Background and aims: Within many alcohol prevention interventions, changes in alcohol-related attitudes (ARA) are often proposed as precursors to changes in drinking behaviour. This study aimed to measure the longitudinal relationship between ARA and behaviour during the implementation of a large-scale prevention trial.
Design and setting: This study was a two-arm school-based clustered randomized controlled trial. A total of 105 schools in Northern Ireland and Scotland participated in the Steps Towards Alcohol Misuse Prevention Programme (STAMPP) Trial.
Participants: A sample of 12 738 pupils (50% female; mean age = 12.5 years at baseline) self-completed questionnaires on four occasions (T1-T4). The final data sweep (T4) was 33 months post baseline.
Measurements: Individual assessments of ARA and heavy episodic drinking (HED) were made at each time-point. Additional covariates included location, school type, school socio-economic status and intervention arm. Estimated models examined the within-individual autoregressive and cross-lagged effects between ARA and HED across the four time-points (Bayes estimator).
Findings: All autoregressive effects were statistically significant for both ARA and HED across all time-points. Past ARA predicted future ARA [e.g. ARAT1 → ARAT2 = 0.071, credibility interval (CI) = 0.043-0.099, P < 0.001, one-tailed]. Similarly, past HED predicated future HED (e.g. HEDT1 → HEDT2 = 0.303, CI = 0.222-0.382, P < 0.001, one-tailed). Autoregressive effects for HED were larger than those for ARA at all time-points. In the cross-lagged effects, past HED statistically significantly predicted more positive ARA in the future (e.g. HEDT2 → ARAT3 = 0.125, CI = 0.078-0.173, P < 0.001, one tailed) except for the initial T1-T2 path. In contrast, past ARA did not predict future HED across any time-points.
Conclusions: Changes in alcohol-related attitudes were not a precursor to changes in heavy episodic drinking within the Steps Towards Alcohol Misuse Prevention Programme (STAMPP) Trial in Scotland and Northern Ireland. Rather, alcohol-related attitudes were more likely to reflect prior drinking status than predict future status. Heavy episodic drinking status appears to have a greater impact on future alcohol attitudes than attitudes do on future heavy episodic drinking.
Many efficacious behavioral and medication treatments exist for substance use disorders (SUDs), but these treatments often have important limitations. Behavioral options that include cognitive–behavioral therapy and contingency management can effectively treat a variety of SUDs [1, 2], but these interventions are limited by their expense, availability of trained clinicians and the motivation and time commitment required of those seeking treatment [3, 4]. SUD medications are similarly impacted by access, cost and motivational barriers [3], with further structural barriers in some countries [5, 6] resulting from unique concerns about the potential for misuse or diversion of highly effective opioid agonist treatments [7]. Along with these limitations, many individuals with SUD may not benefit from a specific treatment, highlighting the need for ongoing medication and behavioral therapy development.
Qeadan et al. [8] provide intriguing evidence that glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonists are linked to reduced incidence of alcohol intoxication and opioid overdose in individuals with alcohol use disorder or opioid use disorder, respectively. Using electronic health record (EHR) data from a US sample, they found a 50% reduction in the incidence of medical visits for alcohol intoxication and a 40% reduction in the incidence of opioid overdose. When combined with animal evidence [9] and emerging but more mixed evidence from human experimental and observational studies [10-12], Qeadan et al.’s [8] methodological perspective strengthens the case for double-blind, randomized controlled trials (RCTs) to evaluate the effectiveness of these medications for SUD. Indeed, the diverse sets of methodologies and samples that support effectiveness of GIP and GLP-1 receptor agonists further increase the case for RCTs, and addictions research needs these diverse methodological perspectives to truly understand the causes and develop treatments for SUD.
Ty S. Schepis: Conceptualization; funding acquisition; writing - original draft.
T.S.S. receives research support from the US National Institute on Drug Abuse, the US Substance Abuse and Mental Health Services Administration and the US Food and Drug Administration.
Background and aim: Although considerable progress has been made regarding the implementation of smoke-free policies (SFPs), many people continue to be exposed to second-hand smoke (SHS) in the home environment. The aim of this study was to conduct a systematic review on the association of SFPs in multi-unit housing (MUH) with smoking behavior and SHS exposure.
Methods: In August 2022, we searched five online databases: PubMed, Embase, Web of Science, PsycINFO and CENTRAL. Keywords included terms for SFPs, MUH, smoking behavior and exposure to SHS. We searched for studies that focused on regular combustible cigarettes. Due to the high heterogeneity in methodology and outcomes of the included studies, a meta-analysis was not performed.
Results: Our search yielded 4750 articles. All of them were screened (24 based on full-text), and 17 met the inclusion criteria. All studies were published between 2001 and 2022. Most studies were conducted in the United States (n = 16) and used a cross-sectional design (n = 7) or a longitudinal design (n = 7). Seven studies evaluated smoking behavior. Five of them reported that SFPs in MUH were statistically significantly associated with decreases in either current smoking, smoking quantity, smoking frequency or smoking cessation. Fourteen studies evaluated exposure to SHS. Ten reported that SFPs in MUH were statistically significantly associated with decreases in self-reported exposure to SHS, airborne nicotine levels and particulate matter levels.
Conclusions: Smoke-free policies in multi-unit housing appear to be associated with reduced smoking behavior and second-hand smoke exposure. Successful implementation depends on accessible cessation support and effective enforcement.
Addiction has increased the maximum word length for abstracts from 300 words to 400 words. The extra length is intended to give authors sufficient space for quantitative estimates in the findings section of the abstract. All inference statements in the findings section (“greater than”, “increased” etc.) should be supported with appropriate estimates and 95% confidence intervals or p-values. The statistics quoted in the abstract should also appear in the body of the paper.
For more information, see our guide to writing abstracts here: https://onlinelibrary.wiley.com/page/journal/13600443/homepage/writing-the-abstract.
Background and aims: Child maltreatment is an important component of alcohol's harm to others. No previous studies have assessed the association between multiple parental alcohol events and child maltreatment. This study aimed to measure the impact of parental alcohol-attributable events on the incidence rate of child maltreatment events over the span of childhood and adolescence in New Zealand.
Design, setting and participants: Longitudinal analysis using the birth cohort data of all live births (n = 58 359) in New Zealand in 2000, with the cohort followed until age 17 years using linked data from the Statistics New Zealand Integrated Data Infrastructure (IDI) from 1995 to 2017.
Measurements: Zero-inflated negative binomial and count regression models were used to measure the association between the number of child maltreatment events [collected from publicly funded hospital discharges, Programme for the Integration of Mental Health Data (PRIMHD), Oranga Tamariki, Children's Action Plan (CAP) and police data sets] and parental exposure to alcohol-attributable hospitalization or service use for mental health/addiction. Potential confounders were included for parents and children.
Findings: Of 58 359 children in the cohort, 86% (50 319) had not experienced any documented maltreatment events. Among those at risk of being maltreated children, the maltreatment incidence rate ratio increased by 35.2% (95% confidence interval = 18.1-55.6%) if a child was exposed to parental alcohol-attributable hospitalization or service use for mental health addiction events. For each additional parental alcohol-attributable hospitalization or service use for mental health or addiction, the risk of being maltreated children increased by 12.8%.
Conclusions: In New Zealand, hazardous alcohol consumption by parents appears to be associated with child maltreatment alongside other contributing factors, in particular parental lower educational attainment.
Aims: To evaluate whether a personalized and normative feedback (PNF) intervention for responsible gambling increases gambling insight as well as intention and self-efficacy to engage in responsible gambling and behavioral engagement.
Design: Two-arm randomized controlled trial. Outcome measurements occurred post-randomization and 3 months later.
Setting: Online, Canada.
Participants: Canadian community members who gambled at a land-based casino or online in the last 3 months [61.9% men; mean age = 56.52 (standard deviation = 14.80)] recruited via an online panel (n = 4091).
Intervention and comparator: Participants were randomized to receive PNF (n = 1940) or no feedback (n = 2151).
Measurements: Primary outcomes included gambling insight, intentions and self-efficacy to engage in seven responsible gambling behaviors post-randomization as well as engagement in these behaviors during the 3-month follow-up.
Findings: Post-intervention, participants receiving PNF (relative to no feedback) had greater gambling insight (d = 0.32, P = 4.59e-25) as well as greater intentions and self-efficacy to learn about how the games they play work (dintention = 0.31, P = 4.92e-24; dself-efficacy = 0.25, P = 4.35e-16), learn about the odds of winning at these games (dintention = 0.30, P = 1.43e-21; dself-efficacy = 0.25, P = 2.13e-15) and use operator-provided tools to help limit their gambling (dintention = 0.20, P = 1.36e-10; dself-efficacy = 0.18, P = 3.92e-9). However, post-intervention differences in intention and self-efficacy to limit time and money spent gambling, openness about gambling with others and balancing gambling with other activities were not observed. Meaningful increases in behavioral engagement 3 months later were observed but were not significant.
Conclusions: PNF for responsible gambling (relative to no feedback) appears to increase gambling insight, intentions and self-efficacy to engage in gambling literacy and use of limit-setting tools. Exploratory analyses indicated receiving PNF (relative to no feedback) led to behavioral changes during the 3-month follow-up period.
Background and aims: Buying smaller-sized alcohol products can reduce alcohol consumption, but larger products have better value for money, which presents a barrier to switching. We tested whether proportional pricing prompts drinkers to buy smaller alcohol products and reduce alcohol purchasing.
Design, setting and participants: This study was an online experiment set in the United Kingdom, using hypothetical shopping tasks in which participants purchased different-sized products presented under proportional pricing (i.e. constant price per litre throughout all sizes of the same product) or standard pricing conditions. Study 1 (comprising n = 210 participants) was a mixed experiment with pricing condition (proportional pricing, standard pricing; within-subjects) and drink type (lager, red wine, vodka; between-subjects) as manipulated factors. Study 2 (comprising n = 90 participants) was a within-subjects experiment with pricing condition (proportional pricing, standard pricing) and multi-pack type (size difference-only, quantity-difference only, size and quantity difference) as manipulated factors. Participants were UK adult alcohol consumers.
Measurements: We measured outcome variables, including alcohol purchasing (UK units) and proportion of alcohol purchased from smaller products.
Findings: Proportional pricing consistently increased the proportion of alcohol purchased from smaller products [study 1: B = 10.82, 95% confidence interval (CI) = 8.72-12.92; study 2: B = 11.64, 95% CI = 3.50-19.77], indicating a switch to smaller products. However, this did not consistently reduce the total amount of alcohol purchased among drink and product types: proportional pricing reduced the total units purchased from lager multi-packs containing more rather than fewer products (B = -2.56, 95% CI = -4.82 to -0.30), but not from other types of lager multi-packs or single lager products. Proportional pricing also reduced vodka purchasing (B = -3.30, 95% CI = -5.21 to -1.40), but the effect of proportional pricing on wine purchasing was moderated by hazardous drinking (B = -0.11, 95% CI = -0.17 to -0.05).
Conclusions: Alcohol sales policies that require proportional pricing may reduce alcohol purchasing.
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