Search

Background and aimsThe ubiquity of tobacco retailers helps to sustain the tobacco epidemic. A tobacco retail reduction approach that has not been tried is transitioning tobacco sales to state-controlled alcohol stores (TTS), which are limited in number and operate under some restrictions, e.g. regarding opening hours or marketing materials. This study summarizes policy experts' and advocates' views of TTS, including (1) advantages and disadvantages; (2) feasibility; and (3) potential implementation obstacles.DesignThis study was a qualitative content analysis of semi-structured interviews.SettingTen US states with alcoholic beverage control systems were included.ParticipantsThe participants comprised a total of 103 tobacco control advocates and professionals, public health officials, alcohol policy experts and alcohol control system representatives, including two tribal community representatives.MeasurementsInterviewees' perspectives on their state's alcoholic beverage control agency (ABC, the agency that oversees or operates a state alcohol monopoly) and on TTS were assessed.FindingsInterviewees thought TTS offered potential advantages, including reduced access to tobacco products, less exposure to tobacco advertising and a greater likelihood of successful smoking cessation. Some saw potential long-term health benefits for communities of color, due to the smaller number of state alcohol stores in those communities. Interviewees also raised concerns regarding TTS, including ABCs' limited focus on public health and emphasis on revenue generation, which could conflict with tobacco use reduction efforts. Some interviewees thought TTS could enhance the power of the tobacco and alcohol industries, increase calls for alcohol system privatization or create difficulties for those in recovery.ConclusionsIn the United States, transitioning tobacco sales to state-controlled alcohol stores (TTS) could have a positive public health impact by reducing tobacco availability, marketing exposure and, ultimately, tobacco use. However, tensions exist between alcohol control system goals of providing revenue to the state and protecting public health. Should a state decide to pursue TTS, several guardrails should be established, including building into the legislation an explicit goal of reducing tobacco consumption.

Aims: This study aimed to identify the prevalence and types of harm to children from others' drinking in Australia, as indicated by caregivers, and examine socio‐demographic characteristics of caregivers who indicated a child was affected by others' drinking. Design, setting, participants and measurements: A subsample of 854 adult respondents, who were caregivers of children under 18 years from the 2021 Australian Alcohol's Harm to Others study, were asked questions about whether children in their care had been negatively affected by others' drinking in the past year. Weighted prevalence estimates of overall and specific harms to children are presented. Logistic regressions were conducted to determine characteristics associated with indicating harms to children from others' drinking. Findings: Over 17% of caregivers (95% confidence interval [CI] = 13.0–19.0) indicated that one or more children in their care had been affected by others' drinking in the past 12 months. Verbal abuse (6.2%; 95% CI = 4.3–8.3) was the most common harm indicated, followed by financial harm (4.3%; 95% CI = 2.7–6.2). One percent of caregivers (95% CI = 0.4–2.3) indicated a child was physically hurt and less than 1% (95% CI = 0.2–1.4) indicated a child was the subject of a child protection call due to someone's drinking. Women and caregivers over 65 years were more likely to indicate a child had been affected compared with men and caregivers under 65 years. Caregivers who drank five or more drinks at least three times per week were four times more likely to indicate a child was affected compared with abstainers. Living in a household with someone who drinks heavily and who had negatively affected the child's caregiver was associated with an increased likelihood of child harm. Conclusions: In 2021, a weighted survey estimate for caregivers in Australia indicated that almost one in six children had been affected by others' drinking. Heavier drinking of caregivers and other household members was the most substantial predictor for indicating a child had been negatively affected by others' drinking. [ABSTRACT FROM AUTHOR]

Background and aims Design Setting Participants Measurements Findings Conclusions Research demonstrates that siblings, especially older siblings, make unique contributions to adolescents' substance use above and beyond shared genetics and shared parenting. Older siblings' influences on younger adolescent siblings' alcohol use operate through both direct and indirect pathways. Using three waves of longitudinal data, the present study tested an integrated model of sibling influence processes focused on the linkages between older adolescent siblings' earlier alcohol use and younger adolescent siblings' later alcohol use.Longitudinal study using data collected from families on three occasions: Time 1 (March 2019–February 2020), Time 2 (July 2020–February 2021) and Time 3 (November 2021–February 2022) via online surveys.Families resided in five midwestern states in the US (Illinois, Indiana, Ohio, Pennsylvania and Wisconsin).Participants included two adolescent‐aged siblings and one parent from 682 families (n = 2046 persons).Alcohol use by adolescents and parents was assessed at Time 1; younger siblings' social alcohol expectancies and perceptions of modeling were measured at Time 2; and younger siblings' alcohol use was measured at Time 3.Older siblings' earlier alcohol use predicted younger siblings' later drinking both directly [b = 0.15, standard error (SE) = 0.04, β = 0.17, P < 0.001] and indirectly through younger siblings' social alcohol expectancies [δ = 0.02, SE = 0.008, 95% confidence interval (CI) = 0.003, 0.03]. The direct (δ = −0.14, SE = 0.07, 95% CI = −0.27, −0.01) and indirect (δ = 0.03, SE = 0.02, 95% CI = 0.0001, 0.06) links were further moderated by younger siblings' reports of sibling modeling, but not by gender composition of the sibling dyad or the interaction of modeling and gender composition.Older siblings' alcohol use appears to influence younger siblings' later alcohol use directly, as well as indirectly through younger siblings' expectancies about alcohol. The global context of the sibling relationship, in this case sibling modeling, may further amplify or dampen these pathways of influence. [ABSTRACT FROM AUTHOR]

Background and Aims Design Setting and Participants Measurements Findings Conclusions Numerous studies have demonstrated that alcohol preceded and increased the odds of intimate partner violence (IPV). These prior studies were restricted to one dyad member despite theory suggesting that acute alcohol use by both partners should increase the risk for IPV to a greater degree than when only one partner drinks. We hypothesized that alcohol use by both dyad members, relative to one or no dyad members, would proximally precede and increase the odds of IPV perpetration and victimization.A 60‐day daily diary design was used, where both dyad members of dating couples completed independent reports on IPV perpetration/victimization and alcohol use via a secure survey website.Alcohol using college‐student couples, aged 18–25 (n = 181 couples), from a Midwestern university in the United States participated. A convenience sample strategy was used.Daily surveys asked about alcohol use and IPV perpetration and victimization the prior day, including whether alcohol use preceded or followed IPV. The primary outcome was psychological IPV; secondary outcomes were physical and sexual IPV.Longitudinal random effects models suggested statistically significant associations between drinking behavior and IPV outcomes. The odds of psychological IPV perpetration were higher when both partners were drinking relative to one partner drinking [adjusted odds ratio (aOR) = 1.13, 95% confidence interval (CI) = 1.06–1.99]. Exploratory analyses showed some indication that the odds of physical IPV victimization were higher when both partners were drinking relative to one partner drinking (aOR = 2.09, 95% CI = 1.71–4.21).The risk for intimate partner violence appears to be greater when both partners drink, relative to one partner or neither partner. [ABSTRACT FROM AUTHOR]

Background and Aims Methods Results Conclusions Studies show that higher levels of positive affect (PA) and lower levels of negative affect (NA) are related to craving and alcohol consumption at a daily level in men, but little is known on these associations at a momentary level, and whether they are present in women. This study measured the dynamics of within‐person NA and PA surrounding craving, non‐heavy alcohol use and binge drinking in women with alcohol use disorder (AUD) and female controls without AUD.53 female patients with AUD and 75 female controls, all recruited in Belgium, were included in an experience sampling study where they reported on momentary NA, PA, craving and alcohol use in daily life over a period of 12 months. Assessments occurred eight times a day on Thursdays, Fridays and Saturdays in seven bursts of three weeks.Within‐person NA at a previous assessment (t−1) predicted craving at the current assessment (t0) in patients with AUD in a positive linear [β = 0.043; 95% confidence interval (CI) = 0.002, 0.057; P = 0.041] and quadratic fashion (β = 0.034; CI = 0.011, 0.057; P = 0.004). Within‐person PA at t−1 predicted craving at t0 in patients with AUD with a positive quadratic relation (β = 0.042; CI = 0.08, 0.065; P < 0.001). Within‐person NA at t−1 negatively predicted non‐heavy alcohol use at t0 in a linear fashion in controls (β = −0.495; CI = ‐0.677, ‐0.312; P < 0.001) and patients with AUD (β = −0.276; CI = ‐0.421, ‐0.132; P < 0.001). Within‐person PA at t−1 significantly predicted non‐heavy alcohol use at t0 with a positive linear term (β = 0.470; CI = 0.329, 0.610; P < 0.001) in controls, but with a positive linear term (β = 0.399; CI = 0.260, 0.454; P < 0.001) and a positive quadratic term (β = 0.203; CI = 0.060, 0.347; P = 0.003) in patients with AUD. Within‐person NA at t−1 predicted binge drinking at t0 in patients with AUD with a significant quadratic term (β = 0.236; CI = 0.060, 0.412; P = 0.008), but not for controls. Within‐person PA at t−1 predicted binge drinking at t0 in patients with AUD with a significant quadratic term (β = 0.378; CI = 0.215, 0.542; P < 0.001), and this was also the case for controls (β = 0.487; CI = 0.158, 0.770; P < 0.001). Non‐heavy alcohol use at t0 predicted lower levels of NA at t+1 in both patients with AUD (β = −0.161; SE = 0.044; CI = ‐0.248, 0.074; P = 0.001) and controls (β = −0.114; CI = ‐0.198, ‐0.029; P = 0.010). Non‐heavy alcohol use at t0 also predicted higher levels of PA at t+1 in both patients with AUD (β = 0.181; CI = 0.088, 0.274; P < 0.001) and controls (β = 0.189; CI = 0.101, 0.278; P < 0.001).The momentary relation between affect and craving or alcohol use seems to be non‐linear in female patients with alcohol use disorder, whereby a worse mood predicts subsequent alcohol use, though more for binge drinking than for non‐heavy alcohol use. [ABSTRACT FROM AUTHOR]

Background and aims: Alcohol consumption has decreased in England in recent decades, while alcohol‐specific death rates have remained relatively stable. Age–period–cohort (APC) models offer the potential for understanding these paradoxical trends. This study aimed to use an APC model approach to measure long‐term trends in alcohol abstention and consumption in England from 2001 to 2019. Design, setting and participants: The study used grouped and proxy‐variable APC models of repeat cross‐sectional survey data, set in England (2001–19). Participants were residents in England aged 13 years or over who took part in the Health Survey for England. Measurements: Outcome variables were alcohol abstention and consumption in units. We created nine age groups (13–15, 16–17, 18–24, 25–34, until 65–74 and 75+, reference 45–54 years), four periods (2001–04, 2005–09, 2010–14 to 2015–19, reference 2005–09) and 18 5‐year birth cohorts (1915–19 to 2000–04, reference 1960–64). We proxied age effects (systolic and diastolic blood pressure), period effects (alcohol affordability, internet usage and household alcohol expenditure) and birth cohort effects (prevalence of smoking and prevalence of overweight). Findings The odds of abstaining were considerably larger at young ages, 13–15 years [odds ratio (OR) = 5.38; 95% confidence interval (CI) = 4.50–6.43], were lowest during the first period, 2001–04 (OR = 0.83; 95% CI = 0.79–0.86) and had a U‐shaped pattern by birth cohort. For units of alcohol, the incidence rate ratio (IRR) increased until age 18–24 years (IRR = 1.41, 95% CI = 1.34–1.48) and decreased afterwards, were highest during the first period, 2001–04 (IRR = 1.07; 95% CI = 1.05–1.08) and showed an inverted J‐shape by birth cohort. Our proxy variable approach revealed that using blood pressure measures, alcohol affordability and prevalence of overweight as proxies resulted in APC effects that differed from our base‐case model. However, internet usage, household expenditure on alcohol and smoking prevalence resulted in APC effects similar to our base‐case model. Conclusions: The discrepancy between decreasing alcohol consumption and increasing alcohol‐related deaths observed in England from 2001 to 2019 may, in part, be explained by the halt in abstention trends since 2010 and a slight consumption decline since 2001. [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]

BACKGROUND AND AIMS: Reduction of alcohol consumption is important for people undergoing treatment for HIV. We tested the efficacy of a brief intervention for reducing the average volume of alcohol consumed among patients on HIV antiretroviral therapy (ART). DESIGN, SETTING AND PARTICIPANTS: This study used a two-arm multi-centre randomized controlled trial with follow-up to 6 months. Recruitment occurred between May 2016 and October 2017 at six ART clinics at public hospitals in Tshwane, South Africa. Participants were people living with HIV, mean age 40.8 years [standard deviation (SD) = 9.07], 57.5% female, and on average 6.9 years (SD = 3.62) on ART. At baseline (BL), the mean number of drinks consumed over the past 30 days was 25.2 (SD = 38.3). Of 756 eligible patients, 623 were enrolled. INTERVENTION: Participants were randomly assigned to a motivational interviewing (MI)/problem-solving therapy (PST) intervention arm (four modules of MI and PST delivered over two sessions by interventionists) or a treatment as usual (TAU) comparison arm. People assessing outcomes were masked to group assignment. MEASUREMENTS: The primary outcome was the number of standard drinks (15 ml pure alcohol) consumed during the past 30 days assessed at 6-month follow-up (6MFU). FINDINGS: Of the 305 participants randomized to MI/PST, 225 (74%) completed the intervention (all modules). At 6MFU, retention was 88% for the control and 83% for the intervention arm. In support of the hypothesis, an intention-to-treat-analysis for the primary outcome at 6MFU was -0.410 (95% confidence interval = -0.670 to -0.149) units lower on log scale in the intervention group than in the control group (P = 0.002), a 34% relative reduction in the number of drinks. Sensitivity analyses were undertaken for patients who had alcohol use disorders identification test (AUDIT) scores ≥ 8 at BL (n = 299). Findings were similar to those of the whole sample. CONCLUSIONS: In South Africa, a motivational interviewing/problem-solving therapy intervention significantly reduced drinking levels in HIV-infected patients on antiretroviral therapy at 6-month follow-up.

Background and aims: Research examining how alcohol consumption changed across different socio‐demographic groups during the pandemic has largely relied upon convenience samples recruited after the onset of the COVID‐19 pandemic. The aim of this study was to measure whether the pandemic shifted alcohol consumption in different gender, age and income groups in Australia. Design, setting and participants: This was a longitudinal study using four waves (2017–20) of the annual Household, Income and Labour Dynamics in Australia (HILDA) Survey to compare pre‐pandemic consumption (2017–19) with consumption in 2020. A total of 11 636 participants in Australia aged 15 years and older took part. Measurements: Participants were asked annually about their alcohol consumption, demographics and income. Findings There was a statistically significant increase in alcohol consumption during the first year of the pandemic [incident rate ratio (IRR) = 1.1, 95% confidence interval (CI) = 1.1, 1.1], largely driven by changes in drinking frequency. We found a significant difference in consumption change from pre‐COVID‐19 to during COVID‐19 for participants aged under 55 years compared with those aged over 55 years. In addition, participants aged 15–34 reported less alcohol consumption during the pandemic than those aged 35 years and older. No significant differences were identified across gender and income groups. Conclusions: Alcohol consumption in Australia increased during the first year of the COVID‐19 pandemic. Survey participants aged 55 years and over seemed to be the least impacted by the public health measures introduced during the pandemic, such as the closure of licensed premises. [ABSTRACT FROM AUTHOR]

Background and aims: Alcohol use disorder (AUD) is characterized by low levels of engagement with effective treatments. Enhancing awareness of AUD treatments and how to navigate the treatment system is crucial. Many individuals use online sources (e.g. search engines) for answers to health‐related questions; web‐based results include a mix of high‐ and low‐quality information. Artificial intelligence may improve access to quality health information by providing concise, high‐quality responses to complex health‐related questions. This study evaluated the quality of ChatGPT‐4 responses to AUD‐related queries. Method: A comprehensive list of 64 AUD‐related questions was developed through a combination of Google Trends analysis and expert consultation. ChatGPT‐4 was prompted with each question, followed by a request to provide 3–5 peer‐reviewed scientific citations supporting each response. Responses were evaluated for whether they were evidence‐based, provided a referral and provided supporting documentation. Results: ChatGPT‐4 responded to all AUD‐related queries, with 92.2% (59/64) of responses being fully evidence‐based. Although only 12.5% (8/64) of responses included referrals to external resources, all responses (100%; 5/5) to location‐specific ('near me') queries directed individuals to appropriate resources like the NIAAA Treatment Navigator. Most (85.9%; 55/64) responses to the follow‐up question provided supporting documentation. Conclusions: ChatGPT‐4 responds to alcohol use disorder‐related questions with evidence‐based information and supporting documentation. ChatGPT‐4 could be promoted as a reasonable resource for those looking online for alcohol use disorder‐related information. [ABSTRACT FROM AUTHOR]

Aims Methods Results Conclusions The aims of this study were to identify alcohol‐related population surveys administered in the Americas, determine which alcohol‐related measures are examined and identify coverage gaps regarding alcohol‐related measures.As part of the Global Information System on Alcohol and Health study, a systematic search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses criteria to identify regionally or nationally representative survey reports of the general population from 1 January 2010 to 6 August 2019. Alcohol‐related measures extracted from surveys were categorized into 10 domains: alcohol consumption status; alcohol consumption; unrecorded alcohol consumption; drinking patterns; symptoms of dependence and/or harmful use; drinking during pregnancy; treatment coverage; second‐hand harms; economic; and other.The systematic search identified 7417 survey reports, 94 of which were new and included in this study, with an additional 11 studies included from a previous systematic study of alcohol surveys. In total, 94 unique surveys and 161 unique survey waves were located, representing 105 unique survey questionnaires covering 30 countries. No population surveys were found for five member states; namely, Antigua and Barbuda, Dominica, Haiti, Saint Vincent and the Grenadines and Saint Kitts and Nevis. All countries with population‐based alcohol surveys had had a population survey probing alcohol use in the past year/month. Questions regarding heavy episodic drinking, alcohol use disorders, treatment‐seeking for alcohol use, drinking during pregnancy, harms to others and the amounts spent on alcohol were asked in 26, 25, 10, 6, 22 and 11 countries, respectively.The heterogeneity in alcohol‐related population surveys in the Americas from 2010 to 2019 limits their comparability throughout countries and over time. Future surveys should implement a standardized set of core questions to provide consistency in the monitoring of alcohol consumption and alcohol‐related harms. [ABSTRACT FROM AUTHOR]

Aims: To describe the range of effects experienced due to the drinking of people respondents know and analyze risk and protective factors for harm from the drinking of partners and household members, other relatives and friends and co‐workers. Design, setting and participants: Surveys of 2574 participants' experiences were obtained from two samples: 1000 people responded to random digitally dialled Australian mobile calls and 1574 participants responded from the Life in AustraliaTM panel survey. Measurements: Respondents were asked whether they had been negatively affected in the previous 12 months by the drinking of persons they knew who were 'a heavy drinker or drank a lot sometimes' and the nature of these harms. Weighted logistic regressions were used to analyze differences in rates of key negative outcomes from known others' drinking by gender, age and socio‐economic status. Findings Almost two thirds [60.2%; 95% confidence interval (CI) = 57.7%–62.7%] of participants reported having heavy drinkers in their lives and 21.8% (95% CI = 19.8%–23.9%) reported being negatively affected by the drinking of people they knew well in some way. Participants reported a gamut of effects, including, most commonly, adverse social effects: having to transport relatives and friends who had been drinking, role failure and faults, being emotionally hurt or neglected, serious arguments, family problems, having to care for drinkers and verbal abuse. Less commonly, respondents reported physical or sexual harm, property damage, financial stress and threats from others' drinking. Women (odds ratio = 1.49; 95% CI = 1.13–1.95), younger people, rural, Australian‐born (vs. respondents born overseas in non‐English speaking countries) and more frequent drinkers were more likely to report harm from a drinker they knew than their counterparts after adjusting for other variables in the model. Conclusions: Australians appear to be commonly adversely affected by the drinking of people they know. Harms from known drinkers are more likely to be experienced by women than men, particularly from the people they live with and other relatives. [ABSTRACT FROM AUTHOR]

Background and aims: The relationship between alcohol consumption and age‐related diseases is inconsistent. Biological age (BA) serves as both a precursor and a predictor of age‐related diseases; however, longitudinal associations between alcohol consumption and BA in middle‐aged and older people remain unclear. We measured whether there was a longitudinal association between drinking frequency and pure alcohol intake with BA among middle‐aged and older people. Design and setting and participants: This study involved two prospective cohort studies, set in Southwestern China and the United Kingdom. A total of 8046 participants from the China Multi‐Ethnic Cohort study (CMEC) and 5412 participants from the UK Biobank (UKB), aged 30–79 years, took part, with complete data from two waves of clinical biomarkers. Measurements: BA was calculated by the Klemera Doubal's method. Accelerated BA equalled BA minus chronological age. Drinking frequency and pure alcohol intake were obtained through self‐reported questionnaires. Drinking frequency in the past year was classified as current non‐drinking, occasional (monthly drinking) and regular (weekly drinking). Findings: Compared with consistent current non‐drinkers, more frequent drinkers [CMEC: β = 0.46, 95% confidence interval (CI) = 0.13–0.80; UKB: β = 0.65, 95% CI = 0.01–1.29)], less frequent drinkers (CMEC: β = 0.62, 95% CI = 0.37–0.87; UKB: β = 0.54, 95% CI = −0.01–1.09), consistent occasional drinkers (CMEC: β = 0.51, 95% CI = 0.23–0.79; UKB: β = 0.63, 95% CI = 0.13–1.13) and consistent regular drinkers (CMEC: β = 0.56, 95% CI = 0.17–0.95; UKB: β = 0.46, 95% CI = 0.00–0.91) exhibited increased accelerated BA. A non‐linear relationship between pure alcohol intake and accelerated BA was observed among consistent regular drinkers. Conclusions: In middle‐aged and older people, any change in drinking frequency and any amount of pure alcohol intake seem to be positively associated with acceleration of biological ageing, compared with maintaining abstinence. [ABSTRACT FROM AUTHOR]

Background and aims: On 1 May 2018, Scotland introduced minimum unit pricing (MUP), a strength‐based floor price below which alcohol cannot be sold, throughout all alcoholic beverages. The legislation necessitates an evaluation of its impact across a range of outcomes that will inform whether MUP will continue beyond its sixth year. We measured the impact of MUP on per‐adult alcohol sales (as a proxy for consumption) after 3 years of implementation. Design, setting and participants: Controlled interrupted time‐series regression was used to assess the impact of MUP on alcohol sales in Scotland after 3 years of implementation, with England and Wales (EW) being the control group. In adjusted analyses, we included household disposable income, on‐trade alcohol sales (in off‐trade analyses) and substitution between drink categories (in drink category analyses) as covariates. Measurements: Weekly data were assessed on the volume of pure alcohol sold in Scotland and EW between January 2013 and May 2021, expressed as litres of pure alcohol per adult. The impact of MUP on total (on‐ and off‐trade combined), off‐trade and on‐trade alcohol sales was assessed separately. Results: The introduction of MUP in Scotland was associated with a 3.0% (95% confidence interval = 1.8−4.2%) net reduction in total alcohol sales per adult after adjustment for the best available geographical control, disposable income and substitution. This reflects a 1.1% fall in Scotland in contrast to a 2.4% increase in EW. The reduction in total alcohol sales in Scotland was driven by reduced sales of beer, spirits, cider and perry. The reduction in total sales was due to reductions in sales of alcohol through the off‐trade. There was no evidence of any change in on‐trade alcohol sales. Conclusion: Minimum unit pricing has been effective in reducing population‐level alcohol sales in Scotland in the 3 years since implementation. [ABSTRACT FROM AUTHOR]

Background and aims: The relationship between alcohol consumption and age-related diseases is inconsistent. Biological age (BA) serves as both a precursor and a predictor of age-related diseases; however, longitudinal associations between alcohol consumption and BA in middle-aged and older people remain unclear. We measured whether there was a longitudinal association between drinking frequency and pure alcohol intake with BA among middle-aged and older people. Design and setting and participants: This study involved two prospective cohort studies, set in Southwestern China and the United Kingdom. A total of 8046 participants from the China Multi-Ethnic Cohort study (CMEC) and 5412 participants from the UK Biobank (UKB), aged 30-79 years, took part, with complete data from two waves of clinical biomarkers. Measurements: BA was calculated by the Klemera Doubal's method. Accelerated BA equalled BA minus chronological age. Drinking frequency and pure alcohol intake were obtained through self-reported questionnaires. Drinking frequency in the past year was classified as current non-drinking, occasional (monthly drinking) and regular (weekly drinking). Findings: Compared with consistent current non-drinkers, more frequent drinkers [CMEC: β = 0.46, 95% confidence interval (CI) = 0.13-0.80; UKB: β = 0.65, 95% CI = 0.01-1.29)], less frequent drinkers (CMEC: β = 0.62, 95% CI = 0.37-0.87; UKB: β = 0.54, 95% CI = -0.01-1.09), consistent occasional drinkers (CMEC: β = 0.51, 95% CI = 0.23-0.79; UKB: β = 0.63, 95% CI = 0.13-1.13) and consistent regular drinkers (CMEC: β = 0.56, 95% CI = 0.17-0.95; UKB: β = 0.46, 95% CI = 0.00-0.91) exhibited increased accelerated BA. A non-linear relationship between pure alcohol intake and accelerated BA was observed among consistent regular drinkers. Conclusions: In middle-aged and older people, any change in drinking frequency and any amount of pure alcohol intake seem to be positively associated with acceleration of biological ageing, compared with maintaining abstinence. [ABSTRACT FROM AUTHOR]

Background and aims: A health warning label (HWL) cautioning about the link between alcohol and cancer may be able to communicate alcohol risks to consumers and potentially counter health‐oriented nutrition advertising on ready‐to‐drink alcoholic beverages. This study aimed to examine the independent and combined effects of nutrient content claims (e.g. 0 g sugar) and a HWL on perceived product characteristics and intentions to consume, and whether these effects differed by gender and age. Design: A between‐subjects randomized experiment. Participants were randomized to view one of six experimental label conditions: nutrient content claims plus nutrition declaration (NCC + ND), ND only, NCC + ND + HWL, ND + HWL, HWL only and no NCC, ND or HWL, all on a ready‐to‐drink (RTD) vodka‐based soda container. Setting and participants: Alcohol consumers (n = 5063; 52% women) in Canada aged 18–64 recruited through a national online panel. Measurements Participants completed ratings of perceived product characteristics, perceived product health risks, and intentions to try, buy, binge and drink the product. Findings Compared with the reference condition NCC + ND (current policy scenario in Canada), the other five experimental label conditions were associated with lower ratings for perceiving the product as healthy. All experimental conditions with a HWL were associated with lower product appeal, higher risk perceptions and reduced intentions to try, buy and binge. The experimental condition with a HWL only was associated with intentions to consume fewer cans in the next 7 days (β = −0.72, 95% confidence interval [CI] = −1.37,−0.08) versus the reference. Few interactions were observed, suggesting that label effects on outcomes were similar by gender and age. Conclusions: Health warning labels on alcohol packaging appear to be associated with lower product appeal, higher perceived health risks and reduced consumption intentions, even in the presence of nutrient content claims. [ABSTRACT FROM AUTHOR]

Background and aims: Whether alcohol‐related DNA methylation has a causal effect on psychiatric disorders has not been investigated. Furthermore, a comprehensive investigation into the causal relationship and underlying mechanisms linking alcohol consumption and psychiatric disorders has been lacking. This study aimed to evaluate the causal effect of general alcohol intake and pathological drinking behaviors on psychiatric disorders, alcohol‐associated DNA methylation on gene expression and psychiatric disorders, and gene expression on psychiatric disorders. Design: Two‐sample design Mendelian randomization (MR) analysis. Various sensitivity and validation analyses, including colocalization analysis, were conducted to test the robustness of the results. Setting: Genome‐wide association study (GWAS) data mainly from GWAS and Sequencing Consortium of Alcohol and Nicotine use (GSCAN), Genetics of DNA Methylation Consortium (GoDMC) and Psychiatric Genomics Consortium (PGC) with European ancestry. Participants: The GWAS summary data on general alcohol intake (drinks per week, n = 941 280), pathological drinking behaviors (including alcohol use disorder [AUD, n = 313 959] and problematic alcohol use [PAU, n = 435 563]) and psychiatric disorders (including schizophrenia, major depressive disorder and bipolar disorder, n = 51 710–500 199) were included. Alcohol‐related DNA methylation CpG sites (n = 9643) and mQTL data from blood (n = 27 750) and brain (n = 1160), BrainMeta v2 and GTEx V8 eQTL summary data (n = 73–2865) were also included. Measurements Genetic variants were selected as instrumental variables for exposures, including drinks per week, AUD, PAU, alcohol‐related DNA methylation CpG sites (mQTL) and genes selected (eQTL). Findings Pathological drinking behaviors were associated with an increased risk of psychiatric disorders after removing outliers or controlling for alcohol consumption. MR analysis identified 10 alcohol‐related CpG sites with colocalization evidence that were causally associated with psychiatric disorders (P = 1.65 × 10−4–7.52 × 10−22). Furthermore, the expression of genes (RERE, PTK6, GATAD2B, COG8, PDF and GAS5) mapped to these CpG sites in the brain, led by the cortex, were significantly associated with psychiatric disorders (P = 1.19 × 10−2–3.51 × 10−7). Conclusions: Pathological drinking behavior and alcohol‐related DNA methylation appear to have a causal effect on psychiatric disorders. The expression of genes regulated by the alcohol‐related DNA methylation sites may underpin this association. [ABSTRACT FROM AUTHOR]

Aims: Three smoking cessation studies (CARE, Break Free, Por Nuestra Salud [PNS]) were used to measure changes in average alcohol consumption, binge drinking and alcohol‐related problems during a smoking cessation attempt and to explore co‐action with smoking abstinence. Design: CARE and PNS were longitudinal cohort cessation studies; Break Free was a two‐arm randomized clinical trial. Setting: Texas, USA. Participants: Participants were current smokers who were recruited from the community and received smoking cessation interventions. All participants received nicotine replacement therapy and smoking cessation counseling. CARE included 424 smokers (1/3 White, 1/3 African American and 1/3 Latino); Break Free included 399 African American smokers; PNS included 199 Spanish‐speaking Mexican‐American smokers. Measurements Weekly alcohol consumption was collected multiple times pre and post‐quit, and binge drinking and alcohol‐related problems were collected at baseline and 26 weeks post‐quit. Analyses included only those who indicated current alcohol use. Findings Average alcohol consumption decreased from baseline to 26 weeks post‐quit in CARE (F = 17.09, P < 0.001), Break Free (F = 12.08, P < 0.001) and PNS (F = 10.21, P < 0.001). Binge drinking decreased from baseline to 26 weeks post‐quit in CARE (F = 3.94, P = 0.04) and Break Free (F = 10.41, P < 0.001) but not PNS. Alcohol‐related problems decreased from baseline to 26 weeks post‐quit in CARE (Chi‐sq = 6.41, P = 0.010) and Break Free (Chi sq = 14.44, P = 0.001), but not PNS. Conclusions: Among current drinkers, alcohol use/problems appear to decrease during a smoking cessation attempt and remain low through 26 weeks after the quit attempt. Little evidence was found for co‐action, with smoking abstainers and relapsers showing similar change in alcohol use/problems. [ABSTRACT FROM AUTHOR]

Background and aims: Adolescent polysubstance use has been associated with adverse social and health outcomes. Our aim was to measure rates and transitions to polysubstance use during adolescence and identify factors associated with initiation and discontinuation of polysubstance use. Design: Prospective cohort study. Multistate Markov modelling was used to estimate rates and identify correlates of transitions between substance use states. Setting and participants: Adolescent‐parent dyads (n = 1927; adolescents in grade 7, age ≈13 years) were recruited from Australian schools during 2010/11 (Wave 1). Adolescents were surveyed annually until 2016/17 (n = 1503; age ≈19 years; Wave 7) and parents were surveyed annually until 2014/15 (Wave 5). Measurements Alcohol, tobacco, cannabis and 3,4‐methylenedioxymethamphetamine (MDMA) use outcomes were collected at Waves 3–7. Potential confounders were collected at Waves 1–6 and consisted of sex, anxiety and depression symptoms and externalizing problems, parental monitoring, family conflict and cohesion, parental substance use and peer substance use. Covariates were age and family socioeconomic status. Findings Few adolescents engaged in polysubstance use at earlier waves (Wave 3: 5%; Wave 4: 8%), but proportions increased sharply across adolescence (Waves 5–7: 17%, 24%, 36%). Rates of transitioning to polysubstance use increased with age, with few (<9%) adolescents transitioning out. More externalizing problems (odds ratio [OR] = 1.10; 99.6% confidence interval [CI] = 1.07–1.14), parental heavy episodic drinking (OR = 1.22; 99.6% CI = 1.07–1.40), parental illicit substance use (OR = 3.56; 99.6% CI = 1.43–8.86), peer alcohol use (OR = 5.68; 99.6% CI = 1.59–20.50) and peer smoking (OR = 4.18; 99.6% CI = 1.95–8.81) were associated with transitioning to polysubstance use. Conclusions: Polysubstance use in Australia appears to be rare during early adolescence but more common in later adolescence with low rates of transitioning out. Externalizing problems and greater parental and peer substance use are risk factors for adolescent polysubstance use that may be suitable intervention targets. [ABSTRACT FROM AUTHOR]

Background and Aims: Non‐alcoholic beverages (NABs) that mimic alcohol without inducing intoxication, such as non‐alcoholic beers, non‐alcoholic wines and spirit‐free drinks, are increasing in popularity. It is unknown whether NABs help to mitigate or stimulate alcohol use. The present study aimed to describe NAB consumption practices among US adults consuming alcohol, characterize who is likely to consume NABs and examine whether NAB use influences desire for and perceived consumption of alcohol. Design and Participants: The survey study used data collected June–July 2023 from an on‐line convenience sample. The first survey (n = 1906) assessed frequency of NAB consumption among US adults who consume alcohol. A second more detailed survey on use patterns was conducted with 466 respondents who reported past‐year NAB consumption, of whom 153 (32.83%) screened positive on the CAGE questionnaire for alcohol use disorder (AUD). Setting: This study took place in the United States. Measurements: NAB consumption measures included type of NAB consumed, frequency, quantity, first consumption age, consumption reasons, consumption contexts and perceived effect on desire for and consumption of alcohol. Alcohol use measures included frequency, quantity and first consumption age. Findings Past‐year NAB use was endorsed by 28.44% of respondents (61.70% ever used). Non‐alcoholic liquor/'mocktails' were the most common NAB type consumed (83.69%). Compared with respondents without AUD, those who screened positive for AUD were significantly more likely to consume NABs in an effort to decrease or abstain from drinking alcohol [adjusted odds ratio (AOR) = 3.54, 95% confidence interval (CI) = 2.24–5.58] and 67.97% endorsed less alcohol consumption (3.23% endorsed more) due to their NAB use. NAB consumption frequency and quantity were significantly positively predicted by alcohol consumption frequency (AOR = 1.46, 95% CI = 1.17–1.83) and quantity (β = 0.25, 95% CI = 0.15–0.35), respectively. Conclusion: Adults who consume alcohol and screen positive for alcohol use disorder report drinking non‐alcoholic beverages as a harm reduction strategy. [ABSTRACT FROM AUTHOR]

Background and aims: Systematic reviews of the relationship between alcohol consumption and all‐cause mortality have reported different relative risk (RR) curves, possibly due to the choice of reference group. Results have varied from 'J‐shaped' curves, where low‐volume consumption is associated with reduced risk, to monotonically increased risk with increasing consumption. We summarised the evidence on alcohol consumption and all‐cause mortality exclusively from systematic reviews using lifetime abstainers or low‐volume/occasional drinkers as the reference group. Methods: We conducted a systematic umbrella review of systematic reviews of the relationship between alcohol consumption and all‐cause mortality in prospective cohort studies using a reference group of lifetime abstainers or low‐volume/occasional drinkers. Several databases (PubMed/Medline/Embase/PsycINFO/Cochrane Library) were searched to March 2022. Reviews were assessed for risk of bias, and those with reference groups containing former drinkers were excluded. Results: From 2149 articles retrieved, 25 systematic reviews were identified, and five did not include former drinkers in the reference group. Four of the five included reviews had high risk of bias. Three reviews reported a J‐shaped relationship between alcohol consumption and all‐cause mortality with significant decreased risk for low‐volume drinking (RR range 0.84 to 0.95), while two reviews did not. The one review at low risk of bias reported monotonically increased risk with greater consumption (RRs = 1.02, 1.13, 1.33 and 1.52 for low‐, medium‐, high‐ and higher‐volume drinking, respectively, compared with occasional drinking). All five reviews reported significantly increased risk with higher levels of alcohol consumption (RR range 1.28 to 3.70). Sub‐group analyses were reported by sex and age; however, there were evidence gaps for many important factors. Conversely, 17 of 20 excluded systematic reviews reported decreased mortality risk for low‐volume drinking. Conclusions: Over 70% of systematic reviews and meta‐analyses published to March 2022 of all‐cause mortality risk associated with alcohol consumption did not exclude former drinkers from the reference group and may therefore be biased by the 'sick‐quitter effect'. [ABSTRACT FROM AUTHOR]

Background and ams: Despite the evident public health impact, the extent and patterns of alcohol use in the Eastern Mediterranean countries remain understudied. The latest estimation for the last 12‐month use of alcohol in the region was 2.9% in 2016 by the World Health Organization. We reviewed the main indicators for alcohol consumption in the region since 2010. Methods: We systematically searched on‐line databases until September 2023, together with other global and regional sources for studies on the adult general population (aged ≥ 15 years) and young general populations (aged < 18 years) and studies on the treatment‐seeking individuals with substance use in Eastern Mediterranean countries. Studies were included from 22 countries: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, United Arab Emirates and Yemen. Results: A total of 148 were included (n = 95 on the prevalence of alcohol use, n = 46 on the prevalence of alcohol use disorder, regular use and heavy episodic drinking, n = 35 on alcohol use pattern among people who use substances and one report on alcohol per capita consumption, n = 29 had data for more than one category). The pooled prevalence of the last 12‐month alcohol use in the adult general population was 9.5% [95% confidence interval (CI) = 6.4–13.7] among males, 2.8% (95% CI = 1.3–5.5\) among females and 6.2% (95% CI = 3.9–9.6) in both sexes in the region, with notable subregional variations. Data on the prevalence of alcohol use disorder and heavy drinking were limited to several countries, with heterogeneous indicators. The pooled estimate of alcohol as the primary substance of use among treatment‐seeking people who used substances was 16.9% (95% CI = 8.8–26.9). Conclusions: More than 30 million adults in the Eastern Mediterranean region used alcohol in the last 12 months, with a prevalence of 6.2%. This is far fewer than the global estimate of 43% of the population aged 15 years and above, but is approximately two times more than the previous estimate (2.9%), reported by the World Health Organization in 2016, which might show an increasing trend. [ABSTRACT FROM AUTHOR]

AIM: To synthesize international findings on the alcohol-dementia relationship, including representation from low- and middle-income countries. METHODS: Individual participant data meta-analysis of 15 prospective epidemiological cohort studies from countries situated in six continents. Cox regression investigated the dementia risk associated with alcohol use in older adults aged over 60 years. Additional analyses assessed the alcohol-dementia relationship in the sample stratified by sex and by continent. Participants included 24 478 community dwelling individuals without a history of dementia at baseline and at least one follow-up dementia assessment. The main outcome measure was all-cause dementia as determined by clinical interview. RESULTS: At baseline, the mean age across studies was 71.8 (standard deviation = 7.5, range = 60-102 years), 14 260 (58.3%) were female and 13 269 (54.2%) were current drinkers. During 151 636 person-years of follow-up, there were 2124 incident cases of dementia (14.0 per 1000 person-years). When compared with abstainers, the risk for dementia was lower in occasional [hazard ratio (HR) = 0.78; 95% confidence interval (CI) = 0.68-0.89], light-moderate (HR = 0.78; 95% CI = 0.70-0.87) and moderate-heavy drinkers (HR = 0.62; 95% CI = 0.51-0.77). There was no evidence of differences between life-time abstainers and former drinkers in terms of dementia risk (HR = 0.98; 95% CI = 0.81-1.18). In dose-response analyses, moderate drinking up to 40 g/day was associated with a lower risk of dementia when compared with lif-time abstaining. Among current drinkers, there was no consistent evidence for differences in terms of dementia risk. Results were similar when the sample was stratified by sex. When analysed at the continent level, there was considerable heterogeneity in the alcohol-dementia relationship. CONCLUSIONS: Abstinence from alcohol appears to be associated with an increased risk for all-cause dementia. Among current drinkers, there appears to be no consistent evidence to suggest that the amount of alcohol consumed in later life is associated with dementia risk.

Background and aims: Hallucinogens encompass a diverse range of compounds of increasing scientific and public interest. Risks associated with hallucinogen use are under‐researched and poorly understood. We aimed to compare the trends in hallucinogen‐associated health‐care use with alcohol‐ and cannabis‐associated health‐care use. Design, setting and cases: We conducted an ecological study with publicly available data on International Classification of Diseases, 10th Revision (ICD‐10) diagnosis codes associated with emergency department (ED) visits and hospitalizations from the California Department of Healthcare Access and Information (HCAI). HCAI includes primary and secondary ICD‐10 codes reported with ED or hospital discharge from every non‐federal health‐care facility licensed in California, United States, from 2016 to 2022. Measurements: ICD‐10 codes were classified as hallucinogen‐, cannabis‐ or alcohol‐associated if they were from the corresponding category in the ICD‐10 block 'mental and behavioral disorders due to psychoactive substance use'. Findings Observed hallucinogen‐associated ED visits increased by 54% between 2016 and 2022, from 2260 visits to 3476 visits, compared with a 20% decrease in alcohol‐associated ED visits and a 15% increase in cannabis‐associated ED visits. The observed hallucinogen‐associated hospitalizations increased by 55% during the same period, from 2556 to 3965 hospitalizations, compared with a 1% increase in alcohol‐associated hospitalizations and a 1% increase in cannabis‐associated hospitalizations. This rise in hallucinogenic ED visits was significantly different from the trend in cannabis‐associated (P < 0.001) and alcohol‐associated (P = 0.005) ED visits. The hallucinogen‐associated hospitalizations trend also significantly differed when compared with cannabis‐ (P < 0.001) and alcohol‐associated (P < 0.001) hospitalizations. Conclusions: Hallucinogen‐associated emergency department visits and hospitalizations in California, USA, showed a large relative but small absolute increase between 2016 and 2022. [ABSTRACT FROM AUTHOR]

Background and aims: Quantifying the health burden of alcohol has largely focused upon harm to drinkers, which is an underestimate. There is a growing literature on alcohol's harm to others (HTO), but it lacks the systematic transfer of HTO into a comparative risk assessment framework. This study calculated disability‐adjusted life years (DALYs) for fetal alcohol spectrum disorder (FASD), interpersonal violence and traffic injury due to another's drinking. Design: This study is a disease burden analysis, using modelling of DALYs for New Zealand in 2018. Setting and participants: The study took place among the Aotearoa/New Zealand population in 2018. Measurements The involvement of others' drinking was obtained from prevalence, alcohol‐attributable fraction studies and administrative data. Disability weights (DW) for FASD were adapted from fetal alcohol syndrome (FAS) weights using a Beta–Pert probability distribution; for interpersonal injury, DWs used hospital events linked with injury compensation; for traffic injury, DWs used hospital events. Populations were stratified by ethnicity, age group and gender. A descriptive comparison was made with a previous estimate of DALYs for drinkers. Findings In 2018, 78 277 healthy life years were lost in Aotearoa/New Zealand due to alcohol's HTO. The main contributor (90.3%) was FASD, then traffic crashes (6.3%) and interpersonal violence (3.4%). The indigenous population, Māori, was impacted at a higher rate (DALYs among Māori were 25 per 1000 population; among non‐Māori 15 per 1000 population). The burden of HTO was greater than that to drinkers (DALYs HTO = 78 277; DALYs drinkers = 60 174). Conclusions: Disability from fetal alcohol spectrum disorder (FASD) appears to be a major contributor to alcohol's harm to others in Aotearoa/New Zealand. Taking FASD into account, the health burden of harm to others is larger than harm to the drinker in Aotearoa/New Zealand, and ethnicity differences show inequity in harm to others. Quantification of the burden of harm informs the value of implementing effective alcohol policies and should include the full range of harms. [ABSTRACT FROM AUTHOR]

Background and aims: Health inequities related to alcohol use exist for transgender individuals. While the Thailand Ministry of Public Health recently published a clinical guideline to implement a Screening, Brief Intervention and Referral to Treatment (SBIRT) in primary care, there has been no study regarding transgender women's (TGW) alcohol use and the acceptability of implementing SBIRT in a Thai context, a gap this study aimed to fill. Design: A mixed‐method approach was used. In the first phase, TGW service users and health‐care providers (HCPs) completed a survey on the acceptability of prospective implementation of SBIRT. TGW service users completed the Alcohol Use Disorder Identification Test‐Consumption (AUDIT‐C). In the second phase, TGW service users, HCPs, clinic administrators and national‐level alcohol, HIV and transgender health policymakers participated in in‐depth qualitative interviews. Setting: The Tangerine Clinic, a transgender‐led sexual health clinic in Bangkok, Thailand. Participants: In the first phase, TGW service users (n = 100) and HCP (n = 8) were surveyed. In the second phase, 22 stakeholders (n = 10 TGW service users; n = 8 HCP; n = 1 clinic administrator; n = 3 policymakers) were interviewed. Measurements Simple proportions were calculated for each survey item. Differences in acceptability by various demographic factors were calculated using univariate analysis. The qualitative data were coded using thematic analysis and a deductive approach. The results were mapped to the Consolidated Framework for Implementation Research domains and constructs. The quantitative and qualitative results were triangulated to expand understanding. Findings Fifty per cent of the TGW participants exhibited problematic drinking levels (AUDIT‐C ≥ 4). Implementing SBIRT was highly acceptable, as more than 95% of participants reported agreeing or completely agreeing to receive SBIRT for alcohol use. Barriers, such as complexity, time constraint and lack of knowledge and skills, were anticipated. Adaptability, such as tailoring the content of brief intervention to suit TGW health needs and SBIRT to fit with existing clinic procedures, might facilitate successful implementation. Conclusion: Screening, Brief Intervention and Referral to Treatment (SBIRT) for alcohol use has the potential to be successfully implemented in transgender‐led sexual health clinic settings, with some adaptations to overcome anticipated barriers. [ABSTRACT FROM AUTHOR]

Background and Aims: Relapse is common in alcohol dependence (AD) and alcohol use disorder (AUD), so alcohol reduction therapy should be measured over as long a period as possible; however, existing reviews do not consider the duration of treatment and therefore alcohol reduction therapy may not have been appropriately evaluated. This review evaluated the efficacy and safety of alcohol reduction pharmacotherapy in patients with AD or AUD according to the duration of treatment. Methods: We conducted a systematic review and network meta‐analysis of randomized controlled trials (RCTs) that assessed 15 pharmacological agents. MEDLINE, Embase, PsycINFO, the Cochrane Central Register of Controlled Trials, the ClinicalTrials.gov and the International Clinical Trials Registry Platform were searched for eligible trials through to May 2021. Outcomes were heavy drinking days (HDD), total alcohol consumption (TAC), any adverse event and days without drinking. Results: Fifty‐five RCTs (n = 8891) were included. Nalmefene was superior to placebo for reducing HDD (standard mean difference [SMD] −0.28, 95% confidence interval [CI] −0.37, −0.18) and TAC (SMD −0.25, 95% CI −0.35, −0.16) in the long‐term, but not in the short‐term. Topiramate was superior to placebo for reducing HDD (SMD −0.35, 95% CI −0.59, −0.12) and days without drinking (SMD 0.46, 95% CI 0.11, 0.82), and baclofen was superior for reducing TAC (SMD −0.70, 95% CI −1.29, −0.11), in the short‐term. The frequency of adverse events was higher with nalmefene and topiramate than with placebo. Conclusion: Nalmefene, topiramate and baclofen may be effective as alcohol reduction pharmacotherapy; however, only nalmefene has demonstrated long‐term efficacy, and nalmefene and topiramate have a significantly higher frequency of adverse events compared with placebo. [ABSTRACT FROM AUTHOR]

Background and Aims: Even though a ban of alcohol marketing has been declared a 'best buy' of alcohol control policy, comprehensive systematic reviews on its effectiveness to reduce consumption are lacking. The aim of this paper was to systematically review the evidence for effects of total and partial bans of alcohol marketing on alcohol consumption. Methods: This descriptive systematic review sought to include all empirical studies that explored how changes in the regulation of alcohol marketing impact on alcohol consumption. The search was conducted between October and December 2022 considering various scientific databases (Web of Science, PsycINFO, MEDLINE, Embase) as well as Google and Google Scholar. The titles and abstracts of a total of 2572 records were screened. Of the 26 studies included in the full text screening, 11 studies were finally included in this review. Changes in consumption in relation to marketing bans were determined based on significance testing in primary studies. Four risk of bias domains (confounding, selection bias, information bias and reporting bias) were assessed. Results: Seven studies examined changes in marketing restrictions in one location (New Zealand, Thailand, Canadian provinces, Spain, Norway). In the remaining studies, between 17 and 45 locations were studied (mostly high‐income countries from Europe and North America). Of the 11 studies identified, six studies reported null findings. Studies reporting lower alcohol consumption following marketing restrictions were of moderate, serious and critical risk of bias. Two studies with low and moderate risk of bias found increasing alcohol consumption post marketing bans. Overall, there was insufficient evidence to conclude that alcohol marketing bans reduce alcohol consumption. Conclusions: The available empirical evidence does not support the claim of alcohol marketing bans constituting a best buy for reducing alcohol consumption. [ABSTRACT FROM AUTHOR]

Aims: The aims of this study were to examine the distribution of alcohol use and to define 'harm density functions' representing distributions of alcohol‐caused health harm in Canada, by sex, towards better understanding which groups of drinkers experience the highest aggregate harms. Design: This was an epidemiological modeling study using survey and administrative data on alcohol exposure, death and disability and risk relationships from epidemiological meta‐analyses. Setting: This work took place in Canada, 2019. Participants: Canadians aged 15 years or older participated. Measurements Measures included modeled life‐time mean daily alcohol use in grams of pure alcohol (ethanol) per day, alcohol‐caused deaths and alcohol‐caused disability‐adjusted life‐years. Findings As a life‐time average, more than half of Canadians aged 15+ (62.8% females, 46.9% males) use fewer than 10 g of pure alcohol per day (g/day). By volume, the top 10% of the population consume 45.9% of the total ethanol among males and 47.1% of the total ethanol among females. The remaining 90% of the population experience a slim majority of alcohol‐caused deaths (males 55.3%, females 46.9%). Alcohol harm density functions compose the size of the using population and the risk experienced at each volume level to show that the population‐level harm experienced is highest for males at 25 g/day and females at 13 g/day. Conclusions: Almost 50% of alcohol use in Canada is concentrated among the highest 10% of drinkers, but more than half of the alcohol‐caused deaths in Canada in 2019 were experienced by the bottom 90% of the population by average volume, providing evidence for the prevention paradox. New alcohol harm density functions provide insight into the aggregate health harm experienced across the mean alcohol use spectrum and may therefore be used to help determine where alcohol policies should be targeted for highest efficacy. [ABSTRACT FROM AUTHOR]

Background and aims: Early alcohol use may predict later alcohol problems, but the magnitude of this effect and impact of delayed onset remain uncertain. This study measured age‐based differences in progression from first full alcoholic drink to hazardous drinking in one of the largest and most recent prospective cohorts of Australian adolescents. Design, settings, participants and measurement: A 7‐year (2012–19) prospective longitudinal cohort of 2082 Australian adolescents was established from the Climate and Preventure (cohort 1) and Climate Schools Combined (cohort 2) studies. Participants completed surveys annually from ages 13 to 20 years. Interval censored survival analyses were conducted with first episode of hazardous drinking [three or more on proxy Alcohol Use Disorders Identification Test (AUDIT‐C)] as the survival end‐point, controlling for age, sex and mental health symptomatology. Onset of hazardous drinking was expressed as hazard ratios (HRs), and median survival time (years) was used to model first onset of hazardous alcohol use in survival curves. Findings: Compared with those aged 15 or older, those who had their first full drink at 12 or younger had significantly elevated risk of hazardous drinking onset during the study period [log (HR): 9.3; 95% confidence interval (CI) = 7.0–12.0, P < 0.001]. Compared with those who had their first full drink at ages 13–14, those who delayed until 15 or older had significantly later onset of hazardous drinking; 1.63 years for males (95% CI = 1.31–1.92, P < 0.001) and 1.50 for females (95% CI = 1.15–1.81, P < 0.001), resulting in a median age of onset of hazardous drinking of > 19 for both sexes (male: 19.05 years, 95% CI = 18.74–19.38; female: 19.47 years, 95% CI = 19.19–19.75). First drink at ages 13–14 was associated with the earliest onset of hazardous drinking (males: 17.43 years; females: 17.98 years). Conclusions: In Australia, alcohol initiation prior to age 15 appears to be associated with an earlier onset of hazardous drinking than initiation after age 15. [ABSTRACT FROM AUTHOR]

Aims: To test differential outcomes between three 6‐month text‐messaging interventions to reduce at‐risk drinking in help‐seeking adults. Design: A three‐arm single‐blind randomized controlled trial with 1‐, 3‐, 6‐ and 12‐month follow‐ups. Setting: United States. A fully remote trial without human contact, with participants recruited primarily via social media outlets. Participants: Seven hundred and twenty‐three adults (mean = 39.9 years, standard deviation = 10.0; 62.5% female) seeking to reduce their drinking were allocated to 6 months of baseline 'tailored statically' messaging (TS; n = 240), 'tailored adaptive' messaging (TA; n = 239) or 'drink tracking' messaging (DT; n = 244). Interventions: TS consisted of daily text messages to reduce harmful drinking that were tailored to demographics and alcohol use. TA consisted of daily, tailored text messages that were also adapted based on goal achievement and proactive prompts. DT consisted of a weekly assessment for self‐reported drinking over the past 7 days. Measurements The primary outcome measure was weekly sum of standard drinks (SSD) at 6‐month follow‐up. Secondary outcome measures included drinks per drinking day (DDD), number of drinking days (NDD) per week and heavy drinking days (HDD) at 1‐, 3‐, 6‐ and 12‐month follow‐ups. Findings At 6 months, compared with DT, TA resulted in significant SSD reductions of 16.2 (from 28.7 to 12.5) drinks [adjusted risk ratio (aRR) = 0.80, 95% confidence interval (CI) = 0.71, 0.91] using intent‐to‐treat analysis. TA also resulted in significant improvements in DDD (aRR = 0.84; 95% CI = 0.77–0.92) and drinking days per week (b = −0.39; 95% CI = −0.67, –0.10), but not HDD compared with DT at 6 months. TA was not significantly different from TS at any time‐point, except DDD at 6 months. All groups made improvements in SSD at 12‐month follow‐up compared with baseline with an average reduction of 12.9 drinks per week across groups. Conclusions: Automated tailored mobile messaging interventions are scalable solutions that can reduce weekly alcohol consumption in remote help‐seeking drinkers over time. [ABSTRACT FROM AUTHOR]

Background and aims: It is postulated that due to decreased smoking rates and increased denormalisation of smoking, those who start and maintain smoking have more socially disadvantaged characteristics and are more dependent on nicotine than those who do not (the so‐called 'hardening' hypothesis). The aim of this study was to measure changes in daily smoking and cigarette consumption among Finnish adolescents according to background factors. Design and setting: A repeated cross‐sectional study using data from European School Survey Project on Alcohol and other Drugs (ESPAD) on six representative cross‐sections of 15‐ to 16‐year‐old students between 1999 and 2019 in Finland. Participants: A total of 11 377 males and 12 247 females. Measurements: The outcome measures included the proportion of daily smokers among current smokers, daily smoking and the estimated mean number of smoked cigarettes per day (CPD). Substance use, parental monitoring and school performance were used as independent variables. All measures were self‐reported. Findings Daily smoking decreased over time and daily smokers constituted a smaller part of current smokers in 2019 compared with 1999 (the ratio among boys 0.68 and 0.43, respectively; among girls 0.59 and 0.43). Boys using cannabis (interaction between cannabis*survey year: P = 0.020; in 2019 odds ratio [OR]: 3.68, 95% confidence interval [CI] 2.23–6.08) and girls with heavy episodic drinking (interaction between heavy episodic drinking*survey year: P = 0.006, in 2019 OR: 9.00, 95% CI 5.61–14.42) had elevated adjusted odds for daily smoking over time. The estimated mean number of CPD decreased among daily smokers from 9.0 in 1999 to 7.2 in 2019 (P = 0.0002) and the differences diminished between groups based on gender, snus/alcohol use and parental monitoring. The between‐group differences remained with regard to cannabis use (P = 0.0233 in 2019) and school performance (P = 0.0111 in 2019). Conclusions: Among currently smoking Finnish adolescents, the proportion of daily smokers decreased between 1999 and 2019, as did the number of cigarettes smoked per day (CPD) among daily smokers, suggesting an absence of 'hardening' in this group. However, differences were observed related to the odds of daily smoking and the mean number of CPD, indicating the change has been less favorable among some adolescent groups than others. [ABSTRACT FROM AUTHOR]

Aims: We investigated whether (1) adolescents selected friends with a similar socio‐economic status (SES), (2) smoking and alcohol consumption spread in networks and (3) the exclusion of non‐smokers or non‐drinkers differed between SES groups. Design: This was a longitudinal study using stochastic actor‐oriented models to analyze complete social network data over three waves. Setting: Eight Hungarian secondary schools with socio‐economically diverse classes took part. Participants: This study comprised 232 adolescents aged between 14 and 15 years in the first wave. Measurements Self‐reported smoking behavior, alcohol consumption behavior and friendship ties were measured. SES was measured based upon entitlement to an income‐tested regular child protection benefit. Findings Non‐low‐SES adolescents were most likely to form friendships with peers from their own SES group [odds ratio (OR) = 1.07, 95% confidence interval (CI) = 1.02–1.11]. Adolescents adjusted their smoking behavior (OR = 24.05, 95% CI = 1.27–454.86) but not their alcohol consumption (OR = 1.65, 95% CI = 0.62–4.39) to follow the behavior of their friends. Smokers did not differ from non‐smokers in the likelihood of receiving a friendship nomination (OR = 0.98, 95% CI = 0.87–1.10), regardless of their SES. Alcohol consumers received significantly more friendship nominations than non‐consumers (OR = 1.16, 95% CI = 1.01–1.33), but this association was not significantly different according to SES. Conclusions: Hungarian adolescents appear to prefer friendships within their own socio‐economic status group, and smoking and alcohol consumption spread within those friendship networks. Socio‐economic groups do not differ in the extent to which they encourage smoking or alcohol consumption. [ABSTRACT FROM AUTHOR]

Background and Aim: Drinking alcohol may cause harm to an individual's health and social relationships, while a drinking culture may harm societies as it may increase crime rates and make an area feel less safe. Local councils in Greater Manchester, UK, developed the Communities in Charge of Alcohol (CICA) intervention, in which volunteers were trained to give alcohol‐related advice to the public and taught how to influence policies to restrict when, where and how alcohol is sold. As part of a larger study, the aim of the current project is to measure the impact of CICA on health and crime outcomes at the lower super output (LSOA) geographical aggregation. Design: Quantitative evaluation using four time series analytic methods (stepped‐wedge design, and comparisons to local controls, national controls and synthetic controls) with findings triangulated across these methods. A cost–benefit analysis was carried out alongside the effectiveness analysis. Setting and Participants: The general public in Greater Manchester, UK, between 2010 and 2020. Measurements: The primary outcome of interest was alcohol‐related hospital admissions. Secondary outcomes were accident and emergency (A&E) attendances, ambulance callouts, recorded crimes and anti‐social behaviour incidents. Findings Triangulation of the results did not indicate any consistent effect on area‐level alcohol‐related hospital admissions, A&E attendances, ambulance callouts, reported crimes or anti‐social behaviour associated with the implementation of CICA. The primary stepped‐wedge analysis indicated an increase in alcohol‐related hospital admissions following the implementation of CICA of 13.4% (95% confidence interval −3.3%, +30.1%), which was consistent with analyses based on other methods with point estimates ranging from +3.4% to 16.4%. Conclusion: There is no evidence of a measurable impact of the Communities in Charge of Alcohol (CICA) programme on area‐level health and crime outcomes in Greater Manchester, UK, within 3 years of the programme start. The increase in alcohol‐related hospital admissions was likely the result of other temporal trends rather than the CICA programme. Possible explanations include insufficient follow‐up time, too few volunteers trained, volunteers being unwilling to get involved in licensing decisions or that the intervention has no direct impact on the selected outcomes. [ABSTRACT FROM AUTHOR]

Background and aims: Sweden has experienced a substantial decrease in adolescent drinking over the past decades. Whether the reduction persists into early adulthood remains unclear. Using survey data, the present study aimed to determine whether reductions in indicators of alcohol use observed among adolescents remain in early adulthood and whether changes in alcohol intake are consistent among light/moderate and heavy drinkers. Design: Data from the Swedish monthly Alcohol Monitoring Survey (2001–20) were used to construct five 5‐year birth cohorts (1978–82, 1983–87, 1988–92, 1993–97 and 1998–2002). Setting: Sweden. Participants: A total of n = 52 847 respondents (48% females) aged 16 and 30 years were included in this study. Measurements For both males and females, temporal changes in the prevalence of any drinking, the prevalence of heavy episodic drinking (HED) and total alcohol intake in the past 30 days in centilitres were analysed. Findings The prevalence of any drinking in more recent cohorts remained low until young people came into their early (females) and mid‐ (males) 20s. Male cohorts differed in the prevalence of HED across age, with the later cohorts showing lower odds than earlier cohorts (odds ratios between 0.54 and 0.66). Among females, no systematic differences between cohorts across age could be observed. Later male birth cohorts in light/moderate drinkers had lower alcohol intake than earlier cohorts (correlation coefficients between −0.09 and −0.54). No statistically significant cohort effects were found for male heavy drinkers. Although differences in alcohol intake among females diminished as age increased, the cohorts did not differ systematically in their level of alcohol intake. Conclusions: In Sweden, the reduced uptake of drinking in adolescents appears to fade as people move into adulthood. Observed reductions in alcohol intake among light and moderate drinkers appear to persist into adulthood. More recent male cohorts show a lower prevalence rate of heavy episodic drinking. [ABSTRACT FROM AUTHOR]

Aims: To estimate the health impacts of key modelled alcohol interventions among Māori (indigenous peoples) and non‐Māori in New Zealand (NZ). Design: Multi‐stage life‐table intervention modelling study. We modelled two scenarios: (1) business‐as‐usual (BAU); and (2) an intervention package scenario that included a 50% alcohol tax increase, outlet density reduction from 63 to five outlets per 100 000 people, outlet hours reduction from 112 to 50 per week and a complete ban on all forms of alcohol marketing. Setting and participants: The model's population replicates the 2018 NZ population by ethnicity (Māori/non‐Māori), age and sex. Measurements Alcohol consumption was estimated using nationally representative survey data combined with sales data and corrected for tourist and unrecorded consumption. Disease incidence, prevalence and mortality were calculated using Ministry of Health data. We used dose–response relationships between alcohol and illness from the 2016 Global Burden of Disease study and calculated disability rates for each illness. Changes in consumption were based on the following effect sizes: total intervention package [−30.3%, standard deviation (SD) = 0.02); tax (−7.60%, SD = 0.01); outlet density (−8.64%, SD = 0.01); outlet hours (−9.24%, SD = 0.01); and marketing (−8.98%, SD = 0.02). We measured health gain using health‐adjusted life years (HALYs) and life expectancy. Findings Compared with the BAU scenario, the total alcohol intervention package resulted in 726 000 [95% uncertainty interval (UI) = 492 000–913 000] HALYs gained during the life‐time of the modelled population. Māori experienced greater HALY gains compared with non‐Māori (0.21, 95% UI = 0.14–0.26 and 0.16, 95% UI = 0.11–0.20, respectively). When modelled individually, each alcohol intervention within the intervention package produced similar health gains (~200 000 HALYs per intervention) owing to the similar effect sizes. Conclusions: Modelled interventions for increased alcohol tax, reduced availability of alcohol and a ban on alcohol marketing among Māori and non‐Māori in New Zealand (NZ) suggest substantial population‐wide health gains and reduced health inequities between Māori and non‐Māori. [ABSTRACT FROM AUTHOR]

Background and aims: Controlled drinking (CD) is an attractive treatment goal for a large proportion of individuals with alcohol use disorder (AUD), but the availability of treatment methods supporting a goal of CD is scarce. We tested if behavioural self‐control training (BSCT) was superior to motivational enhancement therapy (MET) for individuals with AUD with a treatment goal of CD. Design: Randomized controlled two‐group trial. Follow‐ups were conducted at 12 and 26 weeks (primary end‐point) after inclusion. Setting: Three specialized dependency care clinics in Stockholm, Sweden. Participants: Two hundred and fifty self‐referred adults (52% men) fulfilling criteria of AUD (DSM‐5) and a stated treatment goal of CD. Intervention and comparator: BSCT (n = 125), a five‐session treatment based on cognitive behavioural therapy versus the active comparator, MET (n = 125), containing four sessions based on Motivational Interviewing. Measurements Primary outcome measure was mean weekly alcohol consumption at the 26‐week follow‐up, adjusted for baseline consumption. Conclusions: A randomized controlled trial found no evidence of a difference between behavioural self‐control training and motivational enhancement therapy in reducing weekly alcohol consumption. Both groups substantially reduced consumption and behavioural self‐control training was superior in reducing hazardous drinking. [ABSTRACT FROM AUTHOR]

Background and aims: Competing models disagree on three theoretical questions regarding alcohol‐related attentional bias (AB), a key process in severe alcohol use disorder (SAUD): (1) is AB more of a trait (fixed, associated with alcohol use severity) or state (fluid, associated with momentary craving states) characteristic of SAUD; (2) does AB purely reflect the over‐activation of the reflexive/reward system or is it also influenced by the activity of the reflective/control system and (3) does AB rely upon early or later processing stages? We addressed these issues by investigating the time‐course of AB and its modulation by subjective craving and cognitive load in SAUD. Design: A free‐viewing eye‐tracking task, presenting pictures of alcoholic and non‐alcoholic beverages, combined with a concurrent cognitive task with three difficulty levels. Setting: A laboratory setting in the detoxification units of three Belgian hospitals. Participants: We included 30 patients with SAUD self‐reporting craving at testing time, 30 patients with SAUD reporting a total absence of craving and 30 controls matched on sex and age. All participants from SAUD groups met the DSM‐5 criteria for SAUD. Measurements We assessed AB through early and late eye‐tracking indices. We evaluated the modulation of AB by craving (comparison between patients with/without craving) and cognitive load (variation of AB with the difficulty level of the concurrent task). Findings Dwell time measure indicated that SAUD patients with craving allocated more attention towards alcohol‐related stimuli than patients without craving (P < 0.001, d = 1.093), resulting in opposite approach/avoidance AB according to craving presence/absence. SAUD patients without craving showed a stronger avoidance AB than controls (P = 0.003, d = 0.806). AB did not vary according to cognitive load (P = 0.962, η2p = 0.004). Conclusions: The direction of alcohol‐related attentional bias (approach/avoidance) appears to be determined by patients' subjective craving at testing time and does not function as a stable trait of severe alcohol use disorder. Alcohol‐related attentional bias appears to rely on later/controlled attentional stages but is not modulated by the saturation of the reflective/control system. [ABSTRACT FROM AUTHOR]

Background: Low‐Risk Alcohol Drinking Guidelines (LRDGs) aim to reduce the harms caused by alcohol. However, considerable discrepancies exist in the 'low‐risk' thresholds employed by different countries. Argument/analysis: Drawing upon Canada's LRDGs update process, the current paper offers the following propositions for debate regarding the establishment of 'low‐risk' thresholds in national guidelines: (1) as an indicator of health loss, years of life lost (YLL) has several advantages that could make it more suitable for setting guidelines than deaths, premature deaths or disability adjusted years of life (DALYs) lost. (2) Presenting age‐specific guidelines may not be the most appropriate way of providing LRDGs. (3) Given past overemphasis on the so‐called protective effects of alcohol on health, presenting cause‐specific guidelines may not be appropriate compared with a 'whole health' effect derived from a weighted composite risk function comprising conditions that are causally related to alcohol consumption. (4) To help people reduce their alcohol use, presenting different risk zones associated with alcohol consumption instead of a single low risk threshold may be advantageous. Conclusions: National LRDGs should be based on years of life lost and should be neither age‐specific nor cause‐specific. We recommend using risk zones rather than a single drinking threshold to help people assess their own risk and encourage the adoption of behaviours with positive health impacts across the alcohol use spectrum. [ABSTRACT FROM AUTHOR]

Background and aim: Social networking sites (SNS) are interactive internet‐based social platforms that facilitate information sharing. A growing body of literature on exposure to, and self‐posting of, alcohol‐related content on SNS has examined the relationship between SNS use and alcohol consumption in young people. This study aims to synthesise the literature exploring the relationship between exposure (i.e. viewing or listening of alcohol‐related media) and self‐posting (i.e. uploading images or text of alcohol content) of alcohol‐related media on SNS on alcohol consumption. Methods: A pre‐registered systematic review was conducted in June 2022 within PubMed, Scopus, PsycINFO and Web of Science. Original prospective and cross‐sectional studies assessing youth and young adults (≤ 24 years of age) that measured exposure to alcohol‐related media or posting of alcohol‐related content on SNS and self‐reported alcohol consumption outcomes were included. Meta‐analyses were conducted on comparable methodologies. Results: Thirty studies were included (n = 19,386). Meta‐analyses of cross‐sectional studies showed both greater exposure (five studies; pooled β = 0.34, 95% confidence interval [CI] = 0.23, 0.44, i2 = 27.7%) and self‐posting of alcohol‐related content (six studies; pooled β = 0.57, 95%CI = 0.25,0.88, i2 = 97.8%) was associated with greater alcohol consumption. Meta‐analyses of three prospective studies also identified that greater exposure predicted greater future alcohol consumption (three studies; pooled β = 0.13, 95%CI = 0.11,0.15, i2 = 0.0%). Narrative analyses of studies that could not be meta‐analysed due to incompatible methodologies were also conducted. Most studies (all four prospective, one of two cross‐sectional) identified positive associations between exposure to alcohol‐related content and greater average consumption. Most studies (three of four prospective, four of six cross‐sectional) reported a positive association between of alcohol‐related self‐posting and greater average alcohol consumption. Conclusions: Both exposure to, and self‐posting of, alcohol‐related content on social networking sites are positively associated with current average consumption, problem drinking, and drinking frequency. [ABSTRACT FROM AUTHOR]

Background and aims: Although multiracial people comprise the fastest growing population in the United States, multiracial youth are nearly invisible in alcohol research. This meta‐analysis synthesized the youth alcohol literature to estimate the magnitude of difference in alcohol use as a function of multiracial status. Design and Measurements: Empirical studies reporting multiracial and monoracial comparisons in youth (aged 10–24 years) alcohol use were identified through a systematic literature search. A random‐effects meta‐analysis was conducted using 85 effect sizes extracted from 16 studies assessing life‐time, past‐year, past‐month and binge alcohol use. Setting and Participants: A total of n=1 555 635 youth were assessed in the United States. Findings: Multiracial youth are suggested to be more likely to endorse life‐time alcohol use than Asian youth [number of studies (k) = 3; odds ratio (OR) = 1.81, 95% confidence interval (CI) = 1.01, 3.24; p = 0.04], with significant between‐study heterogeneity (Q = 8.42; p < 0.001; I2 = 76%) in effect size comparisons. Multiracial youth are suggested to be more likely to endorse past‐month alcohol use than Black (k = 6; OR = 1.54, 95% CI = 1.38, 1.71; p < 0.001) and Asian (k = 4; OR = 2.09, 95% CI = 1.52, 2.88; p < 0.001) youth, but less likely than White (k = 6; OR = 0.87, 95% CI = 0.84, 0.91; p < 0.001) youth, with significant between‐study heterogeneity for Black youth (Q = 11.94; p = 0.03; I2 = 58%) in effect size comparisons. Lastly, multiracial youth are suggested to be more likely to endorse binge alcohol use than Black (k = 4; OR = 1.98, 95% CI = 1.62, 2.44; p < 0.001) and Asian (k = 4; OR = 2.82, 95% CI = 2.28, 3.48; p < 0.001) youth, but less likely than White (k = 5; OR = 0.75, 95% CI = 0.70, 0.81; p < 0.001) and American Indian/Alaska Native (k = 3; OR = 0.78, 95% CI = 0.71, 0.85; p < 0.001) youth, with significant between‐study heterogeneity among Black (Q = 23.99; p < 0.001; I2 = 87%) and Asian (Q = 17.76; p < 0.001; I2 = 83%) youth in effect size comparisons. Conclusions: In the United States, multiracial youth report distinct alcohol use patterns compared with monoracial youth and may be at elevated alcohol use risk compared with Black and Asian youth. [ABSTRACT FROM AUTHOR]

AIMS: To identify factors asociated with early and sustained cessation of heavy drinking. DESIGN: Retrospective cohort study over 5 years. SETTING: Kaiser Permanente Northern California, United States. PARTICIPANTS: Adults reporting heavy drinking during primary care-based alcohol screening between 1 June 2013 and 31 May 2014. The sample (n = 85 434) was 40.7% female and 33.8% non-white; mean age was 50.3 years (standard deviation = 18.1). MEASUREMENTS: Following US guidelines, early and sustained cessation of heavy drinking was defined as reporting lower-risk drinking or abstinence at 1 year and to 5 years after achieving early cessation, respectively. Associations between patient characteristics and service use and cessation outcomes were examined using logistic regression with inverse probability weights addressing attrition. FINDINGS: Nearly two-thirds of participants achieved early cessation of heavy drinking. Women [odds ratio (OR) = 1.39, 95% confidence interval (CI) = 1.35, 1.44], middle-age (35-64 years: ORs = 1.16-1.19), non-white race/ethnicity (ORs = 1.03-1.57), medical conditions (OR = 1.05, 95% CI = 1.04, 1.06), psychiatric (OR = 1.10, 95% CI = 1.06, 1.15) and drug use disorders (OR = 1.35, 95% CI = 1.17, 1.56) and addiction treatment (OR = 1.19, 95% CI = 1.09, 1.30) were associated with higher odds of early cessation, while older age (≥ 65 years: OR = 0.91, 95% CI = 0.86, 0.96), smoking (OR = 0.81, 95% CI = 0.77, 0.84), higher index drinking levels (exceeding both daily and weekly limits: OR = 0.30, 95% CI = 0.29, 0.32) and psychiatric treatment (OR = 0.91, 95% CI = 0.84, 0.99) were associated with lower odds. Among those who achieved early cessation (n = 19 200), 60.0% sustained cessation. Associations between patient factors and sustained cessation paralleled those observed in analyses of early cessation. Additionally, routine primary care (OR = 1.57, 95% CI = 1.44, 1.71) and addiction treatment post-1 year (OR = 1.41, 95% CI = 1.19, 1.66) were associated with higher odds of sustained cessation. Lower-risk drinking versus abstinence at 1 year was associated with lower odds of sustained cessation (OR = 0.62, 95% CI = 0.57, 0.66). CONCLUSIONS: Nearly two-thirds of a large, diverse sample of patients who reported heavy drinking in a Californian health-care system achieved early and sustained cessation of heavy drinking. Vulnerable subgroups (i.e. non-white patients and those with psychiatric disorders), patients who received routine primary care and those who received addiction treatment were more likely to sustain cessation of heavy drinking than other participants.

Background and aimsLittle is known about how perceived norms about alcohol consumption may influence high alcohol consumption rates in Uganda. This study estimated the accuracy of perceived norms about men's alcohol consumption and estimated the association between perceived norms and personal alcohol consumption.DesignCross-sectional, whole-population, sociocentric social network study.SettingEight rural villages in Rwampara District, southwestern Uganda in 2016-18.ParticipantsA total of 719 men aged 18 years and older (representing 91% of permanent resident men).MeasurementsSelf-reported frequent (≥ 4 days per week) and heavy alcohol consumption (six or more drinks on one occasion, more than three occasions of intoxication, or spending an excessive amount on alcohol). Participants also reported whether they thought most other men in their village engaged in frequent and heavy alcohol consumption (perceived norms). Using the network study design, we calculated alcohol consumption behavior within villages and social networks. Perceived norms were compared with aggregated self-reports. Multivariable Poisson regression models were used to estimate the association between perceived norms and individual behavior.FindingsThroughout villages, frequent and heavy alcohol consumption ranged from 7 to 37%. However, 527 (74%) participants perceived, contrary to fact, that most other men in their villages frequently consumed alcohol, and 576 (81%) perceived that most others heavily consumed alcohol. Overestimation of alcohol consumption by others was pervasive among socio-demographic subgroups and was present irrespective of the actual consumption behavior at the village level and within social networks. Men who misperceived these alcohol consumption behaviors as being common were more likely to engage in frequent [adjusted relative risk (aRR) = 3.98; 95% confidence interval (CI) = 1.69-9.34) and heavy (aRR = 4.75; 95% CI = 2.33-9.69) alcohol consumption themselves.ConclusionsMost men in eight rural Ugandan villages incorrectly thought that frequent and heavy alcohol consumption were common among men in their villages. These misperceived norms had a strong positive association with individual drinking behavior.

Background and Aims: ABC-training is a new intervention to encourage health behavior change that targets the automatic activation of adaptive beliefs (i.e. automatic inferences). The aim of this proof-of-principle study was to test the effectiveness of web-based ABC-training to change outcome expectancies of alcohol drinking in a sample of hazardous drinkers. Design: One exploratory and one confirmatory experiment with two between-subject conditions (online ABC- and control-training) and assessments at baseline and 1 week later (after three sessions of training). Setting: Participants recruited on Prolific Academic completed the web-based study. Participants: Adults with self-reported hazardous alcohol drinking (Experiment 1: 193 adults, United Kingdom, age mean = 46.7 years; Experiment 2: 282 adults, different nationalities, age mean = 38.3 years). Intervention and Comparator: ABC-training involved completing an online task that required choosing personally relevant alternative behaviors to drinking alcohol in personally relevant antecedent contexts to attain personally important outcomes. Comparator was control-training, in which participants selected both the alternative behaviors and alcohol drinking an equal number of times. Training was completed at baseline, after 3 days and after 1 week. Measurements: Primary outcome was change in automatic and self-reported (negative/positive) outcome expectancies of alcohol drinking from baseline to after 1 week. Secondary outcomes were change in weekly alcohol consumption, self-efficacy, craving and motivation (and approach-alcohol associations in Experiment 1). Moderators were baseline outcome scores, motivation, age and alcohol dependency. Findings: Findings of this study are as follows: stronger increase in negative outcome expectancies after ABC- than control-training (Experiment 1: self-report, 95% confidence interval of difference scores (CIdiff) = [0.04, Inf]; automatic, CIdiff = [0.01, Inf]; Experiment 2: self-report, CIdiff = [0.16, Inf]; automatic, CIdiff = [0.002, Inf]). Stronger reduction in self-reported positive outcome expectancies after ABC- than controltraining (Experiment 1: CIdiff = [-Inf, -0.01]; Experiment 2: CIdiff = [-Inf, -0.21]) but mixed findings on automatic positive outcome expectancies (Experiment 1: CIdiff = [-Inf, 0.02]; Experiment 2: CIdiff = [-Inf, -0.001]). Conclusions: ABC-training may change outcome expectancies of alcohol consumption, but testing of clinically relevant effects in other samples is warranted. [ABSTRACT FROM AUTHOR]

Background and Aims: Previous research has pointed to the potential of workplace interventions addressing alcohol consumption. However, there is still no systematic overview of the effects of these interventions. Therefore, we aimed to quantify the effectiveness of workplace interventions addressing alcohol use by conducting a meta-analysis. Methods: A systematic literature search for randomized controlled trials of workplace alcohol interventions published between 1995 and 2020 was conducted in five databases. Studies were included if they were performed in the workplace and reported universal or selective interventions aiming for alcohol use reduction. Primary outcomes were any measures of alcohol use. Standardized mean effect sizes were used to calculate the meta-analytic random-effects-model. Additional analyses were carried out to identify potential moderators and to examine the amount of heterogeneity and publication bias. Results: Twenty studies with 4484 participants were integrated into the meta-analysis. Results revealed a significant overall mean effect indicating a reduction of alcohol use in favor of the treatment group (d = -0.16, 95% CI = [-0.2715; -0.0511]). Heterogeneity within the data structure was found to be moderate to substantial (I² = 75.9%, Q-test P < 0.001, Τ ² = 0.0375). Additional moderator analyses only showed a significant effect for length of measurement period (P = 0.049). Conclusions: Alcohol-related prevention programs conducted in the workplace have a statistically significant and favorable effect on alcohol consumption. Although the overall mean effect is considered to be small, it underlines the effectiveness of workplace interventions targeting a reduction in alcohol use. [ABSTRACT FROM AUTHOR]

Background and aims: Substance use disorders (SUDs) are predominantly studied as drug class specific constructs (e.g. opioid versus alcohol use disorder). Polysubstance use (PSU), or the use of two or more substances from multiple drug classes, is only captured diagnostically by the co‐occurrences of drug class‐specific SUDs, and in many ways is relegated to a secondary position within the literature. However, this is not consistent with mounting empirical evidence regarding the high prevalence of PSU patterns compared with a mono‐use pattern (i.e. all use contained within a single‐drug class). The current study measured how many individuals in the general United States population could be characterized as having a mono‐use versus PSU pattern. Methods: We measured the prevalence of mono‐use versus PSU in those who used substances in the past year, those with at least two symptoms of an SUD and in those who received treatment for alcohol/drug problems in the past year using data from the National Survey on Drug Use and Health (NSDUH) from years 2015–19. Results: Of those who used substance(s) in the past year, 64% reported a mono‐use pattern. Importantly, only 26% of those who had at least two symptoms of an SUD and 22% of those who received treatment for substance use reported a mono‐use pattern. Conclusions: Although mono‐use of drugs is common in the United States at the public health level, it is a much less common presentation than polysubstance use (PSU) among individuals of even mild substance use disorder severity. This means that common efforts to study substances in isolation do not focus upon the most common presentation of the phenomenon. We discuss the importance and implications of embracing a PSU framework in the study of substance misuse and substance use disorders. [ABSTRACT FROM AUTHOR]

Background and Aims: Genome‐wide association studies (GWAS) of opioid use disorder (OUD) and cannabis use disorder (CUD) have lagged behind those of alcohol use disorder (AUD) and smoking, where many more loci have been identified. We sought to identify novel loci for substance use traits (SUTs) in both African‐ (AFR) and European‐ (EUR) ancestry individuals to enhance our understanding of the traits' genetic architecture. Design: We used multi‐trait analysis of GWAS (MTAG) to analyze four SUTs in EUR subjects (OUD, CUD, AUD and smoking initiation [SMKinitiation]), and three SUTs in AFR subjects (OUD, AUD and smoking trajectory [SMKtrajectory]). We conducted gene‐set and protein–protein interaction analyses and calculated polygenic risk scores (PRS) in two independent samples. Setting This study was conducted in the United States. Participants: A total of 5692 EUR and 4918 AFR individuals in the Yale‐Penn sample and 29 054 EUR and 10 265 AFR individuals in the Penn Medicine BioBank sample. Findings MTAG identified genome‐wide significant (GWS) single nucleotide polymorphisms (SNPs) for all four traits in EUR: 41 SNPs in 36 loci for OUD; 74 SNPs in 60 loci for CUD; 63 SNPs in 52 loci for AUD; and 183 SNPs in 144 loci for SMKinitiation. MTAG also identified GWS SNPs in AFR: 2 SNPs in 2 loci for OUD; 3 SNPs in 3 loci for AUD; and 1 SNP in 1 locus for SMKtrajectory. In the Yale‐Penn sample, the MTAG‐derived PRS consistently yielded more significant associations with both the corresponding substance use disorder diagnosis and multiple related phenotypes than the GWAS‐derived PRS. Conclusions: Multi‐trait analysis of genome‐wide association studies boosted the number of loci found for substance use traits, identifying genes not previously linked to any substance, and increased the power of polygenic risk scores. Multi‐trait analysis of genome‐wide association studies can be used to identify novel associations for substance use, especially those for which the samples are smaller than those for historically legal substances. [ABSTRACT FROM AUTHOR]

Background and Aims: Analyzing long‐term trajectories of alcohol use has the potential to strengthen policy and intervention priorities and timing. We identified and described trajectories of alcohol use and binge drinking frequency from mid‐adolescence to early adulthood and measured the association of the role of early drinking initiation with trajectory membership. Design, Setting, Participants: This was a longitudinal cohort study conducted in the United States. The National Longitudinal Survey of Youth 1997 is a nationally representative cohort of youth aged 12–16 years at baseline. The analytic sample included individuals who participated in two or more annual interviews between ages 15 and 30 years (n = 8809). Measurements: Participants self‐reported the number of days in the past 30 days they: (1) drank alcohol and (2) binge drank (five or more drinks on one occasion). We used group‐based trajectory modeling to identify distinct trajectories from ages 15–30 years of past 30‐day drinking and past 30‐day binge drinking. Using multinomial logistic regression, we evaluated associations between early drinking initiation (≤ 14 years) and key demographics with trajectory membership. Findings: We identified five past 30‐day drinking groups: late‐escalating (16.0%), moderate frequency (19.0%), high frequency (11.2%), low frequency (35.4%) and no/infrequent (18.4%). Early drinking initiation (versus later) was associated with higher odds of membership in the moderate [adjusted multinomial odds ratio (aMOR) = 4.88; 95% confidence interval (CI) = 4.00, 5.94] and high‐frequency groups (aMOR = 4.68; 95% CI = 3.74, 5.86) than in the no/infrequent comparator trajectory. We identified five groups with distinct binge drinking frequency patterns: later escalating (9.9%), high frequency (3.9%), low frequency (28.7%), earlier onset (9.5%) and no/infrequent (48.0%). Early initiation was associated with increased odds of membership in earlier‐onset and high‐frequency groups compared with the no/infrequent group. For both outcomes, additional differences in probability of group membership were identified by gender, racial identity, parental factors (religiosity, high school completion) and household characteristics (household size, income, and region of residence). Conclusions: Youth in the United States appear to follow heterogeneous drinking and binge drinking trajectories from adolescence into adulthood. These may include higher‐use trajectories as well as trajectories with different escalation timing (e.g. earlier versus later). Early initiation of drinking may increase risk of membership in higher‐ and earlier‐use trajectory groups. [ABSTRACT FROM AUTHOR]