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Upton E, Clare PJ, Aiken A, Boland VC, Torres CD, Bruno R, Hutchinson D, Kypri K, Mattick R, McBride N, Peacock A. Changes in mental health and help-seeking among young Australian adults during the COVID-19 pandemic: a prospective cohort study. Psychol Med 2023; 53:687-695. [PMID: 33966686 PMCID: PMC8144825 DOI: 10.1017/s0033291721001963] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/11/2021] [Accepted: 04/27/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Young people may have elevated risk for poorer mental health during the coronavirus disease 2019 (COVID-19) pandemic, yet longitudinal studies documenting this impact are lacking. This study assessed changes in mental health and help-seeking since COVID-19 restrictions in young Australians, including gender differences. METHODS Data were drawn from a recent subsample (n = 443; 60% female; Mage = 22.0) of a prospective cohort originally recruited in secondary school to complete annual surveys. The subsample completed an additional COVID-19 survey during COVID-19 restrictions (May-June 2020), which was compared to responses from their latest annual survey (August 2019-March 2020). Mixed effect models with time and gender as the primary predictors were conducted for: (i) scores on the Patient Health Questionnaire Depression 9-item (PHQ-9) and Generalised Anxiety Disorder 7-item (GAD-7) modules assessed before and during COVID-19 restrictions, and (ii) self-reported help-seeking from a health professional in February 2020, and the month preceding May-June 2020. RESULTS Mean symptom scores increased from before to during COVID-19 restrictions on the PHQ-9 (coefficient: 1.29; 95% CI 0.72-1.86) and GAD-7 (0.78; 95% CI 0.26-1.31), but there was no increase in help-seeking over time (odds ratio 0.50; 95% CI 0.19-1.32). There was no evidence of differential changes by gender. CONCLUSIONS This study found increases in depression and anxiety symptoms but not greater help-seeking among young Australian adults during the first wave of the pandemic. Increasing availability and awareness of accessible treatment options and psychoeducation is critical, as well as further research into risk and protective factors to help target treatment to this vulnerable age group.
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Affiliation(s)
- Emily Upton
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Philip J. Clare
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
- Prevention Research Collaboration, The University of Sydney, Sydney, Australia
| | - Alexandra Aiken
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Veronica C. Boland
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Clara De Torres
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Raimondo Bruno
- School of Psychological Sciences, University of Tasmania, Tasmania, Australia
| | - Delyse Hutchinson
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
- Centre for Social and Early Emotional Development, Deakin University, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital, The University of Melbourne, Parkville, Australia
| | - Kypros Kypri
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Richard Mattick
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Nyanda McBride
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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Howard BC, McRobbie H, Petrie D, Barker D, Mendelsohn C, Anderson J, Borland R, Naughton F, Tutka P, Zwar N, Boland VC, Aiken A, Shakeshaft A, Gartner C, Richmond RL, Hall W, Mattick RP, Farrell M, Courtney RJ. Effectiveness, safety and cost-effectiveness of vaporized nicotine products versus nicotine replacement therapy for tobacco smoking cessation in a low-socioeconomic status Australian population: a study protocol for a randomized controlled trial. Trials 2022; 23:777. [PMID: 36104702 PMCID: PMC9473457 DOI: 10.1186/s13063-022-06644-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background In Australia, tobacco smoking rates have declined but inequalities remain with significantly higher smoking prevalence among low-socioeconomic populations. Clinical trial data suggest vaporized nicotine products (VNPs) aid smoking cessation. Most VNP trials have used refillable tank systems, but newer generation (pod) devices now comprise the largest market share yet have limited clinical trial evidence on safety and effectiveness. This study evaluates the effectiveness, safety and cost-effectiveness of VNPs (pod and tank device) compared with nicotine replacement therapy ([NRT]—gum or lozenge) for smoking cessation. Methods This is a two-arm, open-label, superiority, parallel group, randomized controlled trial (RCT) with allocation concealment and blinded outcome assessment. The RCT is conducted at the National Drug and Alcohol Research Centre at the University of New South Wales, Sydney, Australia. Participants are people who smoke daily, are interested in quitting and receive a government pension or allowance (N = 1058). Participants will be randomized (1:1 ratio) to receive 8 weeks of free: VNPs, with pod (40 mg/mL nicotine salt) and tank device (18 mg/mL freebase nicotine) in mixed flavours; or NRT (gum or lozenge; 4 mg). All participants will receive daily text message behavioural support for 5 weeks. Assessments will be undertaken by telephone at baseline, with three follow-up calls (two check-in calls within the first month and final follow-up at 7 months post randomization) to ascertain smoking status, treatment adherence and adverse events. The primary outcome is 6-month continuous abstinence verified by carbon monoxide breath test of ≤5ppm at 7-month follow-up. Safety and cost-effectiveness of VNPs versus NRT will also be evaluated. Discussion Further data are required to strengthen certainty of evidence for VNPs aiding smoking cessation, particularly for newer generation pod devices. To our knowledge, this trial is the first to offer choice of VNPs and no comparative effectiveness trial data exists for new pod devices. If effective, the findings can inform wider implementation of VNPs to aid smoking cessation in a priority group. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12621000076875. Registered on 29 January 2021. https://www.anzctr.org.au Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06644-8.
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Aiken A, Chan G, Yuen WS, Clare PJ, Hutchinson D, McBride N, Najman JM, McCambridge J, Upton E, Slade T, Boland VC, De Torres C, Bruno R, Kypri K, Wadolowski M, Mattick RP, Peacock A. Trajectories of parental and peer supply of alcohol in adolescence and associations with later alcohol consumption and harms: A prospective cohort study. Drug Alcohol Depend 2022; 237:109533. [PMID: 35752023 DOI: 10.1016/j.drugalcdep.2022.109533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/17/2022] [Accepted: 06/06/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Supply of alcohol to adolescents is associated with increased alcohol consumption and harms including alcohol use disorder (AUD). We aimed to identify: (1) trajectories of alcohol supply to adolescents; (2) sociodemographic characteristics associated with supply trajectory; (3) patterns of alcohol consumption by supply trajectory; and (4) supply trajectory associations with adverse alcohol outcomes. METHODS We used Australian longitudinal survey data (N = 1813) to model latent trajectories of parent and peer alcohol supply over five annual follow-ups (Waves 2-6; Mage 13.9-17.8 years). Regression models assessed associations between supply trajectories and Wave 1 (Mage=12.9 years) sociodemographic factors and associations between supply trajectories and Wave 7 (Mage=18.8 years) alcohol outcomes. RESULTS We identified five alcohol supply classes: (1) minimal supply (n = 739, 40.8%); (2) early parent sips, late peer/parent whole drinks (n = 254, 14.0%); (3) late peer/parent whole drinks (n = 419, 23.1%); (4) early parent sips, mid peer/parent whole drinks (n = 293, 16.2%); (5) early peer/parent whole drinks (n = 108, 6.0%). Compared to minimal supply, the other classes were 2.7-12.9 times as likely to binge drink, 1.6-3.0 times as likely to experience alcohol-related harms, and 2.1-8.6 times as likely to report AUD symptoms at age 19. CONCLUSION Earlier supply of whole drinks, particularly from peers, was associated with increased risk of early adulthood adverse alcohol outcomes. While minimal supply represented the lowest risk, supplying sips only in early-mid adolescence and delaying supply of whole drinks until late adolescence is likely to be less risky than earlier supply of whole drinks.
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Affiliation(s)
- Alexandra Aiken
- National Drug & Alcohol Research Centre, UNSW Sydney, NSW 2052, Australia.
| | - Gary Chan
- National Centre For Youth Substance Use Research, The University of Queensland, St Lucia, QLD 4067, Australia
| | - Wing See Yuen
- National Drug & Alcohol Research Centre, UNSW Sydney, NSW 2052, Australia
| | - Philip J Clare
- National Drug & Alcohol Research Centre, UNSW Sydney, NSW 2052, Australia; Prevention Research Collaboration, The Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Delyse Hutchinson
- National Drug & Alcohol Research Centre, UNSW Sydney, NSW 2052, Australia; Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC 3010, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Nyanda McBride
- National Drug Research Institute, Curtin University, Perth, WA 6845, Australia
| | - Jackob M Najman
- Queensland Alcohol and Drug Research and Education Centre, University of Queensland, Brisbane, QLD 4072, Australia
| | - Jim McCambridge
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York YO10 5DD, United Kingdom
| | - Emily Upton
- National Drug & Alcohol Research Centre, UNSW Sydney, NSW 2052, Australia
| | - Tim Slade
- Sydney Medical School / The Matilda Centre, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Veronica C Boland
- National Drug & Alcohol Research Centre, UNSW Sydney, NSW 2052, Australia
| | - Clara De Torres
- National Drug & Alcohol Research Centre, UNSW Sydney, NSW 2052, Australia
| | - Raimondo Bruno
- National Drug & Alcohol Research Centre, UNSW Sydney, NSW 2052, Australia; School of Psychology, University of Tasmania, Hobart, TAS 7000, Australia
| | - Kypros Kypri
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
| | - Monika Wadolowski
- Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW 2109, Australia
| | - Richard P Mattick
- National Drug & Alcohol Research Centre, UNSW Sydney, NSW 2052, Australia
| | - Amy Peacock
- National Drug & Alcohol Research Centre, UNSW Sydney, NSW 2052, Australia; School of Psychology, University of Tasmania, Hobart, TAS 7000, Australia
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Courtney RJ, McRobbie H, Tutka P, Weaver NA, Petrie D, Mendelsohn CP, Shakeshaft A, Talukder S, Macdonald C, Thomas D, Kwan BCH, Walker N, Gartner C, Mattick RP, Paul C, Ferguson SG, Zwar NA, Richmond RL, Doran CM, Boland VC, Hall W, West R, Farrell M. Effect of Cytisine vs Varenicline on Smoking Cessation: A Randomized Clinical Trial. JAMA 2021; 326:56-64. [PMID: 34228066 PMCID: PMC8261608 DOI: 10.1001/jama.2021.7621] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Cytisine is more effective than placebo and nicotine replacement therapy for smoking cessation. However, cytisine has not been tested against the most effective smoking cessation medication, varenicline, which is associated with adverse events known to lead to discontinuation of therapy. OBJECTIVE To examine whether standard cytisine treatment (25 days) was at least as effective as standard varenicline treatment (84 days) for smoking cessation. DESIGN, SETTING, AND PARTICIPANTS This noninferiority, open-label randomized clinical trial with allocation concealment and blinded outcome assessment was undertaken in Australia from November 2017 through May 2019; follow-up was completed in January 2020. A total of 1452 Australian adult daily smokers willing to make a quit attempt were included. Data collection was conducted primarily by computer-assisted telephone interview, but there was an in-person visit to validate the primary outcome. INTERVENTIONS Treatments were provided in accordance with the manufacturers' recommended dosage: cytisine (n = 725), 1.5-mg capsules taken 6 times daily initially then gradually reduced over the 25-day course; varenicline (n = 727), 0.5-mg tablets titrated to 1 mg twice daily for 84 days (12 weeks). All participants were offered referral to standard telephone behavioral support. MAIN OUTCOMES AND MEASURES The primary outcome was 6-month continuous abstinence verified using a carbon monoxide breath test at 7-month follow-up. The noninferiority margin was set at 5% and the 1-sided significance threshold was set at .025. RESULTS Among 1452 participants who were randomized (mean [SD] age, 42.9 [12.7] years; 742 [51.1%] women), 1108 (76.3%) completed the trial. Verified 6-month continuous abstinence rates were 11.7% for the cytisine group and 13.3% for the varenicline group (risk difference, -1.62% [1-sided 97.5% CI, -5.02% to ∞]; P = .03 for noninferiority). Self-reported adverse events occurred less frequently in the cytisine group (997 events among 482 participants) compared with the varenicline group (1206 events among 510 participants) and the incident rate ratio was 0.88 (95% CI, 0.81 to 0.95; P = .002). CONCLUSIONS AND RELEVANCE Among daily smokers willing to quit, cytisine treatment for 25 days, compared with varenicline treatment for 84 days, failed to demonstrate noninferiority regarding smoking cessation. TRIAL REGISTRATION anzctr.org.au Identifier: ACTRN12616001654448.
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Affiliation(s)
- Ryan J. Courtney
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Piotr Tutka
- Department of Experimental and Clinical Pharmacology, University of Rzeszow, Rzeszow, Poland
| | - Natasha A. Weaver
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Dennis Petrie
- Centre for Health Economics, Monash Business School, Monash University, Clayton, Australia
| | | | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Saki Talukder
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Christel Macdonald
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Dennis Thomas
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Benjamin C. H. Kwan
- St George and Sutherland Clinical School, University of New South Wales, Sydney, Australia
| | - Natalie Walker
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Coral Gartner
- School of Public Health, University of Queensland, Herston, Australia
| | - Richard P. Mattick
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Stuart G. Ferguson
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Nicholas A. Zwar
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Robyn L. Richmond
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Christopher M. Doran
- Cluster for Resilience and Wellbeing, Appleton Institute, Central Queensland University, Brisbane, Australia
| | - Veronica C. Boland
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Wayne Hall
- National Centre for Youth Substance Use Research, University of Queensland, Herston, Australia
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, England
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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5
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McRobbie H, Boland VC, Courtney RJ. Assessing cannabis and tobacco co-use: the pros and cons of additional data collection. Addiction 2021; 116:1631-1633. [PMID: 33417256 DOI: 10.1111/add.15373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/07/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Hayden McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
- Lakes District Health Board, Rotorua, New Zealand
| | - Veronica C Boland
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Ryan J Courtney
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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6
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Boland VC, Clare PJ, Yuen WS, Peacock A, Aiken A, Wadolowski M, Hutchinson D, Najman J, Slade T, Bruno R, McBride N, Degenhardt L, Kypri K, Mattick RP. The association between parental supply of alcohol and supply from other sources to young people: a prospective cohort. Addiction 2020; 115:2140-2147. [PMID: 32141130 DOI: 10.1111/add.15033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/21/2019] [Accepted: 03/04/2020] [Indexed: 12/21/2022]
Abstract
AIMS Despite legal age limits set for alcohol consumption, parents are one of the main suppliers of alcohol to underage minors. Although supply from non-parental sources has been found to be associated with greater risk of harm compared with parental supply, the association between parental supply and supply from other sources is unclear. This study investigated the associations between parental supply of sips and whole serves of alcohol on subsequent other supply, conditional on current supply from non-parental sources. METHODS Data from the Australian Parental Supply of Alcohol Longitudinal Study cohort of adolescents was used. A cohort of 1927 Australian children recruited in grade 7 (mean age 12.9 years) was surveyed annually from 2010 to 2016 (94%, n = 1821 included for analyses). The primary outcome was alcohol exposure from other sources ('other supply'), including alcohol supply from other adults, friends, siblings, or self-supply, compared with adolescents reporting no supply from these sources. Analyses were conducted using random intercept logistic regression (to account for within-respondent correlation). RESULTS Parental supply of alcohol alone was associated with increased odds of receiving alcohol from other non-parental sources in subsequent years (OR: 1.99; 95% CI: 1.65-2.39) after adjusting for confounders. Increased odds of subsequent other supply were associated with current parental supply of sips (OR: 1.92; 95% CI: 1.56-2.36) and whole drinks (OR: 2.76; 95% CI: 1.85-4.11). CONCLUSIONS Parental supply of alcohol appears to increase the risk of subsequent supply of alcohol from other sources in certain contexts.
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Affiliation(s)
- Veronica C Boland
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW Australia, Sydney, , NSW, 2052, Australia
| | - Philip J Clare
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW Australia, Sydney, , NSW, 2052, Australia
| | - Wing See Yuen
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW Australia, Sydney, , NSW, 2052, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW Australia, Sydney, , NSW, 2052, Australia
| | - Alexandra Aiken
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW Australia, Sydney, , NSW, 2052, Australia
| | - Monika Wadolowski
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, NSW, 2109, Australia
| | - Delyse Hutchinson
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW Australia, Sydney, , NSW, 2052, Australia.,Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University Geelong, Geelong, Victoria, 3220, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, 3010, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, 3052, Australia.,Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, 3052, Australia
| | - Jackob Najman
- Queensland Alcohol and Drug Research and Education Centre, University of Queensland, Brisbane, QLD, 4072, Australia
| | - Tim Slade
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, 2006, Australia
| | - Raimondo Bruno
- School of Psychology, University of Tasmania, Hobart, TAS, 7000, Australia
| | - Nyanda McBride
- National Drug Research Institute, Curtin University, GPO Box U1987, Perth, , WA, 6845, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW Australia, Sydney, , NSW, 2052, Australia
| | - Kypros Kypri
- School of Medicine and Public Health, University of Newcastle, Newcastle, , NSW, 2308, Australia
| | - Richard P Mattick
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW Australia, Sydney, , NSW, 2052, Australia
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Courtney RJ, Boland VC, McRobbie H. Inequalities in cessation and critique of possible contributing factors: taking stock of a perseveration with current treatment approaches, uptake of promising treatments and limited upscaling of interventions with positive equity impact. Addiction 2020; 115:1788-1790. [PMID: 32267593 DOI: 10.1111/add.15073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Ryan J Courtney
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Veronica C Boland
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales (UNSW), Sydney, NSW, Australia
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8
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Snowdon N, Allan J, Shakeshaft A, Rickwood D, Stockings E, Boland VC, Courtney RJ. Outpatient psychosocial substance use treatments for young people: An overview of reviews. Drug Alcohol Depend 2019; 205:107582. [PMID: 31778903 DOI: 10.1016/j.drugalcdep.2019.107582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/12/2019] [Accepted: 08/16/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Systematic reviews and meta-analyses (reviews) conflict regarding the efficacy and feasibility of substance disorder treatments for young people (YP). This overview of reviews, synthesizes, and methodologically assesses reviews examining substance disorder interventions for YP in outpatient settings. METHODS Reviews published between 1990 and March 2018 were searched using EBM Reviews, PsycINFO, Embase, Ovid Medline, and Campbell Collaboration. Reviews investigating efficacy and/or feasibility of YP substance disorder treatments in outpatient settings were included. FORTY-THREE REVIEWS MET ALL INCLUSION CRITERIA To appraise methodological biases, 40 reviews were assessed using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR2) and 3 were narratively assessed. One reviewer (NS) extracted study data and evaluated all 43 reviews. For inter-rater reliability, 13 (30%) reviews were extracted and appraised in duplicate by a second reviewer (JA, RC or ES). Agreement on AMSTAR2 ratings reached 100%. Agreement was moderate; κ = .52 (p < .05), 95% CI (.20, .84). RESULTS All high quality methodological reviews (n = 6) focused on intervention efficacy and none on treatment feasibility. One (n = 1) high quality review reported evidence for an intervention. Multidimensional Family Therapy (MDFT) has possible efficacy in reducing YP substance use when compared to treatment as usual, Cognitive Behavior Therapy, Adolescent Community Reinforcement Approach and Multifamily Educational Therapy. CONCLUSIONS Methodological and reporting quality of reviews require improvement. High quality reviews focused on intervention efficacy but treatments commonly lacked evidence. One high quality review found MDFT demonstrated promising outcomes. Reviews examining feasibility of interventions were of low methodological quality.
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Affiliation(s)
- Nicole Snowdon
- Lives Lived Well Research Team, Lives Lived Well, P.O. Box 9374, Orange, NSW, 2800, Australia; National Drug and Alcohol Research Centre, 22 - 32 King Street, The University of New South Wales, Randwick, Sydney, NSW, 2031, Australia.
| | - Julaine Allan
- Lives Lived Well Research Team, Lives Lived Well, P.O. Box 9374, Orange, NSW, 2800, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, 22 - 32 King Street, The University of New South Wales, Randwick, Sydney, NSW, 2031, Australia; Faculty of Health, Allawoona St, University of Canberra, Bruce, Canberra, ACT, 2617, Australia
| | - Debra Rickwood
- Research and Evaluation, headspace, The National Youth Mental Health Foundation, South Tower, Level 2, 485 La Trobe St, Melbourne VIC 3000, Australia; Faculty of Health, Allawoona St, University of Canberra, Bruce, Canberra, ACT, 2617, Australia
| | - Emily Stockings
- National Drug and Alcohol Research Centre, 22 - 32 King Street, The University of New South Wales, Randwick, Sydney, NSW, 2031, Australia
| | - Veronica C Boland
- National Drug and Alcohol Research Centre, 22 - 32 King Street, The University of New South Wales, Randwick, Sydney, NSW, 2031, Australia
| | - Ryan J Courtney
- National Drug and Alcohol Research Centre, 22 - 32 King Street, The University of New South Wales, Randwick, Sydney, NSW, 2031, Australia
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9
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Thomas D, Farrell M, McRobbie H, Tutka P, Petrie D, West R, Siahpush M, Gartner C, Walker N, Mendelsohn CP, Hall W, Paul C, Zwar N, Ferguson SG, Boland VC, Richmond R, Doran CM, Shakeshaft A, Mattick RP, Courtney RJ. The effectiveness, safety and cost-effectiveness of cytisine versus varenicline for smoking cessation in an Australian population: a study protocol for a randomized controlled non-inferiority trial. Addiction 2019; 114:923-933. [PMID: 30589984 DOI: 10.1111/add.14541] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/28/2018] [Accepted: 12/17/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Smoking cessation medications are effective, but often underutilized because of costs and side effects. Cytisine is a plant-based smoking cessation medication with more than 50 years of use in central and eastern Europe. While cytisine has been found to be well-tolerated and more effective than nicotine replacement therapy, direct comparisons with varenicline have not been conducted. This study evaluates the effectiveness, safety and cost-effectiveness of cytisine compared with varenicline. DESIGN Two-arm, parallel group, randomized, non-inferiority trial, with allocation concealment and blinded outcome assessment. SETTING Australian population-based study. PARTICIPANTS Adult daily smokers (n = 1266) interested in quitting will be recruited through advertisements and Quitline telephone-based cessation support services. INTERVENTION AND COMPARATOR Eligible participants will be randomized (1 : 1 ratio) to receive either cytisine capsules (25-day supply) or varenicline tablets (12-week supply), prescribed in accordance with the manufacturer's recommended dosing regimen. The medication will be mailed to each participant's nominated residential address. All participants will also be offered standard Quitline behavioural support (up to six 10-12-minute sessions). MEASUREMENTS Assessments will be undertaken by telephone at baseline, 4 and 7 months post-randomization. Participants will also be contacted twice (2 and 4 weeks post-randomization) to ascertain adverse events, treatment adherence and smoking status. The primary outcome will be self-reported 6-month continuous abstinence from smoking, verified by carbon monoxide at 7-month follow-up. We will also evaluate the relative safety and cost-effectiveness of cytisine compared with varenicline. Secondary outcomes will include self-reported continuous and 7-day point prevalence abstinence and cigarette consumption at each follow-up interview. COMMENTS If cytisine is as effective as varenicline, its lower cost and natural plant-based composition may make it an acceptable and affordable smoking cessation medication that could save millions of lives world-wide.
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Affiliation(s)
- Dennis Thomas
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales (UNSW), Sydney, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales (UNSW), Sydney, Australia
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales (UNSW), Sydney, Australia.,Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Piotr Tutka
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales (UNSW), Sydney, Australia.,Department of Experimental and Clinical Pharmacology, Laboratory for Innovative Research in Pharmacology, University of Rzeszów, Rzeszów, Poland
| | - Dennis Petrie
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Australia
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, UK
| | - Mohammad Siahpush
- College of Public Health, University of Nebraska Medical Center, Omaha, United States
| | - Coral Gartner
- Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, Australia
| | - Natalie Walker
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Colin P Mendelsohn
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Wayne Hall
- Faculty of Health and Behavioural Sciences, Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, Australia.,National Addiction Centre, Kings College London, UK
| | - Christine Paul
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Nicholas Zwar
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.,Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
| | | | - Veronica C Boland
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales (UNSW), Sydney, Australia
| | - Robyn Richmond
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Christopher M Doran
- Centre for Indigenous Health Equity Research, Central Queensland University, Brisbane, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales (UNSW), Sydney, Australia
| | - Richard P Mattick
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales (UNSW), Sydney, Australia
| | - Ryan J Courtney
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales (UNSW), Sydney, Australia
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10
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Boland VC, Stockings EA, Mattick RP, McRobbie H, Brown J, Courtney RJ. The Methodological Quality and Effectiveness of Technology-Based Smoking Cessation Interventions for Disadvantaged Groups: A Systematic Review and Meta-analysis. Nicotine Tob Res 2018; 20:276-285. [PMID: 28034998 DOI: 10.1093/ntr/ntw391] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 12/21/2016] [Indexed: 01/08/2023]
Abstract
Aims To assess the methodological quality and effectiveness of technology-based smoking cessation interventions in disadvantaged groups. Method Four databases (EMBASE, Cochrane, Medline, and PsycInfo) were searched for studies conducted from 1980 to May 2016. Randomized controlled trials that compared a behavioral smoking cessation intervention delivered primarily through a technology-based platform (eg, mobile phone) with a no-intervention comparison group among disadvantaged smokers were included. Three reviewers assessed all relevant studies for inclusion, and one reviewer extracted study, participant and intervention-level data, with a subset crosschecked by a second reviewer. Results Thirteen studies targeting disadvantaged smokers (n =4820) were included. Only one study scored highly in terms of methodological rigor on EPOC criteria for judging risk of bias. Of the 13 studies using a technology-based platform, most utilized websites (n = 5) or computer programs (n = 5), and seven additionally offered nicotine replacement therapy. Technology-based interventions increased the odds of smoking cessation for disadvantaged groups at 1 month (odds ratio [OR] 1.70, 95% confidence interval [CI] 1.10, 2.63), 3 months (OR 1.30, 95% CI 1.07, 1.59), 6 months (OR 1.29, 95% CI 1.03, 1.62), and 18 months post-intervention (OR 1.83, 95% CI 1.11, 3.01). Conclusion Few methodologically rigorous studies were identified. Mobile phone text-messaging, computer- and website-delivered quit support showed promise at increasing quit rates among Indigenous, psychiatric and inpatient substance use disorder patients. Further research is needed to address the role technology-based interventions have on overcoming health inequalities to meet the needs of disadvantaged groups. Implications This review provides the first quantitative evidence of the effectiveness of a range of technology-based smoking cessation interventions among disadvantaged smokers, with separate estimates on the basis of intervention type, and cessation outcome measure. Providing cost-effective, easily accessible and real-time smoking cessation treatment is needed, and innovative technology-based platforms will help reach this endpoint. These interventions need to be tested in larger scale randomized controlled trial designs and target broader disadvantaged groups. Data collection beyond 6 months is also needed in order to establish the efficacy of these intervention approaches on long-term cessation rates among disadvantaged population groups.
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Affiliation(s)
- Veronica C Boland
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales (UNSW), Randwick, Australia
| | - Emily A Stockings
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales (UNSW), Randwick, Australia
| | - Richard P Mattick
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales (UNSW), Randwick, Australia
| | - Hayden McRobbie
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Jamie Brown
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Ryan J Courtney
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales (UNSW), Randwick, Australia
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11
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Boland VC, Mattick RP, McRobbie H, Siahpush M, Courtney RJ. "I'm not strong enough; I'm not good enough. I can't do this, I'm failing"- A qualitative study of low-socioeconomic status smokers' experiences with accesssing cessation support and the role for alternative technology-based support. Int J Equity Health 2017; 16:196. [PMID: 29132364 PMCID: PMC5683575 DOI: 10.1186/s12939-017-0689-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 10/30/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The social gradient in smoking rates persist with an overrepresentation of smoking and its associated harms concentrated within lower socioeconomic status (SES) populations. Low-SES smokers are motivated to quit but face multiple barriers when engaging a quit attempt. An understanding of the current treatment service model from the perspectives of treatment-seeking low-SES smokers is needed to inform the design of alternative smoking cessation support services tailored to the needs of low-SES populations. This qualitative study aimed to: i) explore low-SES smokers' recent quitting experiences; ii) assess factors that impact treatment engagement; and iii) determine the acceptability and feasibility of alternative approaches to smoking cessation. METHOD Low-SES participants (n = 24) previously enrolled in a smoking cessation RCT participated in either a semi-structured focus group or in-depth telephone interview. Data was obtained and analysed using thematic analysis from October 2015 to June 2016. Analysis was deductive from the interview guide and supplemented inductively. RESULTS Participants expressed feelings of guilt and shame around their smoking behaviour and experienced stigmatisation for their smoking. Guilt, shame, and stigmatisation negatively impacted treatment seeking behaviours with most avoiding current quit services. Costs of pharmacotherapy and treatment adherence were commonly cited barriers to treatment success. Electronic-cigarettes were perceived to be unsafe due to uncertainty on their legal status and regulatory restrictions. Technology-based text-messaging quit support was endorsed as a more favourable alternative compared to existing behavioural treatment services. CONCLUSION Stigmatisation was commonly endorsed and acted as an impediment to current treatment utilisation. Electronic-cigarettes may present a viable harm reduction alternative, but their likely uptake in socioeconomically disadvantaged groups in Australia is limited by smokers' uncertainty about their regulation and legality. Mobile phone based cessation support may provide an alternative to telephone counselling and overcome the stigmatisation low-SES smokers face while trying to quit.
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Affiliation(s)
- Veronica C. Boland
- University of New South Wales (UNSW), National Drug and Alcohol Research Centre (NDARC), 22-32 King Street, Randwick, NSW 2031 Australia
| | - Richard P. Mattick
- University of New South Wales (UNSW), National Drug and Alcohol Research Centre (NDARC), 22-32 King Street, Randwick, NSW 2031 Australia
| | - Hayden McRobbie
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, EC1M 6BQ, London, UK
| | - Mohammad Siahpush
- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, NE USA
| | - Ryan J. Courtney
- University of New South Wales (UNSW), National Drug and Alcohol Research Centre (NDARC), 22-32 King Street, Randwick, NSW 2031 Australia
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