Do brief interventions which target alcohol consumption also reduce cigarette smoking? Systematic review and meta-analysis

Do in-person and computer-based brief alcohol interventions reduce tobacco smoking among general hospital patients? Secondary outcomes from a randomized controlled trial

BACKGROUND

At-risk alcohol use and tobacco smoking often co-occur. We investigated whether brief alcohol interventions (BAIs) among general hospital patients with at-risk alcohol use may also reduce tobacco smoking over 2 years. We also investigated whether such effects vary by delivery mode; i.e. in-person versus computer-based BAI.

METHODS

A proactively recruited sample of 961 general hospital patients with at-risk alcohol use aged 18 to 64 years was allocated to three BAI study groups: in-person BAI, computer-based BAI, and assessment only. In-person- and computer-based BAI included motivation-enhancing intervention contacts to reduce alcohol use at baseline and 1 and 3 months later. Follow-ups were conducted after 6, 12, 18 and 24 months. A two-part latent growth model, with self-reported smoking status (current smoking: yes/no) and number of cigarettes in smoking participants as outcomes, was estimated.

RESULTS

Smoking participants in computer-based BAI smoked fewer cigarettes per day than those assigned to assessment only at month 6 (meannet change = - 0.02; 95% confidence interval = - 0.08-0.00). After 2 years, neither in-person- nor computer-based BAI significantly changed smoking status or number of cigarettes per day in comparison to assessment only or to each other (ps ≥ 0.23).

CONCLUSIONS

While computer-based BAI also resulted in short-term reductions of number of cigarettes in smoking participants, none of the two BAIs were sufficient to evoke spill-over effects on tobacco smoking over 2 years. For long-term smoking cessation effects, multibehavioural interventions simultaneously targeting tobacco smoking along with at-risk alcohol use may be more effective.

TRIAL REGISTRATION NUMBER

NCT01291693.

Non-pharmacological interventions for smoking cessation: analysis of systematic reviews and meta-analyses

BACKGROUND

Although non-pharmacological smoking cessation measures have been widely used among smokers, current research evidence on the effects of smoking cessation is inconsistent and of mixed quality. Moreover, there is a lack of comprehensive evidence synthesis. This study seeks to systematically identify, describe, and evaluate the available evidence for non-pharmacological interventions in smoking populations through evidence mapping (EM), and to search for best-practice smoking cessation programs.

METHODS

A comprehensive search for relevant studies published from the establishment of the library to January 8, 2023, was conducted in PubMed, Web of Science, Embase, the Cochrane Library, CNKI, CBM, Wan Fang, and VIP. Two authors independently assessed eligibility and extracted data. The PRISMA statement and AMSTAR 2 tool were used to evaluate the report quality and methodology quality of systematic reviews/meta-analyses (SRs/MAs), respectively. Bubble plots were utilized to display information, such as the study population, intervention type, evidence quality, and original study sample size.

RESULTS

A total of 145 SRs/MAs regarding non-pharmacological interventions for smoking cessation were investigated, with 20 types of interventions identified. The most commonly used interventions were cognitive behaviour education (n = 32, 22.07%), professional counselling (n = 20, 13.79%), and non-nicotine electronic cigarettes (e-cigarettes) (n = 13, 8.97%). Among them, counselling and behavioural support can improve smoking cessation rates, but the effect varies depending on the characteristics of the support provided. These findings are consistent with previous SRs/MAs. The general population (n = 108, 74.48%) was the main cohort included in the SRs/MAs. The total score of PRISMA for the quality of the reports ranged from 8 to 27, and 13 studies (8.97%) were rated as high confidence, and nine studies (6.21%) as moderate confidence, in the AMSTAR 2 confidence rating.

CONCLUSIONS

The abstinence effect of cognitive behaviour education and money incentive intervention has advantages, and non-nicotine e-cigarettes appear to help some smokers transition to less harmful replacement tools. However, the methodological shortcomings of SRs/MAs should be considered. Therefore, to better guide future practice in the field of non-pharmacological smoking cessation, it is essential to improve the methodological quality of SRs and carry out high-quality randomized controlled trials (RCTs).

A systematic review and Bayesian meta-analysis of interventions which target or assess co-use of tobacco and cannabis in single- or multi-substance interventions

BACKGROUND AND AIMS

Tobacco and cannabis are commonly co-used, and evidence for the influence of co-use on quit outcomes for either substance is mixed. We sought to determine the efficacy of tobacco and/or cannabis use interventions delivered to co-users on cannabis and tobacco use outcomes.

METHOD

Systematic review with meta-analysis and narrative review, using five databases and author requests for co-use data. Controlled and uncontrolled intervention studies focusing on treatment of tobacco and/or cannabis use assessing use of both pre- and post-intervention were included. Prevention interventions were excluded. Bayesian meta-analysis was used across four outcome measures: risk ratio for tobacco and cannabis cessation post-intervention separately; standardized mean change for tobacco and cannabis reduction post-intervention separately. Narrative reporting of the same outcome measures in non-randomized clinical trials (non-RCTs) and quality assessment of all included studies were conducted.

RESULTS

Twenty studies (12 RCTs and eight uncontrolled) were included. Bayesian meta-analysis with informative priors based on existing data of 11 RCTs (six single-substance, five multi-substance interventions) delivered to co-users (n = up to 1117) showed weak evidence for an effect on cannabis cessation [risk ratio (RR) = 1.48, credibility interval (CrI) = 0.92, 2.49, eight studies] and no clear effect on tobacco cessation (RR = 1.10, CrI = 0.68, 1.87, nine studies). Subgroup analysis suggested that multi-substance interventions might be more effective than cannabis-targeted interventions on cannabis cessation (RR = 2.19, CrI = 1.10, 4.36 versus RR = 1.39, CrI = 0.75, 2.74). A significant intervention effect was observed on cannabis reduction (RR = 0.25, CrI = 0.03, 0.45, nine studies) but not on tobacco reduction (RR = 0.06, CrI = -0.11, 0.23, nine studies). Quality of evidence was moderate, although measurement of co-use and cannabis use requires standardization. Uncontrolled studies targeting both cannabis and tobacco use indicated feasibility and acceptability.

CONCLUSIONS

Single and multi-substance interventions addressing tobacco and/or cannabis have not shown a clear effect on either tobacco or cannabis cessation and reduction among co-users. However, dual substance interventions targeting tobacco and cannabis appear feasible.

Can brief alcohol interventions in general hospital inpatients improve mental and general health over 2 years? Results from a randomized controlled trial

BACKGROUND

Little is known about the impact of brief alcohol interventions on mental and general health. The aim was to investigate whether brief interventions for general hospital inpatients with at-risk drinking can improve mental and general health over 2 years; and whether effects are dependent on how they are delivered: in-person or through computer-generated feedback letters (CO).

METHODS

Three-arm randomized controlled trial with 6-, 12-, 18-, and 24-month follow-ups. Data were collected on 13 general hospital wards from four medical departments (internal medicine, surgical medicine, trauma surgery, and ear-nose-throat) of one university hospital in northeastern rural Germany. A consecutive sample of 961 18- to 64-year-old general hospital inpatients with at-risk alcohol use was recruited through systematic screening. Inpatients with particularly severe alcohol problems were excluded. Participants were allocated to: in-person counseling (PE), CO, and assessment only (AO). PE and CO included three contacts: on the ward, 1, and 3 months later. Mental and general health were assessed using the five-item mental health inventory (0-100) and a one-item general health measure (0, poor - 4, excellent).

RESULTS

Latent growth models including all participants revealed: after 24 months and in contrast to AO, mental and general health were improved in PE (change in mean difference, ΔMmental = 5.13, p = 0.002, Cohen's d = 0.51; ΔMgeneral = 0.20, p = 0.005, d = 0.71) and CO (ΔMmental = 6.98, p < 0.001, d = 0.69; ΔMgeneral = 0.24, p = 0.001, d = 0.86). PE and CO did not differ significantly.

CONCLUSIONS

Beyond drinking reduction, PE and CO can improve general hospital inpatients' self-reported mental and general health over 2 years.

Combination of ALDH2 and ADH1B polymorphisms is associated with smoking initiation: A large-scale cross-sectional study in a Japanese population

BACKGROUND

Aldehyde dehydrogenase 2 (ALDH2; rs671, Glu504Lys) and alcohol dehydrogenase 1B (ADH1B; rs1229984, His47Arg) polymorphisms are known to strongly influence alcohol　drinking behavior. Given evidence of an association between smoking and drinking behaviors, we hypothesized that ALDH2/ADH1B polymorphisms might also be associated with smoking initiation, and conducted a cross-sectional study to examine this hypothesis.

METHODS

Study subjects were first-visit outpatients diagnosed not to have cancer at Aichi Cancer Center Hospital between 2001 and 2005, including 4141 never smokers and 2912 ever smokers. Unconditional logistic regression models were applied to estimate odds ratios (OR) and 95% confidence intervals (CI) for smoking initiation by comparing ever smokers with never smokers.

RESULTS

Excessive alcohol drinking was associated with a higher likelihood of ever smoking. After adjustment for drinking behaviors, compared to individuals with ALDH2 Glu/Glu, the ORs of ever smoking were 1.71 (95% CI, 1.49-1.95) and 2.28 (1.81-2.87) among those with ALDH2 Glu/Lys and Lys/Lys, respectively. Combination of ALDH2 Lys/Lys and ADH1B His/His (i.e., the most alcohol-intolerant subpopulation) showed the highest OR [2.44 (1.84-3.23)], whereas combination of ALDH2 Glu/Glu and ADH1B Arg/Arg (i.e., the most alcohol-tolerant subpopulation) showed the lowest OR [0.83 (0.57-1.21)] compared with ALDH2 Glu/Glu and ADH1B His/His.

CONCLUSION

Besides the amount and frequency of alcohol drinking, the combination of ALDH2 and ADH1B polymorphisms predicts smoking initiation. This study suggests that alcohol tolerance regulated by ALDH2 and ADH1B polymorphisms is associated with smoking initiation, and facilitates the development of targeted interventions to reduce smoking prevalence.

Secondary Effects of an Alcohol Prevention Program Targeting Students and/or Parents

The secondary effects of an alcohol prevention program (PAS) on onset of weekly smoking and monthly cannabis use are examined among >3000 Dutch early adolescents (M age=12.64) randomized over four conditions: 1) parent intervention (PI), 2) student intervention (SI), 3) combined intervention (CI) and 4) control condition (CC). Rules about alcohol, alcohol use, and adolescents' self-control were investigated as possible mediators. PI had a marginal aversive effect, slightly increasing the risk of beginning to smoke at T1, and increased the likelihood of beginning to use cannabis use at T1 and T2. SI delayed the onset of monthly cannabis use at T3. CI increased the risk to use cannabis at T3. No mediational processes were found. In conclusion, though this study show mixed results, negative side effects of the PI were found, particularly at earlier ages. Moreover, these results indicate the need for multi-target interventions.

Do brief alcohol interventions reduce tobacco use among adolescents and young adults? A systematic review and meta-analysis

This meta-analysis synthesizes studies of brief interventions (BIs) that targeted alcohol consumption and reported both alcohol and tobacco outcomes. It examines whether BIs reduce alcohol and tobacco use for adolescents and young adults among interventions that (1) directly targeted tobacco and alcohol use, or (2) did not target tobacco use but measured it as a secondary outcome. Multiple databases and grey literature sources were searched (1980-2012) resulting in the identification of 18 randomized or controlled quasi-experimental studies (5949 participants). Analyses were conducted using random effects inverse-variance weighted three-level models. BIs were associated with a significant reduction in alcohol consumption relative to control groups [g = 0.11, 95 % CI (0.04, 0.17)] but not with a significant decrease in tobacco use [g = 0.07, 95 % CI (-0.01, 0.16)]. Directly addressing tobacco was not a significant moderator affecting tobacco use outcomes. Post-hoc exploratory analysis revealed potential questions to address with future research.

Screening and concurrent brief intervention of conjoint hazardous or harmful alcohol and tobacco use in hospital out-patients in Thailand: a randomized controlled trial

Background

The aim of this study was to conduct a cluster randomized control trial to assess the efficacy of screening and brief intervention (SBI) for conjoint alcohol and tobacco use among hospital out-patients.

Method

In all 620 hospital out-patients who screened positive for both tobacco and alcohol moderate risk in four hospitals were randomized into 2 control and 1 intervention condition using the hospital as a unit of randomization (2 intervention and 2 control hospitals) to 405 patients in the two control groups (tobacco only intervention, n = 199, and alcohol only intervention, n = 206) and 215 in the intervention group. The intervention or control consisted of three counselling sessions.

Results

Results of the interaction (Group × Time) effects using GEE indicated that there were statistically significant differences between the three study groups over the 6-month follow-up on the ASSIST tobacco score (Wald χ² = 8.43, P = 0.004), and past week tobacco use abstinence (Wald χ² = 7.34, P = 0.007). Although there were no significant interaction effects on the other outcomes (Alcohol ASSIST score, low alcohol risk score, past week tobacco abstinence or low alcohol risk score, and past week tobacco abstinence and low alcohol risk score), the scores in all of the six outcome measures showed consistent improvements. For past week tobacco abstinence the tobacco only intervention was more effective than the alcohol only intervention and the integrated alcohol and tobacco intervention. For the outcome of low alcohol risk, the alcohol only intervention and the integrated alcohol and tobacco intervention was more effective than the tobacco only or alcohol only intervention.

Conclusions

The study found that for past week tobacco abstinence the tobacco only intervention was more effective than the alcohol only intervention and the polydrug use (alcohol and tobacco) integrated intervention.

Can brief alcohol interventions for youth also address concurrent illicit drug use? results from a meta-analysis

Brief interventions aimed at reducing alcohol use among youth may interrupt a possible developmental progression to more serious substance use if they can also affect the use of other illicit drugs. This meta-analysis examined the findings of recent research on the effects of brief alcohol interventions for adolescents and young adults on both alcohol and illicit drug use. Eligible studies were those using randomized or controlled quasi-experimental designs to examine the effects of brief alcohol interventions on illicit drug use outcomes among youth. A comprehensive literature search identified 30 eligible study samples that, on average, included participants age 17, with 57 % male participants and 56 % White youth. Three-level random-effects meta-analyses were used to estimate mean effect sizes and explore variability in effects. Overall, brief interventions targeting both alcohol and other drugs were effective in reducing both of these substances. However, the brief interventions that targeted only alcohol had no significant secondary effects on untargeted illicit drug use. The evidence from current research, therefore, shows modest beneficial effects on outcomes that are targeted by brief interventions for youth, but does not show that those effects generalize to untargeted illicit drug use outcomes.

Should brief interventions in primary care address alcohol problems more strongly?

BACKGROUND

Brief interventions have well-established small effects on alcohol consumption among hazardous and harmful drinkers in primary care, and national large-scale programmes are being implemented in many countries for public health reasons.

METHODS

This paper examines data from reviews and draws upon older brief intervention studies and recent developments in the literature on motivational interviewing to consider the capacity of brief interventions to benefit those with problems, including those with severe problems.

RESULTS

Effects on alcohol problems have been shown much less consistently, and evidence cannot be claimed to be strong for any outcomes other than reduced consumption. Combinations of advice and motivational interviewing are a promising target for evaluation in trials, and more detailed studies of the conduct of brief interventions are needed.

CONCLUSIONS

We propose that brief interventions in primary care may be more effective if they offer appropriate content in a person-centred manner, addressing patient concerns more directly.

Screening and brief interventions for hazardous and harmful alcohol use among patients with active tuberculosis attending primary public care clinics in South Africa: results from a cluster randomized controlled trial

Background

In 2008 the World Health Organization (WHO) reported that South Africa had the highest tuberculosis (TB) incidence in the world. This high incidence rate is linked to a number of factors, including HIV co-infection and alcohol use disorders. The diagnosis and treatment package for TB and HIV co-infection is relatively well established in South Africa. However, because alcohol use disorders may present more insidiously, making it difficult to diagnose, those patients with active TB and misusing alcohol are not easily cured from TB. With this in mind, the primary purpose of this cluster randomized controlled trial was to provide screening for alcohol misuse and to test the effectiveness of brief interventions in reducing alcohol intake in those patients with active TB found to be misusing alcohol in primary public health care clinics in three districts in South Africa.

Methods

Within each of the three provinces targeted, one district with the highest TB burden was selected. Furthermore, 14 primary health care facilities with the highest TB caseload in each district were selected. In each district, 7 of the 14 (50%) clinics were randomly assigned to a control arm and another 7 of the 14 (50%) clinics assigned to intervention arm. At the clinic level systematic sampling was used to recruit newly diagnosed and retreatment TB patients. Those consenting were screened for alcohol misuse using the Alcohol Use Disorder Identification Test (AUDIT). Patients who screened positive for alcohol misuse over a 6-month period were given either a brief intervention based on the Information-Motivation-Behavioural Skills (IMB) Model or an alcohol use health education leaflet.

Results

Of the 4882 tuberculosis patients screened for alcohol and agreed to participate in the trial, 1196 (24.6%) tested positive for the AUDIT. Among the 853 (71%) patients who also attended the 6-month follow-up session, the frequency of positive screening results at baseline/follow-up were 100/21.2% for the AUDIT (P < 0.001) for the control group and 100/16.8% (P < 0.001) for the intervention group. The intervention effect on the AUDIT score was statistically not significant. The intervention effect was also not significant for hazardous or harmful drinkers and alcohol dependent drinkers (AUDIT: 7–40), alcohol dependent drinkers and heavy episodic drinking, while the control group effect was significant for hazardous drinkers (AUDIT: 7–19) (P = 0.035).

Conclusion

The results suggest that alcohol screening and the provision of a health education leaflet on sensible drinking performed at the beginning of anti-tuberculosis treatment in public primary care settings may be effective in reducing alcohol consumption.

Trial registrations

PACTR201105000297151

Screening and brief interventions for hazardous and harmful alcohol use among university students in South Africa: results from a randomized controlled trial

The aim of this study was to assess the effectiveness of Screening and Brief Intervention (SBI) for alcohol problems among university students in South Africa. The study design for this efficacy study is a randomized controlled trial with 6- and 12-month follow-ups to examine the effects of a brief alcohol intervention to reduce alcohol use by hazardous and harmful drinkers in a university setting. The unit of randomization is the individual university student identified as a hazardous or harmful drinker attending public recruitment venues in a university campus. University students were screened for alcohol problems, and those identified as hazardous or harmful drinkers were randomized into an experimental or control group. The experimental group received one brief counseling session on alcohol risk reduction, while the control group received a health education leaflet. Results indicate that of the 722 screened for alcohol and who agreed to participate in the trial 152 (21.1%) tested positive for the Alcohol Use Disorder Identification Test (AUDIT) (score 8 or more). Among the 147 (96.7%) university students who also attended the 12-month follow-up session, the intervention effect on the AUDIT score was -1.5, which was statistically significant (P = 0.009). Further, the depression scores marginally significantly decreased over time across treatment groups, while other substance use (tobacco and cannabis use), self-rated health status and Posttraumatic Stress Disorder (PTSD) scores did not change over time across treatment groups. The study provides evidence of effective brief intervention by assistant nurses with hazardous and harmful drinkers in a university setting in South Africa. The short duration of the brief intervention makes it a realistic candidate for use in a university setting.

Mentoring adolescents to prevent drug and alcohol use

BACKGROUND

Many adolescents receive mentoring. There is no systematic review if mentoring prevents alcohol and drug use.

OBJECTIVES

Assess effectiveness of mentoring to prevent adolescent alcohol/drug use.

SEARCH METHODS

Cochrane CENTRAL (issue 4), MEDLINE (1950-to July 2011), EMBASE (1980-to July 2011), 5 other electronic and 11 Grey literature electronic databases, 10 websites, reference lists, experts in addictions and mentoring.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of mentoring in adolescents to prevent alcohol/drug use.

DATA COLLECTION AND ANALYSIS

We identified 2,113 abstracts, independently assessed 233 full-text articles, 4 RCTs met inclusion criteria. Two reviewers independently extracted data and assessed risks of bias. We contacted investigators for missing information.

MAIN RESULTS

We identified 4 RCTs (1,194 adolescents). No RCT reported enough detail to assess whether a strong randomisation method was used or allocation was concealed. Blinding was not possible as the intervention was mentoring. Three RCTs provided complete data. No selective reporting.Three RCTs provided evidence about mentoring and preventing alcohol use. We pooled two RCTs (RR for mentoring compared to no intervention = 0.71 (95% CI = 0.57 to 0.90, P value = 0.005). A third RCT found no significant differences.Three RCTs provided evidence about mentoring and preventing drug use, but could not be pooled. One found significantly less use of "illegal" drugs," one did not, and one assessed only marijuana use and found no significant differences.One RCT measured "substance use" without separating alcohol and drugs, and found no difference for mentoring.

AUTHORS' CONCLUSIONS

All four RCTs were in the US, and included "deprived" and mostly minority adolescents. Participants were young (in two studies age 12, and in two others 9-16). All students at baseline were non-users of alcohol and drugs. Two RCTs found mentoring reduced the rate of initiation of alcohol, and one of drug usage. The ability of the interventions to be effective was limited by the low rates of commencing alcohol and drug use during the intervention period in two studies (the use of marijuana in one study increased to 1% in the experimental and to 1.6% in the control group, and in another study drug usage rose to 6% in the experimental and 11% in the control group). However, in a third study there was scope for the intervention to have an effect as alcohol use rose to 19% in the experimental and 27% in the control group. The studies assessed structured programmes and not informal mentors.

A Review of Multiple Health Behavior Change Interventions for Primary Prevention

Most individuals engage in multiple unhealthy lifestyle behaviors with the potential for negative health consequences. Yet most health promotion research has addressed risk factors as categorically separate entities, and little is known about how to effectively promote multiple health behavior change (MHBC). This review summarizes the recent literature (January 2004 to December 2009) on randomized clinical trials evaluating MHBC interventions for primary prevention. Combining all the studies across all the reviews, fewer than 150 studies were identified. This is a fraction of the number of trials conducted on changing individual behavioral risks. Three primary behavioral clusters dominated: (1) the energy balance behaviors of physical activity and diet; (2) addictive behaviors like smoking and other drugs; and (3) disease-related behaviors, specifically cardiovascular disease (CVD) and cancer related. Findings were largely disappointing for studies of diet and physical activity, particularly with youth. Treating 2 addictions, including smoking, resulted in greater long-term sobriety from alcohol and illicit drugs. MHBC intervention effects were stronger and more consistent for cancer prevention than CVD prevention. MHBC interventions offer a new paradigm for broader, more comprehensive health promotion; however, the potential value in maximizing intervention impact is largely unmet.

Substance use patterns among first-year college students: secondary effects of a combined alcohol intervention

This study explored secondary effects of a multisite randomized alcohol prevention trial on tobacco, marijuana, and other illicit drug use among a sample of incoming college students who participated in high school athletics. Students (n = 1,275) completed a series of Web-administered measures at baseline during the summer before starting college and 10 months later. Students were randomized to one of four conditions: a parent-delivered intervention, a brief motivation enhancement intervention (Brief Alcohol Screening and Intervention for College Students [BASICS]), a condition combining the parent intervention and BASICS, and assessment-only control. A series of analyses of variance evaluating drug use outcomes at the 10-month follow-up assessment revealed significant reductions in marijuana use among students who received the combined intervention compared to the BASICS-only and control groups. No other significant differences between treatment conditions were found for tobacco or other illicit drug use. Our findings suggest the potential utility of targeting both alcohol and marijuana use when developing peer- and parent-based interventions for students transitioning to college. Clinical implications and future research directions are considered.

A Review of Multiple Health Behavior Change Interventions for Primary Prevention

Most individuals engage in multiple unhealthy lifestyle behaviors with the potential for negative health consequences. Yet most health promotion research has addressed risk factors as categorically separate entities, and little is known about how to effectively promote multiple health behavior change (MHBC). This review summarizes the recent literature (January 2004 to December 2009) on randomized clinical trials evaluating MHBC interventions for primary prevention. Combining all the studies across all the reviews, fewer than 150 studies were identified. This is a fraction of the number of trials conducted on changing individual behavioral risks. Three primary behavioral clusters dominated: (1) the energy balance behaviors of physical activity and diet; (2) addictive behaviors like smoking and other drugs; and (3) disease-related behaviors, specifically cardiovascular disease (CVD) and cancer related. Findings were largely disappointing for studies of diet and physical activity, particularly with youth. Treating 2 addictions, including smoking, resulted in greater long-term sobriety from alcohol and illicit drugs. MHBC intervention effects were stronger and more consistent for cancer prevention than CVD prevention. MHBC interventions offer a new paradigm for broader, more comprehensive health promotion; however, the potential value in maximizing intervention impact is largely unmet.

Quitting smoking and change in alcohol consumption in the International Tobacco Control (ITC) Four Country Survey

Although frequent heavy drinking has been associated with decreased odds of quitting smoking, the extent to which smoking cessation is associated with decreased alcohol consumption is less clear. The present study examined over a 2-year period whether individuals who quit smoking for at least 6 months, compared to those making a quit attempt but continuing to smoke and to those not making any attempt to quit smoking, showed greater reductions in drinking frequency, average weekly quantity of alcohol consumption, and frequency of heavy drinking. Data were drawn from the International Tobacco Control Four Country Survey, a prospective cohort study of smokers in Australia, Canada, the UK, and the US. A total of 3614 participants provided alcohol data at one study wave and were re-interviewed 2 years later regarding smoking and alcohol use. Consistent with prior studies, individuals who drank heavily (4+/5+ drinks for women and men, respectively) more than once a week had especially low rates of quitting smoking. There was little evidence, however, that those who achieved sustained smoking cessation made greater reductions in drinking compared to those who continued to smoke. These results were consistent across countries and sexes and did not differ significantly by heaviness of smoking. Results indicate that quitting smoking, in and of itself, does not lead to meaningful changes in alcohol use. Therefore, interventions and policies directed towards increasing smoking cessation are unlikely to affect rates of hazardous drinking unless they include specific elements that address alcohol consumption.

An analysis of inner-city students' attitudes towards violence before and after participation in the "Cradle to Grave" programme

BACKGROUND

Cradle to Grave (C2G), a hospital-based violence prevention programme, brings inner-city youth into an urban Level I trauma centre to follow the path of an adolescent gunshot victim from trauma bay to morgue. We hypothesised that C2G alters student attitudes towards gun violence.

METHODS

Eighty-eight adolescents were prospectively enrolled. With parental and student consent, students completed the Attitudes Towards Guns and Violence Questionnaire (AGVQ), a previously validated and reliable social science assessment tool. Two weeks later, the students participated in C2G. The survey was re-administered four weeks after C2G participation. AGVQ results are reported both as a total score and as a breakdown of the four component subscales. Higher AGVQ scores indicate proclivity towards violence. ANOVA compared scores with respect to demographics and type of school (public vs. charter).

RESULTS

C2G altered student's attitudes towards guns and violence. Of 43 public school students, total scores decreased following C2G (p=0.02). The greatest attitudinal change occurred in subscale 1, "Aggressive Response to Shame" (p<0.01). C2G failed to produce significant changes AGVQ scores in the 45 students attending a city charter school. The two groups were found to have baseline differences, with public school students showing higher baseline tendencies towards violence.

CONCLUSIONS

Our hospital-based programme is capable of positively impacting adolescents' attitudes towards guns and violence. This effect is most pronounced in subjects who already display increased tendencies towards violence. These results suggest that hospitals offer a unique opportunity to address the public health crisis posed by inner-city firearm violence.

The role of marijuana use in brief motivational intervention with young adult drinkers treated in an emergency department

OBJECTIVE

The aim of this research was to study marijuana use, associated risks, and response to brief motivational intervention among young adult drinkers treated in an emergency department.

METHOD

Study participants (N = 215; ages 18-24) were in a randomized controlled trial for alcohol use that compared motivational interviewing with personalized feedback (MI) with personalized feedback only. Past-month marijuana users were compared with nonusers on demographics, readiness, self-efficacy, and behavioral risk variables. Marijuana use was examined as a potential moderator of alcohol outcomes. Whether marijuana use alone or combined marijuana and alcohol use would be reduced as a result of brief intervention for alcohol was examined at 6 and 12 months.

RESULTS

Current marijuana users were younger, were more likely to be white, and reported more alcohol use, other illicit drug use, and more alcohol-related consequences than nonmarijuana users. Marijuana use at baseline did not moderate response to brief alcohol treatment. Marijuana use declined from baseline to 6 months for both treatment groups, but only MI participants continued to reduce their use of marijuana from 6- to 12-month follow-up. Reductions in number of days of use of marijuana with alcohol appeared to be primarily a function of decreased alcohol use.

CONCLUSIONS

Young adult drinkers reporting current marijuana use are at generally higher risk but responded to brief alcohol treatment by reducing alcohol and marijuana use.

Change over time in alcohol consumption in control groups in brief intervention studies: systematic review and meta-regression study

Reactivity to assessment has attracted recent attention in the brief alcohol intervention literature. This systematic review sought to examine the nature of change in alcohol consumption over time in control groups in brief intervention studies. Primary studies were identified from existing reviews published in English language, peer-reviewed journals between 1995 and 2005. Change in alcohol consumption and selected study-level characteristics for each primary study were extracted. Consumption change data were pooled in random effects models and meta-regression was used to explore predictors of change. Eleven review papers reported the results of 44 individual studies. Twenty-six of these studies provided data suitable for quantitative study. Extreme heterogeneity was identified and the extent of observed reduction in consumption over time was greater in studies undertaken in Anglophone countries, with single gender study participants, and without special targeting by age. Heterogeneity was reduced but was still substantial in a sub-set of 15 general population studies undertaken in English language countries. The actual content of the control group procedure itself was not predictive of reduction in drinking, nor were a range of other candidate variables including setting, the exclusion of dependent drinkers, the collection of a biological sample at follow-up, and duration of study. Further investigations may yield novel insights into the nature of behaviour change with potential to inform brief interventions design.