Search

In 1998 the UK government published a White Paper on tobacco which set out the development of smoking cessation treatment services across England. This paper presents a detailed analysis of the events leading up to the inclusion of smoking cessation treatment services within the White Paper, and the background to the evaluation of those services, the results of which are the subject of the remaining papers in this supplement.

Background and Aims Exposure to alcohol marketing is considered to be potentially harmful to adolescents. In addition to statutory regulation, industry self-regulation is a common way to protect adolescents from alcohol marketing exposures. This paper critically reviews research designed to evaluate the effectiveness of the alcohol industry's compliance procedures to manage complaints when alcohol marketing is considered to have violated a self-regulatory code. Methods Peer-reviewed papers were identified through four literature search engines: PubMed, SCOPUS, PsychINFO and CINAHL. Non-peer-reviewed reports produced by public health agencies, alcohol research centers, non-governmental organizations, government research centers and national industry advertising associations were also included. Results The search process yielded three peer-reviewed papers, seven non-peer reviewed reports published by academic institutes and non-profit organizations and 20 industry reports. The evidence indicates that the complaint process lacks standardization across countries, industry adjudicators may be trained inadequately or biased and few complaints are upheld against advertisements pre-determined to contain violations of a self-regulatory code. Conclusions The current alcohol industry marketing complaint process used in a wide variety of countries may be ineffective at removing potentially harmful content from the market-place. The process of determining the validity of complaints employed by most industry groups appears to suffer from serious conflict of interest and procedural weaknesses that could compromise objective adjudication of even well-documented complaints. In our opinion the current system of self-regulation needs major modifications if it is to serve public health objectives, and more systematic evaluations of the complaint process are needed.

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.

Aims This paper describes alcohol industry involvement in the 2010 annual conference proceedings of the National Conference of State Liquor Administrators (NCSLA) in the United States. Design The author attended the conference, observed conference attendees and panelists and identified key themes in the panel sessions. Setting The NCSLA Annual Meeting took place 20–24 June 2010 in New Orleans, Louisiana. Participants NCSLA meeting attendees and panelists were professionals from state alcohol control systems; federal government agencies; and companies representing the alcohol industry. Measurements The total number of conference attendees and participants were counted as well as the number of attendees and participants from regulator, industry and public health sectors. Findings More than two-thirds (72.2%) of the 187 conference attendees were from alcohol producers, importers, wholesalers, retailers or their attorneys. Nearly two-thirds (65.0%) of the 40 panelists were from the alcohol industry. The author of this paper was the only attendee, and the only panelist, representing public health policy. Conclusions The National Conference of State Liquor Administrators in the United States is dominated by the private, global companies that produce, import, distribute and sell alcohol, highlighting a lack of public health considerations within the Association's liquor control agenda.

The five papers in this special issue result from a scientific meeting on the alcohol industry and alcohol policy that was convened in Copenhagen by the Nordic Centre for Alcohol and Drug Research (NAD) and the Society for the Study of Addiction (SSA), with financial support from the Norwegian Government [1–5]. The meeting brought together people involved in research, agenda-setting and decision-making in the field of public health from Canada, Europe, New Zealand and the United States. The industry’s marketing practices, its advantages from trade agreements, lessons from tobacco control and possibilities for pursuing legal action in Europe were some of the topics discussed. Typical situations were described in a handful of case studies from different regions and countries. A sister issue of the Journal Nordic Studies on Alcohol and Drugs includes other papers, case studies and commentaries from the meeting [6]. As Sally Casswell notes in her Editorial [1], there has been a remarkable increase in the attention paid to the alcohol industry in recent years by those working in the public health field, representing a much-needed change. She notes that this change is, of course, a reflection of the changing context for alcohol use and alcohol-related harm and a changing industry: trans-governmental corporations of all types are engaged in marketing their products directly to the consumer and are involved increasingly in the policy process. However, as Casswell points out, although industry activities are increasingly being documented there remains a dearth of scientific literature in this field. David Jernigan [2] reminds us that the globalized segment of the alcohol industry is large and concentrated in the hands of a relatively small number of companies. The top five brewers hold about 50% of the global beer market and the top five spirits companies hold about 50% of the global spirits market between them. Jernigan points out that these companies employ a range of activities to promote themselves and their products. He notes that although longitudinal studies have been conducted to assess the public health impact on young people of a small subset of activities, for the most part public health research has not kept up with the ability of this industry to innovate in its marketing and its organization, and that there is a need for further studies on the health and political impacts of the global alcohol industry. Donald Zeigler [3] describes how trade agreements can impact on alcohol policies, noting that the alcohol industry seeks to influence agreements and can be expected to work through trade agreements to reduce tariffs, increase market access and seek to restrict effective domestic regulations. He concludes that public health experts must be brought into trade deliberations to provide input so that trade policies are less likely to stimulate alcohol use and related consequences. He proposes two supporting strategies: (i) to treat alcohol as an extraordinary commodity, with measures affecting the supply, distribution, sale, advertising, promotion or investment in alcohol beverages being excluded from international trade agreements; and (ii) advocate for a Framework Convention on Alcohol Control to deal effectively and collectively with alcohol issues at the global level. Jim Mosher [4] describes the lessons that can be learnt from the litigation experience in the field of tobacco, concluding that litigation is a powerful tool in addressing aggressive marketing by the purveyors of addictive products such as alcohol. However, Mosher notes that to be effective at both the national and international level, litigation should encompass a broad array of legal tactics designed to identify and restrict unfair, deceptive and misleading alcohol marketing tactics and should be utilized in conjunction with complementary prevention strategies. This requires further research on the impact of alcohol marketing on youth alcohol consumption and problems. OVERVIEW doi:10.1111/j.1360-0443.2008.02428.x

Background and aims In 2013, Uruguay became the first country in the world to fully regulate its marijuana market. This ambitious policy was also an unexpected one: none of the usual explanations for legalization of marijuana in other contexts was present in the Uruguayan case. This paper offers an explanation of why Uruguay legalized marijuana. Drawing on Kingdon's theoretical approach, we argue that a window of opportunity opened in mid-2012, making it both necessary and possible for the government to move towards legalization. Methods A congruence case study using evidence from a series of interviews with political actors and policy makers, media reports and official documents. Results There is evidence that marijuana legalization was possible in Uruguay because of the coincidence of a demand for more public safety (problem stream) with the presence of pro-legalization leaders in strategic political positions (policy stream) and a favorable political environment (political stream) CONCLUSIONS: Applying Kingdon's theory of windows of opportunity, Uruguay may have moved towards full regulation of its marijuana market in 2013 because of the convergence of a specific set of problem, policy and political circumstances in May 2012.

BACKGROUND AND AIMS With governments increasingly relying on the alcohol industry's self-regulated marketing codes to restrict alcohol marketing activity, there is a need to summarize the findings of research relevant to alcohol marketing controls. This paper provides a systematic review of studies investigating the content of, and exposure to, alcohol marketing in relation to self-regulated guidelines. METHODS Peer-reviewed articles were identified through four literature search engines: SCOPUS, Web of Science, PubMed, and PsychINFO. Non-peer reviewed reports produced by public health agencies, alcohol research centers, non-governmental organizations, and government research centers were also identified. 96 publications met the inclusion criteria. RESULTS Of the 19 studies evaluating a specific marketing code and 25 content analysis studies reviewed, all detected content that could be considered potentially harmful to children and adolescents, including themes that strongly appeal to young men. Of the 57 studies of alcohol advertising exposure, high levels of youth exposure and high awareness of alcohol advertising were found for television, radio, print, digital, and outdoor ads. Youth exposure to alcohol advertising has increased over time, even as greater compliance with exposure thresholds has been documented. CONCLUSIONS Violations of the content guidelines within self-regulated alcohol marketing codes are highly prevalent in certain media. Exposure to alcohol marketing, particularly among youth, is also prevalent. Taken together, the findings suggest that the current self-regulatory systems that govern alcohol marketing practices are not meeting their intended goal of protecting vulnerable populations.

Background and Aims Many policies have been introduced to reduce alcohol harm in different countries. However, Muslim majority countries (MMCs), where the major religion (Islam) prohibits alcohol consumption, have less well-developed civil alcohol policies. Overall, MMCs have low prevalence of alcohol consumption, although recently most MMCs have been undergoing transition, which has sometimes increased pressure for alcohol availability and impacted on social practices, alcohol policies and broader public health. Globalization, the influence of the global alcohol industry, recent governmental transition or political instability and the presence of immigrants from non-Muslim countries can all affect civil alcohol policy. In this context, consumption overall has increased compared with two decades ago. This paper presents an overview of current civil alcohol policy, with regard to the presence or absence of alcohol prohibition, and provides an insight into the legal availability of alcohol in MMCs and the challenges facing policymakers. Methods English, Arabic and Persian language sources were examined, using PubMed, government websites for each country and the World Health Organization (WHO). Some of the challenges MMCs may face in developing alcohol policies are explored, including the need to interact with the global economy and the potential influence of the alcohol industry. Conclusion Muslim majority countries have adopted a range of civil alcohol policies in recent decades. There is a pressing need for better data and to support Muslim majority countries in alcohol policy development. Lessons from Muslim majority countries can help to inform other parts of the world.

This paper describes the political origins of the National Treatment Outcomes Research Study (NTORS) and the outputs and impacts of the study. NTORS was designed to meet the request of the Health Secretary and of a Government Task Force for evidence about the effectiveness of the national addiction treatment services. NTORS was a prospective cohort study which investigated outcomes over a 5-year period of drug users admitted to four major treatment modalities: in-patient treatment, residential rehabilitation, methadone reduction and methadone maintenance programmes. The study investigated treatments delivered under day-to-day operating conditions. Outcomes showed substantial reductions in illicit drug use and reduced injecting risk behaviours. These changes were accompanied by improved psychological and physical health and by reductions in criminal behaviour. However, not all outcomes were so positive. There was a continuing mortality rate in the cohort of about 1% per year, and many clients continued to drink heavily throughout the 5-year follow-up. NTORS findings informed and influenced UK addiction treatment policy both at the time and subsequently. The findings were influential in supporting an immediate increase in funding for treatment, and Government Ministers have repeatedly cited NTORS as evidence of the effectiveness of addiction treatment. One finding that received political attention was that of the cost savings provided by treatment through reductions in crime. This important finding led to an unanticipated consequence of NTORS; namely, the greater focus on crime reduction that has increasingly been promoted as a political and social priority for drug misuse treatment.

Griffith Edwards played an important role in cannabis policy debates within government advisory committees in the United Kingdom from the early 1970s until the early 1980s. This has largely been hidden from public knowledge by the confidentiality of these committee discussions. The purpose of this paper is to use Griffith's writings and the results of recent historical scholarship to outline the views he expressed, the reasons he gave for them, and to provide a brief assessment of his contribution to the development of British cannabis policy.

BACKGROUND AND AIMS: The Public Health Responsibility Deal (RD) in England is a public-private partnership involving voluntary pledges between industry, government and other organizations, with the aim of improving public health. This paper aims to evaluate what action resulted from the RD alcohol pledges. METHODS: We analysed publically available data on organizations' plans and progress towards achieving key alcohol pledges of the RD. We assessed the extent to which activities pledged by signatories could have been brought about by the RD, as opposed to having happened anyway (the counterfactual), using a validated coding scheme designed for the purpose. RESULTS: Progress reports were submitted by 92% of signatories in 2013 and 75% of signatories in 2014, and provided mainly descriptive feedback rather than quantifiable performance metrics. Approximately 14% of 2014 progress reports were identical to those presented in 2013. Most organizations (65%) signed pledges that involved actions to which they appear to have been committed already, regardless of the RD. A small but influential group of alcohol producers and retailers reported taking measures to reduce alcohol units available for consumption in the market. However, where reported, these measures appear to involve launching and promoting new lower-alcohol products rather than removing units from existing products. CONCLUSIONS: The RD is unlikely to have contributed significantly to reducing alcohol consumption, as most alcohol pledge signatories appear to have committed to actions that they would have undertaken anyway, regardless of the RD. Irrespective of this, there is considerable scope to improve the clarity of progress reports and reduce the variability of metrics provided by RD pledge signatories.

The work for this paper was conducted as part of a larger project which has received funding from the Australian National Health and Medical Research Council (NHMRC) (grant no. 1005668). This project was also supported by a grant from the Australian Institute of Criminology(AIC) through the Criminology Research Grants Program. S.L., B.L. and R.P.M. are supported by NHMRC Research Fellowships (numbers 1041742, 1035149, 1073858 and 1045318). The National Drug and Alcohol Research Centre at the University of NSW is supported by funding from the Australian Government under the Substance Misuse Prevention and Service Improvements GrantsFund.

Aims This paper examines the strategies and arguments used by segments of the alcohol industry to delay the introduction of mandatory health warning labels on alcohol containers in Australia. These strategies are compared with those used by the tobacco industry to delay the introduction of warning labels for cigarettes. Methods Submissions made by members of the alcohol industry to the Australian Government's review of labelling and Parliamentary Inquiry into Fetal Alcohol Spectrum Disorders were analysed. Results Segments of the alcohol industry have delayed the introduction of mandatory alcohol health warning labels in Australia by questioning the rationale and evidence base for labels; arguing that they will cause damage to public health and the economy; lobbying and seeking to influence government and political representatives including through monetary donations; and introducing its own voluntary labelling scheme. The arguments made by these organizations against the introduction of mandatory health warning labels for alcohol are flawed and their empirical basis is limited. Conclusion The Australian Government has delayed the introduction of mandatory alcohol health warning labels in Australia by 2 years, until at least December 2013. The campaigning of some parts of the alcohol industry appears to have been instrumental in this decision.

Aims and design The historical and economic involvement of Brazil with tobacco, as a major producer and exporter, was considered an insurmountable obstacle to controlling the consumption of this product. Nevertheless, the country was able to achieve significant progress in implementing public policies and to take an international leadership position, meeting its constitutional commitment to protect public health. In this paper we provide a brief historical overview of tobacco control (TC) in Brazil, and analyse the factors that contributed to the major decline in tobacco consumption in the country over the last 20 years, as well as identify the challenges that had to be overcome and those still at play. Findings The Brazilian case demonstrates how cross-sectorial collaborations among health-related groups that capitalize on their respective strengths and capacities can help to influence public policy and overcome industry and population resistance to change. Although Brazil still lags behind some leading TC nations, the country has an extensive collaborative TC network that was built over time and continues to focus upon this issue. Conclusions The tobacco experience can serve as an example for other fields, such as alcoholic beverages, of how networks can be formed to influence the legislative process and the development of public policies. Brazilian statistics show that problems related to non-communicable diseases are a pressing public health issue, and advocacy groups, policy-makers and government departments can benefit from tobacco control history to fashion their own strategies.

Aims This paper provides a historical review of gambling in Canada and examines the benefits and shortcomings of present-day Canadian gambling policies and practices. This includes a discussion of provincial and federal government roles in gambling regulation and an overview of problem gambling prevention and treatment initiatives. Methods The gambling studies literature was probed for pertinent information on factors such as historical development, legislative changes, economic conditions and cultural influences that have affected gambling participation and social responsibility strategies in Canada. Results Two major Criminal Code of Canada amendments (in 1969 and 1985) were pivotal in Canadian gambling expansion. The first decriminalized lotteries and casinos, while the second allowed electronic gambling devices and authorized provinces to operate and regulate gambling. These changes resulted in a radical gambling expansion which, in addition to raising provincial revenues, created public policy concerns. Varying provincial government interpretations of the ambiguous Criminal Code gambling statutes led to a lack of uniformity in how provinces regulate and operate gambling; when gambling expanded, there were no legislative safeguards in place to deal with the personal and societal effects of problem gambling. Subsequent programs designed to prevent and treat problem gambling have not been overly effective. Conclusions Canadian provinces have a monopoly on gambling within their borders and treat the activity as a profit-driven business enterprise. Problems associated with widespread gambling such as addiction, increased crime, bankruptcy and suicide are seen as minor concerns and not addressed in an aggressive fashion. Given the Canadian federal government's detachment from gambling policy and Canadian provinces' heavy reliance on gambling revenues, little change in the Canadian gambling landscape is anticipated in the near future.

Aims This paper examines four specialist medical inebriety institutions in Victoria, Australia between 1870 and 1930, which positioned themselves in distinct ways. It analyses how the treatment in each institution was located within wider medical approaches and contemporary medical ideas and practice. Methods Medical journals and texts, newspaper articles, government reports and institutional archives are used in the analysis. Findings and Conclusions Alcohol treatment institutions in the late 19th and early 20th centuries were of several types, differentiated according to treatment approaches and their underlying premises as to the nature of the disease being treated, the particular patient groups for which they catered and their funding models and capacity to take patients committed for treatment under legislation. The institutional types identified in other Anglophone countries in this period can be extended to Australia, with some local variations in the timing of the appearance of the models, the longevity of institutions and gender of patients. In Australia there was no tradition of mutual patient support, as seen at the time in the United States. Each institution represented itself differently, in particular in terms of its particular medical model, although the treatments in practice differed less than in theory. The models employed allowed each institution to position itself in relation to trends in medical theory and practice, in particular to different conceptualizations of the type of disease being treated. Evaluating treatment models for alcohol problems in terms of medical theory and practice of the time can explain contrasting approaches.

Aim This paper provides a critical overview a decade after the New Zealand Government announced its intention to formally incorporate a public health approach into its comprehensive revision of gambling legislation. Method The initial enthusiasm and the subsequent disillusionment with this approach are tracked. Four reasons for its lack of success are examined. Findings The New Zealand experiment with a public health approach to gambling is seen to have floundered in a network of vested interests. The pathways for influence included inappropriate industry input as wellascommunityandgovernmentsectorrelianceongamblingprofits.Thenewlegislationneglectedtosetupsystems for strong independent accountability, and this weakened the potential of public health initiatives. Conclusion As with tobacco control, the policy integrity of a public health approach to gambling requires close attention to ways of reducing vested interests in both government and community sectors and to establishing strong points of independent

In the 25 years since drug abuse re-emerged in China in the 1980s, the National Institute of Drug Dependence (NIDD) has made many contributions to China's antidrug campaign. This present paper offers an account of the history, current status and future of drug dependence research at NIDD. NIDD was originally a research centre at Beijing Medical University, founded by the Chinese Ministry of Health to address the rapid spread of drug abuse in China. Originally, the main task of NIDD was to complete the commissions assigned by the government and university. Further developments transformed NIDD into a national research institute in the field of drug addiction that began to conduct its own research. NIDD has now created a professional team spread across several independent departments involved in neurobiological mechanisms, epidemiological surveys and monitoring, pre-clinical and clinical evaluation of new drugs (mainly analgesic drugs and detoxification drugs) and informatics and data analysis. As a university-based research institute, NIDD's funding derives mainly from grants provided by the government and financial support from international organizations. Its past and present research has a gained NIDD a reputation with both practitioners and policy makers in the field of drug addiction. In the future, NIDD will continue to engage in various aspects of drug addiction research and will enter the field of brain function.

Aim This paper critically appraises relationship arrangements among three broadly conceived sectors: the government sector, the health sector (including researchers) and addictive consumption industries (particularly tobacco, alcohol and gambling). Method Three models for involvement are examined. In the ‘tripartite partnership model’ health sector agencies engage as co‐equals with the government and industry sectors in order to implement public health initiatives such as host responsibility and public education. In the ‘non‐ association model’ the health sector engages with government agencies but not with the industry sector. In the ‘managed association model’ the health sector engages for specific purposes with the industry sector but contact is monitored and managed by government agencies. Findings Government and industry sectors commonly favour tripartite partnership arrangements. Health sector agencies that opt to engage in these partnership arrangements can encounter conflicts of interest and find their voice subsumed by dominant influences. Furthermore, their partnership compliance generates divisions within the health sector, with partnership dissenters often silenced and excluded from policy processes and funding. The non‐association model is the least hazardous to the health sector because it protects against compromise and dominance. The managed association model is an option only when the government sector as a whole is committed strongly and clearly to the public health objectives. Conclusion In contexts where key parts of the government sector are conflicted over their public health responsibilities, health sector engagement in partnership arrangements entails too many risks.

Background In this paper, we describe an analysis of alcohol policy initiatives sponsored by alcohol producer SABMiller and the International Center on Alcohol Policies, an alcohol industry‐funded organization. In a number of sub‐Saharan countries these bodies have promoted a ‘partnership’ role with governments to design national alcohol policies. Methodology A comparison was conducted of four draft National Alcohol Policy documents from Lesotho, Malawi, Uganda and Botswana using case study methods. Findings The comparison indicated that the four drafts are almost identical in wording and structure and that they are likely to originate from the same source. Conclusions The processes and the draft policy documents reviewed provide insights into the methods, as well as the strategic and political objectives of the multi‐national drinks industry. This initiative reflects the industry's preferred version of a national alcohol policy. The industry policy vision ignores, or chooses selectively from, the international evidence base on alcohol prevention developed by independent alcohol researchers and disregards or minimizes a public health approach to alcohol problems. The policies reviewed maintain a narrow focus on the economic benefits from the trade in alcohol. In terms of alcohol problems (and their remediation) the documents focus upon individual drinkers, ignoring effective environmental interventions. The proposed policies serve the industry's interests at the expense of public health by attempting to enshrine ‘active participation of all levels of the beverage alcohol industry as a key partner in the policy formulation and implementation process’.

Aims In this paper we outline and evaluate competing explanations for a heroin shortage that occurred in Australia during 2001 with an abrupt onset at the beginning of 2001. Methods We evaluated each of the explanations offered for the shortage against evidence from a variety of sources: government reports, police and drug law enforcement documents and briefings, key informant (KI) interviews, indicator data and research data. Results No similar shortage occurred at the same time in other markets (e.g. Vancouver, Canada or Hong Kong) whose heroin originated in the same countries as Australia’s. The shortage was due most probably to a combination of factors that operated synergistically and sequentially. The heroin market had grown rapidly in the late 1990s, perhaps helped by a decline in drug law enforcement (DLE) in Australia in the early 1990s that facilitated high-level heroin suppliers in Asia to establish large-scale importation heroin networks into Australia. This led to an increase in the availability of heroin, increasingly visible street-based drug markets, increased purity and decreased price of heroin around the country. The Australian heroin market was well established by the late 1990s, but it had a low profit margin with high heroin purity, and a lower price than ever before. The surge in heroin problems led to increased funding of the Australian Federal Police and Customs as part of the National Illicit Drug Strategy in 1998‐99, with the result that a number of key individuals and large seizures occurred during 1999‐2000, probably increasing the risks of large-scale importation. The combination of low profits and increased success of law enforcement may have reduced the dependability of key suppliers of heroin to Australia at a time when seized heroin was becoming more difficult to replace because of reduced supplies in the Golden Triangle. These factors may have reduced the attractiveness of Australia as a destination for heroin trafficking. Conclusions The Australian heroin shortage in 2001 was due probably to a combination of factors that included increased effectiveness of law enforcement efforts to disrupt networks bringing large shipments of heroin from traditional source countries, and decreased capacity or willingness of major traffickers to continue large scale shipments to Australia.

Background This paper describes how smoking treatment services in England were delivered beyond the initial set-up phase and explores key factors affecting their development. Services were expected to treat smokers in line with the evidence-base and were issued with government guidance regarding the type of interventions that should be offered. One factor complicating this was the issue of service funding. Funding was initially issued for a 3-year period and although this was extended on two occasions, these extensions were both announced close to the end of funding periods. Objectives To critically assess key elements in the delivery of the English cessation services, including the nature of treatments offered and the impact of short-term funding on staffing. Methods A national postal survey of smoking cessation coordinators in April 2002. Semi-structured interviews with 50 smoking cessation staff in two health regions in autumn 2001, followed by further interviews with 28 staff in the same areas in the autumn of 2002. Results Treatment was delivered in a wide range of venues, ranging from primary care to local authority-owned premises such as town halls and libraries. Most services offered both one-to-one and group support, although interviewees reported an increase in demand for one-to-one support from clients. Pharmacotherapies were used widely; by 2002, 99% of coordinators reported that their advisers recommended nicotine replacement therapy (NRT) to clients, and 95% bupropion. However, prior to April 2001 bupropion was available on prescription, but NRT was not and this variable access to pharmacotherapies posed problems for services. Coordinators reported that the short-term nature of funding made recruiting and retaining staff difficult and interviews revealed that they believed a longer period of protected funding was required for services to demonstrate their effectiveness. Conclusions As English smoking treatment services developed, lessons were learned that could inform the development of services in other health systems. First, early guidance from government can encourage services to adhere to evidence-based treatment. Secondly, treatment needs to be accessible to smokers and thus there must be a flexible approach to implementation at local level. Thirdly, the availability of nicotine addiction and behavioural therapies should be coordinated to minimize barriers and maximize uptake. Finally, fixed-term funding can exacerbate staff recruitment and retention difficulties and countries establishing treatment services need to consider carefully the initial funding period that is required for stable services to become established within their health systems.

This paper summarizes and discusses the key findings of the evaluation of the English smoking treatment services, which were established in 1999 as part of the English National Health Service. Within 4 years these services existed throughout the country and were working at full capacity, a total of pound 76 million having been spent on them over this period, excluding medication costs. In the fourth year almost 235,000 people attended treatment and set a quit date, and the total budget, including medications, was approximately pound 50 million. At the end of the fourth year the government allocated pound 138 million for the services for the period April 2003-March 2006. The CO-validated 4-week abstinence rate was 53%, the validated 52-week abstinence rate was 15%, and the relapse rate from 4 to 52 weeks was 75%. There was no sex difference in cessation rates at long-term follow-up. The cessation results and relapse rate from weeks 4 to 52 are consistent with results from published studies, including clinical trials. The estimated cost per life-year saved was pound 684 and the figure is even lower if the potential future health care cost savings are taken into account at pound 438 per life-year saved. This compares with the benchmark of pound 20,000 per life-year saved, which the National Institute for Clinical Excellence (NICE) is using to recommend new health care interventions in the National Health Service. The services were also succeeding in reaching disadvantaged smokers. However, there have been problems, and other health care systems considering an initiative of this kind should: set national training standards and increase training capacity before launching the services; standardize the provision of pharmaceutical treatments and make them as accessible as possible before launching the services; and give the services at least 5 years of central funding to allow them to become well established. Monitoring is extremely important but should not be so much of a burden that it detracts from developing a quality service and although cessation targets can be helpful, care needs to be taken that they are reasonable and do not promote throughput at the expense of quality.

As Caulkins et al. [1] note, the prevalence of illegal drug use is often cast as an overall indicator of the size of the national drug problem and the annual change is often used as a performance measure of policy efficacy, but the true costs of drug abuse can be understood more clearly by examining a richer set of indices. To this end, they calculated and examined the number of chronic users and other aggregate measures for four illegal drugs. We have had a long-standing interest researching the underlying social processes behind drug use trends, and read Caulkins et al.'s latest contribution from this perspective. We are especially excited about the finding of a sustained decline in the prevalence of chronic cocaine users starting in 2008. However, this good news must be tempered with fuller consideration of other drugs, including the modest increase in chronic heroin use as indicated by Caulkins et al. and the widespread misuse of prescription opioids not discussed in their paper. The increase in frequent marijuana users reported is more complex to interpret, as more individuals and government agencies shift their understanding of marijuana's medical efficacy and safety for recreational use. Thus, there is disagreement as to the extent that marijuana use and even frequent use is necessarily a public health concern. Clearly, this will be a topic of much further research and dialogue. [1] Caulkins J., Kilmer B., Reuter P., Midgette G. Cocaine's fall and marijuana's rise: questions and insights based on new estimates of consumption and expenditures in US drug markets. Addiction 2015; 110: 728-36. Language: en

This paper discusses the history of the changing relationship between research and industrial funding, using the tobacco industry as its example. It seeks to explain why funding which was once acceptable is now unacceptable. The hypotheses advanced include: the changing nature of the industry's interest in research and the role of marketing; the rise of the 'new public health' alliance focused on abstention rather than on harm minimization; the role of government funding and control of research; and the changing meaning of tobacco and especially nicotine.

This paper analyses the interplay between alcohol policy and research in Poland during the last two decades. It was a period of profound political and economic changes that strongly influenced the alcohol scene. In the 1970s alcohol was treated as a secret issue. Despite a rapid growth of alcohol consumption neither the authorities nor media expressed any concern about the growing wave of related problems. Funding allocated to research was very low and only a few devoted individuals continued their studies, albeit on a reduced scale. The beginning of the 1980s saw a sudden politicization of the alcohol issue. The government was blamed for pushing alcohol. In response to this challenge, alcohol controls were tightened. A huge programme of alcohol research was initiated to accumulate knowledge and evidence for further alcohol policy, as well as to symbolize a high priority of the alcohol issue. In following years, however, the political significance of alcohol decreased. The system established for its control was eroded, and finally collapsed in the late 1980s and early 1990s. The huge research evidence that was accumulated during the 1980s is not being applied to alcohol policy, which itself has virtually ceased to exist.

This letter is a reaction to the paper by Chiou and others, in the December 2011 issue of Addiction, on how the use of dietary supplements may induce illusory invulnerability that, in turn, disinhibit smoking [1]. The findings run counter to other research findings of large population samples regarding healthy behaviors of individuals who consume dietary supplements regularly. Recent analysis of the US National Health and Nutrition Examination Survey (NHANES) data finds that dietary supplement use is associated with the avoidance of smoking among American consumers [2,3]. NHANES is a large government program designed to assess the health and nutritional status of adults and children in the United States. Furthermore, the Healthy Habits of Supplement Users and Non-Users survey found that a larger proportion of non-users smoke cigarettes (26% versus 15%, respectively) [4]. Even if there is a potential ‘licensing’ effect that causes a small portion of dietary supplement users to smoke more, the large body of evidence suggests that this does not trump the overall healthier habits of supplement users, including full avoidance from smoking. This leads to the question that if individuals in the study took dietary supplements continuously (not just a placebo), would they be more prone to stop smoking and live healthier life-styles? The outcomes of the study may not be generalized, as the prevalence and attitudes towards smoking are different in this subpopulation of undergraduate Taiwanese students. The study may have also induced bias among the participants, as it was not a blind study (the undergraduate students knew which treatment group they were in as well, as the proposed hypothesis of the study). The authors of this study should consider monitoring the long-term benefits of actual dietary supplement use in university students as a mechanism to help them develop healthier life-style habits.

Summary Estimates of the social costs associated with the consumption of hazardous commodities such as alcohol, cigarettes and illicit drugs feature prominently in the current debate on prevention policy. Such figures are being increasingly used to urge greater government action on prevention. This paper presents an introduction to the welfare economics of government intervention in markets for hazardous commodities and concludes that—contrary to what is often presumed—social cost estimates can never identify situations where greater government involvement is warranted. Policy-makers would therefore seem to be justified in ignoring campaigns for greater government action which are based on social cost figures.

Summary Tobacco was first introduced into Elizabethan England as a new addition to the pharmacopoeia and the non-medical use of tobacco was condemned as being injurious to health. Attempts were made to discourage the recreational use of tobacco through controls over its price, availability and production, and through a stream of hostile pamphlets, verses and Royal Proclamations. Yet this multi-faceted prevention policy was a failure. Within 100 years, Britain was actively promoting the consumption of tobacco throughout the world. This paper provides a brief description of how, over 300 years ago, a government's commitment to combatting the introduction of an addictive drug was undermined, and its policies reversed.

This paper examines U.S. tobacco taxation, the effect of cigarette taxes on smoking and on the health effects of smoking, and equity and efficiency considerations that arise when cigarette excise taxes are used to reduce smoking. Cigarette excise taxes, imposed by the Federal Government, all State governments, and nearly 400 cities and counties, add approximately 34 cents per pack to the price of cigarettes. Real cigarette excise tax rates have fallen because tax increases have not kept pace with inflation. Increases in the price of cigarettes decrease smoking, particularly by adolescents. An estimated 100,000 additional persons may live to the age of 65 as a result of doubling the Federal cigarette tax in 1983. Because cigarette taxes are regressive and are borne primarily by smokers, inequities may arise when they are used to reduce smoking. Success in achieving a tobacco-free society will require that tobacco taxes be replaced with alternative sources of revenue.