Association between smoking and alcohol-related behaviours: a time-series analysis of population trends in England

Applying the Non-adoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework to evaluate automated evidence synthesis in health behaviour change

Automated tools to speed up the process of evidence synthesis are increasingly apparent within health behaviour research. This brief review explores the potential of the Non-adoption, Abandonment, Scale-up, Spread and Sustainability framework for supporting automated evidence synthesis in health behaviour change by applying it to the ongoing Human Behaviour-Change Project, which aims to revolutionize evidence synthesis within behaviour change intervention research. To increase the relevance of NASSS for health behaviour change, we recommend i) terminology changes ('condition' to 'behaviour' and 'patient' to 'end user') and ii) that it is used prospectively address complexities iteratively. We draw conclusions about i) the need to specify the organizations that will use the technology, ii) identifying what to do if interdependencies fail and iii) even though we have focused on automated evidence synthesis, NASSS would arguably be beneficial for technology developments in health behaviour change more generally, particularly for invention development.

Key lifestyles and interim health outcomes for effective interventions in general populations: A network analysis of a large international observational study

Background

The interconnected nature of lifestyles and interim health outcomes implies the presence of the central lifestyle, central interim health outcome and bridge lifestyle, which are yet to be determined. Modifying these factors holds immense potential for substantial positive changes across all aspects of health and lifestyles. We aimed to identify these factors from a pool of 18 lifestyle factors and 13 interim health outcomes while investigating potential gender and occupation differences.

Methods

An international cross-sectional study was conducted in 30 countries across six World Health Organization regions from July 2020 to August 2021, with 16 512 adults self-reporting changes in 18 lifestyle factors and 13 interim health outcomes since the pandemic.

Results

Three networks were computed and tested. The central variables decided by the expected influence centrality were consumption of fruits and vegetables (centrality = 0.98) jointly with less sugary drinks (centrality = 0.93) in the lifestyles network; and quality of life (centrality = 1.00) co-dominant (centrality = 1.00) with less emotional distress in the interim health outcomes network. The overall amount of exercise had the highest bridge expected influence centrality in the bridge network (centrality = 0.51). No significant differences were found in the network global strength or the centrality of the aforementioned key variables within each network between males and females or health workers and non-health workers (all P-values >0.05 after Holm-Bonferroni correction).

Conclusions

Consumption of fruits and vegetables, sugary drinks, quality of life, emotional distress, and the overall amount of exercise are key intervention components for improving overall lifestyle, overall health and overall health via lifestyle in the general population, respectively. Although modifications are needed for all aspects of lifestyle and interim health outcomes, a larger allocation of resources and more intensive interventions were recommended for these key variables to produce the most cost-effective improvements in lifestyles and health, regardless of gender or occupation.

Smoking, betel quid chewing, and alcohol use among an indigenous primitive Tribal group in the Kerala State of India: Secondary analysis of a Tribal household survey

Background: In India, indigenous populations, known as Tribes, are among the poorest and most marginalized groups. We estimated the prevalence of smoking, alcohol use, and betel quid chewing and examined the association between gender and smoking, alcohol use, and betel quid chewing among Kattunayakan primitive Tribes who are categorized as a Particularly Vulnerable Tribal Group (PVTG) in the Kerala State of India.Methods: A secondary analysis of a sample of the Wayanad District Tribal Household survey comprising 388 Kattunayakan PVTG households selected through multistage cluster random sampling was undertaken. Binary logistic regression models were used to estimate an association between gender and smoking, alcohol use, and betel quid chewing in these Tribal households.Results: Mean age was 39.2 years (±15.1), more than three-fourths of the respondents were female (75.3%), and approximately 24% of the respondents reported smoking tobacco in past 12 months. A fivefold increased odds of smoking among males compared to smoking among females was observed (OR = 4.92; p < .01). More than 64% reported betel quid chewing. Prevalence of alcohol use was 16%, which significantly varied between males (49%) and females (5.1%; OR = 17.71; p < .01). Among tobacco smokers, 64.1% were involved in betel quid use. Among alcohol users, 62.9% were involved in betel quid use and more than 58% were smoking tobacco. Betel quid chewing was the most prevalent substance use.Conclusion: Single and dual substance use of the three commonest types were disproportionately high among this hard-to-reach Tribal population in the southern state of India, with some gender variations. Alcohol consumption was relatively low. However, the complex nature of substance use, compounded by inaccessible health services, poses a significant challenge to rethink and to reimagine innovative methods of providing mental health care services, for instance, mobile health clinics.

Gender differences in the association between lifestyle behaviors and mental health among psychiatrists in China

INTRODUCTION

Mental health symptoms are common among health professionals and the influence of lifestyle behaviors on psychiatrists' mental health is insufficiently understood. Based on a nationwide sample, we aimed to survey the lifestyle behaviors and mental health status among psychiatrists, and to identify the co-occurrence and gender differences in lifestyle behaviors.

METHODS

Data were collected through an anonymous questionnaire among psychiatrists in China. Depression, Anxiety and Stress Scale - 21 (DASS-21) was used to evaluate mental health symptoms. Latent class analysis (LCA) was used to explore the co-occurrence of lifestyle behaviors. The multivariate logistic regression model was used to examine the effects of demographic and lifestyle factors.

RESULTS

4520 psychiatrists were included in the analysis with 11.5 % of them reporting smoking, 10 % reporting alcohol misuse, 35.2 % reporting physical inactivity, and 23.1 % reporting insomnia. The prevalence of depression, anxiety and stress symptoms were 29.2 %, 34.5 %, and 12.2 %, respectively. Significant gender differences were found in smoking (P < 0.001), alcohol misuse (P < 0.001), and physical inactivity (P < 0.001), but not in insomnia. Based on these four high-risk health behaviors above, three lifestyle behavior clusters with huge gender differences were identified through the LCA. Accordingly, the unhealthy lifestyle classes, though defined differently for males and females, were significantly associated with depression, anxiety, and stress.

CONCLUSIONS

The co-occurrence and significant gender differences in multiple lifestyle behaviors exist in this group, highlighting the need for gender-specific comprehensive interventions against mental health symptoms and the urgency of promoting their well-being.

Alcohol consumption and its associated factors among adolescents in a rural community in central Thailand: a mixed-methods study

Early onset of alcohol use was associated with alcohol dependence and other health problems. We aimed to identify the prevalence and factors associated with alcohol consumption among adolescents in a rural community in Thailand. A mixed-methods study was carried out in 2021 using an explanatory sequential design. The study enrolled a total of 413 adolescents. On average, young adolescents initiated alcohol consumption at age 13. The lifetime drinking prevalence among adolescents was 60.5%, while the 1-year drinking prevalence was 53.0%. The prevalence of hazardous drinking among current drinkers was 42.0%. Alcohol consumption was associated with females (adjusted prevalence ratio (APR): 1.19; 95% CI 1.01-1.41), age ≥ 16 years (APR: 1.28; 95% CI 1.09-1.50), having close friends consuming alcohol (APR: 1.75; 95% CI 1.43-2.14), night out (APR: 1.93; 95% CI 1.53-2.45), being a current smoker (APR: 1.39; 95% CI 1.15-1.69), and having relationship (with boyfriend/girlfriend) problems (APR: 1.18; 95% CI 1.01-1.38). Qualitative data demonstrated that individual and environmental factors, including friends, family, social media use, and alcohol accessibility, affect alcohol use in this population. Therefore, effective strategies should be implemented across multiple levels of the socio-ecological model simultaneously to alleviate alcohol consumption and attenuate its complications.

Associations of handgrip strength with all-cause and cancer mortality in older adults: a prospective cohort study in 28 countries

Background

mixed evidence exists on the association between muscle strength and mortality in older adults, in particular for cancer mortality.

Aim

to examine the dose–response association of objectively handgrip strength with all-cause and cancer mortality.

Study Design and Setting

data from consecutive waves from the Survey of Health, Ageing and Retirement in Europe comprising 27 European countries and Israel were retrieved. Overall, 54,807 men (45.2%; 128,753 observations) and 66,576 women (54.8%; 159,591 observations) aged 64.0 (SD 9.6) and 63.9 (SD 10.2) years, respectively, were included. Cox regression and Fine-Grey sub-distribution method were conducted.

Results

during the follow-up period (896,836 person-year), the fully adjusted model showed the lowest significant risk estimates for the highest third of handgrip strength when compared with the first third (reference) in men (hazard ratio [HR], 0.41; 95% confidence interval [CI], 0.34–0.50) and women (HR, 0.38; 95% CI, 0.30–0.49) for all-cause mortality. We identified a maximal threshold for reducing the risk of all-cause mortality for men (42 kg) and women (25 kg), as well as a linear dose–response association in participants aged 65 or over. No robust association for cancer mortality was observed.

Conclusion

these results indicate an inverse dose–response association between incremental levels of handgrip and all-cause mortality in older adults up to 42 kg for men and 25 kg for women, and a full linear association for participants aged 65 years or over. These findings warrant preventive strategies for older adults with low levels of handgrip strength.

A 114% Cigarette Tax Hike and Drinking Behavior: Results From Nationally Representative Longitudinal Panel Data in Korea

This study investigated whether or not drinking behavior changed among Korean adult smokers after a 114% cigarette tax hike in 2015. Data were drawn from waves 9 to 12 (collected yearly from 2014 to 2017) of the nationally representative longitudinal study, the Korean Welfare Panel Study. Korean adults who were ≥19 years comprised the analysis sample (N = 10 875). We applied a difference-in-differences approach to compare drinking behavior before and after the tax increase among three groups (ie, quitters, continued smokers, and nonsmokers). We found that alcohol drinking significantly decreased among those who quit smoking after the tax increase, compared with nonsmokers ( P = .022). Our findings support that a cigarette tax increase may have the beneficial spillover influence of reduction in drinking as well as smoking if the tax increase can induce smokers to quit, but such positive spillover influence may be short-term or null for continued smokers.

Impact of Residential Concentration of PM2.5 Analyzed as Time-Varying Covariate on the Survival Rate of Lung Cancer Patients: A 15-Year Hospital-Based Study in Upper Northern Thailand

Air pollutants, especially particulate matter (PM) ≤ 2.5 µm (PM2.5) and PM ≤ 10 µm (PM10), are a major concern in upper northern Thailand. Data from a retrospective cohort comprising 9820 lung cancer patients diagnosed from 2003 to 2018 were obtained from the Chiang Mai Cancer Registry, and used to evaluate mortality and survival rates. Cox proportional hazard models were used to identify the association between the risk of death and risk factors including gender, age, cancer stage, smoking history, alcohol-use history, calendar year of enrollment, and time-updated PM2.5, PM10, NO₂ and O₃ concentrations. The mortality rate was 68.2 per 100 persons per year of follow-up. In a multivariate analysis, gender, age, cancer stage, calendar year of enrollment, and time-varying residential concentration of PM2.5 were independently associated with the risk of death. The lower the annually averaged PM2.5 and PM10 concentrations, the higher the survival probability of the patient. As PM2.5 and PM10 were factors associated with a higher risk of death, lung cancer patients who are inhabitant in the area should reduce their exposure to high concentrations of PM2.5 and PM10 to increase survival rates.

A national study of alcohol consumption patterns among population-based U.S. cancer survivors compared with cancer-free individuals

BACKGROUND

This study characterized alcohol consumption behaviors among adult cancer survivors and determined how these behaviors compared with cancer-free individuals using NHANES data (1999-2016).

METHODS

Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were estimated using multinomial logistic regression for the association between cancer survivors vs cancer-free individuals and odds of drinking status (former/current/never drinkers), accounting for demographic and socioeconomic factors. Among current drinkers, multivariable logistic regression was used to calculate the aORs for binge drinking and exceeding moderate drinking.

RESULTS

A total of 3113 survivors and 39,527 cancer-free individuals were included. Cancer survivors were less likely to be current drinkers (63.4% vs. 72.6% in cancer-free) and were more likely to be former drinkers (24.4% vs. 15.5% in cancer-free). Cancer survivors had significant lower odds of being current vs. never drinkers (aOR, 0.84, 95% CI: 0.71-0.99). By cancer types, cervical cancer survivors were more likely to be binge drinkers (aOR, 2.51, 95% CI: 1.27-4.92), particularly among women aged ≥ 55 years (aOR, 6.90, 95% CI: 1.28-37.3).

CONCLUSION

Given the high odds of binge drinking among cervical cancer survivors, public health strategies are needed to reduce alcohol consumption in this group.

Associations of Alcohol Consumption and Smoking With Disease Risk and Neurodegeneration in Individuals With Multiple Sclerosis in the United Kingdom

IMPORTANCE

Understanding the effects of modifiable risk factors on risk for multiple sclerosis (MS) and associated neurodegeneration is important to guide clinical counseling.

OBJECTIVE

To investigate associations of alcohol use, smoking, and obesity with odds of MS diagnosis and macular ganglion cell layer and inner plexiform layer (mGCIPL) thickness.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study analyzed data from the community-based UK Biobank study on health behaviors and retinal thickness (measured by optical coherence tomography in both eyes) in individuals aged 40 to 69 years examined from December 1, 2009, to December 31, 2010. Risk factors were identified with multivariable logistic regression analyses. To adjust for intereye correlations, multivariable generalized estimating equations were used to explore associations of alcohol use and smoking with mGCIPL thickness. Finally, interaction models explored whether the correlations of alcohol and smoking with mGCIPL thickness differed for individuals with MS. Data were analyzed from February 1 to July 1, 2021.

EXPOSURES

Smoking status (never, previous, or current), alcohol intake (never or special occasions only [low], once per month to ≤4 times per week [moderate], or daily/almost daily [high]), and body mass index.

MAIN OUTCOMES AND MEASURES

Multiple sclerosis case status and mGCIPL thickness.

RESULTS

A total of 71 981 individuals (38 685 women [53.7%] and 33 296 men [46.3%]; mean [SD] age, 56.7 [8.0] years) were included in the analysis (20 065 healthy control individuals, 51 737 control individuals with comorbidities, and 179 individuals with MS). Modifiable risk factors significantly associated with MS case status were current smoking (odds ratio [OR], 3.05 [95% CI, 1.95-4.64]), moderate alcohol intake (OR, 0.62 [95% CI, 0.43-0.91]), and obesity (OR, 1.72 [95% CI, 1.15-2.56]) compared with healthy control individuals. Compared with the control individuals with comorbidities, only smoking was associated with case status (OR, 2.30 [95% CI, 1.48-3.51]). High alcohol intake was associated with a thinner mGCIPL in individuals with MS (adjusted β = -3.09 [95% CI, -5.70 to -0.48] μm; P = .02). In the alcohol interaction model, high alcohol intake was associated with thinner mGCIPL in control individuals (β = -0.93 [95% CI, -1.07 to -0.79] μm; P < .001), but there was no statistically significant association in individuals with MS (β = -2.27 [95% CI, -4.76 to 0.22] μm; P = .07). Smoking was not associated with mGCIPL thickness in MS. However, smoking was associated with greater mGCIPL thickness in control individuals (β = 0.89 [95% CI, 0.74-1.05 μm]; P < .001).

CONCLUSIONS AND RELEVANCE

These findings suggest that high alcohol intake was associated with retinal features indicative of more severe neurodegeneration, whereas smoking was associated with higher odds of being diagnosed with MS.

Towards quantifying the reciprocal associations between frequency of cannabis use and alcohol consumption: a cross-lagged analysis from the CONSTANCES cohort

OBJECTIVE

Disentangle the temporal relationships between frequency of cannabis use and alcohol consumption.

METHODS

A cross-lagged model providing standardised coefficients (SCs)±their standard errors in 13 255 men and 13 696 women enrolled in 2015 or 2016 in the French population-based 'CONSulTANts des Centres d'Examens de Santé' (CONSTANCES) cohort. Cannabis use was categorised as follows: 'No use during the past 12 months', 'Use during the past 12 months but not in the past month' and 'Use in the past month' for cannabis use at baseline, and No use during the past 12 months, 'Use less than once per month' and 'Use once per month or more' for cannabis use at 1 year of follow-up. Alcohol consumption was measured at baseline and at 1 year of follow-up and three categories were determined: low risk (<28 drinks per week in men; <14 drinks per week in women), moderate risk (≥28 and<42 in men; ≥14 and<28 in women) and high risk (≥42 in men; ≥28 in women). Analyses were adjusted for age, sex, education, income, tobacco consumption, self-rated health status and depressive symptoms.

RESULTS

Both associations from alcohol to cannabis and from cannabis to alcohol were significant (SC=0.02±0.01 with p=0.003 and SC=0.06±0.01 with p<0.001, respectively). However, the SC of the association from cannabis to alcohol was three times higher than the opposite association (p<0.001). After stratification for sex, SCs of the association from cannabis to alcohol were more than two times higher than for the opposite association in men, and more than four times higher in women (both p<0.001).

CONCLUSIONS

The association between frequency of cannabis use and subsequent alcohol consumption was stronger than the opposite association. This finding encourages considering the risk of increased alcohol consumption among cannabis users.

Alcohol consumption and associations with sociodemographic and health-related characteristics in Germany: A population survey

BACKGROUND

To assess the prevalence of ever-drinking and hazardous drinking among adults in Germany, and investigate the factors associated with level of alcohol consumption.

METHODS

Cross-sectional population survey of a representative sample of 11,331 adults in Germany (2018 to 2019). The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) was used to define ever-drinking (AUDIT-C>=1), hazardous drinking (AUDIT-C>=5) and an overall AUDIT-C (alcohol consumption) score (from 0 to 12). Regression models were used to examine sociodemographic and health-related characteristics associated with AUDIT-C score.

RESULTS

The prevalence of ever-drinking and hazardous drinking was 84.7% (95% CI = 84.1-85.4) and 19.4% (95% CI = 18.6-20.1), respectively. The mean AUDIT-C score was 2.8 (SD = 2.16). AUDIT-C scores were independently positively associated with having medium (Badj = 0.12, 95% CI = 0.02-0.21) and high (Badj = 0.11, 95% CI = 0.01-0.21) educational qualifications (compared with low), monthly income (Badj = 0.31 per €1,000, 95% CI = 0.26-0.36), being a current smoker (Badj = 0.94, 95% CI = 0.86-1.02), anxiety (Badj = 0.26, 95% CI = 0.02-0.50), and living in North East (Badj = 0.43, 95% CI = 0.29-0.58), North West (Badj = 0.47, 95% CI = 0.39-0.55) and South East (Badj = 0.79, 95% CI = 0.64-0.93) Germany (compared with South West), and negatively associated with age (Badj = -0.17, 95% CI = -0.21- -0.13), being female (Badj = -1.21, 95% CI = -1.28- -1.14) and depression (Badj = -0.22, 95% CI = -0.43- -0.02).

CONCLUSION

In a large, representative sample of adults in Germany, the majority were ever-drinkers and one fifth were hazardous drinkers. Higher alcohol consumption scores were associated with being younger, male, current smoker, of high socioeconomic position, anxiety, and not living in South West Germany, and lower scores were associated with depression. These groups may benefit from targeted alcohol reduction policies and support.

Alcohol Use and Misuse Among Chinese Psychiatrists During the Early COVID-19 Pandemic

AIM

Survey alcohol use and misuse among Chinese psychiatrists during the Coronavirus diseases 2019 (COVID-19) pandemic.

METHODS

We conducted a large-scale, nationwide online survey of psychiatrists regarding their alcohol use during the pandemic. The Alcohol Use Disorder Identification Test-Concise (AUDIT-C) was used to assess alcohol use and misuse.

RESULTS

Of 3,815 psychiatrists who completed the survey, alcohol use and misus were 47.5% and 8.2%, respectively, and both were significantly higher in males. The majority (59%) reported no change in alcohol use during the pandemic, one-third (34.5%) reported a decrease, and 6.5% reported an increase. Alcohol misuse was associated with middle-age (OR = 1.418), male sex (OR = 5.089), Northeast China (OR = 1.507), cigarette-smoking (OR = 2.335), insomnia (OR = 1.660), and regular exercise (OR = 1.488). A master's degree (OR = 0.714) and confidence in clinical work (OR = 0.610) were associated with less alcohol misuse. Those who reported a decrease in alcohol use during the pandemic were more likely to be male (OR = 2.011), located in Northeast China (OR = 1.994), and feel confident in their clinical work (OR = 1.624). Increased alcohol use was significantly associated with insomnia (OR = 3.139).

CONCLUSIONS

During the COVID-19 pandemic, alcohol use and misuse among Chinese psychiatrists declined. While males were more likely to misuse alcohol, they were also more likely to have reduced their intake. Age, location, and lifestyle factors also predicted alcohol use and misuse. Further examination of specific factors that reduced alcohol use and misuse may help guide public health efforts to sustain the lower rates beyond the pandemic.

Up-scheduling and codeine supply in Australia: analysing the intervention and outliers

BACKGROUND AND AIMS

Over-the-counter codeine products were up-scheduled to prescription only in Australia from February 2018. This trend study aimed to identify changes in codeine supply before and after the February 2018 implementation.

DESIGN, SETTING AND CASES

Time-series regression analysis of monthly medicine supplies in Australia from 2014 to 2018. The February 2018 up-scheduling was pre-specified as the intervention; outlier analysis was used to detect automatically sudden unexpected changes before February 2018.

MEASUREMENTS

Per-capita supplies based on national data for pharmaceutical wholesales and population exposure. Weight of supplies in milligrams for low-dose codeine (≤ 15 mg per tablet or ≤ 1.92 mg per ml, originally sold over the counter but up-scheduled after February 2018), high-dose combination codeine (30 mg per tablet, prescription only throughout the study period) and all codeine.

FINDINGS

Several level shifts in supply occurred during the 5 years, led by one of -4.4% [95% confidence interval (CI) = -6.6 to -2.1%] in high-dose codeine in 2015, followed by shifts in low-dose codeine of -40.0% (CI = -46.9 to -32.3%) and -82.2% (CI = -84.3 to -79.9%), respectively, before and after February 2018. High-dose codeine supply increased by 4.4% (CI = 1.8-7.1%) immediately after up-scheduling. Also detected were transient increases and decreases in 2016 and 2017. Compared with pre-2015 levels, the February 2018 up-scheduling was associated with reductions of 45.7% (CI = 43.2-48.0%) and 89.3% (CI = 87.9-90.6%), respectively, in all and low-dose codeine supply but no change in high-dose codeine supply. The level shifts and transient changes were located around various regulatory activities, including public announcements and expert advisory meetings on up-scheduling.

CONCLUSION

Up-scheduling of over-the-counter codeine products in Australia in 2018 appears to have been associated with a near halving of Australia's national codeine supply. The transition occurred in multiple forms and phases.

Burnout, lifestyle and relaxation among dentists in Lithuania: a cross-sectional study

BACKGROUND

The aim of this study was to estimate the association of burnout level with lifestyle and relaxation among dentists in Lithuania. A better understanding of this association could help in the development of targeted interventions to prevent burnout among these professionals.

METHODS

The survey was conducted among practising dentists (N = 380) using the Maslach Burnout Inventory (MBI) and an authors' proposed scale to measure lifestyle and relaxation. Poisson regression was applied to examine the association between variables.

RESULTS

Regular cigarette smoking among dentists in Lithuania was 16.8 % and alcohol consumption was 31.3 %. Some forms of active relaxation were also common: regular playing sports (57.9 %), and spending time in nature (61.4 %). Emotional exhaustion (EE) and depersonalization (DP) burnout dimensions were negatively related to the regular use of illegal substances, alcohol, medication and smoking, while personal achievement (PA) was negatively related to smoking only. Dentists who regularly exercised had significantly lower EE and DP sum scores, and better assessments of PA. There were also positive relationships of EE, DP and PA sum scores with the variables of relaxation (e.g., spending time with family or friends, visiting a theatre, engaging in art, listening to music).

CONCLUSIONS

It was concluded that the burnout dimensions are negatively associated with unhealthy lifestyle factors and positively associated with active relaxation among dentists in Lithuania. Therefore, burnout prevention should target specific lifestyle and relaxation improvement strategies.

Characterising the patterns of and factors associated with increased alcohol consumption since COVID-19 in a UK sample

INTRODUCTION

To examine changes in drinking patterns and to assess factors associated with reported increases in frequency of drinking, units consumed and frequency of heavy episodic drinking (HED) during the UK lockdown.

METHODS

Online cross-sectional survey of 2777 self-selected UK adults.

RESULTS

Thirty percent of participants reported drinking more frequently in lockdown, 16% reported drinking more units per drinking occasion and 14% reported more frequent HED. For men and women, increased frequency of drinking was associated with being less likely to believe alcohol drinking would lead to greater chance of catching COVID-19 (men: OR = 0.99, 95% CI = 0.98, 1.00; women: OR = 0.99, 95% CI = 0.99, 1.00) and deterioration in psychological wellbeing (OR = 1.27, 95% CI = 1.04, 1.54; OR = 1.29, 95% CI = 1.11, 1.51); increased unit consumption was associated with deterioration in financial situation (OR = 1.50, 95% CI = 1.21, 1.86; OR = 1.31, 95% CI = 1.05, 1.64) and physical health (OR = 1.31, 95% CI = 1.03, 1.67; OR = 1.66, 95% CI = 1.31, 2.10). Finally, increases in the frequency of HED were associated with deterioration in psychological wellbeing (OR = 1.65, 95% CI = 1.25, 2.18; OR = 1.46, 95% CI = 1.17, 1.82) and being furloughed (OR = 3.25, 95% CI = 1.80, 5.86; OR = 2.06, 95% CI = 1.19, 3.56). Other gender differences were detected, for example, living with children was associated with an increase in units consumed (OR = 1.72, 95% CI = 1.09, 2.73) and the frequency of HED (OR = 2.40, 95% CI = 1.44, 3.99) for men, but not women.

DISCUSSION AND CONCLUSIONS

In this self-selected UK sample, a significant proportion of individuals reported drinking more frequently in lockdown, drinking more units per drinking occasion and more frequent HED. There were consistent predictors of increased consumption across men and women, but other gender differences were detected. This study identifies groups that may require targeted support in future lockdowns.

England SimSmoke: the impact of nicotine vaping on smoking prevalence and smoking-attributable deaths in England

BACKGROUND AND AIMS

Whereas the use of nicotine vaping products (NVPs) is widespread, their impact on smoking prevalence is controversial. This study considered the potential impact of NVPs on smoking prevalence in England.

DESIGN

Indirect simulation model. The England SimSmoke model is validated through 2012, before NVP use became more widely used by smokers. Because information on NVP-related transitions is limited, an indirect method is used; the difference in observed smoking prevalence (reflecting NVPs) is compared with a 2012-2019 counterfactual No-NVP scenario (without NVPs) to estimate the impact of NVPs on smoking and smoking-attributable deaths.

SETTING

England, 2000-2019.

PARTICIPANTS

Nationally representative sample of population.

MEASUREMENTS

England's population, mortality rates and smoking prevalence estimates from three national surveys and tobacco control policies.

FINDINGS

Between 2000 and 2012, SimSmoke projected a decline in age 18+ smoking prevalence of 23.5% in men and 27.0% in women. These projections, as well as those by specific age groups, were generally consistent with findings from the three national surveys. Comparing 2012-2019 relative reduction in age 18+ prevalence from the Annual Population Survey (males, 27.5%) with the model-predicted No-NVP reduction (males, 7.3%), the implied NVP-attributable relative reduction in adult smoking prevalence was 20.2% (95% CI, 18.8%-22.0%) for males and 20.4% (18.7%-22.2%) for females. The NVP-attributable reduction was 27.2% (22.8%-31.6%) for males and 31.7% (27.4%-36.5%) for females ages 18-24 and 18.6% (15.2%-21.8%) for males and 15.0% (11.1%-18.8%) for females ages 25-34, with similar reductions for ages 35+. The implied reduction in smoking prevalence between 2012 and 2019 equates to 165 660 (132 453-199 501) averted deaths by 2052. Other surveys yielded smaller, but relatively consistent results.

CONCLUSIONS

An indirect method of simulation modelling indicates that substantial reductions in smoking prevalence occurred in England from 2012-2019 coinciding with the growth in nicotine vaping product use.

Independent Associations Between Different Measures of Socioeconomic Position and Smoking Status: A Cross-Sectional Study of Adults in England

INTRODUCTION

To gain a better understanding of the complex and independent associations between different measures of socioeconomic position (SEP) and smoking in England.

AIMS AND METHODS

Between March 2013 and January 2019 data were collected from 120 496 adults aged 16+ in England taking part in the Smoking Toolkit Study. Of these, 18.04% (n = 21 720) were current smokers. Six indicators of SEP were measured: social grade, employment status, educational qualifications, home and car ownership and income. Models were constructed using ridge regression to assess the contribution of each measure of SEP, taking account of high collinearity.

RESULTS

The strongest predictor of smoking status was housing tenure. Those who did not own their own home had twice the odds of smoking compared with homeowners (odds ratio [OR] = 2.01). Social grade, educational qualification, and income were also good predictors. Those in social grades C1 (OR = 1.04), C2 (OR = 1.29), D (OR = 1.39), and E (OR = 1.78) had higher odds of smoking than those in social grade AB. Similarly, those with A-level/equivalent (OR = 1.15), GCSE/vocational (OR = 1.48), other/still studying (OR = 1.12), and no post-16 qualifications (OR = 1.48) had higher odds of smoking than those with university qualifications, as did those who earned in the lowest (OR = 1.23), third (OR = 1.18), and second quartiles (OR = 1.06) compared with those earning in the highest. Associations between smoking and employment (OR = 1.03) and car ownership (OR = 1.05) were much smaller.

CONCLUSIONS

Of a variety of socioeconomic measures, housing tenure appears to be the strongest independent predictor of smoking in England, followed by social grade, educational qualifications, and income. Employment status and car ownership have the lowest predictive power.

IMPLICATIONS

This study used ridge regression, a technique which takes into account high collinearity between variables, to gain a better understanding of the independent associations between different measures of SEP and smoking in England. The findings provide guidance as to which SEP measures one could use when trying to identifying individuals most at risk from smoking, with housing tenure identified as the strongest independent predictor.

Similar countries, similar factors? Studying the decline of heavy episodic drinking in adolescents in Finland, Norway and Sweden

AIM

To (i) examine several factors associated with trends in heavy episodic drinking (HED) in Finland, Norway and Sweden, (ii) investigate similarities in these associations across the countries and (iii) analyse the contribution of these factors to the trend in HED and the differences across the countries.

DESIGN AND SETTING

Observational study using five waves of the European School Survey Project on Alcohol and Other Drugs (ESPAD) from Finland, Norway and Sweden between 1999 and 2015.

PARTICIPANTS

A total of 18 128 male and 19 121 female 15- to 16-year-old students.

MEASUREMENTS

Monthly HED, perceived access to alcohol, truancy, parental control, leisure time activities and daily smoking. The Cochran-Armitage test was used to examine linear time trends in HED. Logit regression models using the Karlson-Holm-Breen (KHB) method were fitted for each country separately, including all the independent variables together with time and adjusted for family status, parental education and gender.

FINDINGS

In Finland, Norway and Sweden, perceived access to alcohol, truancy and daily smoking decreased significantly between 1999 and 2015 whereas risk perceptions, parental control and participation in sports increased in the same period. The confounding percentage of all the independent variables related to the trend in HED was 48.8%, 68.9% and 36.7% for Finland, Norway and Sweden, respectively. Decline in daily smoking (P < 0.001) and perceived access to alcohol (P < 0.001) were positively and increase in parental control (P < 0.001) negatively associated with the decline in HED in all three countries. Changes in truancy, going out with friends, and engaging in sports and other hobbies had little or no impact on the decline in HED or displayed no consistent results across the countries.

CONCLUSIONS

The decline in adolescent heavy episodic drinking in Finland, Norway and Sweden between 1999 and 2015 appears to be associated with a decline in adolescent daily smoking and perceived access to alcohol and an increase in parental control.

Alcohol Use Among Mental Health Professionals in China: A Nationwide Cross-sectional Survey

AIM

To survey the use of alcohol, and its correlates by mental health professions in China, a nation where there is rapid increase in alcohol consumption and problems.

METHODS

As a part of a large-scale, nation-wide online survey of healthcare professionals, we collected demographic variables and other health-related variables anonymously. The Alcohol Use Disorder Identification Test-Concise (AUDIT-C) was used to collect data on alcohol use.

RESULTS

13,980 mental health professionals completed the survey (4382 doctors, 9339 nurses and 259 clinical psychologists), representing 64% of the total targeted. Respondents were predominantly female (75.1%). Alcohol consumption was reported by 41.8% of participants (by 53.9% of doctors, 36.2% of nurses and 40.5% of clinical psychologists). Based on the cut-off scores of the AUDIT-C (≥3 for women and ≥4 for men), 7.5% were classified as probable alcohol misusers in the past year, and the rates were 10.2% in doctors, 6.3% in nurses and 5.8% in clinical psychologists. Multiple logistic regression showed that male sex (OR = 3.772; CI = 3.206-4.439), being a doctor (OR = 1.259; CI = 1.052-1.506), being divorced or widowed (OR = 1.979; CI = 1.467-2.666), having an associate degree or less (OR = 1.809; CI = 1.040-3.147), working in Northeast China (OR = 1.538; CI = 1.281-1.848) and the habit of smoking (OR = 3.345; CI = 2.280-3.967) were significantly associated with alcohol misuse.

CONCLUSIONS

Alcohol use and misuse were relatively common among mental health professionals in China, and male sex, being a doctor, with lower education, working in Northeast China and cigarette smoking were significant associations. Awareness and interventions are recommended to promote healthier use of alcohol in this professional group, especially among risk subgroups.

Are population trends in high-risk alcohol consumption in smokers associated with trends in quit attempts and quit success? A time-series analysis

OBJECTIVES

Monthly changes in the prevalence of high-risk drinking and smoking in England appear to be positively correlated. This study aimed to assess how far monthly changes in high-risk drinking were specifically associated with attempts to stop smoking and the success of quit attempts.

DESIGN

Data were used from the Alcohol and Smoking Toolkit Studies between April 2014 and June 2018. These involve monthly household face-to-face surveys of representative samples of ~1800 adults.

SETTING

England.

PARTICIPANTS

Data were aggregated on 17 560 past-year smokers over the study period.

PRIMARY AND SECONDARY OUTCOME MEASURES

Autoregressive integrated moving average with exogenous input (ARIMAX) modelling was used to assess the association over time between monthly prevalence of high-risk drinking among smokers and (a) prevalence of attempts to quit smoking and (b) prevalence of successful quit attempts in those attempting to quit. Bayes factors (BF) were calculated to compare the null hypothesis with the hypothesis of an effect sufficiently large (β=0.6) to explain the established association between overall prevalence in smoking and high-risk drinking.

RESULTS

No statistically significant associations were found between monthly changes in prevalence of high-risk drinking among smokers and attempts to quit smoking (β=0.156, 95% CI -0.079 to 0.391, p=0.194) or quit success (β=0.066, 95% CI -0.524 to 0.655, p=0.827). BF indicated that the data were insensitive but suggested there is weak evidence for the null hypothesis in the case of both quit attempts (BF=0.80) and quit success (BF=0.53).

CONCLUSIONS

Monthly changes in prevalence of high-risk alcohol consumption in England are not clearly associated with changes in quit attempt or quit success rates.

Evaluation of the Impact of a Regional Educational Advertising Campaign on Harm Perceptions of E-Cigarettes, Prevalence of E-Cigarette Use, and Quit Attempts Among Smokers

INTRODUCTION

We evaluated how effective an advertising campaign that was piloted by Cancer Research UK in January/February 2018 was at promoting quit attempts by increasing awareness of the relative harms of e-cigarettes compared with smoking.

METHODS

Adults (≥16 years, n = 2217) living in Greater Manchester (campaign region), Yorkshire & Humber and the North East of England (control regions) completed cross-sectional surveys immediately before and after the campaign period. Surveys measured socio-demographics, perceptions and use of e-cigarettes, and motivation and attempts to quit smoking. We tested interactions between time (pre, post) and region (campaign, control).

RESULTS

36.7% (95% CI 33.0%-40.6%) of those in the intervention region recognized the campaign. In the general population, interactions were nonsignificant for all outcomes except for perception of e-cigarettes as effective cessation aids, with smaller increases from pre- to post-campaign in the campaign (49.9% to 54.0%) compared with the control region (40.5% to 55.0%; odds ratio [OR] = 0.66, 95% CI .45-0.98). Among smokers, motivation to quit increased in the intervention region (44.0% to 48.0%) but decreased in the control region (40.5% to 21.5%; OR = 2.97, 95% confidence interval [CI] 1.25-7.16), with no other significant differences between regions over time. Bayes factors confirmed that nonsignificant results were inconclusive.

CONCLUSIONS

Compared with the control region, the campaign was associated with an increase in smokers' motivation to quit but a smaller increase in adults' perception of e-cigarettes as an effective cessation aid. There was insufficient evidence to determine whether the campaign affected other outcomes.

IMPLICATIONS

Past extended mass media tobacco control campaigns have been shown to change public attitudes towards smoking, improve motivation to quit smoking, and reduce smoking prevalence. Much less is known about shorter, targeted campaigns. Here we show that using mass media to communicate accurate information about the relative harms of e-cigarettes compared with smoking may be an effective strategy in increasing smokers' motivation to quit. Moreover, even when only run for a month, such campaigns can reach a large proportion of the targeted population. Further research is needed to evaluate effects on quit attempts and success.

Smoking Prevalence, Patterns, and Cessation Among Adults in Hebei Province, Central China: Implications From China National Health Survey (CNHS)

As part of the China National Health Survey, the objective of this study was to explore the prevalence, patterns, and influencing factors of smoking, and understand reasons for smoking cessation among adults in Hebei Province, central China. Using a multi-stage stratified cluster sampling method, 6,552 adults (2,594 males) aged 20–80 were selected in 2017. Demographic, socioeconomic, and tobacco use information were collected by questionnaire interview. The prevalence of ever-smoking, current smoking, and ex-smoking was 28.94, 21.08, and 7.86%, respectively. Male participants had a much higher prevalence of ever-smoking and current smoking (67.39 and 48.77%) than females (3.74 and 2.93%). In male participants, the daily cigarette consumption was 16.61, and the mean age of smoking initiation was 20.95, decreasing with birth year (27.50 in people born before 1946 vs. 17.9 for those born after 1985, p for trend < 0.001). Over 40% of male ever-smokers initiated regular smoking before 20. Compared with never drinking, the ORs (95% CI) of ever-smoking for low, moderate, and high alcohol consumption in male participants were 1.44 (1.11–1.86), 2.80 (1.91–4.11), and 2.40 (1.72–3.33), respectively. Among 479 male ex-smokers, 50.94% stopped smoking because of illness and 49.06% by choice. Among male ex-smokers, hypertensive men were more likely to quit smoking than the normotensive individuals (OR: 1.48, 95% CI: 1.13–1.96). For CVD patients, this effect was estimated as 2.27 (95% CI: 1.56–3.30). This study revealed a high prevalence of ever-smoking, especially in men, in a representative population in central China. Health education focus on tobacco control could be integrated with alcohol consumption reduction to achieve additional benefit.

Associations of cigarette smoking with gray and white matter in the UK Biobank

Cigarette smoking is associated with increased risk for myriad health consequences including cognitive decline and dementia, but research on the link between smoking and brain structure is nascent. In the current study, we assessed the relationship of cigarette smoking with gray matter (GM) and white matter (WM) in the UK Biobank, controlling for numerous confounding demographic and health variables. We used negative-binomial regression to model the association of cigarette smoking (having ever smoked regularly, cigarettes per day, and duration smoked) with GM and WM (GM N = 19,615; WM N = 17,760), adjusting for confounders. Ever smoked and duration were associated with smaller total GM volume. Ever smoked was associated with reduced volume of the right VIIIa cerebellum and elevated WM hyperintensity volume. Smoking duration was associated with reduced total WM volume. Regarding specific tracts, ever smoked was associated with reduced fractional anisotropy in the left cingulate gyrus part of the cingulum, left posterior thalamic radiation, and bilateral superior thalamic radiation, and increased mean diffusivity in the middle cerebellar peduncle, right medial lemniscus, bilateral posterior thalamic radiation, and bilateral superior thalamic radiation. This study identified significant associations of cigarette exposure with global measures of GM and WM, and select associations of ever smoked, but not cigarettes per day or duration, with specific GM and WM regions. By controlling for important sociodemographic and health confounders, such as alcohol use, this study identifies distinct associations between smoking and brain structure, highlighting potential mechanisms of risk for common neurological sequelae (e.g., dementia).

Is the use of e-cigarettes for smoking cessation associated with alcohol consumption? A population-level survey of successful quitters in England

OBJECTIVE

To examine associations between the use of e-cigarettes for smoking cessation and levels of alcohol consumption, high-risk drinking, and attempts to cut down alcohol consumption compared with use of nicotine replacement therapy (NRT) or no aid.

METHODS

Cross-sectional survey of adults (≥16 years) in England. The sample included a total of 961 people who had quit smoking with the use of either e-cigarettes (n = 425), NRT (n = 116), or no aid (n = 421) within the past year and were still abstinent at the survey. Drinking behaviour was assessed with the AUDIT.

RESULTS

Mean (SD) alcohol consumption among those who quit smoking with e-cigarettes, NRT, and no aid was 7.78 (13.41), 7.12 (13.85), and 5.55 (8.70) units/week, respectively. The prevalence of high-risk drinking was 43.3% (n = 184), 32.2% (n = 37), and 36.8% (n = 155), respectively. Among high-risk drinkers, the prevalence of attempts to cut down alcohol consumption was 22.3% (n = 41), 18.9% (n = 7), and 27.7% (n = 43), respectively. After adjustment for covariates, those who quit with e-cigarettes had significantly higher alcohol consumption than those who quit unaided (B = 1.69, 95%CI 0.21-3.17), but there was no significant difference relative to those who quit with NRT. Differences in high-risk drinking and attempts to cut down were not significant, but Bayes factors indicated the data were insensitive (range: 0.47-0.95).

CONCLUSIONS

Recent ex-smokers who used e-cigarettes to help them quit consumed around two more units of alcohol each week than those who quit unaided, but their alcohol consumption was similar to those who quit with NRT. Data on differences in high-risk drinking and attempts to cut down alcohol consumption among high-risk drinkers were inconclusive.

Cigarette Smoking, Health-Related Behaviors, and Burnout Among Mental Health Professionals in China: A Nationwide Survey

OBJECTIVES

Mental health professionals (MHPs) play an important role in treating patients with nicotine addiction. However, data on MHPs' cigarette smoking habits are scarce. This survey aimed to collect such data and to examine the correlates of smoking among MHPs working in China.

METHODS

A cross-sectional survey was conducted in all 41 provincial, tertiary psychiatric hospitals, and MHPs from these hospitals were targeted. An anonymous questionnaire was designed to collect socio-demographic and occupational factors, and the Maslach Burnout Inventory-Human Service Survey was used to assess burnout. Data about smoking and other health behaviors were also collected.

RESULTS

In total, 13,614 MHPs were included in the analysis. The overall rate of current smoking was 8.6% (31.3% in males, and 1.1% in females). A substantial proportion (28.0%) of life-time smokers had abstained for more than 3 months. Those who were male (OR=37.73), older (OR=1.02), divorced or widowed (OR=1.72), working in West (OR=1.45), and Northeast China (OR=1.65), were nurses (OR=1.44), had a high income (OR=1.31), experienced burnout (OR=1.29), frequent insomnia (OR=1.39), and used alcohol (OR=2.76) were significantly more likely to be smokers, while those who had a higher level of education (OR=0.67, 0.47, and 0.43 for college, master, and doctorate degrees, respectively), and exercised regularly (OR=0.73) were significantly less likely to be smokers.

CONCLUSION

Although lower than that of the general population in China, smoking is still relatively high among MPHs. Efforts to lower smoking rates among MHPs in China should continue and should incorporate strategies that target burnout, sleep, alcohol use, exercise and other factors associated with smoking.

Prevalence and correlates of long-term e-cigarette and nicotine replacement therapy use: a prospective study in England

OBJECTIVES

To examine the prevalence of, and sociodemographic and smoking-related characteristics associated with, long-term e-cigarette use compared with long-term nicotine replacement therapy (NRT) use.

DESIGN

Cross-sectional and prospective survey, the Smoking Toolkit Study, with baseline data collected between September 2014 and September 2016 and follow-ups at 6 and 12 months.

SETTING

England.

PARTICIPANTS

Population representative sample of 40 933 adults aged 16+ years.

MAIN OUTCOME MEASURES

Prevalence of long-term (≥12 months) use of e-cigarettes and NRT by retrospective self-report among baseline respondents (all adults, n=40 933; smokers, n=8406) and current use at baseline, 6 months and 12 months in a subsample of smokers who responded to follow-up (n=733).

RESULTS

Of baseline respondents, 1.5% (95% CI 1.4% to 1.6%, n=604) of adults and 3.9% (95% CI 3.5% to 4.3%, n=327) of smokers were long-term e-cigarette users and 0.5% (95% CI 0.4% to 0.6%, n=205) of adults and 1.3% (95% CI 1.1% to 1.5%, n=112) of smokers were long-term NRT users. Assessed prospectively, 13.4% (95% CI 10.9% to 15.9%, n=100) of smokers were long-term e-cigarette users and 1.9% (95% CI 0.9% to 2.9%, n=14) were long-term NRT users. Among all adults, long-term use by never smokers of either e-cigarettes (0.1%, n=27) or NRT (0.0%, n=7) was rare. Among past-year smokers, long-term e-cigarette and NRT use was higher among older smokers compared with those who were 16-34 years old (OR range=1.55-5.21). Long-term e-cigarette use only was lower in smokers who were less educated (OR=0.63, 95% CI 0.49 to 0.81), from social grades C2DE (OR=0.66, 95% CI 0.52 to 0.84) and with children in the household (OR=0.66, 95% CI 0.51 to 0.85). Long-term e-cigarette use and long-term NRT use were higher among smokers more motivated to quit (OR=2.05, 95% CI 1.63 to 2.60 and OR=2.33, 95% CI 1.57 to 3.46).

CONCLUSIONS

In the adult population in England, long-term use of e-cigarettes and long-term use of NRT are almost exclusively by current or ex-smokers. Only a minority of past-year smokers retrospectively report long-term e-cigarette or NRT use, but this figure may be an underestimate, especially for e-cigarette use, which is more than threefold higher when assessed prospectively.

Understanding and using time series analyses in addiction research

Time series analyses are statistical methods used to assess trends in repeated measurements taken at regular intervals and their associations with other trends or events, taking account of the temporal structure of such data. Addiction research often involves assessing associations between trends in target variables (e.g. population cigarette smoking prevalence) and predictor variables (e.g. average price of a cigarette), known as a multiple time series design, or interventions or events (e.g. introduction of an indoor smoking ban), known as an interrupted time series design. There are many analytical tools available, each with its own strengths and limitations. This paper provides addiction researchers with an overview of many of the methods available (GLM, GLMM, GLS, GAMM, ARIMA, ARIMAX, VAR, SVAR, VECM) and guidance on when and how they should be used, sample size det ermination, reporting and interpretation. The aim is to provide increased clarity for researchers proposing to undertake these analyses concerning what is likely to be acceptable for publication in journals such as Addiction. Given the large number of choices that need to be made when setting up time series models, the guidance emphasizes the importance of pre-registering hypotheses and analysis plans before the analyses are undertaken.

Exploring the characteristics of newly defined at-risk drinkers following the change to the UK low risk drinking guidelines: a retrospective analysis using Health Survey for England data

BACKGROUND

Alcohol guidelines enable individuals to make informed choices about drinking and assist healthcare practitioners to identify and treat at-risk drinkers. The UK Low Risk Drinking Guidelines were revised in 2016 and the weekly guideline for men was reduced from 21 to 14 units per week. This study sought to retrospectively establish 1) the number of additional at-risk male drinkers in England, 2) which demographic characteristics were associated with being an at-risk drinker under the previous versus new guidelines.

METHODS

Average weekly alcohol consumption for men aged 16+ from the cross-sectional nationally representative Health Survey for England were used to 1) calculate annual population prevalence estimates for newly defined at-risk (> 14 to ≤21 units/week) male drinkers from 2011 to 2015 (N = 3487-3790), and 2) conduct logistic regression analyses for at-risk vs low risk male drinkers under the previous (> 21 vs ≤21 units/week) and new (> 14 vs ≤14 units/week) guidelines to assess characteristics associated with being at-risk drinkers under each guideline using 2015 data (N = 2982).

RESULTS

Population prevalence estimates of newly defined at-risk drinkers ranged from 10.2% (2014 = 2,182,401 men)-11.2% (2011 = 2,322,896 men). Under the new guidelines, men aged 55-74 (OR = 1.63,95% CI = 1.25-2.12); men in managerial/professional occupations (OR = 1.64,95% CI = 1.34-2.00); current smokers (OR = 2.26,95% CI = 1.73-2.94), ex-regular smokers (OR = 2.01,95% CI = 1.63-2.47) and ex-occasional smokers (OR = 1.85,95% CI = 1.25-2.74); men from the North East (OR = 2.08,95% CI = 1.38-3.13) and North West (OR = 1.91,95% CI = 1.41-2.60) of England all had greater odds, and non-white men had reduced odds (OR = 0.53,95% CI = 0.34-0.80) of being at-risk drinkers, as they had under the previous guidelines. Under the new guidelines only: a higher percentage of at-risk drinkers aged 16-34 (32% vs 19%) attenuated the odds of men aged 35-54 being at-risk (OR = 1.18,95% CI = 0.92-1.51); a higher percentage of married at-risk drinkers (37% vs 24%) attenuated the odds of single men being at-risk (OR = 1.28,95% CI = 0.99-1.67); men from the West Midlands (OR = 1.68,95% CI = 1.17-2.42) and London (OR = 1.53,95% CI = 1.03-2.28) had greater odds of being at-risk drinkers.

CONCLUSIONS

The change to the Low Risk Drinking Guidelines would have resulted in more than 2 million additional male at-risk drinkers in England. Most groups with greater odds of being at-risk drinkers under the new guidelines were those already known to be drinking the most, strengthening the case for targeted screening and education. Additionally, under the new guidelines, a marked proportion of 16-35 year olds and married men were at-risk and men in the West Midlands and London had greater odds of being at-risk drinkers. These groups may benefit from specific education around the new Low Risk Drinking Guidelines.

Prevalence and characteristics associated with concurrent smoking and alcohol misuse within Australian general practice patients

Objectives This study sought to determine, among a large sample of Australian general practice patients: (1) the prevalence of smoking among different levels of alcohol misuse; and (2) whether the associations between demographic characteristics and alcohol use differ according to smoking status. Methods A cross-sectional survey was administered from 2010 to 2011 to 3559 patients from 12 Australian urban general practices. Patients reported their demographic details, smoking status and their alcohol intake. Results The overall prevalence of reported concurrent smoking and alcohol misuse was 7.8%. Smokers were 3.81-fold more likely to have a higher level of alcohol consumption than non-smokers (95% confidence interval 3.13-4.63; P<0.0001). There was evidence that smoking was an effect modifier of the relationship between alcohol misuse and chronic illness. Conclusions There was an increasing prevalence of smoking with increasing level of alcohol consumption. In addition, those with chronic conditions who smoked had greater odds of higher levels of alcohol consumption. Preventative interventions for these substances are needed to reduce the burden associated with concurrent smoking and alcohol misuse. What is known about the topic? Tobacco and alcohol are the most commonly used substances and contribute to over 10million deaths annually. The risk of disease is high when using either of these substances, however, concurrent use is associated with a greatly compounded risk. Australian data is limited regarding the prevalence of concurrent tobacco and alcohol misuse, however, international studies suggest variation in prevalence rates between different clinical settings. What does this paper add? This study examined the prevalence of concurrent smoking and alcohol misuse among different levels of alcohol misuse severity within an Australian general practice setting. Additionally it explored whether the associations between demographic characteristics and alcohol use differ according to smoking status. What are the implications for practitioners? This study has important implications for disease prevention and the delivery of preventive health services by general practitioners. Considering one in 100 clinical treatments provided in general practice relate to preventative smoking or alcohol counselling, it is critical that efforts are made to ascertain risk factors such as smoking and alcohol misuse to increase treatment rates. General practitioners should consider screening for smoking and alcohol misuse opportunistically during routine clinical encounters, as well as screening for smoking or alcohol misuse if one or the other is present.

The Effects of an Urban Forest Health Intervention Program on Physical Activity, Substance Abuse, Psychosomatic Symptoms, and Life Satisfaction among Adolescents

Background: At-risk adolescents have been defined as youth who are or might be in physical, mental, or emotional danger. An Urban Forest Health Intervention Program (UFHIP) was formed at a center for at-risk adolescents in Israel, in order to promote physical activity and reduce risky behavior. Objective: To evaluate the intervention’s effect on physical activity, smoking, alcohol consumption, psychosomatic symptoms, and life satisfaction. Methods: From 2015 to 2016, at-risk youth were nonrandomly selected to participate in the UFHIP. Questionnaires were administered to both intervention and control groups before and after the intervention. Univariate and multivariable analyses evaluated the intervention’s effect. Results: The study participants (n = 53) showed 0.81 more sessions per week of 60 min of physical activity than did the control group (n = 23; p = 0.003). Among the intervention group, smoking frequency reduced from a mean of 2.60 (SD = 1.30) to 1.72 (SD = 1.08), whereas that in the control group increased from 3.17 (1.03) to 3.39 (1.03). In both groups, there was a reduction in alcohol consumption, with a greater change among intervention participants: −1.08 (SD = 1.30), compared with −0.09 (SD = 1.79) in the control group. Conclusions: Findings indicate that the environmental intervention was efficacious in increasing physical activity and reducing risky behaviors among youth. The effectiveness of this intervention among larger samples is warranted in future prospective studies.

Association between smoking and alcohol-related behaviours: a time-series analysis of population trends in England

AIMS

This paper estimates how far monthly changes in prevalence of cigarette smoking, motivation to quit and attempts to stop smoking have been associated with changes in prevalence of high-risk drinking, and motivation and attempts to reduce alcohol consumption in England.

DESIGN

Data were used from the Alcohol and Smoking Toolkit Studies between April 2014 and June 2016. These involve monthly household face-to-face surveys of representative samples of ~1700 adults in England.

MEASUREMENTS

Autoregressive Integrated Moving Average with Exogeneous Input (ARIMAX) modelling was used to assess the association over time between monthly prevalence of (a) smoking and high-risk drinking; (b) high motivation to quit smoking and high motivation to reduce alcohol consumption; and (c) attempts to quit smoking and attempts to reduce alcohol consumption.

FINDINGS

Mean smoking prevalence over the study period was 18.6% and high-risk drinking prevalence was 13.0%. A decrease of 1% of the series mean smoking prevalence was associated with a reduction of 0.185% of the mean prevalence of high-risk drinking 2 months later [95% confidence interval (CI) = 0.033 to 0.337, P = 0.017]. A statistically significant association was not found between prevalence of high motivation to quit smoking and high motivation to reduce alcohol consumption (β = 0.324, 95% CI = -0.371 to 1.019, P = 0.360) or prevalence of attempts to quit smoking and attempts to reduce alcohol consumption (β = -0.026, 95% CI = -1.348 to 1.296, P = 0.969).

CONCLUSION

Between 2014 and 2016, monthly changes in prevalence of smoking in England were associated positively with prevalence of high-risk drinking. There was no significant association between motivation to stop and motivation to reduce alcohol consumption, or attempts to quit smoking and attempts to reduce alcohol consumption.