorder (AUD) as in the Diagnostic and Statistic Manual of Mental Disorders (DSM) 5), but their reliability is questionable. Recent studies called for more evidence-based measurements for population-based screening (eg, heavy alcohol use over time (HAU)). This study aims to test the reliability of different self-reported measures of alcohol use., Methods and Analysis: Based on stratified random selection, 280 participants will be recruited from the French-speaking subgroup of the Swiss National Science Foundation-supported Cohort Study on Substance Use and Risk Factors (C-SURF). This cohort is a population-based sample of young Swiss men in their mid-20s (n=2668). The sample size calculation is based on a proportion non-inferiority test (alpha=5%, power=80%, margin of equivalence=10%, difference in sensitivity between self-reported AUD and HAU=5%, correlation between AUD and HAU=0.35, and drop-outs=15%). Assessment will include a clinical interview as the gold standard of alcohol-related dependence, self-reported alcohol measures (HAU, AUD and drinking patterns), biomarkers as gold standards of chronic excessive drinking, and health outcomes. To assess the validity of the self-reported alcohol measures, sensitivity analyses will be run. The associations between alcohol-related measures and health outcomes will be tested. A non-response analysis will be run using the previous waves of the C-SURF study using logistic regressions., Ethics and Dissemination: The study protocol has been approved by the Human Research Ethics Committee of the Canton of Vaud, Switzerland (no. 2017-00776). The results will be submitted for publication in peer-reviewed journals and presented at national and international conferences., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Although several studies have investigated longitudinal associations between social norms and alcohol use behaviors, less is known about associations between social norms and use of other substances, such as cigarettes and cannabis. The present study aimed to examine the temporal ordering of descriptive norms and cigarette and cannabis use over time., Method: A sample of 5,158 young Swiss men from the Cohort Study on Substance Use Risk Factors (C-SURF) completed baseline and 15-month follow-up questionnaires assessing frequency of use and descriptive norms of cigarette and cannabis use. Bidirectional, longitudinal associations between descriptive norms and cigarette and cannabis use were examined using cross-lagged panel models., Results: Descriptive norms for cigarette use at baseline predicted increased frequency of use at follow-up, whereas the opposite association, from frequency of cigarette use at baseline to descriptive norms at follow-up, was not significant. For cannabis, associations between descriptive norms and frequency of use were reciprocal. Descriptive norms at baseline predicted an increased frequency of cannabis use at follow-up, and frequency of cannabis use at baseline predicted a later increase in descriptive norms., Conclusions: For cigarette use, findings suggest that descriptive norms shape later cigarette use behaviors. For cannabis use, findings suggest that descriptive norms shape cannabis use, but cannabis use also shapes later descriptive norms.

The aim of this study was the validation of a brief form of the Perceived Neighborhood Social Cohesion questionnaire using data from 5065 men from the "Cohort Study on Substance-Use Risk Factors." A 9-item scale covering three factors was proposed. Excellent indices of internal consistency were measured (α = .93). The confirmatory factor analyses resulted in acceptable fit indices supporting measurement invariance across French and German forms. Significant correlations were found between the brief form of the Perceived Neighborhood Social Cohesion questionnaire, and satisfaction and self-reported health, providing evidence of the concurrent validity of the scale. Perceived neighborhood social cohesion, and depression and suicide attempts were negatively associated, sustaining the protective effect of perceived social cohesion.

Intense stress increases substance use (SU). However, little is known about the extent to which distinctive forms of stress should be weighted with regard to their effects on SU. This study aimed to determine whether family-related stress factors (FSF) influenced SU in a different way than external stress factors (ESF). Data was drawn from a Swiss cohort study on SU risk factors (C-SURF), involving 5,308 young adult men. Twelve month use of alcohol and of illicit substances was assessed. FSF and ESF for the time period preceding SU were measured. FSF and ESF were both significantly associated with SU. FSF had a greater impact on the use of most substances than did ESF. The FSF with the strongest association with SU was lack of parental monitoring. Regarding ESF, the cumulative number of stressful external events had a higher impact on SU than previous physical or sexual assault by a stranger. In contrast, physical or sexual assault by a family member was not found to be associated with subsequent SU. These findings have important implications for SU prevention programmes focusing on male teenagers, as it is difficult to screen and intervene in subtle forms of maltreatment in families., (© 2017 S. Karger AG, Basel.)

Background: Not much is known about how much geographical units matter for heavy alcohol consumption and how much of the geographical variations are explained by characteristics such as institutional alcohol policies and regional economic conditions. The study aim was to address these gaps considering three types of heavy alcohol consumption., Methods: Analyses were based on data collected on 5879 men (age: 20.0 years, standard deviation: 1.2) years participating in the Cohort Study on Substance Use Risk Factors in Switzerland. Generalized linear mixed models were used to assess overall prevalence, geographical variations in prevalence across geographical units (institutional units, economic micro regions, linguistic regions, urban/rural status), and explanatory variables in three different types of heavy alcohol consumption (heavy weekend drinking, heavy workweek drinking, heavy volume drinking)., Results: The overall prevalence for heavy weekend drinking was 46.8%, 10.8% for heavy volume drinking and 3.6% for heavy workweek drinking. The extent and locations of geographical variation in prevalence rates were contingent upon the type of alcohol consumption. Institutional alcohol policies explained substantial geographical variations in heavy weekend drinking, but not in heavy workweek or heavy volume drinking. Regional economic conditions were not related to alcohol consumption., Conclusions: Different types of heavy alcohol consumption are determined by different geographical units. Alcohol policies protectively impact the major drinking style of heavy weekend drinking, but not other low prevalence forms of heavy drinking. Research and public health efforts must take into account these differences between types of alcohol consumption., (© The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)