Addiction

Background and AimsDue to the COVID-19 pandemic, the survey mode of the Smoking and Alcohol Toolkit Study, a long-running repeat cross-sectional survey, had to change from face-to-face to telephone interviews. This study aimed to assess similarities and differences in sociodemographic, smoking, alternative nicotine and alcohol use estimates between the two survey modes, to understand the potential impacts of this change in methodology on prevalence estimates and trends over time. DesignAfter COVID-19 restrictions were lifted, we conducted parallel telephone and face-to-face household surveys in March 2022 and in January to March 2024, using a hybrid of random and quota sampling. Data from both years were aggregated. Setting and ParticipantsPeople aged 16+ years living in private households in Great Britain. MeasurementsSociodemographic characteristics, nicotine and alcohol use related estimates and their 95% CIs -- unweighted and weighted -- collected via telephone versus face-to-face in a household. FindingsIn the unweighted analyses, the telephone sample included slightly younger and less socioeconomically advantaged groups than the face-to-face sample. After the samples were weighted, estimates of sociodemographic characteristics and nicotine and alcohol use were generally consistent across methodologies, including daily cigarette smoking (face-to-face: 11.1% [10.1-12.1] vs. telephone: 10.6% [9.5-11.7]), non-daily cigarette smoking (face-to-face: 2.7% [2.2-3.3] vs. telephone: 3.4% [2.8-4.1]), and e-cigarette use among people who smoke (face-to-face: 27.0% [23.5-30.5] vs. telephone: 29.3% [25.4-33.3]). However -- compared with telephone participants -- a lower proportion of face-to-face participants reported currently using e-cigarettes (face-to-face: 6.4% [5.6-7.1] vs. telephone: 10.4% [9.3-11.5]), and a higher proportion reported never drinking alcohol (face-to-face: 31.1% [29.7-32.5] vs. telephone: 25.0% [23.5-26.5]) and never having 6 or more standard drinks on one occasion (face-to-face: 46.6% [44.7-48.5] vs. telephone: 40.2% [38.4-42.1]). More participants provided "dont know" or "refused" responses in the telephone compared with the face-to-face interview, including in response to questions about tobacco use, e-cigarette device type, and the number of standard drinks on a typical day. ConclusionsFace-to-face and telephone surveys generally yield similar estimates of nicotine and alcohol use. However, there may be some underreporting of vaping and drinking in a face-to-face survey conducted in the home compared with telephone.

Withdrawal statementThe authors have withdrawn this preprint because peer review resulted in substantial changes to analysis methods, outcomes, and interpretation. Hence the final peer-reviewed version is substantially different from this preprint. Therefore, the authors do not wish this work to be cited as reference for the project. Please instead see the peer-reviewed version available at http://doi.org/10.1111/add.70184 and if you have any questions, please contact the corresponding author.

ObjectivesTo evaluate the effectiveness and cultural feasibility of family-supervised disulfiram as a first-line treatment for alcohol use disorder (AUD) in Sri Lanka, and to compare its clinical outcomes with standard therapy delivered at a tertiary psychiatric unit. DesignSingle-blind Randomized Controlled Trial known as ETAT-RCT (Efficacy of Two Alcohol Treatments) was conducted under routine clinical setup with three parallel groups: family-supervised disulfiram, locally developed psychosocial intervention, and routine treatment. Allocation was independently concealed; assessors were blinded. Analyses followed an intention-to-treat approach using repeated-measures ANOVA (group x time). This paper reports the disulfiram (test) versus routine treatment (control) comparison; the psychosocial intervention will be reported separately. SettingUniversity Psychiatry Unit, National Hospital of Sri Lanka, Colombo (UPU, NHSLC). ParticipantsPatients aged [&ge;]14 years with AUD presenting to the unit were recruited consecutively without inducements. Planned allocation ratio was 1:1:1 with 31 participants per arm; key exclusions were lifetime psychotic disorder and current contraindication to disulfiram. RandomisationParticipants were randomised into each treatment arm using an independent concealed paper-based allocation system. Intervention(1) family-supervised disulfiram, with psychoeducation/support only - DT arm, (2) a locally developed denormalization focused psychosocial programme - PT arm, and (3) standard therapy (motivational/cognitive/behavioural input; naltrexone permitted; no disulfiram/denormalisation) - ST arm. Outcome measuresPrimary outcome was Alcohol Use Disorders Identification Test (AUDIT) score at 12 months. Key secondary outcomes were past 30 day alcohol use via Timeline Follow-Back (TLFB); alcohol biomarkers [ALT (alanine aminotransferase), {gamma}-GT (gamma-glutamyl transferase), MCV (mean corpuscular volume)]; locally developed measures of addiction-relevant cognitive, affective, behavioural factors [AARSU (Attitude Assessment Related to Substance Use), BARSU (Behaviour Assessment Related to Substance Use)]; and Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF). Outcomes were assessed at baseline, 6, and 12 months. ResultsParticipants in DT (n=33) and ST (n=38) were comparable at baseline. Both groups showed clinically and statistically significant improvement in AUDIT scores over 12 months (DT: F=39.90, p<0.001; ST: F=49.90, p<0.001), with no groupxtime interaction (F<0.001, p=0.98). Biomarkers and AARSU, and BARSU and Q-LES-Q-SF to a lesser degree, mirrored the AUDIT pattern. TLFB did not change significantly over time in either arm (p>0.05). In moderator analyses, improvement in AUDIT was not moderated by baseline motivation (F=0.20, p=0.89) but was moderated by baseline AUD severity (F=7.70, p=0.007). No serious adverse events were attributed to disulfiram. Adherence to supervised dosing was generally high during periods of supervision but intermittent overall. ConclusionsIn this pilot RCT, family-supervised disulfiram achieved 12-month outcomes comparable to standard therapy in a tertiary Sri Lankan setting. Improvements were independent of baseline motivation and varied by baseline AUD severity. These findings may support family-supervised disulfiram as a culturally feasible first-line option in Sri Lanka; larger, adequately powered multicentre trials are warranted to confirm effectiveness and scalability. Trial registrationSLCTR/2014/021 Strengths and limitations of this studyO_LIThis pragmatic randomised controlled trial demonstrates an improved real world applicability and validity as it was conducted in an unmodified public-sector psychiatric setting. C_LIO_LIStrong generalisability of the study with similar health systems due to broad eligibility criteria of patients warranted the inclusion of regular and general patient cohort with alcohol use disorders, strengthening generalisability within similar health systems. C_LIO_LIInterventions were carried out without additional staff or patient monitoring reflecting routine clinical practice. C_LIO_LIComprehensive assessment beyond abstinence alone with multidimensional outcomes such as alcohol related harm, biomarkers, cognitive behavioural change and quality of life. C_LIO_LIMinor potential in performance bias due to the nature of intervention where blinding study subjects and clinicians is not feasible. C_LIO_LISampling bias towards males and variability within the ST arm can affect the generalisability. C_LI

BackgroundThe impact of the COVID-19 crisis on potentially harmful alcohol consumption is unclear. AimsTo test whether the prevalence of problem drinking has changed from before to during the COVID-19 crisis in the US and UK. Design/SettingWe examined nationally representative longitudinal data on how problem drinking has changed from pre-pandemic levels among adults in the US (N=7,327; Understanding America Study) and UK (N=12,594; UK Household Longitudinal Study). MethodsIn the US, we examined rates of consuming alcohol [&ge;] 4 times in the past week at baseline (March, 2020) and across four waves of follow-up (April-May, 2020). In the UK we assessed the prevalence of consuming alcohol [&ge;] 4 times per week and weekly heavy episodic drinking using the AUDIT-C at baseline (2017-2019) and during the COVID-19 lockdown (April, 2020). We also tested whether there were specific groups at greater risk of increased problem drinking during the pandemic. ResultsAmong US adults, there was a statistically significant increase in the percentage of participants reporting drinking alcohol [&ge;] 4 times a week which rose significantly from 11.7% to 17.9% (53% increase, p < .001) as the COVID-19 crisis developed in the US. Among UK adults, the percentage of participants reporting drinking [&ge;] 4 times a week increased significantly from 14.2% to 23% (62% increase, p < .001) and heavy episodic drinking at least weekly increased significantly from 9.7% to 16.6% (71% increase, p < .001) when compared to pre-COVID-19 lockdown levels. Trends were similar across population demographics, although those aged under 50 years and higher income groups displayed the largest increases. ConclusionsThe COVID-19 crisis has been associated with substantial increases in problematic drinking in both US and UK adults.

AimsTo examine the association between household members and their tobacco smoking behaviour on patterns of smoking cessation and relapse. Design and participantsData was sourced from 19 waves (years 2001 to 2019) of the nationally representative Household Income and Labour Dynamics in Australia (HILDA) survey, with all household members 15 years or older completing the survey annually. The final sample included, on average, 3,056 ex-smokers and 2,612 smokers per wave. MeasurementsSelf-reported annual smoking status was used to construct measures of smoking cessation and relapse. Information on household structure and relationships was then used to develop variables describing the presence of household members and their smoking status by relationship to the individual (i.e., child, parent, spouse, sibling, or other). Multivariate regression analyses were then used to predict the likelihood of smoking cessation and relapse controlling for the presence of other household members and their smoking status, sociodemographic characteristics, number of cigarettes smoked per day, previous quit attempts, and years abstained from smoking. FindingsIndividuals that lived with non-smokers were more likely to quit [OR1.22 (95%CI 1.11;1.34)] relative to those living alone. However, this favourable association was negated if living with another smoker, which was associated with a reduced likelihood of smoking cessation [OR0.77 (95%CI 0.72;0.83)] and a higher likelihood of relapse [1.37 (95%CI 1.22;1.53)]. In particular, living with a spouse or parent that smoked reduced the likelihood of smoking cessation [OR0.71 (95%CI 0.65;0.78) and OR0.71 (95%CI 0.59;0.84), respectively] and increased the likelihood of relapse [OR1.47 (95%CI 1.28;1.69) and OR1.39 (95%CI 1.00;1.94) respectively] relative to living with their non-smoking counterparts. ConclusionsHousehold composition and intrahousehold smoking behaviour should be considered when delivering, or estimating the benefits of, smoking cessation interventions. Interventions which encourage smoking cessation at the household level may assist individuals to quit and abstain from smoking.

Background: The UK Government aims to reduce smoking rates by implementing new, and investing in existing, tobacco control strategies including increased funding for Stop Smoking Services (SSS) in England. This study examined whether the additional funding starting in April 2024 was associated with a detectable increase in quit attempts supported by SSS and whether it was cost-effective. Methods: We used data from the Smoking Toolkit Study, a repeat cross-sectional survey conducted in 2021 to 2025. Adults aged [&ge;]18 years who smoked cigarettes and had made a quit attempt in the past year were included (weighted n=5,076). The outcome was monthly prevalence of past-year quit attempts supported by SSS. We fitted general additive models with a step change in April 2024 to represent the start of the increased funding. We adjusted for tobacco tax increases, the Swap-to-Stop scheme, age, gender, and a measure of socioeconomic position. In an unplanned analysis, we extended the time series back to 2006. For the cost-effectiveness, we estimated incremental cost-effectiveness ratios for the total population and age groups, accounting for future lifetime cessation. Results: In the primary model, the April 2024 step change was not statistically significant (adjusted odds ratio: 1.13; 95% CI: 0.52, 2.49). The cost-effectiveness analysis ranged from cost-effective to extremely ineffective (incremental cost-effectiveness ratio (ICER): GBP 104,126, 95% CI: 939,398 to 8,293). When using the extended time series, the adjusted odds ratio for the step change was 2.70 (95% CI: 2.03, 3.60) and the intervention was cost-effective (ICER: GBP 13,857; 21,393 to 9,620). Conclusions: Compared with the long-term trend, increased funding to SSS in England in 2024 appeared to lead to an increase in quit attempts supported by SSS at the population level. This result is somewhat uncertain because our primary pre-planned analyses assessing the impact relative to a more recent trend were insensitive.

Background: Alcohol use is a leading modifiable risk factor for injury in sub-Saharan Africa. In Tanzania, young people ([&le;]24 years) experience greater alcohol-related harm despite drinking less frequently than adults. Punguza Pombe kwa Afya Yako (PPKAY) is a culturally adapted, brief intervention for injury patients in Tanzania. This study examined whether age moderates its effectiveness. Methods: We conducted an exploratory secondary analysis of baseline and 3-month data from the PPKAY randomized trial among injury patients aged [&ge;]18 years at Kilimanjaro Christian Medical Centre, Tanzania. Eligible participants reporting alcohol use before injury, AUDIT [&ge;]8, or positive breathalyzer were randomized to usual care or PPKAY with SMS boosters. The primary outcome was binge drinking days. Count outcomes were analyzed using negative binomial regression with robust SEs and continuous outcomes using mixed-effects models. Effect modification was assessed using a three-way interaction (Time x intervention x Age). Results: Among 543 participants (mean age 36.8 years; 16.2% aged 18--24), age moderated the intervention effect for drinking days (IRR = 0.27, 95% CI 0.07 -- 0.98; p = 0.046) and drinks consumed (IRR = 0.17, 95% CI 0.04 -- 0.77; p = 0.021). The intervention reduced 4 drinking days (95% CI -7.1 to -0.8) and 27.5 drinks (95% CI -42.8 to -12.2) among young people, while adults showed reductions in both arms, without intervention-specific effect. Conclusion: The effects of ED-based brief alcohol interventions are not uniform, varying across both age groups and alcohol-related outcomes. We found a greater responsiveness in drinking frequency and quantity reported among young people.

Background: Alcohol consumption is a modifiable risk factor linked to anxiety and depression, yet the population-level impact of reducing alcohol use on the prevalence of anxiety and depression symptoms remains unclear. Prior studies are limited by methodological challenges including health-related selection into abstinence, time-varying confounding and reverse causation. Methods: We used data from 2,813 participants without documented underlying health conditions in a U.S. national longitudinal cohort (September 2021-December 2023) and applied the parametric g-formula within a target trial emulation framework to estimate the effect of a hypothetical intervention reducing alcohol consumption to low-risk levels on the prevalence of moderate-to-severe anxiety (GAD-7 [&ge;]10) and depression (PHQ-8 [&ge;]10) symptoms. The intervention set moderate- and high-risk drinking to low-risk at each follow-up, while leaving abstinent and low-risk drinking unchanged. Models adjusted for time-varying and baseline covariates, with uncertainty estimated using bootstrap resampling. Results: Under the natural course, the estimated prevalence of moderate-to-severe depressive symptoms was 12.67% (95% CI: 12.17, 13.23), compared to 12.77% (95% CI: 12.26, 13.29) under the intervention (risk difference: 0.10 percentage points; 95% CI: -0.22, 0.50). For anxiety symptoms, prevalence was 10.40% (95% CI: 8.89, 11.89) under the natural course and 10.25% (95% CI: 8.76, 11.98) under the intervention (risk difference: -0.15 percentage points; 95% CI: -0.68, 0.35). Conclusions: Under a hypothetical population-wide intervention reducing alcohol consumption to low-risk levels, differences in the prevalence of moderate or severe anxiety and depression symptoms were near null. These findings suggest that reducing alcohol use alone may be insufficient to meaningfully shift the population-wide burden of common mental health disorders.

This paper shows the prevalence, trends and heterogeneity in maternal smoking around birth in the United Kingdom, focusing on the war and post-war reconstruction period in which there exists surprisingly little systematic data on (maternal) smoking behaviours. Within this context, we highlight relevant events, the release of new information about the harms of smoking, and changes in (government) policy aimed at reducing smoking prevalence. We show stark changes in smoking prevalence over a 30-year period, highlight the onset of the social gradient in smoking, as well as genetic heterogeneities in smoking trends.

Aims To estimate the prevalence of past-year smoking quit attempts in Great Britain and examine variation by sociodemographic and socioeconomic characteristics, mental health, alcohol use, smoking-related characteristics, and geographic area. Design Cross-sectional analysis of data from a nationally representative household survey (the Smoking Toolkit Study) conducted October 2020 to May 2026. Setting Great Britain. Participants 24,786 adults ([&ge;]18y) who reported past-year tobacco smoking. Measurements The outcome was self-reporting having made at least one serious attempt to stop smoking in the previous 12 months. Associations with age, gender, ethnicity, social grade, health-related economic inactivity, mental health conditions, psychological distress, alcohol consumption, use of non-combustible nicotine, cigarette type and consumption, strength of urges to smoke, and motivation to stop smoking were assessed. We calculated weighted prevalence estimates and odds ratios (ORs) adjusted for survey year. Findings Overall, 36.7% [95%CI=36.0-37.4] of adults who had smoked in the past year self-reported making at least one quit attempt. Annual prevalence was relatively stable over the study period (range: 35.5% [33.9-37.1] to 37.6% [35.9-39.3]). Making a past-year quit attempt was more common among younger adults (48.0% among 18-24-year-olds) and declined progressively with age (24.6% among [&ge;]65-year-olds; OR=0.35, 95%CI=0.31-0.39). Compared with White adults, making a past-year quit attempt was more common among Black (OR=1.31, 1.11-1.55) and Asian (OR=1.40, 1.21-1.62) adults. Adults with a history of diagnosed mental health conditions (OR=1.27, 1.17-1.38) and moderate (OR=1.31, 1.20-1.43) or severe psychological distress in the past month (OR=1.39, 1.25-1.56) had greater odds of reporting a past-year quit attempt than those without. Those reporting increasing/higher risk alcohol consumption had lower odds than non-drinkers (OR=0.88, 0.82-0.95). Current use of nicotine replacement therapy (OR=2.59, 2.36-2.83) and vapes (OR=2.15, 2.02-2.30) were positively associated with reporting a past-year quit attempt. Odds were lower among those with greater cigarette consumption (OR range 0.79-0.86 among those smoking >10 vs. [&le;]5 cigarettes per day). Motivation to stop smoking showed the strongest gradient (OR range 2.95-29.09). Geographic differences were modest, with prevalence ranging from 32.1% [29.9-34.3] in Wales to 39.4% [35.9-43.1] in North East England. Conclusions Between 2020 and 2026, around one in three adults in Great Britain who smoked in the past year reported making a serious attempt to quit, corresponding to approximately 3.5 million people annually. Making a past-year quit attempt was more strongly associated with smoking-related factors than sociodemographic characteristics.

ObjectivesUptake of evidence-based smoking cessation support remains limited. Digital interventions offer the prospect of scalable and highly accessible support. Smoke Free, a digital mobile application using established behaviour change techniques, has shown promise, but no large-scale randomised controlled efficacy trial has yet been conducted. We assessed its effectiveness for smoking cessation. DesignIn this prospective, randomised, controlled, two-arm, parallel clinical trial with 6-month follow-up, study personnel and patients were blinded. SettingThe trial was conducted nationwide in Germany, utilising a decentralised, fully remote trial design. Enrolment took place digitally after receiving brief advice from a healthcare professional, following guidelines for primary care. ParticipantsOut of a volunteer sample of 1850 patients assessed for eligibility, 1466 adult cigarette smokers who had at least moderate cigarette dependence (F17.2, FTCD[&ge;]3) were recruited between August 2023 and February 2024; 84.1% (1233 participants) completed the primary outcome measure. InterventionsThe intervention group (IG) received the Smoke Free app including behaviour-change missions and gamification elements, while the control group (CG) received a text-only cessation information app. Both groups received brief advice from a healthcare professional. Main outcome measuresThe prespecified primary outcome was self-reported 7-day point-prevalence abstinence from combustible tobacco at 6 months post-randomisation; secondary outcomes included biochemical validation of abstinence in participants providing a saliva sample (59% of eligible participants). ResultsSelf-reported abstinence (primary outcome) was significantly higher in the IG compared with the CG (283 [39.3%] vs. 182 [24.4%], OR=2.01, 95% CI 1.60 to 2.50, p<0.0001). The NNT was 6.7 (5.1 to 9.8). The effect was consistent with biochemical validation (OR=1.76, 95% CI 1.27 to 2.44, p<0.0001) and across secondary outcomes and sensitivity analyses. The 6-month follow-up rates for the primary outcome did not differ between groups (IG: 601 [83.5%]; CG: 632 [84.7%]; p=0.52). Eighty-four serious adverse events were reported by 75 participants (IG: 31, 4.3%; CG: 44, 5.9%; p=0.53); none were treatment-related. ConclusionsThe Smoke Free app is effective for aiding smoking cessation in at least moderately dependent cigarette smokers compared with an informational app when provided as an adjunct to brief advice from a healthcare professional. Trial registrationThe trial was registered with the German Clinical Trials Register (DRKS00031140). FundingSmoke Free 23 GmbH (for-profit company).

ObjectiveMinimum unit pricing (MUP) aims to reduce use of cheap, high strength alcoholic beverages that drive harm, yet concerns remain about inequitable effects for structurally vulnerable groups. As part of the Costs, Harms, Expenditures and Alcohol Prices (CHEAP) study, we linked individual-level, product-specific alcohol consumption data from a customized survey with provincial retail price data to estimate prices per standard drink (PPSD) and examine their association with alcohol-related outcomes across sociodemographic groups. MethodA cross-sectional survey of past-week drinkers in British Columbia, Canada, was linked to provincial product-level alcohol sales data. The population weighted sample included 1,217 adults aged [&ge;] 19 years (716 men; mean age 49.34, SD 16.98). Participants reported product-specific consumption, which was matched to retail prices to calculate individual-level PPSD. Survey weighted quasibinomial models then examined associations between PPSD and three outcomes: (1) causing harm to self or others in the past year, (2) scoring [&ge;] 8 on the Alcohol Use Disorder Identification Test, and (3) consuming [&ge;] 15 standard drinks per week. Analyses were stratified by income, education, subjective social status, and race/ethnicity. ResultsLower price per standard drink was associated with higher odds of harm (OR 3.05, 95% CI 1.25-7.40) and scoring [&ge;] 8 on the AUDIT (OR 2.34, 95% CI 1.37-3.99). Associations were stronger among structurally disadvantaged groups, including low-income respondents and Indigenous participants. ConclusionsLower alcohol affordability is linked to risky alcohol use, with the strongest effects among structurally disadvantaged groups. MUP would reduce this risk and promote health equity.

PurposeWhile a growing body of research categorizes early drinking behaviors into experimentation and initiation, factors driving the transition remain underexplored. This study examined individual and environmental influences on the time from alcohol experimentation to initiation among preadolescent youth. MethodsData came from the Adolescent Brain Cognitive Development (ABCD) Study (2016-2021). Experimentation was defined as first sip and initiation as first full drink during follow-up. Extended Cox models assessed the impact of sociodemographic factors, alcohol expectancies, family and peer dynamics, and neighborhood-level factors on the likelihood of alcohol initiation following experimentation. ResultsOf 1,213 youths, 87 (7.2%) progressed from sipping to drinking within 45 months. Older age at onset of sipping was associated with the highest likelihood of alcohol initiation (adjusted hazard ratio [HR]=6.40, 95% confidence interval [CI]: 3.72-11.02, p<0.001), followed by peer alcohol use (adjusted HR=4.11, 95% CI: 2.55-6.65, p<0.001), household rules allowing alcohol consumption (adjusted HR=2.14, 95% CI: 1.17-3.91, p=0.014), family conflict (adjusted HR=1.14, 95% CI: 1.04-1.26, p=0.007), and positive alcohol expectancies (adjusted HR=1.10, 95% CI: 1.01-1.21, p=0.032). Conversely, older chronological age was protective (adjusted HR=0.30, 95% CI: 0.18-0.51, p<0.001). No significant differences in the likelihood of alcohol initiation were observed based on sex, race, ethnicity, household income, parental drinking problems, alcohol availability, and neighborhood safety. DiscussionAge, social and familial influences, and positive alcohol expectancies play central roles in early drinking progression. Interventions that integrate individual beliefs, family practices, and peer dynamics should be considered for delaying initiation.

IntroductionTobacco smoking remains a leading cause of preventable death in the UK. Although e-cigarettes are promoted as a harm-reduction option, longitudinal evidence on short-term health outcomes across different smoking transition pathways is limited. This study examined short-term associations between transitions to exclusive e-cigarette use, dual use, or cessation and physical health, mental health, and health-related quality of life, compared with continued smoking. MethodsA target trial emulation framework was applied to Waves 7-14 (2015-2024) of the UK Household Longitudinal Study, including 18,011 participant-wave observations from baseline smokers. Propensity score matching (1:3) was used to create comparable exposure groups. A doubly robust analysis-combining matching with Ordinary Least Squares regression-estimated outcomes using the SF-12 Physical (PCS) and Mental (MCS) Component Summary scores and a mapped EuroQol 5-Dimensions 3-Level version (EQ-5D-3L) index. The SF-12 is a validated generic health measure, where PCS and MCS are norm-based scores (mean = 50, SD = 10). The EQ-5D-3L index (range: 0 to 1) reflects overall health utility. ResultsCompared with continued smokers, exclusive e-cigarette users had higher short-term mental health scores (SF-12 MCS {beta} = 1.042; 95% CI: 0.229 to 1.855). In contrast, dual users had lower mental health scores ({beta} = -1.023; 95% CI: -1.574 to -0.472). Short-term physical health scores (SF-12 PCS) were lower among both exclusive switchers ({beta} = -0.670; 95% CI: - 1.287 to -0.053) and quitters ({beta} = -0.486; 95% CI: -0.853 to -0.119), with no evidence of short-term physical health improvement for any transition group. Dual users also had lower health-related quality of life (EQ-5D-3L {beta} = -0.016; 95% CI: -0.025 to -0.008). Subgroup analyses suggested heterogeneity by age and socioeconomic position, with poorer outcomes among older and more disadvantaged smokers. Sensitivity analyses produced directionally consistent findings. ConclusionExclusive switching to e-cigarettes was associated with higher short-term mental health scores, whereas dual use was associated with poorer mental health and health-related quality of life. These findings underscore the importance of distinguishing complete switching from dual use when designing harm-reduction policies and smoking cessation support.

BackgroundAlcohol-free and low-alcohol (no/lo) drinks ([&le;]1.2% ABV) are increasingly popular in high-income countries. Their potential to reduce alcohol-related harm depends on who buys them, in what quantity, and their incorporation into overall drinking patterns. We aimed to (i) compare characteristics of purchases containing only no/lo drinks, only alcoholic drinks, or both, over time between 2018 and 2023; (ii) identify subgroups with distinct purchasing patterns in 2023; and (iii) describe purchasing and soiodemographic differences between these subgroups. DesignLatent profile analysis of cross-sectional household purchasing data. SettingGreat Britain, 2018 and 2023. ParticipantsNationally representative samples of 30,401 (2018) and 28,254 (2023) households. 4,975 households who purchased no/lo drinks in 2023 were included in the latent profile analysis. MeasurementsData included off-trade (i.e. shop) purchases categorised into: no/lo-only; alcohol-only; or no/lo alongside alcohol. Household characteristics were frequency of each purchase type; standard servings of no/lo drinks per adult; alcohol risk levels based on weekly units of alcohol purchased per adult in household (non-drinker: 0 units; low-risk:[&le;] 14 units; increasing risk: >14[&le;] 35 units; high-risk: >35 units [1 unit = 8g alcohol]); household age; social class; region; and ethnicity. FindingsFrom 2018 to 2023, the proportion of purchases that were alcohol-only fell from 97% (95% CI: 97%-97%) to 95% (CI: 95%-95%) while no/lo-only purchases rose from 1.4% (CI: 1.3%-1.4%) to 2.7% (CI: 2.7%-2.8%) and no/lo alongside alcohol purchases rose from 1.2% (CI: 1.2%-1.2%) to 1.9% (1.9%-2.0%). In 2023, no/lo-only purchases contained fewer servings (median = 6.9) than no/lo alongside alcohol purchases (median = 6.5 plus 24.5 alcohol units) and alcohol-only purchases (median = 24.6 units). No/lo-only purchases occurred earlier in the week, no/lo alongside alcohol purchases peaked on Fridays and Saturdays. Latent profile analysis identified three classes: (i) no/lo triers (53%) averaged 2.1 no/lo servings per adult annually with 95% purchasing no or low-risk levels of alcohol. (ii) Occasional purchasers (34%) averaged 7.5 servings with 20% purchasing alcohol at increasing or high-risk levels. (iii) Dual purchasers (13%) averaged 37.8 servings with 39% purchasing alcohol at increasing or high-risk levels. Dual purchasers and occasional purchasers were older than no/lo triers (60% [p<0.001], 54% [p=0.010], and 49% 55 years respectively). Dual and occasional purchasers were more often white than no/lo triers (97% [p = 0.014], 97% [p=0.0074], 94% respectively). ConclusionsIn Great Britain, most households purchasing no/lo drinks do so infrequently and purchase alcohol at low-risk levels; however, a smaller group of older, higher-risk households purchase no/lo drinks more frequently.

BackgroundTobacco smoking rates in alcohol and other drug (AOD) treatment settings is much higher than in the general Australian population. As a result, people seeking treatment for AOD use experience a greater tobacco-related burden of illness. Attempts to reduce smoking rates in AOD treatment consumers have failed to identify smoking cessation strategies with long term effectiveness. The primary aim of this study is to examine the effectiveness of nicotine vaporised products (NVPs) or nicotine replacement therapy (NRT)on self-reported 6 months continuous abstinence at the 9-month follow-up (6 months following end-of 12 weeks of nicotine treatment) for people leaving smoke-free residential withdrawal treatment. Both groups will also receive Quitline telephone counselling. Secondary outcomes and process measures will also be collected. MethodsA two-arm, single-blinded, parallel-group randomised trial with a 6-month post-intervention follow-up (9 months following baseline) will be conducted. The setting is five residential and inpatient government-funded AOD withdrawal units across three cities in three states of Australia (New South Wales, Queensland, Victoria). Participants will be service users aged 18 years or over who smoked at least 10 cigarettes per day, interested in quitting in the next 30 days and have capacity to give informed consent. Research assistants will recruit participants during intake, who then complete a baseline survey, will be randomised to a condition, and receive their first Quitline call during AOD treatment. At discharge, all participants receive a discharge pack containing either NVPs or NRT, depending on condition allocation. DiscussionThis is the first study we know of that will be testing intervening with a tobacco smoking cessation approach during the transition phase from AOD treatment to community. From a public health perspective, this approach has the potential to have tremendous reach into a priority population for smoking cessation. Trial registrationAustralian and New Zealand Clinical Trials Registry (ACTRN12619001787178)

BackgroundThe HARMONY study is a multicentre, randomised, single-blinded parallel group trial. It will compare the effectiveness of a 12-week course of liquid nicotine delivered via vapourised nicotine products (VNPs) to best practice nicotine replacement therapy (NRT) for smoking cessation in individuals receiving opiate agonist treatment (OAT). The aim of publishing this statistical analysis plan is to make the pre-specified statistical principles and procedures to be performed in the analysis of data generated by the HARMONY study, publicly accessible prior to the commencement of data analysis. MethodsThe plan outlines the analysis procedures for analysing the primary outcome of self-reported 7-day point prevalence abstinence from tobacco after 12-weeks of treatment. Secondary outcomes include biochemically verified abstinence, self-reported 30-day abstinence, number of cigarettes smoked each day, craving and withdrawal symptoms, and VNP safety. Between-group comparisons will be conducted at end of treatment, and at 12-weeks post-treatment. Researchers collecting outcome data are blind to the treatment group of each participant. AnalysisBayesian hierarchical models will be used to estimate the treatment effects for all outcomes with uninformative prior distributions for all effect parameters. Alongside the treatment effect estimate of each outcome, a 95% credible interval (highest posterior density), Bayes factor, and probability of direction will be presented. The analyses will be performed under an ITT framework assuming missing at random. All missing outcome and baseline data will be multiply imputed with predictive mean matching. ConclusionMaking the statistical analysis plan for the HARMONY study publicly accessible prior to the commencement of data analysis minimises the risk of bias in the analysis of data, and the interpretation and reporting of results generated by the study. RegistrationThe study was registered in the Australian New Zealand Clinical Trials Registry (Reference ACTRN12621000148875).

AimsTo update a previous typology of British alcohol drinking occasions using a more recent and expanded dataset and revised modelling procedure. To estimate the average consumption level, prevalence of heavy drinking, and distribution of total alcohol consumption and heavy drinking within and across occasion types. DesignCross-sectional latent class analysis of event-level diary data. SettingGreat Britain, 2019. Cases43,089 drinking occasions reported by 17,821 adult drinkers. MeasurementsThe latent class indicators are characteristics of off-trade only (e.g. home), on-trade only (e.g. bar) and mixed trade (e.g. home and bar) drinking occasions. These describe companions, venue(s) and location, purpose, motivation, accompanying activities, timings, weekday, consumption volume in units (1 UK unit = 8g ethanol) and predominant beverage consumed. FindingsThree latent class models identified four off-trade only occasion types (i.e. latent classes), eight on-trade only occasion types and three mixed-trade occasion types. Mean consumption per occasion varied between 4.4 units in Family meals to 17.7 units in Big nights out with pre-loading. Mean consumption exceeded ten units in all mixed-trade occasion types and in Off-trade get togethers, Big nights out and Male friends at the pub. Three off-trade occasion types accounted for 50.8% of all alcohol consumed and 51.8% of heavy drinking occasions: Quiet drink at home alone, Evening at home with partner and Off-trade get togethers. For thirteen out of fifteen occasion types, more than 25% of occasions involved heavy drinking. Conversely, 41.7% of Big nights out and 16.4% of Big nights out with preloading were not heavy drinking occasions. ConclusionsAlcohol consumption varies substantially across and within fifteen types of drinking occasion in Great Britain. Heavy drinking is common in most occasion types. However, moderate drinking is also common in types often characterised as heavy drinking practices. Mixed-trade drinking occasions are particularly likely to involve heavy drinking.

Background Mandatory reductions in tobacco product nicotine content to non-addictive levels may help achieve a tobacco endgame. Evidence exists for potential positive impacts of 'very low nicotine content' (VLNC) cigarettes in promoting smoking cessation in trial settings, but the population-level policy impact is unknown. Methods An online expert knowledge elicitation survey was undertaken to generate estimates for the impact of a VLNC mandate in Australia. Global experts in tobacco control were recruited to individually estimate impacts on smoking initiation, cessation, and switching to e-cigarettes or illicit market cigarettes. Linear pooling was used to estimate a combined (non-parametric) distribution per question, incorporating minimum, maximum, and best guess values from each respondent. Results The survey was completed by 15 experts. Interquartile ranges from pooled responses indicated that in the first year of a VLNC policy, smoking cessation could increase by 1.2-7.1 times the rate without the policy and switching to vaping by 1.3-8 times. Switching to illicitly supplied 'normal' nicotine cigarettes was estimated between 15-50% of those who smoke. Smoking initiation estimates varied greatly. Experts from Australia (n=8) consistently reported lower estimates for positive outcomes, and higher illicit market switching estimates, than experts from other countries. Conclusions Given the absence of implementation evidence, this study provides Australia-specific estimates of the potential behavioural effects of a VLNC policy. The findings suggest that denicotinisation would accelerate declines in smoking, but that it may be undermined by illicit cigarette access in Australia. Estimates should be updated with real-world evidence as it becomes available.

BackgroundVaping cessation is virtually unexplored. The efficacy and safety of varenicline for vaping cessation has not been studied and rigorous research is required to advance best practice and outcomes for e-cigarettes users who want to quit. MethodsEligible patients were randomized to either varenicline (1 mg, administered twice daily for 12 weeks) or placebo treatment (administered twice daily, for 12 weeks) combined with vaping cessation counseling. The trial consisted of a 12-week treatment phase followed by a 12-week follow-up, nontreatment phase. The primary efficacy endpoint of the study was biochemically validated continuous abstinence rate (CAR) at weeks 4 to 12. Secondary efficacy end points were the CAR at weeks 4 to 24 and 7-day point prevalence of vaping abstinence at weeks 12 and 24. ResultsCAR was significantly higher for varenicline vs placebo at each interval: weeks 4-12, 40.0% and 20.0%, respectively (OR = 2.67, 95% CI = [1.25 - 5.68], P = 0.011); weeks 4-24, 34.3% for varenicline and 17.2% for placebo (OR = 2.52, 95% CI = [1.14 - 5.58], P = 0.0224). The 7-day point prevalence of vaping abstinence was also higher for the varenicline than placebo at each time point. Serious adverse events were infrequent in both groups and not treatment-related. ConclusionsInclusion of varenicline and counseling in a vaping cessation program for EC users intending to quit may result in prolonged abstinence. These positive findings may also help guiding future recommendations for vaping cessation by health authorities and healthcare providers.