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Heavy alcohol drinking is a major, preventable problem that adversely impacts the physical and mental health of US young adults. Studies seeking drinking risk factors typically focus on young adults who enrolled in 4-year residential college programs (4YCP) even though most high school graduates join the workforce, military, or community colleges. We examined 106 of these understudied young adults (USYA) and 453 4YCPs from the National Consortium on Alcohol and NeuroDevelopment in Adolescence (NCANDA) by longitudinally following their drinking patterns for 8 years from adolescence to young adulthood. All participants were no-to-low drinkers during high school. Whereas 4YCP individuals were more likely to initiate heavy drinking during college years, USYA participants did so later. Using mental health metrics recorded during high school, machine learning forecasted individual-level risk for initiating heavy drinking after leaving high school. The risk factors differed between demographically matched USYA and 4YCP individuals and between sexes. Predictors for USYA drinkers were sexual abuse, physical abuse for girls, and extraversion for boys, whereas 4YCP drinkers were predicted by the ability to recognize facial emotion and, for boys, greater openness. Thus, alcohol prevention programs need to give special consideration to those joining the workforce, military, or community colleges, who make up the majority of this age group.

ObjectiveIndividuals with unhealthy alcohol use and comorbid depression or anxiety may be vulnerable to alcohol use escalation in times of stress such as the COVID-19 pandemic. Among a cohort of individuals with pre-pandemic unhealthy drinking, we compared changes in alcohol use by whether people had a depression or anxiety diagnosis, and examined whether mental health treatment was related to these changes.MethodsUsing electronic health record data from Kaiser Permanente Northern California, we analyzed drinking changes during the pandemic (3/1/2020-6/30/2022) among adults identified in primary care with unhealthy alcohol use (exceeding daily/weekly recommended limits) pre-pandemic (1/1/2019-2/29/2020). Outcomes were mean changes in number of heavy drinking days (prior three months), drinks/week, drinks/day, and drinking days/week. Multivariable linear regression models were fit to: 1) compare outcomes of patients with depression or anxiety diagnoses to those without, and 2) among patients with depression or anxiety, estimate associations between mental health treatment and outcomes.ResultsThe sample included 62,924 adults with unhealthy alcohol use, of whom 12,281 (19.5%) had depression or anxiety. On average, alcohol use significantly decreased across all measures during the pandemic, but patients with depression or anxiety had greater decreases in drinks/week (adjusted mean difference [aMD] [CI]=-0.34 [-0.55, -0.12]) and drinking days/week (-0.15 [-0.20, -0.10]). No associations were found between mental health treatment and changes in drinking.ConclusionsContrary to expectations, patients with unhealthy alcohol use and depression or anxiety decreased alcohol use more than those without depression or anxiety during COVID-19, whether or not they accessed mental health services.

BackgroundSocial media can influence alcohol initiation behaviors such as sipping, which can lead to future adverse alcohol-related outcomes. Few studies have examined the role of problematic social media use, characterized by addiction, mood modification, tolerance, withdrawal, conflict, and relapse, especially in early adolescence.ObjectiveTo examine the prospective association between social media use and sipping alcohol in a nationwide sample of early adolescents, and the extent to which problematic social media use mediates the association.MethodsWe analyzed prospective data from the Adolescent Brain Cognitive Development Study (N = 7514; ages 9-10 years at baseline; 2016-2018) to estimate associations between social media time (Year 1) and alcohol sipping (Year 3) using modified Poisson regression, adjusting for confounders and testing problematic social media use (Year 2) as a mediator.ResultsSocial media time (Year 1) was prospectively associated with 1.31 (95% confidence interval 1.20-1.43) times higher risk of new-onset sipping (Year 3). The association between social media time and new-onset alcohol sipping was partially mediated by problematic social media use at Year 2 (25.0% reduction in the association between the former two factors after adding problematic social media use, p = 0.002).ConclusionsTime spent on social media was associated with a higher risk of alcohol sipping in a diverse national sample of early adolescents, and the association was partially mediated by problematic social media use. Media literacy education and family media use plans could advise early adolescents about exposure to alcohol content on social media and warning signs for problematic use.

Adolescent traumatic brain injury (TBI) has long-term effects on brain functioning and behavior, impacting neural activity under cognitive load, especially in the reward network. Adolescent TBI is also linked to risk-taking behaviors including alcohol misuse. It remains unclear how TBI and neural functioning interact to predict alcohol experimentation during adolescence. Using Adolescent Brain Cognitive Development (ABCD) study data, this project examined if TBI at ages 9-10 predicts increased odds of alcohol sipping at ages 11-13 and if this association is moderated by neural activity during the Emotional EN-Back working memory task at ages 11-13. Logistic regression analyses showed that neural activity in regions of the fronto-basal ganglia network predicted increased odds of sipping alcohol by ages 11-13 (p

One promising avenue of research is the use of neuroimmune modulators to treat substance use disorders (SUDs). Neuroimmune modulators target the interactions between the nervous system and immune system, which have been found to play a crucial role in the development and maintenance of SUDs. Multiple classes of substances produce alterations to neuroimmune signaling and peripheral immune function, including alcohol, opioids, and psychostimulants Preclinical studies have shown that neuroimmune modulators can reduce drug-seeking behavior and prevent relapse in animal models of SUDs. Additionally, early-phase clinical trials have demonstrated the safety and feasibility of using neuroimmune modulators as a treatment for SUDs in humans. These therapeutics can be used as stand-alone treatments or as adjunctive. This review summarizes the current state of the field and provides future directions with a specific focus on personalized medicine.

AIM: The 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Patients With Atrial Fibrillation provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS: A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE: Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation and the 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.

BACKGROUND: Post-traumatic stress disorder (PTSD) and substance use (tobacco, alcohol, and cannabis) are highly comorbid. Many factors affect this relationship, including sociodemographic and psychosocial characteristics, other prior traumas, and physical health. However, few prior studies have investigated this prospectively, examining new substance use and the extent to which a wide range of factors may modify the relationship to PTSD. METHODS: The Advancing Understanding of RecOvery afteR traumA (AURORA) study is a prospective cohort of adults presenting at emergency departments (N = 2,943). Participants self-reported PTSD symptoms and the frequency and quantity of tobacco, alcohol, and cannabis use at six total timepoints. We assessed the associations of PTSD and future substance use, lagged by one timepoint, using the Poisson generalized estimating equations. We also stratified by incident and prevalent substance use and generated causal forests to identify the most important effect modifiers of this relationship out of 128 potential variables. RESULTS: At baseline, 37.3% (N = 1,099) of participants reported likely PTSD. PTSD was associated with tobacco frequency (incidence rate ratio (IRR): 1.003, 95% CI: 1.00, 1.01, p = 0.02) and quantity (IRR: 1.01, 95% CI: 1.001, 1.01, p = 0.01), and alcohol frequency (IRR: 1.002, 95% CI: 1.00, 1.004, p = 0.03) and quantity (IRR: 1.003, 95% CI: 1.001, 1.01, p = 0.001), but not with cannabis use. There were slight differences in incident compared to prevalent tobacco frequency and quantity of use; prevalent tobacco frequency and quantity were associated with PTSD symptoms, while incident tobacco frequency and quantity were not. Using causal forests, lifetime worst use of cigarettes, overall self-rated physical health, and prior childhood trauma were major moderators of the relationship between PTSD symptoms and the three substances investigated. CONCLUSION: PTSD symptoms were highly associated with tobacco and alcohol use, while the association with prospective cannabis use is not clear. Findings suggest that understanding the different risk stratification that occurs can aid in tailoring interventions to populations at greatest risk to best mitigate the comorbidity between PTSD symptoms and future substance use outcomes. We demonstrate that this is particularly salient for tobacco use and, to some extent, alcohol use, while cannabis is less likely to be impacted by PTSD symptoms across the strata.

INTRODUCTION: Alcohol expectancies predict subsequent alcohol use and related problems among adolescents, although predictors of alcohol expectancies remain unclear. This study examined the longitudinal association between family conflict, a sociocultural factor strongly implicated in adolescent alcohol use, and positive and negative alcohol expectancies of adolescents of diverse racial/ethnic backgrounds. METHODS: Data were from the Adolescent Brain Cognitive Development Study 4.0 release, a multisite longitudinal study (N = 6,231, baseline age 9-10). Linear mixed-effects regression, with interactions between race/ethnicity and family conflict, tested the association between family conflict and alcohol expectancies, for each racial/ethnicity (e.g., Black vs. non-Black; White vs. non-White). RESULTS: Interactions of family conflict with race/ethnicity in predicting negative and positive alcohol expectancies were statistically significant for models testing Black and White adolescents, but not for Asian, Hispanic, and Other. Family conflict at baseline predicted lower negative alcohol expectancy for Black adolescents (B = -.166, p = 0.033) and positive alcohol expectancy for White adolescents (B = 0.71, p = 0.023) at the year 3 follow-up. All models controlled for sex, age, family socioeconomic status, alcohol expectancies at year 1, and family conflict at year 3. CONCLUSION: The results indicate that family conflict is a potential risk factor for problematic alcohol expectancies for Black and White adolescents. Although we did not directly compare Black and White adolescents, our findings indicate that family conflict may operate differently for Black and White adolescents. Prevention and intervention efforts targeting family conflict may be relevant for different aspects of alcohol expectancies in Black and White families.

Background and aimsRecently, we demonstrated that a distinct pattern of structural covariance networks (SCN) from magnetic resonance imaging (MRI)-derived measurements of brain cortical thickness characterized young adults with alcohol use disorder (AUD) and predicted current and future problematic drinking in adolescents relative to controls. Here, we establish the robustness and value of SCN for identifying heavy alcohol users in three additional independent studies.Design and settingCross-sectional and longitudinal studies using data from the Pediatric Imaging, Neurocognition and Genetics (PING) study (n = 400, age range = 14-22 years), the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) (n = 272, age range = 17-22 years) and the Human Connectome Project (HCP) (n = 375, age range = 22-37 years).CasesCases were defined based on heavy alcohol use patterns or former alcohol use disorder (AUD) diagnoses: 50, 68 and 61 cases were identified. Controls had none or low alcohol use or absence of AUD: 350, 204 and 314 controls were selected.MeasurementsGraph theory metrics of segregation and integration were used to summarize SCN.FindingsMirroring our prior findings, and across the three data sets, cases had a lower clustering coefficient [area under the curve (AUC) = -0.029, P = 0.002], lower modularity (AUC = -0.14, P = 0.004), lower average shortest path length (AUC = -0.078, P = 0.017) and higher global efficiency (AUC = 0.007, P = 0.010). Local efficiency differences were marginal (AUC = -0.017, P = 0.052). That is, cases exhibited lower network segregation and higher integration, suggesting that adjacent nodes (i.e. brain regions) were less similar in thickness whereas spatially distant nodes were more similar.ConclusionStructural covariance network (SCN) differences in the brain appear to constitute an early marker of heavy alcohol use in three new data sets and, more generally, demonstrate the utility of SCN-derived metrics to detect brain-related psychopathology.

Introduction Methods Results Discussion and Conclusions Online forums provide an environment for peer discussions to anonymously share experiences about sensitive topics. In this article we explore discussions about alcohol use during pregnancy, including representations of ‘appropriate’ behaviour and risks, in relation to alcohol use.We sampled Mumsnet posts from 2016 to 2021 and analysed these using a two‐staged approach: describing the content of original posts and employing discourse analysis on the entire thread which focused on unpacking the significance, activity and identity within the discourse.Seventy‐three threads with 1554 replies analysed. Users engaged with different sources of evidence and mentioned guidelines and scientific sources, though most commonly provided, requested and appreciated anecdotal information. Risk was discussed in several ways but all users engaged with ‘othering’ drinking they perceived as risky. Only a few prescribed risks to any and all levels of drinking. There was a lack of knowledge around drinking while trying to conceive and early pregnancy. Expectations and norms of behaviour during pregnancy engaged in a ‘good motherhood’ discourse. Users positioned their drinking according to perceived norms through language choices; when not pregnant (or unknowingly pregnant) being ‘plastered’ was justified but when pregnant drinking only ‘sips’ or ‘tiny’ quantities of alcohol was considered appropriate.Forum users demonstrated a desire to adhere to ‘responsible motherhood’, which did not equate to abstinence if consumption was perceived as acceptable and justified. Future research should explore information needs and effective approaches to health communication for pregnant women or those planning pregnancy. [ABSTRACT FROM AUTHOR]

Background Method Results Discussion and Conclusions Evidence supports the effectiveness of alcohol brief interventions (ABI) in health‐care settings but the acceptability of conducting ABIs in wider community venues such as supermarkets, hospital atriums and train stations remains unclear. This study examines the acceptability of conducting ABIs for older adults in community settings.ABIs were conducted in community venues in five sites across the United Kingdom as part of the Drink Wise, Age Well program. ABIs used the Alcohol Use Disorders Identification Test–Consumption to measure alcohol use, with personalised feedback delivered in relation to alcohol intake. Data on age, gender, ethnicity, alcohol use and intention to change drinking was collected. Qualitative interviews to explore the acceptability of delivering ABIs within community venues were conducted with a sub‐set of ABI recipients (n = 16) and practitioners (n = 12). Data were analysed using Framework Analysis.A total of 3999 people received an ABI. Fifty‐eight percent of ABI recipients were female. The largest age group was 50–54 years (28%). Almost 80% (n = 3180) of ABI recipients were drinking at hazardous levels. Of hazardous drinkers that were asked (n = 2726), 40% reported intentions to change their drinking. Qualitative analysis indicted that ABIs conducted in community venues were acceptable and considered to be valuable in raising awareness of alcohol‐related risks.Community venues represent a promising context to engage older people in alcohol intervention, with the potential to lead to reductions in alcohol consumption. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Discussion and Conclusions Phosphatidylethanol (PEth) is a specific and persisting marker of ethanol (alcohol) consumption. Early success of medically necessary abstinence can be assessed by monitoring PEth disappearance at a biologically plausible rate. This requires an understanding of PEth elimination, its variability and its determinants. To achieve this, we characterised PEth elimination in drinkers who voluntarily abstained. We aimed to derive a nomogram from the data to assist practitioners in recognising abstinence.Twenty‐nine usual drinkers who were prepared to abstain from alcohol consumption for 4 weeks were recruited. Erythrocyte PEth was measured weekly. A population pharmacokinetic model for PEth was developed, describing the time‐course of PEth elimination. Estimates were derived for population average, inter‐individual variability in PEth half‐life and any covariate influences. These estimates informed a nomogram of PEth elimination that incorporated a boundary separating continued abstinence from resumed drinking. The nomogram was tested to identify drinking events among participants.The model estimated a population average elimination rate constant (k) of 0.088 day−1, corresponding to a half‐life of 7.9 days with a residual coefficient of variation of 8.5%. Elimination was first order and no covariate influences were identified. The nomogram was internally assessed as predictively accurate for 21 successfully abstinent participants and in detecting alcohol consumption in 2 further participants, using a 99.9% prediction interval.The value of PEth in distinguishing alcohol abstinence from consumption is enhanced by using a nomogram to confirm abstinence within weeks of its medically necessary imposition. Further work will establish the value of this approach in clinical practice. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion Sex workers suffer considerable marginalization that limits their choices and exposes them to various types of harm. Hence, it is important to examine sex workers' professional agency and its association with quality of life. In the current study, we investigated professional agency, quality of life, and problematic substance use among sex workers in Finland.Using an online survey, we collected data from 136 sex workers contacted through Finnish sex work organizations and social media platforms. We conducted correlational analyses between the study variables and linear regression analyses with professional agency as the independent variable and quality of life and problematic alcohol and drug use as dependent variables.As expected, in the regression analyses, professional agency was strongly positively associated with quality of life (β = 0.86, p < 0.001) and negatively associated with problematic alcohol (β = −0.38, p = 0.002) and drug (β = −0.69, p < 0.001) use. Professional agency explained as much as 73% of the variance in quality of life. Most sex workers rated their quality of life as either good or very good.Our results underscore the importance of professional agency to sex workers' well‐being, explaining a substantial proportion of the variance in quality of life. Promoting agency should therefore be at the heart of sex work policymaking. However, as most of the respondents were Finnish‐born cis women, our results might not generalize to foreign‐born, male, and gender diverse sex workers. Future studies should prioritize reaching these populations to ensure broader representativeness. [ABSTRACT FROM AUTHOR]

Background: Liver cancer remains the leading cause of death and public health threat among the Mongolian population. So far, there has been no in-depth analysis to describe the burden of common attributable factors to liver cancer in Mongolia. Therefore, we aimed to explore the most prevalent causes of liver cancer and its trends from 1990 to 2019. Methods: We extracted the primary liver cancer data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to examine the mortality and morbidity of liver cancer by its etiological types, which included alcohol, viral hepatitis B and C, and non-alcoholic steatohepatitis (NASH). The data was extracted by sex and 5-year age intervals from 1990 to 2019. Data included mortality, incidence, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted l i fe-years (DALYs) of liver cancer among the Mongolian population. Results: Mongolia had the world's highest age-standardized DALYs for liver cancer (2558.1) in 2019. Alcohol-attributable DALYs (786.6) were 29 times higher than the global average (26.1), and liver cancer due to hepatitis C (752.6) and B (763.2) were 21.5 (35.0) and 10.9 (69.1) times higher, respectively. Over the past 30 years, there has been a steady increase in the incidence and number of deaths caused by liver cancer in Mongolia. In 2019, liver cancer incidence due to alcohol consumption was 3.1 times higher for males than females, and hepatitis B was 2.7 times higher for males than females. However, the incidence of hepatitis C and NASH were slightly higher for females. Deaths from liver cancer accounted for 9.51% (2365) of total deaths in Mongolia in 2019, with a continuously increasing trend in the fraction of death compared to 1990, which was 11 times higher than the global average (0.86%), particularly in females with a 319.6% (95% UI 234.9-435.7) increase observed during the study period. Liver cancer due to hepatitis B, C, and alcohol each shared about one-third of liver cancer deaths. Conclusion: A comprehensive analysis of the burden of liver cancer in Mongolia reveals alcohol use as a primary cause of liver cancer mortality, particularly affecting men and significantly impacting the disease burden. Viral hepatitis continues to pose a major public health concern in the country. Although significant milestones have progressed, addressing the unique demographic and geographical challenges requires tailored approaches for specific target populations. The evidence generated from this analysis is crucial to support policy guidance, contribute to evidence-based decisions, guide public health prevention measures, and amplify population health promotion and disease prevention throughout Mongolia. [ABSTRACT FROM AUTHOR]

Background: Veteran residents in Northern Ireland (NI) are an under-researched population. Little is known about their experiences of trauma and mental health management. The overall mental well-being of veterans living in NI may be poorer than other veteran populations, due to the challenges presented by the unique landscape. Understanding their experiences is crucial for providing appropriate, targeted support. Method: Six male veterans, who had received a mental health diagnosis, living in NI and all aged > 40 years participated. Semi-structured interviews, using open-ended questions, were conducted over the telephone. Interpretative phenomenological analysis was used to explore their experiences. Results: Two experiential themes were identified each containing three experiential statements. Statements for ‘an extreme lack of’ included: lack of mental health literacy/awareness; lack of expectations of official support; lack of a sense of perceived appreciation. Statements for ‘an extreme abundance of’ included: exacerbated exposure to a range of extreme environments; high levels of ruled-based living; high levels of engaging with informal/local level support. Conclusions: Several experiential statements aligned with existing literature, including having poor mental health literacy and problem recognition, and heavily utilising social support versus formal help-seeking. Some novel findings included bouncing between extreme positive and negative environments which could be as detrimental to mental health as experiencing conflict trauma. Heavy alcohol use was just another rule soldiers followed. Positive help-seeking experiences failed to improve poor opinions of support organisations. Finally, poor self-perceptions connected to military status are pertinent in NI, which seems to fuel self-marginalisation and distrust. A combination of factors likely contributes to many veterans living in NI having poorer mental well-being. Novel findings would benefit from further exploration as understanding how NI veterans interpret their experiences is key to providing adequate healthcare. [ABSTRACT FROM AUTHOR]

Background: Late-onset multiple sclerosis (LOMS), defined as the development of MS after the age of 50, has shown a substantial surge in incidence rates and is associated with more rapid progression of disability. Besides, studies have linked tobacco smoking to a higher chance of MS progression. However, the role of smoking on the risk of developing LOMS remains unclear. This study aims to evaluate the possible association between lifetime exposure to cigarette and waterpipe smoking, drug abuse, and alcohol consumption and the risk of LOMS. Methods: This population-based case-control study involved LOMS cases and healthy sex and age-matched controls from the general population in Tehran, Iran. The primary data for confirmed LOMS cases were obtained from the nationwide MS registry of Iran (NMSRI), while supplementary data were collected through telephone and on-site interviews. Predesigned questionnaire for multinational case-control studies of MS environmental risk factors was used to evaluate the LOMS risk factors. The study employed Likelihood ratio chi-square test to compare qualitative variables between the two groups and utilized two independent sample t-test to compare quantitative data. Adjusted odds ratio (AOR) for age along with 95% confidence intervals (CI) were calculated using matched logistic regression analysis in SPSS 23. Results: Totally, 83 LOMS cases and 207 controls were included in the analysis. The female to male ratio in the cases was 1.5: 1. The mean ± SD age of 83 cases and 207 controls was 61.14 ± 5.38) and 61.51 ± 7.67 years, respectively. The mean ± SD expanded disability status scale (EDSS) score was 3.68 ± 2.1. Although the results of waterpipe exposure had no significant effect on LOMS development (P-value: 0.066), ever cigarette-smoked participants had a significantly higher risk of developing LOMS than those who never smoked (AOR: 2.57, 95% CI: 1.44–4.60). Furthermore, people with a history of smoking for more than 20 years had 3.45 times the odds of developing MS than non-smokers. Drug and alcohol abuse were both associated with LOMS in our study; of which opioids (AOR: 5.67, 95% CI: 2.05–15.7), wine (AOR: 3.30, 95% CI: 1.41–7.71), and beer (AOR: 3.12, 95% CI: 1.45–6.69) were found to pose the greatest risk of LOMS, respectively. Conclusion: For the first time, we identified smoking, drug, and alcohol use as potential risk factors for LOMS development. According to the global increase in cigarette smoking and alcohol use, these findings highlight the importance of conducting interventional approaches for prevention. [ABSTRACT FROM AUTHOR]

Background: Unhealthy alcohol use represents a significant risk for morbidity and mortality among people living with HIV (PLWH), in part through its impact on HIV management. Chronic pain, a common comorbidity, exacerbates suboptimal engagement in the HIV care continuum and has reciprocal detrimental effects on alcohol outcomes. There are no integrated, accessible approaches that address these comorbid conditions among PLWH to date. This paper describes a research study protocol of an integrated telehealth intervention to reduce unhealthy drinking and chronic pain among PLWH (Motivational and Cognitive-Behavioral Management for Alcohol and Pain [INTV]). Methods: Two-hundred and fifty PLWH with unhealthy drinking and chronic pain will be recruited nationally via online advertisement. Informed consent and baseline assessments occur remotely, followed by 15 days of ecological momentary assessment to assess alcohol use, chronic pain, functioning, and mechanisms of behavior change. Next, participants will be randomized to either the INTV or Control (CTL) condition. Individuals in both conditions will meet with a health counselor through videoconferencing following randomization, and those in the INTV condition will receive 6 additional sessions. At 3- and 6-months post-baseline, participants will complete outcome assessments. It is hypothesized that the INTV condition will result in reduced unhealthy alcohol use and pain ratings compared to the CTL condition. Conclusion: This protocol paper describes a randomized controlled trial which tests the efficacy of a novel, integrated telehealth approach to reduce unhealthy alcohol use and chronic pain for PLWH, two common comorbid conditions that influence the HIV treatment cascade. ClinicalTrials.gov identifier: NCT05503173. Highlights: Unhealthy alcohol use and chronic pain are common in people living with HIV. An integrated telehealth intervention may improve alcohol, pain, and HIV outcomes. Ecological momentary assessment will examine processes underlying behavior change. [ABSTRACT FROM AUTHOR]

Background and Aims Participants Measurements Findings Conclusion Heavy episodic drinking (HED) trends have not been comprehensively examined in Canada. We measured age, period and birth cohort trends in HED in Canada by sex/gender and socioeconomic position.Design and setting.We analyzed repeat cross‐sectional data from the 10 provinces in the Canadian Community Health Surveys from 2000 to 2021 using hierarchical cross‐classified random effects logistic regression.1 167 831 respondents aged 12+ .HED was defined as 4+ standard drinks for women or 5+ for men at least monthly in the past 12 months. Socioeconomic position was measured using household income and education.We observed steeper HED decreases in young adult men (aged 18–29) than women (by 14.4% and 8.7%, respectively, from 2015 to 2021) and HED increases in middle adult women (ages 50–64) (by 8.0% from 2000 to 2014). Sex/gender‐specific age‐period‐cohort models revealed strong age and birth cohort effects. In women and men, respectively, HED peaked in young adulthood (18.2% and 33.8%) and decreased with age, and HED was greatest in the 1980–1989 cohort (20.7% and 35.8%) and decreased in the most recent cohort born in 1990–2009 (15.6% and 19.8%), particularly in men. Higher household incomes had greater HED across age, periods and cohorts, while trends varied by education. Compared with lower education groups, people with a bachelor's degree or above had the lowest HED in middle adulthood. People with a bachelor's degree or above had low HED in earlier cohorts, which converged with other education groups in recent cohorts due to a pronounced HED increase, particularly in women.The sex/gender gap in heavy episodic drinking (HED) appears to be converging in Canada: current young adult men are reducing HED, while high‐risk cohorts of women are aging into middle adulthood with greater HED. Recent birth cohorts with a bachelor's degree or above experienced pronounced HED increases, which among women suggests greater educational attainment contributes to the converging gender gap in HED. [ABSTRACT FROM AUTHOR]

Background: Unhealthy alcohol use is a common public health problem in HIV care settings in Africa and it affects the HIV continuum of care. In Uganda and other low-income countries, HIV care providers are a key resource in caring for young people (15–24 years) living with HIV (YPLH) with unhealthy alcohol use. Caring for YPLH largely depends on care providers' perceptions of the problem. However, data that explores HIV care providers' perceptions about caring for YPLH with unhealthy drinking are lacking in Uganda. We sought to describe the perceptions of HIV care providers regarding caring for YPLH with unhealthy drinking in the Immune Suppression Syndrome (ISS) Clinic of Mbarara Regional Referral Hospital in southwestern Uganda. Methods: We used semi-structured in-depth interviews (IDIs) to qualitatively explore HIV care providers' perceptions regarding caring for YPLH with unhealthy alcohol use. The study was conducted at the adolescent immunosuppression (ISS) clinic of Mbarara Regional Referral Hospital. Interviews were tape-recorded and transcribed verbatim. Using thematic content analysis, data from 10 interviews were analyzed. Results: HIV care providers were concerned and intended to care for YPLH with unhealthy alcohol use. They understood that unhealthy drinking negatively impacts HIV care outcomes and used counseling, peer support, and referrals to routinely intervene. They however, did not apply other known interventions such as health education, medications and follow-up visits because these required family and institutional support which was largely lacking. Additional barriers that HCPs faced in caring for YPLH included; gaps in knowledge and skills required to address alcohol use in young patients, heavy workloads that hindered the provision of psychosocial interventions, late payment of and low remunerations, lack of improvement in some YPLH, and inadequate support from both their families and hospital management. Conclusion: HIV care providers are important stakeholders in the identification and care of YPLH with unhealthy alcohol use in Southwestern Uganda. There is a need to train and skill HCPs in unhealthy alcohol use care. Such training ought to target the attitudes, subjective norms, and perceived control of the providers. [ABSTRACT FROM AUTHOR]

A study was conducted to investigate the potential protective effects of Bacopa monnieri extract on alcohol-induced toxicity in rats, focusing on its hypolipidemic and cardioprotective properties. For a period of 30 days, the experimental rats were orally intoxicated with alcohol (2 g/kg body weight) daily. Simultaneously, Bacopa monnieri extract was administered at a dose of 200 mg/kg body weight. The results of the study revealed that the rats subjected to alcohol-induced toxicity experienced a significant reduction in antioxidant defense systems, such as reduced glutathione (GSH) and ascorbic acid, while the activity of glutathione-S-transferase was enhanced compared to the control group. Additionally, the alcoholinduced group exhibited increased levels of triglycerides (TG) and total cholesterol (TC), as well as a significant decrease in phospholipids (PL). However, when Bacopa monnieri was supplemented along with alcohol, it significantly improved the antioxidant status and normalized the lipid profiles. These findings suggest that Bacopa monnieri possesses cardioprotective and hypolipidemic activities, which provide protection against alcohol-induced toxicity [ABSTRACT FROM AUTHOR]

Blood–brain barrier (BBB) injury and dysfunction following infection with the human immunodeficiency virus (HIV) enables viral entry into the brain, infection of resident brain cells, neuronal injury and subsequent neurodegeneration leading to HIV-associated neurocognitive disorders (HAND). Although combination antiretroviral therapy has significantly reduced the incidence and prevalence of acquired immunodeficiency syndrome and increased the life expectancy of people living with HIV, the prevalence of HAND remains high. With aging of people living with HIV associated with increased comorbidities, the prevalence of HIV-related central nervous system (CNS) complications is expected to remain high. Considering the principal role of the brain endothelium in HIV infection of the CNS and HAND, the purpose of this manuscript is to review the current literature on the pathobiology of the brain endothelium structural and functional dysregulation in HIV infection, including in the presence of HIV-1 and viral proteins (gp120, Tat, Nef, and Vpr). We summarize evidence from human and animal studies, in vitro studies, and associated mechanisms. We further summarize evidence of synergy or lack thereof between commonly abused substances (cocaine, methamphetamine, alcohol, tobacco, opioids, and cannabinoids) and HIV- or viral protein-induced BBB injury and dysfunction. [ABSTRACT FROM AUTHOR]

Introduction: To assesses the alcohol‐related burden of child maltreatment among Māori in Aotearoa New Zealand. We compared the risk of child maltreatment among Māori (0–17 years) exposed to parents with alcohol‐related hospitalisation or mental health/addiction service use. We also conducted a sensitivity analysis to estimate the number of cases of maltreatment that could be attributed to alcohol among Māori. Methods: A cohort study of 16,617 Māori aged 0–17 and their parents from 2000 to 2017 was conducted using the Statistics New Zealand Integrated Data Infrastructure. A Bayesian piecewise exponential model estimated the risk of time to first child maltreatment event. This analysis used data from child protection, hospital, mortality and police records, and specifically focused on the risk associated with exposure to parents with an alcohol‐attributable hospitalisation or mental health/addiction service use event. Potential confounders for both parents and Māori (0–17 years) were included. We calculated a population‐attributable fraction to estimate the proportion of maltreatment cases that could be attributed to alcohol in 2017. Results: Results showed a 65% increased risk for young Māori exposed to parents with heavy alcohol use. We estimated 17% of substantiated child maltreatment among Māori could be attributed to parental hazardous alcohol consumption. Discussion and Conclusions: Severe or hazardous alcohol consumption among parents is a risk factor for child maltreatment among Māori. Māori alcohol consumption and harm are symptomatic of wider inequities related, among other things, to the ongoing effects of colonisation, as well as gaps in the regulation of alcohol sales. [ABSTRACT FROM AUTHOR]

Introduction: Alcohol‐free drinks are suggested as healthy alternatives for alcohol consumption. To achieve benefits, alcohol‐free beverages must be consumed as a substitute for alcoholic beverages, not in addition. This study examined in a student sample (i) the frequency/quantity of alcohol(‐free) consumption; (ii) the relationship between alcohol‐free and alcohol consumption; (iii) alcohol‐free drinks as substitution or in addition to alcoholic drinks; and (iv) possible gender differences. Methods: Survey data regarding alcohol(‐free) consumption (May–June 2022) of Dutch university students (N = 4.318, females 70.2%; males 28.5%, average age 22.6 years [SD = 2.4]). Results: (i) A total of 42.8% of the students indicated they had never consumed alcohol‐free versus 10.1% who never consumed alcoholic beverages; (ii) the group who recently consumed alcohol‐free also most often recently consumed alcoholic beverages (42.7%). The group that had never consumed alcohol‐free drank on average more alcoholic beverages (M = 3.98 on a drinking day) compared to past and recent alcohol‐free drinkers (respectively, M = 3.44 and M = 3.59). (iii) Most students (54.9%) reported drinking alcohol‐free beverages in addition to alcohol, 17.4% indicated using it as a substitution. Students who consumed alcohol‐free as 'substitution' were older, more often living alone or with a partner, less often living with parents and more often involved in a steady relationship compared to students who consumed in 'addition'. (iv) No prominent gender differences were found. Discussion and Conclusions: The majority of students remained consuming the same number of alcoholic beverages since they started consuming alcohol‐free beverages, pointing to an addition effect. A small group did use alcohol‐free beverages as a substitute for their alcohol consumption. [ABSTRACT FROM AUTHOR]

Introduction: Alcohol's harm to others (AHTO) refers to harms caused to those other than the drinker. The current paper estimates the prevalence of formal and informal supports sought due to AHTO and examines whether the type of support accessed varies by sociodemographic, economic and harm‐related characteristics. Methods: An Australian sample of 2574 people completed the 2021 AHTO survey, out of which 888 perceived they experienced harm from another's drinking. Prevalence of accessing services and supports was measured. Additionally, several sociodemographic factors, economic factors and harm‐related factors were included in multivariable logistic regression models predicting service/support use. Specifically, four models were constructed probing use of any service/support, use of police, use of counselling services and use of family/friend support. Results: Of the survey sample, 12.4% accessed any support/service. Seeking support from family and/or friends was most common, followed by police, counselling, healthcare services and being admitted to hospital. Women had higher odds of accessing counselling and family/friend support. Respondents with a higher education level and two or more financial stressors had higher odds of accessing police and counselling. Respondents harmed by a stranger had higher odds of accessing police, whereas respondents harmed by someone they know had higher odds of seeking support from family/friends. Experiencing more severe harm was associated with greater odds of accessing any support. Discussion and Conclusions: Several sociodemographic and economic factors were associated with accessing different supports. These findings may inform service development, interventions and policy changes for people affected by others' drinking. [ABSTRACT FROM AUTHOR]

Introduction: Due to the widespread use of social media by young adults, the alcohol industry has been increasingly using social media marketing (SMM) to target potential customers. This study examines the prevalence and factors associated with past‐month exposure to alcohol SMM among young Chinese adults, a group with rapidly increasing uptake of alcohol consumption. Methods: An anonymous, random telephone survey was conducted between June and August 2021 on Hong Kong Chinese residents between 18 and 34 years old (n = 675). Results: Of respondents, 52.3% reported past‐month exposure to alcohol SMM (68.6% of past‐month drinkers and 48.0% of non‐past‐month drinkers, p < 0.05) while 71.6% reported exposure to non‐SMM alcohol marketing. Direct alcohol SMM exposure was reported by 40.9% (e.g., business‐to‐consumer postings, alcohol banner ads) while 27.4% of respondents reported exposure to indirect alcohol SMM marketing (e.g., shared/'liked' alcohol brand posts). Of those exposed to alcohol SMM, 13.7–15.5% reported that the various forms indirect alcohol SMM influenced them to drink more (vs. 6.2–8.9% for direct alcohol SMM). Being male, lower‐income, university educated and spirits/cocktail drinker were independently associated with exposure to direct alcohol SMM (ORmv 1.71–3.14). Past‐month exposure to indirect alcohol SMM was independently associated with lower income, not working full‐time and drinking any type of alcohol (ORmv 1.59–4.44). Discussion and Conclusion: The comparative effectiveness of indirect SMM on influencing young adults drinking intentions may be a form of peer endorsement of drinking. The pervasiveness of alcohol SMM and lack of alcohol SMM policies may indicate the need for greater alcohol marketing regulation in this region. [ABSTRACT FROM AUTHOR]

Introduction: There is growing concern over the lack of regulation of alcohol advertisements on social media platforms frequented by youths. This study aims to build upon existing literature by assessing the frequency with which young Australians (17–25) are shown advertisements promoting alcohol use and the themes utilised in these advertisements. Methods: A total of 125 Australian youths (mean age 18.74 years; 74.40% female) were recruited in exchange for course credit to participate in an online study. Participants scrolled through Facebook or Instagram for a period of 30 min and screenshotted any alcohol advertisements encountered. Participants then identified the advertisement qualities (or 'themes') present in the advertisements, based on pre‐identified categories. Demographic, social media usage and historical personal, peer or familial substance use behaviour data was also collected. Results: Seventy‐one university students were exposed to 796 alcohol advertisements across both platforms, and they encountered an advertisement every 2 min and 43 s on average. Most advertisements included call to action features on both Facebook (78.80%) and Instagram (71.17%). Advertisements relating to ease of access (promoting subscription/home delivery; 41.72% and 42.56%) and sales incentives (special offers, promotions, samples or bonuses with purchase; 43.70% and 46.84%) were most common across both platforms. Discussion and Conclusions: Alcohol advertisements are highly prevalent online, particularly among Australian youth social media users. Future research should endeavour to identify whether temporal use of alcohol is a predictor of subsequent exposure to alcohol advertising on social media, and whether this exposure is likely to increase successive alcohol use behaviours. [ABSTRACT FROM AUTHOR]

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

Introduction: To evaluate use and utility of the Fetal Alcohol Spectrum Disorder (FASD) Hub Australia website. Methods: Online REDCap user survey incorporating the Website Evaluation Questionnaire, open ended questions, Google metrics data and an accessibility audit. Results: Seventy‐six participants: researchers (32%), health professionals (29%) and policymakers/advocates (16%) completed the survey. Most were from Australia (95%) and were likely or very likely to recommend the FASD Hub to colleagues (92%), friends (74%) and patients (72%). The mean Website Evaluation Questionnaire score was at least 3.45/5 for all dimensions (ease of use, hyperlinks, structure, relevance, comprehension, completeness, layout, search option); range 3.45 (search option) to 4.04 (relevance). Participants found the content trustworthy (92%) but wanted more information for, and to support, Aboriginal and Torres Strait Islander peoples, and improved search capacity. Google metrics identified 25,534 unique users over 6 months (82% new users); 83% aged 18–44 years, 72% female and 35% international. Conclusions: Users found the FASD Hub accessible, authoritative and useful and suggested improvements. [ABSTRACT FROM AUTHOR]

Introduction: Alcohol consumption is associated with unintended pregnancies among teenagers. Its role as a broader determinant of teenage fertility rates remains unclear. We investigate whether adolescent binge drinking affects the number of teenage births. Methods: Binge drinking data from 137,898 females aged 15–16 were collected in the HBSC study (2002–2018, 43 countries/regions) and 267,359 in the ESPAD study (1995–2019, 41 countries/regions). Age‐specific fertility rates were from the Human Fertility Database and the World Health Organization. We examined changes over time in countries' average levels of binge drinking among female pupils aged 15–16 and population‐level fertility rates for the same cohorts when aged 16–19 years. Results: Controlling for differences between countries and survey waves, we found an association between binge drinking and fertility rate, B = 0.019, 95% confidence interval [0.004, 0.034]. When accounting for the countries' time trends, the association was substantially reduced, B = 0.006, 95% confidence interval [−0.0062, 0.0174]. The relationship was not moderated by abortion rates and controlling for contraceptive use had no impact on the findings. Discussion and Conclusions: The association between adolescent binge drinking and fertility rates diminishes when accounting for country‐specific time trends. Given the lack of clear mechanisms linking binge drinking to trends in fertility rates rather than shorter‐term changes, the association likely reflects broader secular trends. Binge drinking may be involved in teen pregnancy and childbirth in individual cases but it does not explain recent developments in teenage fertility rates. [ABSTRACT FROM AUTHOR]

Introduction: Despite vulnerability to alcohol‐related harms, women have historically been under‐represented in alcohol research. This study examined the prevalence and characteristics of women who drink at very high‐risk levels (11+ standard drinks monthly), factors associated with this consumption and comparisons with men. Methods: Secondary analyses of 2019 National Drug Strategy Household Survey data were undertaken. Significant differences by sex in the distribution of demographic and alcohol‐related variables were explored using chi‐squared and Mann–Whitney U tests. Binary logistic regression examined factors associated with very high‐risk drinking. Results: Very high‐risk drinking was reported by 10.4% of men and 3.1% of women. Compared to men, women were significantly younger with higher levels of psychological distress/mental health conditions, and were more likely to be unmarried. Both women and men engaged in a range of harm‐minimisation strategies. Odds of very high‐risk drinking were significantly higher for respondents who were male, younger, employed, lived in a regional/rural/remote area, psychologically distressed, smoked and used illicit drugs. Interactions with sex indicated that very high‐risk drinking declined after the age of 24 for men compared to 44 for women. Being married reduced the likelihood of very high‐risk drinking more greatly among women compared to men, while living in a major city reduced the likelihood among men (and not women). Discussion and Conclusions: Very high‐risk drinking is not limited to Australian men, and the women who drink at these levels have distinct profiles and factors associated with consumption. [ABSTRACT FROM AUTHOR]

Background and aims: Previously identified national drinking patterns in Europe lack comparability and might be no longer be valid due to changes in economic conditions and policy frameworks. We aimed to identify the most recent alcohol drinking patterns in Europe based on comparable alcohol exposure indicators using a data‐driven approach, as well as identifying temporal changes and establishing empirical links between these patterns and indicators of alcohol‐related harm. Design: Data from the World Health Organization's monitoring system on alcohol exposure indicators were used. Repeated cross‐sectional hierarchical cluster analyses were applied. Differences in alcohol‐attributable harm between clusters of countries were analyzed via linear regression. Setting: European Union countries, plus Iceland, Norway and Ukraine, for 2000, 2010, 2015 and 2019. Participants/Cases: Observations consisted of annual country data, at four different time points for alcohol exposure. Harm indicators were only included for 2019. Measurements Alcohol exposure indicators included alcohol per capita consumption (APC), beverage‐specific consumption and prevalence of drinking status indicators (lifetime abstainers, current drinkers, former drinkers and heavy episodic drinking). Alcohol‐attributable harm was measured using age‐standardized alcohol‐attributable Disability‐Adjusted Life Years (DALYs) lost and deaths per 100 000 people. Findings The same six clusters were identified in 2019, 2015 and 2010, mainly characterized by type of alcoholic beverage and prevalence drinking status indicators, with geographical interpretation. Two‐thirds of the countries remained in the same cluster over time, with one additional cluster identified in 2000, characterized by low APC. The most recent drinking patterns were shown to be significantly associated with alcohol‐attributable deaths and DALY rates. Compared with wine‐drinking countries, the mortality rate per 100 000 people was significantly higher in Eastern Europe with high spirits and 'other' beverage consumption [ β^ = 90, 95% confidence interval (CI) = 55–126], and in Eastern Europe with high lifetime abstainers and high spirits consumption (β^ = 42, 95% CI = 4–78). Conclusions: European drinking patterns appear to be clustered by level of beverage‐specific consumption, with heavy episodic drinkers, current drinkers and lifetime abstainers being distinguishing factors between clusters. Despite the overall stability of the clusters over time, some countries shifted between drinking patterns from 2000 to 2019. Overall, patterns of drinking in the European Union seem to be stable and partly determined by geographical proximity. [ABSTRACT FROM AUTHOR]

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

Background and aims: Population‐level alcohol use data are available from high‐income countries, but limited research has been conducted in sub‐Saharan Africa. This systematic review and meta‐analysis aimed to summarize population‐level alcohol use in sub‐Saharan Africa. Method: Databases searched included PubMed, EMBASE, PsycINFO and AJOL, without language restrictions. Searches were also conducted in the Global Health Data Exchange (GHDx) and Google Scholar. Search terms encompassed 'substance' or 'substance‐related disorders' and 'prevalence' and 'sub‐Saharan Africa'. We included general population studies on alcohol use (including any use, high‐risk alcohol use and alcohol use disorders) from 2018 onwards. Prevalence data for alcohol use among sub‐Saharan African adolescents (10–17) and adults (18+) were extracted. Analyses included life‐time and past 12‐ and 6‐month alcohol use. Results: We included 141 papers. Among adolescents, the life‐time prevalence of alcohol use was 23.3% [95% confidence interval (CI) = 11.3–37.1%], 36.2% (CI = 18.4–56.1%) in the past year and 11.3% (CI = 4.5–20.4%) in the past 6 months. Among adolescents, 12‐month prevalence of alcohol use disorder and alcohol dependence were 7.7% (CI = 0.0–27.8%) and 4.1% (CI = 1.4–7.9%), respectively. Among adults, the life‐time prevalence of alcohol use was 34.9% (CI = 17.7–54.1%), 27.1% (CI = 5.0–56.4%) in the past year and 32.2% (CI = 19.8–46.0%) in the past 6 months. Among adults, the 12‐month prevalence of alcohol use disorder and alcohol dependence were 9.5% (CI = 0.0–30.4%) and 4.3% (CI = 0.8–9.8%), respectively. The highest weighted life‐time prevalence of alcohol use, 86.4%, was reported in Tanzania among adults. The highest weighted past 6‐month prevalence of alcohol use, 80.6%, was found in Zambia among adolescents. Conclusion: Alcohol use patterns vary across countries and subregions within sub‐Saharan Africa, and comprehensive population‐level data on alcohol use remain scarce in numerous sub‐Saharan African countries. The prevalence of alcohol use disorder is common among adolescents in sub‐Saharan Africa. [ABSTRACT FROM AUTHOR]

Background and aims: Multiple countries are considering revising cannabis policies. This study aimed to measure long‐term trends in cannabis use in the United States and compare them with alcohol use. Design and setting: Secondary analysis of United States general population survey data. Participants: The national surveys had a total of 1 641 041 participants across 27 surveys from 1979 to 2022. Measurements: Rates of use reported to the US National Survey on Drug Use and Health and its predecessors are described, as are trends in days of use reported. Four milepost years are contrasted: 1979 (first available data and end of relatively liberal policies of the 1970s), 1992 (end of 12 years of conservative Reagan‐Bush era policies), 2008 (last year before the Justice Department signaled explicit federal non‐interference with state‐level legalizations) and 2022 (most recent data available). Findings Reported cannabis use declined to a nadir in 1992, with partial recovery through 2008, and substantial increases since then, particularly for measures of more intensive use. Between 2008 and 2022, the per capita rate of reporting past‐year use increased by 120%, and days of use reported per capita increased by 218% (in absolute terms from the annual equivalent of 2.3 to 8.1 billion days per year). From 1992 to 2022, there was a 15‐fold increase in the per capita rate of reporting daily or near daily use. Whereas the 1992 survey recorded 10 times as many daily or near daily alcohol as cannabis users (8.9 vs. 0.9 M), the 2022 survey, for the first time, recorded more daily and near daily users of cannabis than alcohol (17.7 vs. 14.7 M). Far more people drink, but high‐frequency drinking is less common. In 2022, the median drinker reported drinking on 4–5 days in the past month, versus 15–16 days in the past month for cannabis. In 2022, past‐month cannabis consumers were almost four times as likely to report daily or near daily use (42.3% vs. 10.9%) and 7.4 times more likely to report daily use (28.2% vs. 3.8%). Conclusions: Long‐term trends in cannabis use in the United States parallel corresponding changes in cannabis policy, with declines during periods of greater restriction and growth during periods of policy liberalization. A growing share of cannabis consumers report daily or near daily use, and their numbers now exceed the number of daily and near daily drinkers. [ABSTRACT FROM AUTHOR]

Background and aims: Alcohol use and anxiety often co‐occur, causing increased severity impairment. This protocol describes a randomized controlled trial (RCT) that aims to test the efficacy and cost‐effectiveness of a web‐based, self‐guided alcohol and anxiety‐focused program, compared with a web‐based brief alcohol‐focused program, for young adults who drink at hazardous levels and experience anxiety. It will also test moderators and mechanisms of change underlying the intervention effects. Design: This RCT will be conducted with a 1:1 parallel group. Setting: The study will be a web‐based trial in Australia. Participants: Individuals aged 17–30 years who drink alcohol at hazardous or greater levels and experience at least mild anxiety (n = 500) will be recruited through social media, media (TV, print) and community networks. Intervention and comparator: Participants will be randomly allocated to receive a web‐based, integrated alcohol‐anxiety program plus technical and motivational telephone/e‐mail support (intervention) or a web‐based brief alcohol‐feedback program (control). Measurements Clinical measures will be assessed at baseline, post‐intervention (2 months), 6 months (primary end‐point), 12 months and 18 months. Co‐primary outcomes are hazardous alcohol consumption and anxiety symptom severity. Secondary outcomes are binge‐drinking frequency; alcohol‐related consequences; depression symptoms; clinical diagnoses of alcohol use or anxiety disorder (at 6 months post‐intervention), health‐care service use, educational and employment outcomes; and quality of life. Mediators and moderators will also be assessed. Efficacy will be tested using mixed models for repeated measures within an intention‐to‐treat framework. The economic evaluation will analyze individual‐level health and societal costs and outcomes of participants between each trial arm, while mediation models will test for mechanisms of change. Comments This will be the first trial to test whether a developmentally targeted, web‐based, integrated alcohol‐anxiety intervention is effective in reducing hazardous alcohol use and anxiety severity among young adults. If successful, the integrated alcohol‐anxiety program will provide an accessible intervention that can be widely disseminated to improve wellbeing of young adults, at minimal cost. [ABSTRACT FROM AUTHOR]

• Avoidance/rumination predicted poorer health outcomes among people living with HIV. • Findings over time were significant after accounting for depression severity. • Avoidance/rumination may be a useful treatment target. Pain, substance use, and mental health conditions are common among people living with HIV (PLWH), and avoidance and rumination may influence the co-occurrence of these conditions. The present study examined longitudinal associations between avoidance/rumination and pain outcomes, anxiety, anger, and substance use among PLWH. Participants (N = 187) with chronic pain and depressive symptoms completed self-report assessments over a 1-year period. Greater avoidance/rumination was positively associated with mental health outcomes (anxiety, anger), pain interference, and alcohol use across participants after controlling for depression severity. At time points with greater avoidance/rumination than average, participants also reported increased pain severity and interference, anxiety and anger symptoms, and alcohol use. No associations were found between avoidance/rumination and cannabis use. Results suggest a mechanistic effect of avoidance/rumination, such that increases in avoidance/rumination correspond with poorer health outcomes among PLWH over time. Targeting avoidance/rumination through intervention approaches may be beneficial for addressing comorbid health conditions among PLWH. Additional research is necessary to investigate this possibility and further characterize the effects of avoidance/rumination on health outcomes for PLWH. [ABSTRACT FROM AUTHOR]

Early adolescent alcohol use is associated with adverse developmental and health outcomes. Parental knowledge can prevent or delay substance use, while youth behaviors may concurrently influence parenting. More research is needed to examine the role of youth's perceptions of legitimacy of parental authority. This multi‐informant study examined prospective bidirectional effects between parental knowledge and child disclosure alongside youth‐reported alcohol use and perceived legitimacy of parental authority. Data were analyzed across three waves in a community sample of 304 mother–child dyads. A cross‐lagged panel model was estimated using repeated measures of adolescent alcohol use, perceived legitimacy of parental authority, parental knowledge, and child disclosure. Positive reciprocal associations were found in early adolescence between child disclosure and both parental knowledge and perceived legitimacy of parental authority. Legitimacy of parental authority negatively predicted alcohol use across adolescence. Child alcohol use also negatively predicted parental knowledge among mothers in later adolescence. Effects were not reciprocated nor sustained. Novel findings demonstrate that the parental legitimacy beliefs predict reduced alcohol use and have a reciprocal association with child disclosure. Clinical implications to mitigate youth alcohol use initiation, by enhancing parental self‐efficacy and positive parenting, are discussed. [ABSTRACT FROM AUTHOR]

• Low dose ondansetron (AD04) notably decreased heavy drinking days among individuals with alcohol use disorder and a specific genetic profile. • This genotypic profile is in the serotonin transporter and serotonin-3AB receptor complex. • AD04′s adverse events match those of a placebo. • Combining AD04 with psychological intervention will improve access to and acceptance of modern AUD treatment. • These findings are an important advance in the field of precision medicine. Alcohol use disorder (AUD) is among the leading causes of morbidity and mortality worldwide, and over 95 million people live with alcohol dependence globally. The estimated heritability of AUD is 50–60 %, and multiple genes are thought to contribute to various endophenotypes of the disease. Previous clinical trials support a precision medicine approach using ondansetron (AD04, a 5-HT3 antagonist) by segregating AUD populations by the bio-genetic endophenotype of specific serotonergic genotypes and the bio-psychosocial endophenotype of the severity of drinking or both. By targeting the modulation of biogenetic signaling within the biopsychosocial context of AUD, low-dose AD04 holds promise in reducing alcohol consumption among affected individuals while minimizing adverse effects. This was a phase III, 6-month, 25-site, randomized, placebo-controlled clinical trial using AD04 to treat DSM-V–categorized AUD individuals who were pre-stratified into the endophenotypes of heavy or very heavy drinking individuals and possessed a pre-defined profile of genetic variants related to the serotonin transporter and serotonin-3AB receptor. Participants (N = 303) presented moderate to severe AUD, >80 % were men, mostly in their fifties, and >95 % were of European descent. Low-dose AD04 (approx. 033 mg twice daily) or a matching placebo was administered twice daily for 6 months. Brief Behavioral Compliance Enhancement Treatment (BBCET [ 53 ]) was administered every two weeks to enhance medication compliance and clinic attendance. There was a significant reduction in the monthly percentage of heavy drinking days, PHDD (-46·7 % (2·7 %), 95 %CI: -52·1 % to -41·2 % vs. -38·1 % (2·9 %), 95 %CI: -43·8 % to -32·5 %, respectively; LS mean difference=-8·5 %; p = 0.03) among AD04-treated vs. placebo-receiving heavy drinking individuals at month 6. Heavy drinking individuals were also less likely to be diagnosed with AUD [Month 1: -32·0 % (2·8 %), 95 %CI: -37·5 % to -26·5 % vs. -23·2 % (2·9 %), 95 %CI: -28·9 to -17·5 %; LS mean difference= -8·8 %; p = 0·026)], and improved on the WHO quality of life BREF scale with a significant effect for at least a 1-level downward shift (OR = 3.4; 95 % CI: 1·03–11·45, p = 0·044). Importantly, heavy drinking individuals, as distinct from very heavy drinking individuals, were the bio-psychosocial endophenotype more predictive of therapeutic response to AD04. AD04 had an exceptional safety and tolerability profile, like the placebo's. In this Phase 3 clinical trial, AD04 was shown to be a promising treatment for currently drinking heavy drinking individuals with AUD who also possess a specific genotypic profile in the serotonin transporter and serotonin-3AB receptor complex. Using AD04 to reduce the harm of AUD in heavy drinking individuals who are currently drinking, without the necessity of abstinence or detoxification from alcohol use, is an important advance in the field of precision medicine. AD04's adverse events profile, which was like placebo, should enhance accessibility and acceptance of modern medical treatment for AUD by lowering the incorrect but commonly perceived stigma of personal failure. [Display omitted] [ABSTRACT FROM AUTHOR]

While young people's alcohol consumption has fallen sharply in the United Kingdom and other high-income countries, universities remain places where heavy drinking is routine and normative. Drawing on interviews with undergraduate students, this article explores how heavy drinking is part of how students negotiate a sense of belonging and form personal relationships. Theoretical work on belonging and relationality is used to make sense of students' encounters with alcohol. Consistent with the decline in youth drinking, several interviewees had limited experience of heavy drinking prior to university, and some were not interested in taking it up. After describing how heavy drinking facilitates belonging in certain spaces of student life, we examine the strategies of non- and low-drinking students in navigating these spaces. Attending to their strategies suggests that becoming known as 'social persons' is key to negotiating belonging without drinking heavily. We conclude by considering how universities might better accommodate the desire for belonging for the increasingly large proportion of students with limited experience of or desire for alcohol by creating opportunities for students to form personal relationships in ways that do not involve alcohol or where alcohol is peripheral to the activity. [ABSTRACT FROM AUTHOR]

Background: Sociosexuality—attitudes, behaviors, and desires related to casual sex—partly predicts drinking behavior in both men and women because drinking is thought to facilitate interactions that lead to casual sex. It follows that sociosexuality would predict drinking intake (e.g., quantity consumed)—but perhaps not drinking consequences (e.g., blacking out)—on the premise that drinking large quantities with high frequency (but not to such high degrees/levels of intoxication that negative consequences occur) would facilitate casual sex. Objectives: This set of studies evaluated whether baseline measures of sociosexuality predict drinking intake (i.e., frequency, quantity, and binge drinking) but not experiencing blacking out at follow-up in two samples (Study 1, N = 172; Study 2, N = 1,038) of college-aged men. Results: As predicted, men's sociosexuality prospectively predicted drinking frequency, quantity, and binge drinking. Contrary to our predictions, men's sociosexuality also predicted blacking out. Conclusions: College men's drinking interventions should be tailored to high-risk groups and consider individual differences like sociosexuality. [ABSTRACT FROM AUTHOR]

Background & Aims: The benefits of prophylactic antibiotics in patients with alcohol‐associated hepatitis (AH) receiving steroids remain unclear. We aimed to assess the clinical impact of prophylactic antibiotics in AH patients receiving steroids. Methods: We systematically reviewed four electronic databases from inception to 30 November 2023. Pooled estimates were analysed using random‐effects models. The primary outcome was 90‐day survival. Secondary outcomes included infection at days 30 and 90 days, hepatorenal syndrome (HRS), acute kidney injury (AKI), hepatic encephalopathy (HE) and drug‐related adverse events (AE). Trial sequential analyses were performed for the primary outcome of 90‐day mortality. Results: We screened 419 articles and included six eligible studies (four RCTs and two matched cohort studies) with a total of 510 patients. Compared to standard medical treatment (SMT), prophylactic antibiotics were associated with a lower risk of infection at 30 days (OR: 0.35, 95%CI: 0.20–0.59, I2 = 0%), infection at 90 days (OR: 0.26, 95%CI: 0.10–0.67, I2 = 0%) and a lower rate of HE (OR: 0.32, 95%CI: 0.12–0.87, I2 = 0%). However, prophylactic antibiotics did not improve 90‐day survival, sepsis‐related mortality, HRS, or AKI. The risks of drug‐related AE and fungal infections were similar in patients with AH who received prophylactic antibiotics or SMT. Using trial sequential analysis, the minimum sample size required to detect a 15% relative risk reduction in 90 days mortality with prophylactic antibiotics was 1171. Conclusions: In hospitalized AH patients receiving steroid therapy, prophylactic antibiotics reduced the risk of infection and HE, but did not improve survival or prevent AKI compared to SMT. [ABSTRACT FROM AUTHOR]

Non-drinkers report experiencing stigma, which can act as a barrier to non-drinking. Two studies were undertaken to develop and test a new scale to measure attitudes towards non-drinkers. In Study 1, 29 items were presented to 426 Australian drinkers. In Study 2, the refined 12-item Cheers Attitudes to Non-drinkers Scale (CANS) was presented to 389 drinkers. Alcohol consumption, Harm and the Regan Attitudes towards Non-drinkers Scale (RANDS) were presented for scale validation. Exploratory factor analysis revealed three factors representing the Threats to Fun, Connection and Self that drinkers perceive non-drinkers to pose. Confirmatory factor analysis showed that the scale meets the required fit indices and had good reliability (α = 0.842). Evidence of validity was shown through significant correlations with Alcohol Consumption, Harm and the RANDS. These studies show the CANS to be a reliable and valid measure that could be utilised to understand and modify the stigma experienced by non-drinkers. [ABSTRACT FROM AUTHOR]

Alcohol consumption is a significant risk factor for several types of injuries and trauma recidivism and remains an important public health concern worldwide. We aimed to describe the implementation of mandatory alcohol screening and the AUDIT tool among trauma patients admitted to a level 1 trauma center in a country with a partial ban on alcohol consumption. This was a retrospective analysis of trauma patients (>12 years old) who required hospital admission and underwent blood alcohol concentration (BAC) screening between 2014 and 2019. This was achieved via an enzymatic method using alcohol dehydrogenase for ethanol detection in the plasma and serum samples. Trauma patients with a BAC <2.2 mmol/L were referred to as "negative", and BAC >2.2 mmol/L was referred to as "BAC positive". A comparative analysis was performed between the two BAC groups. Alcohol Screening, Brief Intervention, Referral for Treatment [ASBIRT] program, and AUDIT were applied. A total of 7326 BAC screening tests were performed on 7284 patients during the study period. With slight variation over the years, the compliance rate was 77% (70.4%–85.3%), and the test positivity rate was 10% (8.6%–12.5%). There were 42 repeated admissions, of which seven patients were BAC positive at every admission. Young age and non-Arab patients were more likely to test positive, and the main mechanism of injury (MOI) was road traffic-related trauma (p < 0.05). Assault and self-inflicted injuries were significantly higher in BAC-positive patients than in BAC-negative patients (18% vs. 4% and 2.7% vs. 1.3%, respectively; p = 0.001). The injury severity score (ISS) and mortality rate were comparable between the study groups. Patients with a positive BAC were significantly more likely to undergo pan-CT scan in the emergency department, intubation, and exploratory laparotomy than those with a negative BAC. In patients who sustained injuries due to assault, all-terrain vehicles, or motorcycle crashes, there was a significant association between the positivity of BAC tests and the patient's ISS. Despite improvements in BAC screening in trauma admissions over the years, almost 20% of cases were missed. Although the mortality rates were comparable, alcohol consumption burdens resources in terms of excess imaging, intubation, open abdominal surgery, and possible disability. Further studies are needed to understand the key obstacles and challenges to achieving optimum compliance for screening in trauma settings. • Alcohol consumption is a significant risk factor for several types of injury and trauma recidivism. • In Qatar, there is a partial ban on alcohol use and a zero-tolerance policy for driving under the influence of alcohol. • There is a newly implemented mandatory alcohol screening protocol and auditing in the national trauma center since 10 years. • The compliance rate for BAC screening and psychiatry referral in trauma patients has improved over the study period. • Although mortality was comparable, alcohol consumption poses a burden on the hospital resources. [ABSTRACT FROM AUTHOR]

Many drugs of abuse, including alcohol, disrupt long-term synaptic depression (LTD) at dorsal striatal glutamate synapses. This disruption is common to many forms of LTD that are mediated by G protein coupled receptors (GPCRs) that signal through the inhibitory G i/o class of G proteins. A loss of LTD is thought to mediate behavioral changes associated with the development of substance use disorders. We have previously shown in multiple studies that LTD mediated by the G i/o -coupled mu opioid receptor is disrupted by in vivo opioid and alcohol exposure in adolescent and adult mice. One of our previous studies suggested that LTD mediated by delta and kappa opioid receptors was resistant to the LTD-disrupting properties of in vivo opioid exposure. We hypothesized that delta and kappa opioid receptor-mediated LTD would be exceptions to the generalizable observation that forms of dorsal striatal G i/o -coupled receptor LTD are disrupted by drugs of abuse. Specifically, we predicted that these forms of LTD would be resistant to the deleterious effects of alcohol consumption, just as they were resistant to opioid exposure. Indeed, in adult male mice that drank alcohol for 3 weeks, delta and kappa opioid receptor-mediated LTD at glutamatergic inputs to direct pathway and indirect pathway medium spiny neurons in the dorsolateral striatum was unaffected by alcohol. These data demonstrate that alcohol effects on GPCR-mediated LTD are not generalizable across all types of G i/o -coupled GPCRs. • Kappa and delta opioid receptor long-term depression occur at glutamate inputs to both subtypes of medium spiny neurons in dorsolateral striatum. • Neither kappa or delta opioid receptor long-term synaptic depression is sensitive to previous alcohol drinking. • Alcohol effects on opioid long-term depression are not generalizable across all subtypes of opioid receptors. [ABSTRACT FROM AUTHOR]

The aim of this qualitative study, nested in a randomized controlled trial, was to assess the mechanisms of the effects in both arms through examining perceptions of the participants about changes in their drinking behavior and their attributions for any perceived changes. We conducted semi-structured interviews with a sub-sample of trial participants. We used thematic analysis to analyze the data. Self-perceived change, mostly positive, was reported regardless of the objectively measured remission status. Participating in the trial itself was a major catalyst for change. Participants in both arms used a variety of similar strategies to make these changes; additionally, for those who received the intervention, both the style of the counselor (for example, the non-judgmental stance) as well as specific elements of the intervention were seen to influence change in drinking behavior. Absence of self-reported change was relatively uncommon and primarily related to the felt need for alcohol (e.g., drinking was perceived to be necessary to maintain good health), or the belief that one did not need to or want to change. Experiences of participating in a trial, the counselor style, and specific elements of a brief psychological treatment, play a role in influencing change in harmful drinking behaviors. • Positive change may be reported in the absence of objectively measured remission. • Trial procedures themselves become a major catalyst for modifying drinking behaviors. • Counselor style and specific elements of the intervention influence change in drinking. [ABSTRACT FROM AUTHOR]

Alcohol and nicotine are the two most important risk factors of chronic pancreatitis, and they often occur together. It is still unclear how much they influence the severity of the disease and which of the two addictions should be treated with priority. We performed a single-center, retrospective, cross-sectional study in a mixed medicosurgical cohort of 870 patients diagnosed with chronic pancreatitis (CP). We analyzed the impact of the drinking pattern and abstinence for alcohol and nicotine on the course of the disease. Patients with alcoholic CP were subdivided into 1) patients with "life-time drinking history" (LTDH), 2) "current drinkers" with current alcohol abuse without signs of LTDH, and 3) "former drinkers" who stopped or reduced alcohol intake dramatically. Compared to patients with LTDH, "former drinkers" had a lower rate of exocrine insufficiency (29% vs. 59%) and pseudocysts (33% vs. 49%), were more often relapse-free (37% vs. 5%), and had less abdominal pain. There was no correlation detected between the quantity of alcohol consumption and the severity or progression of the disease. Regarding nicotine, 29 pack-years are the threshold for developing the early stage of CP. Under nicotine abstinence, only slightly more patients were relapse-free (37% vs. 22%). In contrast, the cumulative amount of nicotine consumed correlated with overall disease severity and the development of pseudocysts. The need for surgery was increased, with odds ratios of 1.8, for both alcohol and nicotine abuse. Alcohol cessation in chronic pancreatitis reduces exocrine insufficiency, abdominal pain, and local complications. The effect of nicotine cessation is less pronounced in our cohort. However, nicotine abuse represents an important factor for the development of the disease. • Alcohol cessation results in a lower rate of exocrine insufficiency, pseudocysts, and acute pancreatitis episodes. • The drinking pattern, but not the absolute amount of alcohol, correlates with the disease severity. • We were able to identify a threshold of 29 pack-years for the development of chronic pancreatitis. • Smoking cessation only reduced the relapse frequency of acute pancreatitis episodes without affecting the disease severity. [ABSTRACT FROM AUTHOR]

Objective: Researchers and theorists studying intergroup relations have been interested in the impact of alcohol on interracial responding. Theories predict that alcohol will exacerbate expressions of racial bias by increasing reliance on stereotypes and/or by decreasing controlled processing and self-monitoring. Prior studies testing these theories have often examined alcohol's effects on implicit (i.e., indirect) measures of racial bias with inconsistent results. However, previous research in this area has suffered from several methodological limitations, including small sample sizes and doses of alcohol that may have been too low to induce substantial intoxication. Method: Here, in more than triple the number of alcohol participants than the largest prior study, we tested whether an intoxicating dose of alcohol (target breath alcohol concentration of.08%) exacerbated implicit racial bias. Young adults who identified as races other than Black or African American (N = 207) were randomly assigned to consume an alcoholic or placebo beverage and completed the race-based Implicit Association Test (race IAT) testing implicit preference for White (vs. Black) individuals [or, conversely, bias against Black (vs. White) individuals]. Results: All participants demonstrated an implicit racial bias (i.e., linking traditionally Black names with negative/unpleasant words), with no difference in this implicit racial bias across beverage conditions. Specifically, there were no differences between alcohol participants' race IAT D scores (M = 0.55, SD = 0.39), and placebo participants' race IAT D scores (M = 0.59, SD = 0.35), b = 0.05, 95%CI [−0.07, 0.18], p =.422. Conclusions: These findings challenge theories and prior studies suggesting that alcohol increases implicit racial bias. Public Health Significance Statement: Alcohol often has robust social facilitative effects, but it is unclear the extent to which these effects are seen in intergroup contexts as they relate to stereotyping, prejudice, and discrimination. Prior studies have examined alcohol's effects on implicit (i.e., indirect) measures of racial bias with inconsistent results. In the largest study to date by several fold, we used an intoxicating dose of alcohol and found no effect of alcohol consumption on implicit racial bias. [ABSTRACT FROM AUTHOR]