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

Aims This paper provides an overview of gambling issues in China, including historical development, governmental responses and social consequences. Methods Based on materials written in Chinese or English available at academic databases and other online resources, historical, cultural and policy analyses were conducted. The focus is on mainland China, but reference is made to Hong Kong and Macao to illustrate differences. Results Throughout Chinese history, gambling was strictly prohibited by law. In contrast, small-stakes betting for entertainment instead of monetary gain, defined as 'gaming' in this paper, has been culturally acceptable and tolerated by governments. After banning gambling for three decades, the Chinese government attempts to meet public demand for 'gaming' and to confine gambling to 'gaming' by issuing national lotteries. In response to increased economic wealth, gambling opportunities were allowed to develop, but were restricted to Macao. Social problems such as illegal and youth gambling are, however, emerging. The 'gaming' perception may predispose Chinese individuals to wagering activities and increase the risk of gambling disorder, which has been widely seen as misconduct rather than a mental disorder. Currently, the country has a dearth of gambling research and limited prevention and rehabilitation services, almost none at national level. Conclusions A distinction between small-stakes 'gaming' and large-stakes 'gambling', which has cultural roots, plays an important role in relevant governmental policies and social responses in mainland China. Gambling disorder prevention and treatment is not yet on the national agenda. The country's knowledge and services gaps on gambling problems need to be filled out. [ABSTRACT FROM AUTHOR]

Background and aims: Although men's alcohol misuse and less gender‐equitable attitudes have been identified as risks for perpetration of intimate partner violence (IPV), less is known about how men's gender‐equitable attitudes and drinking act together to increase risk of IPV. This study aimed to assess the independent relationships of lower gender‐equitable attitudes and drinking to perpetration of IPV and their interaction among men in seven countries. Design Secondary analysis of the United Nations Multi‐Country Study on Men and Violence (UNMCS) and Nabilan Study databases consisting of (1) unadjusted and adjusted logistic regression to measure the association of perpetration of IPV with gender‐equitable men (GEM) scale score and regular heavy episodic drinking (RHED) and (2) meta‐analyses of prevalence and effect estimates adjusted for country‐level sites and countries. Setting and participants: A total of 9148 ever‐partnered 18–49‐year‐old men surveyed in 2011–15 from 18 sites in Bangladesh, Cambodia, China, Indonesia, Papua New Guinea, Sri Lanka and Timor Leste. Measurements The outcome variable is reported perpetration of physical or sexual IPV in the previous year. Independent variables: GEM scale scores; RHED, defined as six or more drinks in one session at least monthly (compared with other drinkers and abstainers). Findings Pooled past‐year prevalence of perpetration of IPV was 13% [95% confidence interval (CI) = 9–16%]. GEM scores and RHED were independently associated with perpetration of IPV overall and in most sites. Pooled odds ratios (ORs) for perpetration of IPV with less equitable GEM scores were 1.07 (95% CI = 1.04, 1.09) and with RHED were 3.42 (95% CI = 2.43, 4.81). A significant interaction between GEM score and RHED (P = 0.001) indicated that RHED increased the relationship of less gender‐equitable attitudes and perpetration of IPV. Conclusion: Both gender‐inequitable attitudes and drinking appear to be associated with perpetration of intimate partner violence by men, with regular heavy episodic drinking increasing the likelihood of intimate partner violence among men with less equitable gender attitudes. [ABSTRACT FROM AUTHOR]

Background and aims: Since its first release in 2011, WeChat (Chinese pinyin: Wei Xin) has been widely used to promote health. As the most popular all‐in‐one social media application providing free instant messaging, voice, text, pictures, videos and location information exchange via smartphone, WeChat holds promise for delivering smoking cessation services to a large number of people at low unit cost in China, a country with more than 300 million smokers. This protocol is for a study that aims to assess the efficacy of a WeChat‐based smoking cessation intervention ('WeChat WeQuit') for treatment‐seeking smokers in China. Design In this two‐arm randomized controlled trial (RCT), the control group will receive only a digital version of a booklet of 'Happy Quit'. The intervention group will also receive the 2 weeks pre‐ and 12 weeks post‐quit 'WeChat WeQuit' intervention. Both groups will be followed‐up to 26 weeks (6 months) after quit day. Setting: This on‐line trial has no restrictions on setting or location. Participants: Chinese‐speaking current smokers (have smoked ≥100 cigarettes in their life‐time and currently smoke cigarettes) aged 18+ years willing to make a quit attempt within 1 month (n = 2000) will be recruited by on‐ and off‐line advertising. Potential participants will register their interest by sending WeChat messages or text messages, or making a voice call. Measurements The primary outcome measure is self‐reported 26‐week continuous smoking abstinence with biological verification [test by clinic visit: expired carbon monoxide concentration <10 parts per million (p.p.m.) or by mailing cotinine urine dipsticks: urine cotinine <200 ng/ml]. Secondary outcome measures include: 7‐day point prevalence abstinence at weeks 1, 4, 8, 12, 16, 20 and 26 after‐quit day; self‐reported 12‐week continuous smoking abstinence and 26‐week continuous smoking abstinence; reductions in number of cigarettes smoked per day; and rates of participation in and completion of the smoking‐cessation program. Conclusions: If the 'WeChat WeQuit' program is found to be effective, it will be an accessible, affordable and widely implementable intervention to help cigarette smokers to quit. The potential public health impact of its expansion into underserved regions or communities is considerable. [ABSTRACT FROM AUTHOR]

Aim: To assess the causality between alcohol intake, diabetes risk and related traits. Design Mendelian randomization (MR) study. Subgroup analysis, standard instrumental variable analysis and local average treatment effect (LATE) methods were applied to assess linear and non‐linear causality. Setting: China. Participants: A total of 4536 participants, including 721 diabetes cases. Findings Carriage of an ALDH2 rs671 A allele reduced alcohol consumption by 44.63% [95% confidence interval (CI) = –49.44%, −39.37%]. In males, additional carriage of an A allele was significantly connected to decreased diabetes risk for the overall population [odds ratio (OR) = 0.716, 95% CI = 0.567–0.904, P = 0.005] or moderate drinkers (OR = 0.564, 95% CI = 0.355–0.894, P = 0.015). In instrumental variable (IV) analysis, increasing alcohol consumption by 1.7‐fold was associated with an incidence‐rate ratio of 1.32 (95% CI = 1.06–1.67, P = 0.014) for diabetes risk, and elevated alcohol intake was causally connected to natural log‐transformed fasting, 2‐hour post‐load plasma glucose (β = 0.036, 95% CI = 0.018–0.054; β = 0.072, 95% CI = 0.035–0.108) and insulin resistance [homeostatic model assessment for IR (HOMA‐IR] (β = 0.104, 95% CI = 0.039–0.169), but was not associated with beta‐cell function (HOMA‐beta). In addition, the LATE method did not identify significant U‐shaped causality between alcohol consumption and diabetes‐related traits. In females, the effects of alcohol intake on all the outcomes were non‐significant. Conclusion: Among men in China, higher alcohol intake appears to be causally associated with increased diabetes risk and worsened related traits, even for moderate drinkers. This study found no significant U‐shaped causality between alcohol consumption and diabetes‐related traits. [ABSTRACT FROM AUTHOR]

The regulation of new psychoactive substances (NPS) has confounded governments throughout the western world. In 2014 the UK government convened an NPS Review Expert Panel to consider a range of approaches. Ultimately the Panel recommended that the government ban all new psychoactive drugs and allow only psychoactive substances specifically exempted, such as alcohol, tobacco and those allowed as medicines. The government introduced the Psychoactive Substances Bill (PSB) in response to that recommendation. Passed in 2016, the Bill has attracted a torrent of criticism from scientists and experts. The Bill could be improved with revision, but the problems of the total ban, as envisioned by the PSB, with respect to the NPS, may be inherent: (1) defining psychoactivity is conceptually fraught, with great consequence for the scope of the prohibition; (2) operationalizing psychoactivity as a usable concept for legal control purposes is extremely difficult, perhaps impossible; and (3) the detachment of penalties for violating a total ban from establishing the harmfulness of a substance is normatively troubling. Given the uncertainties about the effects of a total ban, it is appropriate at this time for other governments to assess more fully the nature of the NPS problem, and the potential control approaches. [ABSTRACT FROM AUTHOR]

The article presents drug and alcohol addiction-related news briefs and information about events such as the 9th European Public Health Conference which will be held on November 9-12, 2016 in Vienna, Austria. Legislation to legalise cannabis for medical purposes in Germany is examined, along with the trafficking of synthetic drugs on the Vietnam-China border. Laws regulating the use of tax revenues to fund public health programmes in places such as Panama and Poland are assessed.

Aims To identify studies about the prevalence of alcohol use disorder (AUD) in mainland China, evaluate the quality of these studies and conduct a meta-analysis of the prevalence of AUD in China's adult population and in population subgroups defined by sex, age and urban versus rural residency. Methods Relevant studies published prior to January 2014 were identified from the following databases: China Knowledge Resource Integrated (CNKI), Wanfang, Pubmed, EmBase and Web of Science. A 16-item quality assessment inventory for epidemiological studies in mainland China was constructed to evaluate the methodological rigor of the studies. A total of 38 studies including 1 304 354 individuals were identified. Outcomes included current and life-time prevalence of AUD, alcohol dependence and alcohol abuse. Results The pooled life-time and current prevalence of alcohol dependence were 1.4% [95% confidence interval (CI) = 1.3, 1.5] and 1.5% (95% CI = 1.2, 1.9). For males, pooled estimates of the current prevalence of alcohol dependence, alcohol abuse and AUD were 4.4 (95% CI = 3.1, 5.7), 4.0 (95% CI = 2.2, 5.7) and 10.1% (95% CI = 4.7, 15.4), respectively; the corresponding values for females were all below 0.2, 0.1, and 0.1%. There was large between-study heterogeneity in the prevalence measures that was associated with sample size, the use of key informants and the use of substitute respondents. The quality of included studies was generally low. Higher-quality studies reported higher prevalence. Conclusions Alcohol use disorder is an urgent public health problem in China, especially among males. When using high-quality studies, current and life-time prevalence estimates of alcohol dependence in China measure 2.2% and 3.7%, respectively, approaching those of the Netherlands, United States and other western countries. [ABSTRACT FROM AUTHOR]

Background and Aims Large cohort studies on smoking and mortality in elderly people are scarce, and few studies examined smokers aged 85+ years separately. We estimated the risks of all-cause and cause-specific mortality due to smoking in an elderly Chinese cohort in Hong Kong. Design A population-based prospective cohort of 65 510 Chinese enrolled from 1998 to 2001 and followed until May 2012. Setting All 18 Elderly Health Service centres in Hong Kong, China. Participants Elderly people aged 65+ years. Measurements Self-reported smoking status was assessed at baseline interview and categorized as never, former and current smokers. Findings Compared with never smokers, after adjustment for sex, age, education, social security assistance, housing type, monthly expenditure, alcohol use, depressive symptoms and health status, the hazard ratio ( HR) for current smokers was 1.89 [95% confidence interval ( CI) = 1.81-1.98] for all participants aged 65+ years at baseline, corresponding to an attributable fraction ( AF) of about 50%, which is based on AF = ( HR-1)/ HR. As the effect of smoking varied with age ( P for age interaction <0.001), subgroup analysis by age group showed that the adjusted HR for current smokers aged 65-84 years was 1.93 (95% CI = 1.84-2.03), and for 85+ years was 1.29 (95% CI = 1.05-1.58). All the risk estimates did not vary by sex ( P for sex interaction ranged 0.74-0.89). Conclusions In Hong Kong, the risk of death from smoking appears to be the same for Chinese women as it is for men. Half of all deaths in Chinese smokers aged 65 years and older and a quarter of all deaths in Chinese smokers aged 85 years and older are caused by smoking-attributable diseases. [ABSTRACT FROM AUTHOR]

Aims Steady increases in alcohol consumption and related problems are likely to accompany China's rapid epidemiological transition and profit-based marketing activities. We reviewed research on health promotion interventions and policies to address excessive drinking and to guide health-care reform. Methods We searched Chinese- and English-language databases and included 21 studies in China published between 1980 and 2013 that covered each policy area from the World Health Organization ( WHO) Global Strategy to Reduce the Harmful Use of Alcohol. We evaluated and compared preventive interventions to the global alcohol literature for cross-national applicability. Results In contrast with hundreds of studies in the global literature, 11 of 12 studies from mainland China were published in Chinese; six of 10 in English were on taxation from Taiwan or Hong Kong. Most studies demonstrated effectiveness in reducing excessive drinking, and some reported the reduction of health problems. Seven were randomized controlled trials. Studies targeted schools, drink-driving, work-places, the health sector and taxation. Conclusions China is the world's largest alcohol market, yet there has been little growth in alcohol policy research related to health promotion interventions over the past decade. Guided by a public health approach, the WHO Global Strategy and health reform experience in Russia, Australia, Mexico and the United States, China could improve its public health response through better coordination and implementation of surveillance and evidence-based research, and through programmatic and legal responses such as public health law research, screening and early intervention within health systems and the implementation of effective alcohol control strategies. [ABSTRACT FROM AUTHOR]

Aims To describe the data collected by the Chinese methadone maintenance treatment ( MMT) system and the characteristics of clients entering the programme. Design Descriptive study using routinely collected data from the MMT data management system for the period March 2004 and March 2010. Setting All MMT clinics in China. Participants Clients who enrolled for services between March 2004 and March 2010. Measurements Routinely collected data included: demographic information; drug use, sexual and criminal behaviours; status of infection with human immunodeficiency virus ( HIV), hepatitis C virus ( HCV) and syphilis; random urine-opiate test results; and the daily methadone dose received. Differences among clients by year were examined. Findings During the period examined, there were 251 974 clients attending 684 clinics in 27 provinces. Overall, the mean age was 34.4 years, 83.8% were male, 70.2% were unemployed, 75% had ever injected drugs, 17% had shared needles and 7.4% were HIV-positive. The profile of clients changed over time, with fewer HIV-positive individuals, fewer injecting drug users, fewer needle-sharers, fewer females and fewer unemployed. Half the clients dropped out within 6 months. The average final dose received was 49.4 mg. The estimated probability of interrupting treatment before 6 months was 52.5%. Conclusions The profile of clients enrolling in methadone maintenance treatment in China is continually changing and appears to be associated with reduced risk of HIV. High dropout in the programme may limit its effectiveness. The availability of a centralized, real-time data system was extremely useful for monitoring the progress of the Chinese methadone maintenance treatment programme. [ABSTRACT FROM AUTHOR]

Aim To investigate the characteristics of the different club drugs and associated high-risk sexual behaviours in China. Design Multicentre cross-sectional study. Setting Drug Detoxification and Rehabilitation Centres in six provinces, China. Participants A total of 1434 eligible club drug users were included. Measurements Participants were investigated by trained interviewers using a self-designed structured questionnaire to collect information on club drug use and associated behaviours. Findings Methamphetamine was the most commonly abused drug in participants (73.92%), who used it in their or their friends' homes by non-injection for the purpose of feeling euphoria. Among participants with sexual behaviours after club drug use, 75.21% reported having engaged in sex with multiple partners after club drug use during the past year and 79.84% had unprotected sex after using club drug during the past year. A two-level logistic model showed that male gender [adjusted odds ratio ( AOR) = 7.14; 95% confidence interval ( CI) = 4.17-12.5], unmarried ( AOR = 1.71, 95% CI = 1.04-2.79), long duration of club drug use during their life-time ( AOR = 1.76, 95% CI = 1.28-2.42) and severe acute intoxication after using club drugs during the past year ( AOR = 2.11, 95% CI = 1.07-4.15) were independent risk factors of multiple sex partners during the past year. Another two-level model showed that the club drug users who were female ( AOR = 1.79, 95% CI = 1.03-3.11) and had polydrug use during their lifetime ( AOR = 1.55, 95% CI = 1.01-2.34) had more risk for unprotected sex during the past year than without these characteristics. Conclusion High-risk sexual behaviours are common among club drug users in China. The prevention and intervention of club drug use could decrease the risk of sexual behaviours which further prevent HIV transmission and other sexually transmitted infections in China. [ABSTRACT FROM AUTHOR]

Aim To characterize trends in drug abuse in China before and after the 2005 initiation of the ' People's War on Drugs'. Design Retrospective self-controlled study. Setting Annual, nation-wide surveillance from 2003 to 2010 of all registered drug users in China's National Surveillance System on Drug Abuse ( NSSDA). Participants A total of 1 184 124 drug users registered in NSSDA were involved in this study and were classified into three groups based on registered dates-pre-war group ( n = 230 278) registered 2003-04, phase I group ( n = 518 651) registered 2005-07 and phase II group ( n = 435 195) registered 2008-10. Measurements Indicators included proportions of:(i) new and relapsed drug users, (ii) heroin and synthetic drug users among new users, (iii) people aged 35 years or younger and (iv) women. Comparisons were made across groups using annual data to describe temporal trends. Findings Between 2003 and 2010 the proportion of heroin users decreased by 52.3% and synthetic drugs use increased 860.7% among new users, while a 12.8% decrease in the proportion of heroin users and a 918.8% increase in synthetic drug use in all users was detected. Compared with the pre-war group, the proportion of relapsed users decreased 2.6% and 29.1% in the phase I and phase II groups, respectively, but a significant increase in the proportion of new users was found in phase I ( OR = 1.24, CI = 1.15-1.35, p < 0.0001), followed by an apparent decrease in phase II compared with phase I ( OR = 0.75, CI = 0.70-0.80, p < 0.0001). Similarly, the proportion of heroin users decreased 15.1 and 24.2% among new drug users in phase I and phase II in comparison with the pre-war group. Conclusion The decrease in proportions of drug users in China between 2003/4 and 2008/10 may suggest some positive influence of the ' People's War on Drugs', especially in the decreased proportion of relapsed users. In contrast, there was a rapid increase in new synthetic drug use over the same period. [ABSTRACT FROM AUTHOR]

The authors reflect on efforts to eliminate HIV and AIDS among drug users in China. They suggest that the drug abuse epidemic in China has grown significantly since the 1970s and that there has been a shift from heroin use to synthetic drugs. They argue that China has increased programs to help curb the HIV epidemic among drug users and that while the country may be able to decrease HIV infections in drug users by 2015, it will face several challenges while doing so.

The article responds to the issue article "Early Second-Hand Smoke Exposure and Child and Adolescent Mental Health: Evidence From Hong Kong's 'Children of 1997' Birth Cohort" by C. Y. Leung, G. M. Leung, and C. M. Schooling. Topics include the health impacts of prenatal exposure to second-hand smoke, neurodevelopmental effects of such exposure, and the impact of smoking during pregnancy on childhood and adolescent mental health.