Dr Emma Davies

Objectives: As part of a wider study describing the impact of a breast cancer diagnosis on lifestyle behaviours, this paper describes the impact of a breast cancer diagnosis on alcohol consumption and factors influencing consumption.

Methods: Cross-sectional online survey of 140 people (138 women) and interviews with 21 women diagnosed with breast cancer in the last 10 years.

Results: Of the 100 survey participants who drank alcohol 25% were drinking at increasing or higher risk levels and 17% strongly wanted to change their drinking behaviour. The habitual aspects of alcohol consumption were the strongest predictor of current alcohol consumption behaviours. Social norms and perceptions about conflicting information were substantial barriers to change.

Conclusions: Breast cancer survivors need accurate information about the risks of alcohol consumption and guidelines in order to make informed decisions about making changes to their behaviour. Interventions to support breast cancer survivors to reduce alcohol consumption need to focus on the development of healthy habits and may benefit from a focus which includes partners and friends.

Introduction: This study explores how individuals self-treat psychiatric conditions with psychedelics outside medical guidance, bridging the gap in understanding unregulated therapeutic use.

Aims: The primary objective was to extract specific factors underlying the effects of psychedelics, exploring their relationship with the need for medication, particularly for mental health conditions like depression and anxiety. Additionally, we aimed to understand how the likelihood of being prescribed pharmacological medication varies based on mental health diagnoses and demographic factors.

Methods: This research utilised the Global Drug Survey 2020, an annual online survey focused on substance use patterns and demographics, incorporating modules addressing mental health and psychedelic use. The study employed Exploratory Factor Analysis to discern latent factors underlying self-reported effects of psychedelics. Bivariable and multivariable logistic regressions were conducted to investigate the association between identified factors and the likelihood of current prescribed medication usage.

Results: 2,552 respondents reported using psychedelics for self-treatment of mental health conditions. Three significant factors were identified: Improved Mental Health, Improved Self-Awareness, and Neuro-Sensory Changes. The majority of the sample reported a history of depression (80%) or anxiety (65.6%), with a significant association observed between reported factors of psychedelics' effects and current medication usage for mental health, especially notable in cases of depression or comorbid depression and anxiety.

Conclusions: Perceived symptom improvement following psychedelic self-treatment may reduce the need for medically supervised pharmacological interventions. These findings highlight the potential of psychedelics to positively influence mental health and self-awareness, paving the way for further research into their therapeutic application.

Background: Production and use of no- and low-alcohol (NoLo) beverages has increased globally in recent years. Using data from a large international sample of people who drink alcohol, this study aimed to investigate patterns of NoLo drink consumption.

Methods: The study utilised data from the 2022 Global Drug Survey (GDS). We used cross-tabulation and multiple correspondence analysis to understand usage patterns and identify key groupings.

Results: Of the 15,686 participants reporting NoLo use, most (59%) reported drinking NoLo products less than monthly. Frequent NoLo consumption was more prevalent in relaxed environments (92%) compared to team environments (27%) and party settings (49%), with a significant relationship between heavy alcohol drinking prevalence and increased likelihood of engaging in NoLo alcohol consumption.

Conclusions: We uncovered nuanced preferences for NoLo drinks driven by cultural, consumption, and economic factors. Heavy alcohol drinking and an increased likelihood of NoLo consumption is suggestive of a growing acceptance of NoLo beverages as substitutes for alcoholic beverages perhaps, for example, as a response to avoiding experiences of embarrassment due to drunkenness in particular social settings. This suggests a need for further research into public health policies promoting NoLo options to mitigate alcohol-related problems.

Background: The recreational use of LSD, a synthetic psychedelic drug, has surged in recent years, coinciding with a renewed research focus on its potential psychotherapeutic properties.

Aim: This study aims to describe the experiences and perceptions of individuals engaging in LSD use for the first time, derived from a large international sample.

Methods:  This study utilised 2018 Global Drug Survey data, collected from November 6, 2017, to January 10, 2018. Participants who initiated LSD use in the preceding 12 months answered questions on their experiences, social settings, harm-reduction behaviours, and demographics. Descriptive statistics were employed, and characteristics of those seeking emergency medical treatment (EMT) and those not planning further LSD use were compared with other respondents.

Results: Among 3,340 respondents who used LSD in the past year, their first-time experiences generally exceeded expectations, with 97.7% expressing excitement. Adverse and unwanted side effects were rarely reported and only 17 individuals needed EMT. Feelings of fear were reported by most (64.1%), but only very mildly and not enough to put them off from wanting to use LSD again.

Discussion: Although the occurrence of unwanted side effects seems low and the LSD experience is generally pleasurable, vigilance amid the rising illicit use of LSD through harm reduction education is still important in preventing possible risks.

This study explored experiences of spiking following the re-opening of nightlife settings post COVID-19 lockdown. Global Drug Survey 2022, respondents were asked about experience, context, and consequences of drink/needle spiking. In a sample of 7,697 respondents 2% reported experiencing spiking the last 12 months, and 20% over a year ago. Most occurred in clubs/bars (54.8%), but a quarter occurred in a private home.  84.9% of respondents suspected a drug was added to their drink; 4.2% thought they had been injected with a drug. Almost a fifth experienced sexual assault during the incident.  Only 7.2% who experienced drink spiking reported it to police. Higher AUDIT scores, being a woman, recent illicit substance use and recent clubbing experience were also associated with recent spiking.  Low rates of reporting means it is difficult to understand prevalence and causes. However, media reports of an epidemic of spiking appear to have been disproportionately emphasised.

Objectives: Risky drinking is a concern among UK-based middle-aged adults.

We aimed to explore the relationship between risky drinking, drinking motives, wellbeing, and mental health literacy (MHL).

Method: Cross-sectional analysis of online survey data completed by 193 UK-based adults aged 40-65 who drank alcohol, incorporating the Alcohol Use Disorders Identification Test (AUDIT); Drinking Motives Questionnaire-Revised (DMQ-R); Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS); Mental Health Literacy Scale (MHLS) and demographic questions.

Results:  Coping, enhancement and conformity motives and gender significantly predicted higher AUDIT scores (measuring risky drinking). Enhancement motives were found to mediate the relationship between the self-help component of MHL and AUDIT scores, while coping motives mediated the association between wellbeing and AUDIT scores.

Conclusion: Findings support research emphasising the influence of drinking motives on risky drinking and highlights how low wellbeing may interact with coping motives to explain risky drinking among middle-aged adults, particularly men. Interventions supporting individuals to understand the relationship between drinking motives and risky drinking, develop adaptive coping strategies, and address the causes of low wellbeing, may be beneficial. However, as the sample was 84% ethnically White, 64% women, 85% educated to at least undergraduate level, and reported a relatively high mean socioeconomic status (6.98 out of 10), the results may not generalise beyond these groups. Future research should use stratified sampling to increase generalisability, as well as exploring whether alcohol-specific, component-specific, or disorder-specific MHL is associated with risky drinking and wellbeing.

Background: Despite various interventions available for substance use disorders, relapse rates remain substantial and, therefore, alternative strategies for attenuating dependence are sorely needed. This study examined the associations between exercise frequency, illicit substance use, and dependence severity among a large sample of people who use drugs. Methods: The study utilised data from the Global Drug Survey 2018 (N = 57,112) to investigate the relationship between exercise frequency, illicit substance use, and substance dependence severity. Binomial regressions were employed to examine the relationship between exercise and SDS scores for 9 drugs. Results: Greater exercise frequency correlated with reduced severity of substance dependence for specific drugs: cannabis (χ2 = 14.75, p p = .029), cocaine (χ2 = 8.37, p = .015), amphetamine powder (χ2 = 6.39, p = .041), and methamphetamine (χ2 = 15.17, p Conclusions: These findings suggest a potential link between exercise and reduced substance use dependency. Further research is needed to understand the complex dynamics between exercise and substance use, considering potential bidirectional relationships and concurrent factors.

Introduction: Excessive alcohol consumption is often followed by feelings of regret. This study aimed to explore country differences in experiences of drunkenness and regrets and predictors of experiencing a greater number of regrettable drinking occasions.

Methods: This study draws on a sample of 82,821 respondents from 31 countries who completed the 2020 Global Drug Survey. Respondents were asked to report how many times in the last year they had been drunk, how many of those times they felt regret afterwards and to complete a range of sociodemographic measures.

Results: In the last 12 months, the median times drunk was 6 and the median number of regretted occasions was 2. There was an inverse relationship between times drunk and regret. Respondents who got drunk more often regretted it a smaller percentage of the time than those who got drunk less often. Respondents from Argentina and Colombia regretted being drunk the most and Denmark the least. Being younger, in higher AUDIT categories were associated with more times drunk. Being a woman, having mental health conditions were associated with more regretted occasions.

Discussion and Conclusions: Country variations may reflect relative acceptability of being drunk. Those who drink more, per occasion, may become accustomed to the consequences and feel fewer regrets. Interventions promoting reduced alcohol consumption may benefit from encouraging people to consider their future regret following a drinking occasion but should account for lower levels of regret in those who get drunk more often.

Introduction: Transgender (trans) and non-binary people experience disproportionate harm from alcohol use, have a greater likelihood of developing dependence, and experience exclusion from both clinical and peer-based support systems. This study aimed to understand experiences with and preferences for alcohol reduction support among UK-based transgender and non-binary people.

Methods: The study team and community stakeholders co-produced a cross-sectional survey and administered it to a purposive sample of trans and non-binary people from 1st February to 31st March 2022. The study recruited participants through social media, mailing lists, blog posts, and news articles. Participants (n=565) had a lifetime history of alcohol use, were in one of five gender categories, and were classified as people who drink or formerly drank alcohol. Open- and closed-ended questions measured motivations for alcohol reduction and views surrounding various support modalities. 

Results: More than 15% of the sample no longer drink alcohol and reported long-term abstinence, achieved without support, and were motivated by a loss of control over drinking behaviour and a desire to improve both physical and mental health. Mental illness, gender dysphoria, and a culture of alcohol excess were common antecedents of alcohol use. Thirty percent of participants who drink alcohol wanted to reduce their consumption. They suggested that this could be achieved with self-help tools, specialist trans and non-binary or LGBT+ services, access to both gender-affirming medical services, and sober queer social spaces.

Conclusions: UK-based trans and non-binary people face unique gender minority-related stressors which contribute to patterns of alcohol use that are perceived to be out of control and harmful to health. While many wanted access to self-help tools, there was interest in the availability of specialist alcohol reduction services and more inclusive general services. Conducting needs assessments to inform Needs assessments should inform the development of such services and trans-affirmative training should be mandated for all who provide support with alcohol reduction.

Purpose

Using data from 36,981 respondents to the Global Drug Survey COVID-19 Special Edition (GDS) this study aimed to compare changes, following the first ‘lockdown’, in alcohol consumption between LGB+ and heterosexual respondents with and without lifetime mental health and neurodevelopmental (MHND) conditions.

Design/method/approach

Characteristics and drinking behavior of respondents to GDS who disclosed their sexual orientation, and past 30-day alcohol use were described and compared. LGB+ participants with and without MHND conditions were compared and logistic regression models identified correlates of increased drinking among LGB+ people. The impact of changed drinking on the lives of LGB+ participants with and without MHND conditions was assessed.

Findings

LGB+ participants who reported they were “not coping well at all” with the pandemic had 2-fold greater odds of reporting increased binge drinking. LGB+ participants with MHND conditions were significantly more likely than those without to report increased drinking frequency (18.7% vs 12.4%), quantity (13.8% vs 8.8%) and that changed drinking had impacted their lives.

Originality

This study, which has a uniquely large and international sample, explores aspects of alcohol use not considered in other COVID-19 alcohol use research with LGB+ people and is the first to explore alcohol use among LGB+ people with MHND conditions. 

There has been an increase in the number of UK university students disclosing mental health conditions in recent years. This paper describes the evaluation of the Mind Tutor app, an artificial intelligence based wellbeing app specifically designed for first year undergraduate students, which included a chatbot function that guided students to relevant wellbeing content. The content of the app was developed based on data about mental health and wellbeing issues reported by students and focussed on anxiety, low mood, academic study, transition to university and relationships. Two randomised controlled evaluation studies were conducted with N = 177 and N = 240 first year undergraduate students from two UK universities (the second due to delays in development work and difficulties with recruitment in the first trial). The Mind Tutor had no significant impact on student wellbeing. The study suffered from poor recruitment and retention rates. However, further research is warranted to understand factors that may increase engagement and acceptability of app based tools to increase student wellbeing.

Background Trans and non-binary people may be at increased risk of alcohol harms, but little is known about motives for drinking in this community.

Aims This study explored the relationship between risk of alcohol dependence, experience of alcohol harms, drinking motives, dysphoria and discrimination within a United Kingdom sample of trans and non-binary people with a lifetime history of alcohol use.

Methods A cross-sectional survey was co-produced with community stakeholders and administered to a purposive sample of trans and non-binary people from 1st February until 31st March 2022. A total of 462 respondents were included - 159 identified as non-binary and/or genderqueer (identities outside the man/woman binary), 135 solely as women, 63 solely as men, 15 as another gender identity, 90 selected multiple identities.

Results Higher levels of reported discrimination were associated with higher risk of dependence and more reported harms from drinking. Coping motives, enhancement motives, and drinking to manage dysphoria were associated with higher AUDIT scores. Social, coping, and enhancement motives alongside discrimination and drinking to have sex were associated with harms. The relationship between discrimination and risk of dependence was mediated by coping motives and drinking to manage dysphoria.

Conclusions: Further to these associations, we suggest that reducing discrimination against trans and non-binary communities might reduce  alcohol harms in this population. Interventions should target enhancement motives, coping motives and gender dysphoria. Social and enhancement functions of alcohol could be replaced by alcohol free supportive social spaces. 

Objectives: This study explored how ‘dark nudges’ (tactics used in alcohol industry funded responsible drinking campaigns) affect drinking intentions, perceived source credibility and whether individual differences in perceptions of prototypical drinkers moderated these effects.

Design: Two 2x2 between-groups online experimental studies.

Methods: Study 1 (N = 164) presented three alcohol health messages per condition, comprising social norm (healthy/unhealthy (“dark nudge”)) by frame (loss/gain). Study 2 (N = 229) presented one message per condition, comprising cancer causality (single cause/multiple causes (dark nudge)) by funding disclosure (disclosure/non-disclosure (dark nudge)). Outcomes were drinking intentions and perceived source credibility. Exploratory analyses considered prototype perceptions as a between-subjects moderator.

Results:  No significant effects of message frame, social norm or multiple cancer causality arguments on drinking intentions were found. In Study 2, in the dark nudge multiple cancer causality conditions, perceived source credibility was high when funding was undisclosed, but significantly lower when it was disclosed. Exploratory analyses suggested effects were moderated by prototype similarity- in Study 1, higher perceived similarity to a heavy drinker, and lower perceived similarity to a responsible drinker, were associated with higher drinking intentions in the unhealthy norm/gain frame condition, but lower drinking intentions in the other conditions.

Conclusions: Framing, social norm and multiple causality manipulations as tested in this study did not exert a dark nudge effect on drinking intentions. However, the exploratory analyses suggest it could be hypothesised that the types of messages used in alcohol industry-funded responsible drinking campaigns may result in greater drinking intentions among those who identify more as heavy drinkers and less as responsible drinkers. Perceived prototype similarity may be an important moderator of the impact of alcohol health messages that warrants further research. Study 2 suggests disclosure of industry funding guides judgements of the credibility of sources of misleading messages about alcohol and cancer.

Alcohol is a causal factor in about 10% of breast cancer (BCa) cases, but awareness of this link is low. This study explored how to raise awareness and inform the development of an intervention using the COM-B model (capability, opportunity, motivation, behavior) framework. Eight online focus groups were conducted with 36 participants (6 expert stakeholders, and 30 women aged 40-65). Participants reflected on a package of information about alcohol and BCa and discussed how to impart this information and encourage women to reduce drinking.  Thematic analysis of focus group transcripts was undertaken. Three themes were identified: understanding ineffective messaging; transitions and challenges; and message acceptability. Current health information about alcohol was perceived as judgmental and BCa was put down to chance. Mid-life consisted of many challenges that could lead to increased consumption, but menopause transition may be a key moment for alcohol reduction.  Barriers and enablers to communicating risk information and encouraging alcohol reduction were mapped onto the COM-B model. Psychological capability (relating to knowledge), social opportunity (in the form of social pressure) and automatic motivation (relating to drinking to cope) were barriers to behavior change.  These will be targeted in an alcohol reduction intervention. It is important to tailor information to women’s experiences, taking into account the social benefits of drinking, and encourage the development of healthy coping strategies. Acceptable intervention messages may include personal stories, clear statistics, and suggest healthy alternatives to drinking. It is vital that messaging does not appear judgmental or patronizing. 

Background: The COVID-19 pandemic is hypothesized to have impacted cannabis access and usage worldwide. This study describes changes in cannabis use and related impacts following COVID-19-related restrictions among an international sample of people who use drugs.

Methods: Using data from the Global Drug Survey COVID-19 Special Edition, we identified 20,417 respondents from 13 countries who reported whether the number of THC-containing cannabis usage days changed compared to before COVID-19 restrictions. Using a multinomial multivariable logistic regression we investigated the impact of changes in cannabis use on respondents’ mental health, physical health, relationships, finances, work/study performance, and cannabis-related pleasure/enjoyment.

Results: Similar proportions of respondents reported that their cannabis use had stayed the same (38.2%) or increased (38.3%) compared to February 2020, while 21.9% of respondents reported a decrease. The most common reason for increased use was having more time (68.4%), while decreased use was associated with having less contact with people they use cannabis with (58.4%). The likelihood of reporting worse mental and physical health, finances, and work/study performance was highest among those who reported increased cannabis use.

Conclusions: These findings highlight the need for policy to address the improved provision of mental health and other support for people who frequently use cannabis.

Introduction: Initial COVID-19 restrictions forced changes in the contexts (e.g., with who and where) within which individuals consumed alcohol. We aimed to explore different profiles of drinking contexts during initial COVID-19 restrictions and their association with alcohol consumption.

Method: We used latent class analysis (LCA) to explore subgroups of drinking contexts among 4,891 respondents of the Global Drug Survey from the United Kingdom, New Zealand and Australia who reported drinking alcohol in the month prior to data collection (3 May- 21 June 2020). Ten binary LCA indicator variables were generated from a survey question about last month alcohol settings. Negative binomial regression was used to explore the association between the latent classes and respondents’ total number of drinks consumed in the last 30 days (i.e., alcohol consumption).

Results: The LCA found six distinct classes of individuals who reported drinking in the following contexts: Household (36.0%); Alone (32.3%); Alone & household (17.9%); Gatherings & household (9.5%); Party (3.2%), and Everywhere (1.1%), with the last group associated with the highest probability of increased alcohol consumption during this time. Male respondents and those aged 35 or older were most likely to report increased alcohol consumption.

Discussion and Conclusions: Our findings suggest that drinking contexts, sex, and age influenced alcohol consumption during the early stages of the COVID-19 pandemic. These findings highlight a need for improved policy targeting risky drinking in home settings. Further research should explore whether COVID-19-induced shifts in alcohol use persist as restrictions are lifted.

Objectives: This study aimed to explore a) how people interpret responsible drinking messages on alcohol product labels, and b) the acceptability of including health information on labels.

Design: Qualitative interviews

Methods: Face to face semi-structured interviews were conducted with 20 people aged 21 - 63; 18 were classified risky drinkers using AUDIT-C. They were shown three sets of alcohol product labels: one including three responsible drinking messages (drink responsibly), one with three positively worded health messages (drinking less reduces risks), and one with three negatively worded health messages (drinking more increases risks). Health messages included information about cancer, liver and heart disease).

Results: Thematic analysis identified three themes: ambiguity about alcohol labelling; identifying oneself as responsible; and acceptability of enhanced product labelling. Participants were critical of responsible drinking messages and wary of conflicting health information in the media. They positioned themselves as responsible, knowledgeable drinkers and distanced themselves from problem drinkers. They did not appear to support the inclusion of health information on labels, however novel information was considered more impactful. 

Conclusions: Responsible drinking messages were seen by our sample as an alcohol industry ploy. Although health messages about cancer were seen as potentially impactful, the ability of consumers to position themselves as unproblematic drinkers means that they may not see the information on the label as relevant to themselves. Understanding factors that increase the personal relevance of messages is needed, alongside an exploration of a wider range of methods for alcohol health communication.

Background: Current alcohol product labelling tends to include ambiguous messages such as ‘drink responsibly’. Consumers who identify as responsible drinkers may not pay heed to health warning messages, believing that they are not the intended target.

Aims: We aimed to determine how responses to responsible drinking labels would differ from responses to positively and negatively framed health messages. We also explored if prototype perceptions would moderate the message impact.

Methods: A between groups, three arm (ambiguous, positive or negative messages) experiment recruited 465 participants.  Outcomes were drinking intentions and label acceptability (novelty, believability, personal relevance, and potential to change behaviour). Measures of heavy and responsible drinker prototype perceptions were included for exploratory moderation analyses.

Results: Positive and negative messages were rated significantly more likely to change behaviour than ambiguous messages.  There was also a moderation effect: participants with stronger favourability and similarity to the responsible drinker prototype intended to drink more alcohol in the future after exposure to negatively framed labels, but not after exposure to ambiguous or positively framed labels.

Discussion: ‘Drink responsibly’ messages are unlikely to lead to behaviour change. Incorporating theoretical moderators may have value in developing our understanding of the impact of alcohol product labelling. 

​​​​​​​Purpose

The purpose of this study was to compare five gender groups (cisgender women, cisgender men, transgender women, transgender men, people with non-binary/other identities) on measures of use of and dependence on seven substances.

Methods

A two-stage approach to assessing gender allowed 126,648 participants from the 2018 Global Drug Survey to be classified to one of these five gender groups. Participants were asked to disclose use of each substance in the preceding 12 months. The Alcohol Use Disorder Identification Test and the Severity of Dependence Scale were used to assess dependence. Multivariable logistic regression generated odds ratios to measure the association between gender and each substance use/dependence outcome, with cisgender women as the reference group.

Results

The sample comprised 43,331 cisgender women, 81,607 cisgender men, 215 transgender women, 254 transgender men, and 1,241 people with non-binary/other identities. Relative to cisgender women, non-binary/other participants reported greater odds of last 12-month use of all substances (adjusted odds ratio (AOR)=1.66-2.93), except alcohol (lower odds; AOR=0.42), and greater odds of dependence on cannabis (AOR=2.39), 3,4-methylenedioxymethamphetamine (MDMA; AOR=1.64) and alcohol (AOR=3.28), adjusting only for age (all p

Conclusion

Transgender 2018 Global Drug Survey respondents, particularly those with non-binary/other identities, had greater odds of reporting most substance use outcomes than cisgender women. These findings suggest a nuanced approach to gender reporting in surveys and treatment centres is required to understand the needs of transgender people who use substances.  

Individuals abstaining from alcohol consumption frequently find themselves in contexts encouraging consumption, with limited alternative social interaction opportunities. Conscious clubbing events exclude alcohol and drugs, possibly providing valuable social connections, but little is known about event benefits. 12 conscious clubbing event attendees and facilitators aged 25-55 from across Europe participated in semi-structured photo-elicitation interviews, which were analysed using thematic analysis. Findings suggested that conscious clubbing appears to enhance health, healing and growth, aiding recovery from substance dependency and trauma. Positioned as a modern ritual, symbolic and ritualistic preparations and experiences promoted storytelling and self-discovery. Connecting through synchronised but unchoreographed movement, participants engaged in powerful journeys and transformative experiences detached from life constraints. Inclusive digital and face-to-face conscious clubbing communities provided a sense of meaning and belonging away from substance use pressures and harms, particularly for those marginalised within society. Findings provide important and in-depth insights, including novel harm prevention implications. Future work should consider participatory barriers, event sustainability and misconceptions to increase event availability and participation.

Aims: The aim of this paper was to explore responses to alcohol health information labels from a cross sectional survey of people who drink alcohol from 29 countries.

Design: This paper draws on findings from the Global Drug Survey (GDS) – an annual cross sectional online survey.

Participants: 75,969 (64.3% male) respondents from 29 countries were included in the study.

Measures: Respondents were shown seven health information labels (topics were heart disease, liver, cancer, calories, violence, taking two days off and myth of benefits of moderate drinking). They were asked if the information was new, believable, personally relevant, and if it would change their drinking. A multivariate multilevel Bayesian logistic regression model was used to estimate predicted probabilities for newness, believability, relevance and if messages would change drinking behaviour by country and information label.

Findings: Predicted probabilities showed substantial variability in responses across countries. Respondents from Colombia, Brazil and Mexico were more likely to consider drinking less as well as have lower levels of previous awareness. Those from Denmark and Switzerland were not as likely to say the labels would make them consider drinking less.  The cancer message was consistently the newest and most likely to make people consider drinking less across countries.

Conclusions: Country differences in responses to messages can be used to create targeted harm reduction measures as well as inform what should be on labels.  The provision of such health information on alcohol product labels may play a role in raising awareness of the risk of drinking.

Introduction: The effect of socioeconomic status on adolescent substance abuse may be mediated by family socialization practices. However, traditional mediation analysis using a product or difference method is susceptible to bias when assumptions are not addressed. We aimed to use a potential outcomes framework to assess assumptions of exposure‐mediator interaction and of no confounding of the results.

Method: We revisited a traditional mediation analysis with a multiple mediator causal mediation approach using data from 17,761 Norwegian young people (13–18 years), 51% female. Data were collected through a print questionnaire. Socioeconomic status was operationalized as parental education and employment status (employed or receiving welfare); drinking behavior as the frequency of alcohol consumption and frequency of intoxication in the past year; and socialization practices as general parenting measures, alcohol‐related parental permissiveness, and parent drinking behavior.

Results: There was no consistent evidence of exposure‐mediator interaction. Formal sensitivity analysis of mediator‐outcome confounding was not possible in the multiple mediator model, and this analysis supported the hypothesis that socioeconomic status effects on adolescent substance abuse are fully mediated by family socialization practices, with apparently stronger effects in younger age groups observed in plots.

Conclusion: We found that the effect of socioeconomic status on adolescent substance abuse was fully mediated by family socialization practices. While our analysis provides more rigorous support for causal inferences than past work, we could not completely rule out the possibility of unmeasured confounding.

Objectives. Physical activity declines during adolescence. The Theory of Planned Behaviour is a useful framework for investigating activity, but leaves variance unexplained. We explored the utility of a dual-process approach by using the Theory of Planned Behaviour and the Prototype Willingness Model to investigate correlates of physical activity, and of one-year change in physical activity, among a large sample of adolescents.

Design. A cross-sectional and longitudinal analysis of baseline and follow-up data from the Fit to Study cluster-randomised trial. 

Methods. 9,699 secondary school pupils at baseline and 4,632 at follow-up (mean age=12.5 years) completed measures of past week physical activity and constructs from the two behaviour-change models, at time-points one year apart. Cross-sectional analyses used multilevel, stepwise models to measure strength of associations between model constructs and physical activity, and variance in behaviour explained by Prototype Willingness Model over and above Theory of Planned Behaviour. In longitudinal analyses, change scores were calculated by subtracting follow-up from baseline scores. Models controlling for trial treatment status measured strength of associations between change scores, and variance explained.

Results. At baseline, after controlling for past behaviour, physically-active prototype similarity had the strongest relationship with activity after intention to be active.  Change in prototype similarity had the strongest relationship with change in activity after change in intention and attitudes. Prototype perceptions and willingness explained additional variance in behaviour.

Conclusion. A dual-process model incorporating prototype perceptions could more usefully predict  physical activity than models based on rational expectations alone.  Behaviour-change interventions promoting an active self-image could be tested for effects on physical activity.

Key words: Theory of Planned Behaviour, Prototype Willingness Model, physical activity, adolescent, behaviour-change

Background. Digital technologies continue to facilitate drug trading. Televend was an innovative combination of multiple digital technologies, with its backend hosted on the darknet, while purchases were made through the messaging app Telegram. Here, we provide an initial characterisation of this nascent market. Methods. Televend and White House Market (WHM) were scraped (Jun–Jul 2021) and a global cross-sectional web survey of 15,513 drug buyers (Global Drug Survey; GDS) was conducted (Dec 2020–Mar 2021). Results. Televend was 10% of the size of WHM, the largest drug cryptomarket (4,515/44,830 listings per week). Both markets predominantly contained drug-related listings covering similar drug categories, with similar country of origin and destination. Very few GDS drug buyers reported use of Televend (0.73%). Most Televend buyers (68/114) reported buying cannabis, then cocaine (20), MDMA (17), and LSD (12). The Televend and darknet groups had similar demographic and drug use characteristics; whereas compared with app purchasers, older age increased the odds of Televend use (aRRR=1.06, p

Background
Intimate partner violence and abuse (IPVA) includes controlling behaviours, psychological, physical, sexual and financial abuse. Globally, surveys and emergency services have recorded an increase in IPVA since restrictions were imposed to limit COVID-19 transmission. Most studies have only included heterosexual women.

Methods
Data from the Global Drug Survey (an annual, anonymous, online survey collecting data on drug use) Special Edition were analysed to explore the impact of COVID-19 on people’s lives, including their intimate relationships. Five relationship groupings were created using respondents’ lived gender identity: women partnered with men (46.9%), women partnered with women (2.1%), men partnered with men (2.9%), men partnered with women (47.2%), and partnerships where one or both partners were non-binary (1%). Self-reported experience and perpetration of IPVA in the past 30 days before (February) and during COVID-19 restrictions (May or June) in 2020 (N=35,854) was described and compared for different relationship groupings using Fishers Exact Tests. Changes in IPVA during restrictions were assessed using multivariable logistic regression.

Results
​​​​​​​During restrictions, 17.8% and 16.6% of respondents had experienced or perpetrated IPVA respectively; 38.2% of survivors and 37.6% of perpetrators reported this had increased during restrictions. Greater proportions of non-binary respondents or respondents with a non-binary partner reported experiencing or perpetrating IPVA (p

Conclusions
This study confirmed that IPVA can occur in all intimate relationships, regardless of gender of the perpetrator or survivor. Non-binary respondents or respondents with non-binary partners reported the highest use and experience of IPVA. Most IPVA victim support services have been designed for heterosexual, cisgender women. IPVA support services and perpetrator programmes must be tailored to support all perpetrators and survivors during the pandemic and beyond, regardless of their sexual or gender identity.

This study applied the Behaviour Change Wheel (BCW) to understand barriers and facilitators to bystander behaviours in UK students.  The BCW includes detailed examination of the capabilities, opportunities and motivations involved in behaviours. Two surveys (n=515; n=201) and a focus group study (n = 12) were undertaken.  Capability to intervene may be influenced by confidence and beliefs about physical ability and safety. Students appeared to have the physical opportunity to intervene, but social opportunity might be influenced by cultural norms. Motivations might be influenced by beliefs as well as inherent stereotypes about perpetrators and victims.  Behaviour change techniques (BCTs) such as instruction on how to perform the behaviour, reattribution and creating a valued self-identity should be applied to overcome these barriers. A logic model to theorise the change processes underlying bystander behaviours in this population offers a new perspective on what needs to be addressed in interventions.

Background: The initial period of COVID-19-related restrictions affected substance use in some population groups. We explored how changes in alcohol use at the beginning of the pandemic impacted the health and well-being of people with and without mental health and neurodevelopmental conditions (MHDCs).

Methods: Data came from the Global Drug Survey Special Edition on COVID-19 conducted in May-June 2020. Measured were; changes in drinking compared to February 2020 (pre-COVID-19 restrictions), reasons for changes, and impact on physical health, mental health, relationships, finances, work/study, and enjoyment. This study included 38,141 respondents (median age = 32 IQR 25-45; 51.9% cis man; 47.8% cis woman; 1.2% trans/non-binary; 30.2% with MHDCs e.g. depression 20.0%, anxiety 16.3%, ADHD 3.8%, PTSD 3.3%).

Results: A third (35.3%) of respondents with MHDCs and 17.8% without MHDCs indicated that increased drinking affected their mental health negatively (p

Conclusion: Among people with MHDCS, reduced alcohol consumption was associated with better mental health, while the negative effects of increased drinking were more pronounced when compared to people without MHDCS. When supporting people in reducing alcohol consumption during uncertain times, people with MHDCS may need additional support, alongside those experiencing greater levels of distress.

Despite the health benefits of physical activity (PA), participation rates Black, Asian and minority ethnic (BAME) adults in the United Kingdom (UK) are low in comparison to the general population. This study aimed to explore the social-ecological factors related to PA participation among BAME immigrants.

Methods: Semi-structured interviews were carried out with 12 purposively selected adults from the BAME populace residing in one postcode district of a city in southern England.

Results:  The two main themes that developed from this study demonstrated that the barriers to PA participation among BAME were perceived to exist at intrapersonal and environmental (social and physical) levels. 

Originality: Prominent barriers included intrapersonal factors such as deportation fear and cultural beliefs; and environmental factors such as the cost of accessing PA facilities. Length of residency appeared to be related to increased PA.

Research implications: Understanding these unique social-ecological factors may assist in intervention development.

Background:  This paper aimed to explore the differences in subjective experiences of intoxication depending on drinking location and drink type.

Methods: Data came from 32,194 respondents to The Global Drug Survey (GDS) 2015, an annual, cross-sectional, online survey. Respondents selected their usual drinking location (home alone: home with partner/family: house parties: pubs/bars or clubs) and usual drink (wine; beer/cider/lager; spirits or alcopops/coolers). They indicated how many drinks they required to reach three stages of intoxication (feeling the effects; an ideal stage of intoxication; and the tipping point) and how frequently they reached each stage.

Results: Drink type affected grams of alcohol reported to reach the tipping point: 109gm wine, 127gm alcopops, 133gm of beer, and 134gm of spirts. Respondents who drank at home alone, or in clubs reached their tipping point more frequently compared to other locations.

Conclusions: Where people drink, and the type of alcohol they drink, affected the amount of alcohol reported to reach different stages of intoxication. Understanding why different drinking locations, and drink types lead to a need for greater consumption to reach an ideal state of drunkenness, such as social cues from other people who drink, may enable people to reduce their drinking.

A small body of literature suggests that transgender people are more frequently exposed to sexual violence while they are under the influence of alcohol than cisgender counterparts. The goal of this study was to report any differences between transgender (n=1,136) and cisgender (n=74,277) respondents to the Global Drug Survey on their experiences of being taken advantage of sexually while under the influence of alcohol and/or other drugs. We found that transgender people were more likely than cisgender people to have experienced being taken advantage of in the last year (9.3% vs 4.2%) and more than 12 months preceding the survey (24.9% vs 14.3%). Non-binary participants were more likely than binary transgender participants (27.7% vs 17.8%) to report being taken advantage of sexually more than a year preceding the survey. Similarly, trans respondents assigned female at birth were more likely than trans respondents assigned male at birth to report this (30.0% vs 19.7%). Non-specialist services for survivors of sexual violence should be adequately prepared for and accommodating towards transgender clients. Future research should explore their unique needs. Moreover, clinicians who assess transgender people should remain mindful of their increased likelihood of being taken advantage of sexually while under the influence of alcohol and other drugs and consider trauma-informed interventions.

Background: To encourage people to lead healthier lifestyles, governments in many countries publish guidelines for alcohol intake, physical activity (PA), and fruit and vegetable (FV) intake. However, there is a need for better understanding of whether people understand such guidelines, consider them useful, and adhere to them. University students are a group worth of attention because although they are less likely than older adults to exceed UK weekly alcohol intake guidelines or to be inactive, they are also less likely to meet FV consumption targets. Furthermore, because behaviour during youth predicts adult behaviour, it is important to identify influences on healthier behaviour.

Methods: An online survey was completed by 559 UK university students. Key outcome variables were knowledge of guidelines, motivation to adhere to them, and adherence to them.

Results: 72% adhered to guidelines for alcohol intake, 58% for PA, and 20% for FV intake. Students generally had poor or moderate knowledge of guidelines, perceived them as only moderately useful, and were only moderately motivated to adhere to them. Greater motivation to adhere to guidelines was not significantly related to more accurate knowledge. However, it was related to greater familiarity, and perceiving guidelines as useful and realistic, and greater conscientiousness.

Discussion: There is a need to ensure that students understand the UK guidelines for alcohol intake, PA, and FV intake. However, simply increasing knowledge may not lead to greater adherence to the guidelines: there is also a need to focus on improving perceptions of how useful and realistic they are.

Background. Reducing the alcohol content of drinks has the potential to reduce alcohol consumption. Aims: (1) test the feasibility of a randomised controlled trial (RCT) to assess the effect of alcohol strength on alcohol consumption within licensed premises in the United Kingdom (UK), (2) provide data to estimate key parameters for a RCT. 

Methods. Double-blind randomised controlled cross-over pilot trial based within four licensed premises in the UK. Participants (n=36) purchased and consumed ad libitum a 3.5% lager and a 4.8% lager during two separate study sessions. Descriptive statistics reported the efficacy and efficiency of the study processes, and the rates of licensed premises recruitment, and participant recruitment and attrition. Mean and the 95% confidence interval (CI) compared alcohol consumption between conditions. The mean, standard deviation (SD) and CI of UK units of alcohol consumed were used to calculate a sample size for a RCT. Responses to participant questionnaires and duration of participation in study sessions between conditions were analysed.

Results. Components of the study protocol were effective and efficient. The venue recruitment rate was less than anticipated. The participant recruitment rate was greater than anticipated. The rate of attrition was 23% and varied by less than 1% according to the arm of the trial. There was a reduction of alcohol consumed under the intervention conditions. Estimated mean difference, and 95% CI (UK units): -3.76 (-5.01 to -2.52). The sample size required for a RCT is 53. Participants did not find one lager more pleasant in taste: (on a scale of one to 10) -0.95 (-2.11 to 0.21). Participants found the reduced-strength lager less enjoyable: (on a scale of one to 10) -1.44 (-2.64 to -0.24) and they perceived themselves to be less intoxicated after consuming it: (on a scale of one to 10) -1.00 (-1.61 to -0.40).

Conclusion. A RCT is feasible with minor alterations to the study protocol and scoping work to establish different brands of alcohol that are more alike and more enjoyable than the products used in the pilot trial. 

Objective: Alcohol misuse prevention often fails to account for or replace the pleasurable benefits of drinking such as relaxing and socialising with friends.  Increasingly, alcohol free dance music events are emerging, allowing people to gain the positive outcomes of dancing without recourse to alcohol. This study sought to explore whether conscious-clubbing would be rated as an acceptable alternative to traditional alcohol-focused events.

Design/Setting: An online cross-sectional survey was completed by 281 young respondents (80.4% female; mean age = 22).

Method: Health-related cognitions (attitudes, intentions), perceived acceptability towards alcohol free dance events and the extent to which these were predicted by demographics and individual differences were assessed in the survey.

Results: T-tests indicated overall positive attitudes, acceptability, support towards and intention to attend alcohol-free clubbing events regardless of drinking status, with the exception of drinkers’ intentions to attend an event. Exploratory multiple regression analyses indicated that young women and individuals who had previously attended these events held more positive attitudes. These attitudes were associated with acceptability and support, but more favourable attitudes towards alcohol consumption were inversely related to acceptability. More positive attitudes, previous attendance and lower life satisfaction associated with higher intentions to attend an event.

Conclusion: Results indicate that alcohol free events may provide an alternative socialising experience, with greater potential utility for young women, non-drinkers and individuals who have previously attended these events. This is of particular importance given that recent literature highlights the need for (non-alcohol) alternatives to socialise in a growing number of individuals.

Objectives. To explore UK clinicians’ beliefs and behaviours around recommending e-cigarettes as a smoking cessation aid for patients with cancer.

Design. Cross-sectional online survey.

Setting. England, Wales, Scotland and Northern Ireland.

Participants. Clinicians involved in the care of patients with cancer.

Primary and secondary outcomes. Behavioural Change Wheel capability, opportunity and motivation to perform a behaviour, knowledge, beliefs, current practice around e-cigarettes and other smoking cessation practices.

Method. Clinicians (n=506) completed an online survey to assess beliefs and behaviours around e-cigarettes and other smoking cessation practices for patients with cancer. Behavioural factors associated with recommending e-cigarettes in practice were assessed.

Results. 29% of clinicians would not recommend e-cigarettes to patients with cancer who continue to smoke. Factors associated with recommendation include smoking cessation knowledge (OR 1.56, 95% CI 1.01 to 2.44) and e-cigarette knowledge (OR 1.64, 95% CI 1.06 to 2.55), engagement with patients regarding smoking cessation (OR 2.12, 95% CI 1.12 to 4.03), belief in the effectiveness of e-cigarettes (OR 2.36 95% CI 1.61 to 3.47) and belief in sufficient evidence on e-cigarettes (OR 2.08 95% CI 1.10 to 4.00) and how comfortable they felt discussing e-cigarettes with patients (OR 1.57 95% CI 1.04 to 2.36).

Conclusion. Many clinicians providing cancer care to patients who smoke do not recommend e-cigarettes as a smoking cessation aid and were unaware of national guidance supporting recommendation of e-cigarettes as a smoking cessation aid.

Objectives. To determine the prevalence, patterns of use and consequences of inhaling alcohol vapour or mist. 

Design. Cross-sectional survey recruiting an international non-probability sample of people who use alcohol and other drugs as part of the annual Global Drug Survey (GDS).

Setting. Online questionnaire translated into 19 languages. 

Participants. 110,557 people took part in GDS2020 and 88,124 completed a question about inhaling alcohol in the last 12 months. The focus of this study is GDS2020 respondents who reported inhaling alcohol mist/vapour from a balloon in the last 12 months. 

Main outcomes. Last 12-month use of alcohol vapour, onset duration, intensity of effects, value for money compared with alcohol, and incidence of falls/injuries.  

Results. A total of 803 people reported the use of alcohol vapour in the last 12 months, with 51% of the sample coming from 3 countries: Australia, Denmark and England.  Two-thirds were male, and they were more likely to be under 25. 45.7% reported that they were a bit/very drunk before they inhaled alcohol. 51.3% reported that the effects lasted for less than 5 minutes. Both the intensity of effect and perceived value for money showed a normal distribution on a 10-point scale. 12.7% of respondents reported falling/injuring themselves.

Conclusion. Inhaling alcohol vapour appears to be more common among younger, higher-risk drinkers.  The rapid onset of action and inability to titrate consumption to effect is a risk for acute injury. We consider that alcohol is harmful enough through oral consumption without adding to the risk of injury by offering such a potentially risky additional administration method. 

Background: People who drink alcohol often seek to manage their intake in order to maximise the pleasurable effects, such as feelings of sociability and relaxation, without reaching their ‘tipping point’, where they feel out of control, or unwell. This paper aimed to explore three stages of intoxication; feeling the effects; being as drunk as you would like to be; and reaching the tipping point (feeling more drunk than you want to be) in a large international sample.

Methods: The Global Drug Survey (GDS) is an annual, cross-sectional, online survey of drug use. This paper draws on data from 61,043 respondents (63.7% male) from 21 countries who took part in GDS2015 collected in November 2014 to January 2015. Respondents reported their usual type of drink; how many drinks they would require to reach each stage of intoxication and how frequently they reached each stage. Alongside socio-demographic measures, they also completed the Alcohol Use Disorders Identification Test (AUDIT).

Results: Male respondents reported consuming 87.55gm to be as drunk as they want to be and female respondents reported 70.16gm, on average. The tipping point was reached at 138.65gm for male respondents and 106.54 gm for female respondents. Overall 20.3% reported reaching their tipping point at least once a month. Being male, aged under 25 and at higher risk for alcohol use disorder was associated with reporting reaching the tipping point more frequently.

Conclusions: The amount of alcohol being consumed to reach a desired point of intoxication is much higher than the maximum daily, and sometimes weekly, amount recommended by country guidelines. Encouraging people to avoid reaching their tipping point may be a useful intervention point alongside better communication of low risk drinking guidelines.

Background. The emergence of legal cannabis industries poses a new public health challenge. Health information labels are part of the public health strategy for tobacco and alcohol, but there is limited research on cannabis-related messaging. This study explored perceptions of cannabis health information labels among people who used cannabis in the last 12 months residing in the U.S. and Canada.
Methods. The Global Drug Survey (GDS) is a large anonymous cross-sectional web-survey. In GDS2019, respondents were presented with six labels with cannabis-related health information (dependence; driving stoned; harms of smoking; harms to developing brain; lack of motivation; effects on memory), and asked if information was new, believed, would it change behavior, and about acceptability of having health labels on legal products. This paper includes 1,275 respondents from Canada and 2,224 from U.S. states where cannabis was legal at the time of the survey, and 5,230 from other U.S. states.
Results. Few respondents said that the information was new (6.6-24.6%). Most said the information was believable (63.5-72.0%) other than for the dependence message (28.1% new, 56.8% believed), which was perceived to be the least likely to change behavior (10.2%). Driving stoned was the message perceived to be the most likely to change behavior (58.5%). Respondents living in Canada were less likely to say information was new and rated most messages more believable than those in the U.S. Respondents from legal U.S. states were less likely to say information was new compared to other states. Respondents who used cannabis daily rated acceptability of labels lower (27.8%) than those using 1-48 days (40.6%).
Conclusions. Novel, believable information may be more effective at changing behavior. Regular consumers may be less susceptible to messages. Information focusing on safer use strategies and benefits of reducing use may be more acceptable and should be assessed in future research.

The benefits of physical activity are known, but the proportion of adolescents meeting daily activity guidelines remains low. Physical activity interventions based on psychological behavioural models can be more effective than programmes which are not underpinned by theory, so exploring behavioural constructs to target is important.  The Theory of Planned Behaviour, which assumes reasoned intentions explain actions, is a useful framework for predicting activity, but it leaves variance unexplained.  The Prototype Willingness Model, which proposes a second pathway in which perceptions of social images, or prototypes, explain actions via behavioural willingness, may account for the more impulsive decisions that adolescents are inclined to make in social situations.   We aimed to determine whether variables in the social reactive pathway of the Prototype Willingness Model explain variance in an objective measure of daily activity, over and above the reasoned action path.  Participants aged 12-13 (n= 205) from three schools were invited to complete measures of constructs in the Prototype Willingness Model and to wear an accelerometer for the next seven days to measure physical activity.  Overall, 126 students (65 males) participated. Hierarchical regression showed that intention, attitudes and subjective norms explained 12.8% of variance in activity.  Prototype perceptions and willingness explained an additional 13.1% of variance. Participants’ perceived similarity to active prototypes, and unfavourable perceptions of inactive prototypes, significantly predicted activity in the full model.   Boys were significantly more active than girls, t(124) = 6.11, p

Introduction. Transgender (trans) people experience stressors related to their minority status which have been associated with increased rates of psychoactive substance use and related harm. Despite this, there is a paucity of evidence relating to the treatment needs of trans people who use psychoactive substances, beyond a small body of literature describing a culture of transphobic hostility in general substance misuse services. This paper aims to describe and compare psychoactive substance misuse help-seeking among trans and cisgender (cis) participants from a large multi-national cross-sectional survey.

Methods. Over 180,000 participants, recruited from the world's largest annual survey of drug use - the Global Drug Survey - during 2018 and 2019, reported use of a range of psychoactive substances in the preceding 12 months. Five gender groups (118,157 cis men, 64,319 cis women, 369 trans men, 353 trans women and 1857 non-binary people) were compared on items relating to the desire to use less psychoactive substances and the need to seek help to achieve this.

Results. Trans respondents (n = 1710) to GDS 2018 were significantly more likely to report use of illicit substances (OR = 1.66–2.93) and dependence on cannabis (OR = 2.39) and alcohol (OR = 3.28). In the combined GDS 2018 and 2019 dataset, there were no significant differences between trans (n = 2579) and cis (n = 182,476) participants on the desire to reduce substance use. However, among those who did report wanting to use less, trans participants were more likely to want help to achieve this.

Conclusion. Trans respondents reported a greater need for help with reducing substance use than cis respondents. Given the deficit of specialist services for psychoactive substance users who are trans, there is a need for a more thorough understanding of the barriers and facilitators to their engagement in general substance misuse services. In the interim, substance misuse service providers require education about gender minority status to help meet the needs of trans clients.

Personal, Social, Health and Economic Education (PSHE) is undergoing changes within UK schools, and many topics, including healthy lifestyles, sex and relationships, and mental resilience/wellbeing will become statutory parts of the curriculum.  The overall aim of this study was to describe teachers’ views about these topics and how they should be delivered.  A cross sectional online survey was completed by 167 teachers (87.8% female).  Questions were asked about what was currently covered in schools, and which topics were important, and appropriate.  Rating scales were used to garner attitudes and open ended questions probed for more details from the participants.  Peer pressure about drugs and alcohol was commonly discussed (72% of participants) however pleasurable effects of drugs were rated inappropriate by 38.1%.  Sexting (75.4%), sexual consent (69.5%) were the most frequently discussed in the sex and relationship topics, while 26.5% said that sexually transmitted diseases were not appropriate to talk about in school. Resilience (94.3%), body image/appearance (91.9%) had high levels of coverage, while 41.8% said treatments for mental health conditions were not discussed but should be. For all topics, most teachers rated their access to training as insufficient. Confidence in talking about the topic of mental health and wellbeing was lower than for the other topics. Issues highlighted by these findings should be addressed when new curriculums are being planned. Teachers witness the challenges faced by their pupils on a daily basis and their experiences, alongside further engagement with pupils, should be used to meaningfully inform the new PSHE curriculum.

Aims:  This paper aimed to explore perceptions of alcohol health warning labels among a large international sample of people who drink alcohol. 
Methods: The Global Drug Survey (GDS) is the world’s largest annual cross sectional survey of drug use. Seven health warning labels were presented (relating to heart disease, liver, cancer, calories, violence, taking two days off and the myth of benefits to moderate drinking). People were asked if they were aware of the information, believed it, if it was personally relevant, and if it would change their drinking. This paper included data from 75,969 respondents from 29 countries/regions who reported the use of alcohol in the last 12 months, collected during November-December 2017 (GDS2018).  
Results:  The fact that drinking less can reduce the risk of seven types of cancer was the least well known, and yet was demonstrated to encourage almost 40% of drinkers to consider drinking less. Women and high risk drinkers were more likely to indicate they would reduce their drinking in response to all labels. Personal relevance was identified as a key predictor of individual responses.
Conclusions:  Findings highlight the potential of a range of health messages displayed on alcoholic beverages to raise awareness of alcohol related harms and potentially support a reduction in drinking. Further research should explore what influences personal relevance of messages as this may be a barrier to effectiveness.

Purpose: Half of British university students experience assault and harassment behaviours; few report them. Bystander intervention training has been recommended as a means of reducing these behaviours, but there is little evidence about their potential effectiveness in UK contexts. This study sought to understand UK students’ attitudes towards reporting and intervening in sexual assault, harassment, and hate crimes. Design: A mixed methods cross sectional survey (N=201; 75.6% women) was conducted in one British university. Open text data were analysed using thematic analysis. Findings: Students considered harassment and assault unacceptable, and were confident to intervene in and likely to report incidents. However, fear of backlash was a barrier to intervening and reporting, and they felt that victims should decide whether to report incidents. Students perceived perpetrators as being ignorant about what constitutes consent, harassment, and assault. They identified a need for university community education about this and how to report incidents and support peers. Research limitations/implications: This cross sectional survey was conducted at one UK University. The data might not reflect other students’ attitudes, and may be subject to response bias. 
Practical implications: University community bystander training should be acceptable, report and support systems might be utilised by students. This may have potential to reduce prevalence and increase reporting. 
Originality: This is the first study to investigate UK student attitudes to prosocial bystander behaviours.

Frequent weight loss dieting leads to increased BMI and is associated with eating pathologies.  Theoretical models can aid the development of interventions to reduce risk behaviours such as frequent dieting if they are able to adequately account for the target behaviour.  The Prototype Willingness Model (PWM) may be able to account for weight loss dieting as this behaviour is often associated with social images. This study explored whether the PWM could predict weight loss dieting status over and above the Theory of Planned Behaviour (TPB).  One hundred and ninety two participants (69% female; mode age 35-44) completed PWM and TPB measures and recorded their height and weight. Males were more likely to be non-dieters than females. Frequent dieters had a higher BMI than non-dieters and rated themselves as more similar to the overweight prototype.  Prototype perceptions predicted willingness to eat unhealthy foods alone. Similarity to the overweight prototype predicted weight loss dieting status over and above TPB measures and sex. Further research should explore prototype perceptions in an obese/overweight frequent dieting population as this may be a fruitful direction for developing interventions to reduce weight loss dieting.

Objectives: Government guidelines aim to promote sensible alcohol consumption but such advice is disconnected from people’s lived experiences. This research investigated how people construct personal thresholds of ‘too much’ alcohol. 

Design and measures: 150 drinkers completed an online survey (Mage=23.29(5.51); 64.7þmale). Participants were asked whether they had an intuitive sense of what constitutes too much alcohol. They wrote open-ended descriptions of how that threshold had been established and how it felt to approach/exceed it. These qualitative accounts were coded using thematic analysis and interpreted with an experiential theoretical framework. 

Results: Personal thresholds were based on previously experienced embodied states rather than guidelines, or health concerns. Describing the approach to their threshold, 75% of participants fell into two distinct groups. Group 1’s approach was an entirely negative (nausea/anxiety) and Group 2’s approach was an entirely positive, embodied experience (relaxed/pleasurable). These groups differed significantly in awareness of alcohol’s effects, agency and self-perceptions, but not on alcohol consumption. Exceeding their threshold was an entirely negative embodied experience for all.

Conclusion: These findings illustrate that people are guided by experientially grounded conceptions of consumption. Interventions could target different groups of drinker according to their embodied experience during the approach to ‘too much’ alcohol.

Introduction. Drinking alcohol is legal in most countries of the world. Given the social acceptance of this behavior despite potential negative impact on health, help-seeking behavior could differ when compared to other drugs. This paper aimed to assess intentions to reduce drinking and the preferred sources of support among a large international sample of people who drink alcohol.  Materials and methods. The Global Drug Survey (GDS) is the world’s largest annual survey of drug use. This paper included data from 82,190 respondents from 12 countries on four continents who reported the use of alcohol in the last 12 months, collected during November 2016 - January 2017 (GDS2017). Results. Overall, 34.8% said they would like to drink less in the following 12 months and 7.6% said they would like help to drink less. Online tools were the preferred source of support to reduce drinking by respondents from Australia, New Zealand, and the UK, those with low AUDIT scores and without a mental health condition. Specialist counselling was most preferred by those from Germany, Switzerland, and Denmark and those with high AUDIT scores, not educated to degree level and with a mental health condition. Conclusion. Interest in online interventions for harmful drinking is significant and highest among people who drink at low risk. Online tools should offer brief screening and feedback, ensuring that people with high risk drinking patterns are referred to more specialist services. 

Psychology students often feel anxious about learning statistics, which can impact their performance.  However, less research has explored statistics confidence, which may be an important way to reduce the negative connotations of associating statistics with anxiety.  We aimed to explore whether modifying an existing measure of statistics anxiety (the STARS scale) and reframing the questions so students rated their confidence instead, would be associated with competence, prior knowledge and experience. A total of 104 undergraduate students completed an online questionnaire comprising these measures.  The factor structure of the STARS scale was predominantly maintained when wording was changed to measure confidence instead of anxiety.  Confidence was related to experience and competence, but not knowledge.  Two aspects of confidence (interpretation of statistics, and exam confidence) plus initial experiences were significant predictors of competence. Confidence was a mediator of the relationship between experience and competence.  These findings suggest statistics confidence can be measured in a similar way to anxiety, and highlight areas that could be addressed to increase competence.  Future research is needed to explore the relationship between statistics anxiety and statistics confidence, as well as to determine their individual impact on performance in assessments. 

Background. Social anxiety and self-consciousness are associated with alcohol-related problems in students. The practice of pre-loading is one avenue for exploration regarding this relationship.  Individuals may pre-load to reduce social anxiety and feel more confident when socialising, which could lead to the increased harms experienced. The current study aimed to explore reasons for pre-loading, and whether public and private self-consciousness and social anxiety were related to pre-loading, increased drinking and harms. Method. Prospective study with four-week follow up of 325 UK students aged 18-30 years old. Participants completed measures of private and public self-consciousness, social anxiety, alcohol consumption, alcohol-related harms and pre-loading. Results. Financial motives and mood-related reasons, such as gaining confidence were reported as reasons for pre-loading. Pre-loading predicted hazardous alcohol consumption, but social anxiety, and public and private self-consciousness did not.  However, pre-loading, public self-consciousness and social anxiety predicted alcohol-related harms.  Furthermore, public self-consciousness mediated the relationship between pre-loading and harms in a positive direction and this appeared to be more relevant in high risk (AUDIT 8+) than low risk drinkers. Conclusion. Students who scored higher in public self-consciousness appeared to be at greater risk of harms from pre-loading.  Further research should examine this relationship further with particular attention to high risk drinkers, and explore which aspects of a night out are related to heightened self-consciousness. Interventions could incorporate measures to reduce public self-consciousness, in order to reduce the negative impacts of pre-loading.

Objective. The aim of the present study was to explore whether constructs within the Prototype Willingness Model (PWM) predicted risky drinking as measured by AUDIT-C, drinking harms and unplanned drunkenness in a sample of UK young adults.  Previous studies exploring the PWM often do not use validated measures of alcohol consumption, and the outcomes of risky drinking are underexplored. Design. An online prospective study design with four week follow up was employed and 385 young adults completed the study (M age = 21.76, SD = 3.39, 69.6% female; 85.2% students). Main outcome measures. Intentions to get drunk, AUDIT-C, drinking harms experienced in the last four weeks, and unplanned drunkenness in the last four weeks. Results.  Heavy and non-drinker prototype similarity predicted AUDIT-C, drinking harms and unplanned drunkenness when controlling for past behaviour and reasoned action pathway constructs.  Intentions and willingness both mediated the relationship between prototype perceptions and AUDIT-C. Conclusion. This study supports the use of the PWM in the prediction of AUDIT-C, drinking harms and unplanned drinking in a UK sample.  Prototype perceptions influenced behaviour via both reasoned and reactive cognitions. Targeting similarity to heavy and non-drinker prototypes should be the focus of future interventions in this population.

Background: Effective interventions are required to reduce alcohol consumption and its associated harms at the population level. Reducing the alcohol content of beverages has the potential to reduce alcohol consumption through non-conscious processes. Before implementing a randomised controlled trial (RCT) to assess the effect of alcohol strength on alcohol consumption its feasibility needs to established. This study aims to pilot a RCT and obtain data to estimate key parameters required when designing a RCT. These key parameters include the direction and size of the intervention effect, the efficacy and efficiency of the study processes, and the rates of licensed premises recruitment, participant recruitment and attrition. 

Methods: A double blind randomised controlled cross-over pilot trial comparing the number of units of reduced strength lager consumed and the number of units of regular strength lager consumed in a single drinking occasion within licensed premises in the UK. Descriptive statistics will report the efficacy and efficiency of the study processes, and the rates of licensed premises recruitment, participant recruitment and attrition. Mean and 95% confidence intervals will be used to compare the consumption of alcohol, and the duration of participation in study sessions, between the intervention arm and the control arm. The mean and standard deviation of UK units of alcohol consumed will be used to calculate a sample size for a definitive RCT. 

Discussion: This is the first naturalistic experimental study to assess the effect of alcohol strength on alcohol consumption in a single drinking occasion within licensed premises. Results from this pilot study will establish the feasibility of, and inform key data parameters for, a larger-scale study. 

Purpose: Sexual assault is prevalent on UK University campuses, and prevention efforts are being increased. However, at present there is limited evidence about UK students’ attitudes towards sexual assault prevention and what they think should be done to effectively address the issue. The purpose of this study was to explore these views to provide a foundation for the development of a new intervention.

Methods: A cross sectional anonymous online survey was completed by 515 students (73% women; M age 21.56; 79% heterosexual; 82.9% White). There were quantitative questions about experiences of sexual assault, attitudes towards sexual consent and victim blaming. Qualitative data was collected regarding participants’ views on what universities should do to target sexual assault.

Findings: In line with previous studies, we found evidence of commonplace and normalised sexual assault behaviours. Women had more positive attitudes towards explicit consent than men, and were less likely to blame victims of sexual assault who had been drinking. Consent behaviour was predicted by positive views towards consent and lower levels of blaming. Themes relating to ‘awareness’, ‘attitudes’, ‘environment’ and ‘opposition’ were identified in the qualitative data.

Practical implications: Findings highlight the importance of engaging with students to develop effective prevention measures. Students are likely to find university led prevention strategies acceptable, but this topic needs to be addressed in the context of the prevailing culture, which may provide an environment where certain behaviours are tolerated. New prevention programmes need to treat the issue as one that is relevant to all students and not just target men as perpetrators and women as victims. Such strategies need to do more than treat this as an isolated issue, to which the solution is re-education about the meaning of consent.

Aims. Brief interventions delivered by doctors and other healthcare practitioners might be meaningfully enhanced by understanding what individual experiences might lead patients to cut down. The aim of the current paper was to explore the experiences that might lead people to reduce their alcohol consumption and to compare these findings between respondents from 21 different countries.
Methods. Global Drug Survey is an online cross sectional, opportunistic anonymous survey. This paper includes 72,209 respondents from 21 counties with over 250 respondents (60.8% male).

Results. Almost a third (32.9%) of participants reported that they would like to drink less alcohol over the next 12 months, and a third thought their GP would tell them to cut down if they were honest about their drinking. The primary experiences that were rated as most likely to lead to a change in behaviour were related to physical health, sexual assault and having to seek emergency medical treatment. Respondents from Germany were more likely to select embarrassment as a motivation to reduce drinking than those from other counties. Females were more likely to report indicate motivations related to sexual regret, sexual assault or seeking treatment. Older participants and those in the low risk audit category were more likely to report embarrassment or forgetfulness as potential motivation for change.
Conclusion. Understanding the different motivations that may lead individuals to change their drinking behaviours can be used to inform targeted brief interventions and targeted public health guidance.

Design: The study involved a cross-sectional design. The sample included 501 participants from the United Kingdom (Mean age 18.92; range 11-51; 63% female); 230 school pupils and 271 university students.
 

Methods: Participants completed explicit measures of alcohol prototype perceptions, willingness, drunkenness, harms, and intentions.  They also completed an implicit measure of alcohol attitudes, using the Implicit Association Test.
 

Results: Implicit alcohol attitudes were only weakly related to the explicit measures. When looking at the whole sample, implicit alcohol attitudes did not add to the prediction of willingness over and above prototype perceptions. However, for university students implicit attitudes added to the prediction of behaviour, over and above intentions and willingness.  For school pupils, willingness was a stronger predictor of behaviour than intentions or implicit attitudes. 

Conclusions: Adding implicit measures to the PWM may contribute to our understanding of the development of alcohol behaviours in young people.  Further research could explore how implicit attitudes develop alongside the shift from reactive to planned behaviour.  

Methodology: Semi structured interviews were conducted with nine female teachers from a range of schools who had responsibility for designing and delivering Personal Social and Health Education (PSHE).
 

Findings: Three main themes were identified in a thematic analysis of the interview transcripts.  The themes demonstrated the importance of PSHE to these teachers, who faced challenges in delivering a comprehensive enough curriculum.  Alcohol unit knowledge and responsible drinking were priorities for the teachers.  However, given the many pressures faced by young people, alcohol could be viewed as just one challenge amongst many.  

Research Implications: Interventions may be seen as too compartmentalised by teachers if they fail to address the wider concerns of adolescents.  Intervention developers should consider gaining input from teachers on the content of their programmes prior to running a trial to enhance feasibility and acceptability.

Originality/Value: There are few studies that have explored what teachers think about alcohol education in general or about the content of specific interventions prior to their implementation.

This study adds their voice to the literature, and highlights the importance of considering the views and first hand experiences when developing new alcohol interventions aimed at adolescents.

Background: The Strengthening Families Programme for youth aged 10-14 and parents/carers (SFP10-14) is a family-based prevention intervention with positive results in trials in the United States. We assessed the effectiveness of SFP10-14 for preventing substance misuse in Poland.

Methods: Cluster randomized controlled trial with 20 communities (511 families; 614 young people) were allocated to SFP10-14 or a control arms. Primary outcomes were alcohol, smoking and other drug use. Secondary outcomes included parenting practices, parent–child relations, and child problem behaviour. Interview-based questionnaires were administered at baseline and at 12- and 24-months post-baseline, with respective 70.4% and 54.4% follow-up rates.

Results: In Bayesian regression models with complete case data we found no effects of SFP10-14 for any of the primary or secondary outcomes at either follow-up. For example at 24-months, posterior odds ratios and 95% credible intervals for past year alcohol use, past month binge drinking, past year smoking, and past year other drug use, were 0.83 (0.44-1.56), 0.83 (0.27-2.65), 1.94 (0.76-5.38), and 0.74 (0.15-3.58), respectively. Although moderate to high attrition rates, together with some evidence of systematic attrition bias according to parent education and family disposable income, could have biased the results, the results were supported in further analyses with propensity score matched data and 40 multiple imputed datasets.

Conclusion: We found no evidence for the effectiveness of SFP10-14 on the prevention of alcohol or tobacco use, parenting behaviour, parent-child relations or 4 child problem behaviour at 12- or 24-month follow-up in a large cluster randomised controlled trial in Poland. 

Background/Objectives: Breakfast skipping increases during adolescence and is associated with lower levels of physical activity and weight gain. Theory-based interventions promoting breakfast consumption in adolescents report mixed findings, potentially due to limited research identifying which determinants to target. This study aimed to: (i) utilise the Theory of Planned Behaviour (TPB) to identify the relative contribution of attitudes (affective, cognitive and behavioural) to predict intention to eat breakfast and breakfast consumption in adolescents; (ii) determine whether demographic factors moderates the relationship between TPB variables, intention and behaviour.

Subjects/Methods: Questionnaires were completed by 434 students (mean 14 ± 0.9 years) measuring breakfast consumption (0-2, 3-6 or 7 days), physical activity levels and TPB measures. Data were analysed by breakfast frequency and demographics using hierarchical and multinomial regression analyses. 

Results: Breakfast was consumed every day by 57% of students with boys more likely to eat a regular breakfast, report higher activity levels and more positive attitudes towards breakfast than girls (p

Conclusions: Findings confirm that the TPB is a successful model for predicting breakfast intentions and behaviours in adolescents. The potential for a direct effect of attitudes on behaviours should be considered in the implementation and design of breakfast interventions. 

Purpose of the paper: The purpose of this paper is to report on the use of the Delphi method to gain expert feedback on the identification of behaviour change techniques (BCTs) and development of a novel intervention to reduce adolescent alcohol misuse, based on the Prototype Willingness Model (PWM) of health risk behaviour.

Methodology:  Four BCTs based on the PWM were identified and incorporated into a draft intervention that aimed to change alcohol prototypes and enable adolescents to deal with social pressure.  Using the Delphi process, successive questionnaires were distributed to 20 international experts to build consensus on the theoretical validity of the intervention.

Findings: Fifteen experts completed round one and eleven completed round two of the Delphi study.  A high level of consensus was achieved.   Four priority areas were identified to improve the intervention: 1) incorporating extra techniques to address social pressure, 2) increasing intensity, 3) providing incentives, and 4) addressing credibility.

Limitations:  The sample of experts was self-selected and four participants were lost between the first and second round of the study.

Implications: The effectiveness of the identified BCTs will be evaluated within an intervention to reduce alcohol misuse in adolescents.  Further work should build towards a more unified approach to developing interventions based on the PWM.  The Delphi method is likely to be particularly useful when there is no existing consensus about which BCTs to use that reflect certain theoretical constructs or that best target a specific population or behaviour.

Originality/ value: This paper is the first to address the identification of specific BCTs based on the PWM and thus makes an important contribution to the application of this model to interventions.  This novel application of the Delphi method also makes a useful addition to the growing field of intervention development and design.   

The British Psychological Society’s Public Engagement and Media Award in 2015 went to Mindhacks, a blog led by psychologists Dr Vaughan Bell and Dr Tom Stafford that has featured over 5000 posts across the past decade. Example posts include descriptions of visual illusions, a self-test for synaesthesia, and tips on the best way to win an argument. Accepting the award at the Society’s Annual Conference, the pair urged: ‘Each one of you has probably got those 5000 posts inside you. Make use of the resources on the internet, but put your own thoughts online too.’ We share their passion for ‘blogademia’ (a term coined by Saper, 2006), and here we aim to reflect on its purpose, positives and pitfalls, moving on to some general tips and guidance on blogging specifically for psychologists.

Using the Prototype Willingness Model (PWM) as a framework, this study sought to explore the relationship between prototype perceptions, willingness and alcohol consumption in a sample of adolescents in the United Kingdom.  Adolescents aged 11-17 were asked about their alcohol prototype perceptions, willingness to drink, intentions, alcohol consumption, drunkenness and harms using a cross sectional online survey.  Participants were recruited through opportunity sampling via schools and parents.  The survey was completed by 178 respondents (51% female; 91 aged 11-15, 87 aged 16-17).  Multivariate analysis revealed significant differences between participants aged 11-15 and 16-17 on PWM measures, even when experience with drinking was accounted for (pppp

Background: The Prototype Willingness Model (PWM) may offer an appropriate basis for explaining and preventing adolescent alcohol misuse.  An intervention was developed using a co-production approach, and consisted of an online quiz featuring 10 questions linked to PWM.

Objectives: This study sought to determine the acceptability and relevance of the intervention content to young people, in order to incorporate their feedback into a final version.

Methods: A qualitative think aloud study with follow up semi-structured interviews was undertaken with 16 young people aged 11-15 (50% female), Transcripts were analysed using thematic analysis.

Results: Three main themes relating the acceptability of the intervention were identified; ‘challenging expectations of alcohol education’; ‘motivations for drinking or not drinking’ and ‘the inevitability of drinking’.  Participants found the intervention appealing because it was counter to their expectations.  The content appeared to reflect their experiences of social pressure and drinking encounters.  There was evidence that a focus on drinker/non-drinker prototypes was too narrow and that because adolescents perceived drinking as inevitable, it would be challenging to enact any plans to resist pressure to drink. 

Conclusions: An online intervention based on the PWM has the potential to engage and interest adolescents.  A wide range of alcohol prototypes should be targeted and a focus on short term harms should ensure that the intervention is credible to young people.  

Students often struggle with learning about statistics, which encompass a large proportion of a psychology degree.  This pilot study explored how first- and final-year students reflected on their experiences of being taught this topic, in order to identify needs that could be addressed in a project to improve their learning. 

First-year students reported that they initially found their module challenging but that it became easier towards the end.  Third year students recognised the importance of the topic but were not confident in their abilities.  Most students reported anxiety about statistics.  Although students were positive about practical classes, many felt that they could not easily remember the materials.   The findings suggested three areas of focus to improve student learning.  Firstly, diverse needs and levels of ability should be catered for.  Secondly, students need help to go beyond surface learning and button clicking.  Finally, low levels of engagement should be addressed.

This work has informed a project to develop an online resource to address the above identified needs to enhance teaching of this important topic. 

Statistics and Research Methods modules are often unpopular with psychology students; however, at Oxford Brookes University the seminar component of the second-year research methods module tends to get very positive feedback. Over half of the seminars work towards the submission of a research-based experimental lab report. This article introduces and reflects on some of the recent changes made to improve this coursework by increasing the similarities with staff research; specifically targeting the areas of supervision, ethical review, peer review and dissemination. These developments are aligned with the teaching fellowship project, Vertical Enhancement of Statistics and Psychology Research, and aim to encourage second-year students to treat their group experiments as part of the department’s research activity, rather than simply as pieces of coursework. Enhancing this research-based aspect of the student experience teaching will hopefully, in turn, lead to higher quality third-year dissertations by increasing student enthusiasm for academic research. 

Gaining teaching experience is an important aspect of being a psychology postgraduate.  We undertook an online survey of 140 postgraduates from 50 UK institutions to explore their experiences of teaching with a focus on research methods in order to inform training and workshop provision. Of the sample, 91% we involved in some type of teaching; the most commonly reported activity was marking.  Participants reported a high level of enjoyment of teaching and thought it was an important part of their future careers.  Written responses were received from 85 respondents about their experiences of teaching research methods.  Qualitative analysis of these findings allowed us to identify the positive aspects of this experience, such as finding it rewarding to help students with this important area of their learning.  Our findings also identified challenges in teaching research methods such as confidence, student disengagement and lack of control over content taught.   The findings are discussed in light of their implications for future training provision for postgraduates who teach.

Aim: This study aimed to explore constructs in the prototype willingness model (PWM) to establish if it provides a basis for understanding and preventing alcohol misuse in teenagers in the UK.

Methods: Four focus groups were carried out with 11–13 and 16–17 year olds. There were 13 males and 14 females. Transcripts of the focus groups were analysed using thematic analysis in NVivo.

Findings: Three PWM relevant themes were identified. The first theme brought together the alcohol prototypes described by participants. The second theme addressed drinking contexts and contrasts evidence that suggests that some drinking is planned and some is unplanned. The final theme looks at attitudes and norms including participants’ attitudes towards alcohol education.

Conclusions: The findings from this study show that young people in this sample held clear prototypes in relation to alcohol. The evident difference between ‘planned’ and ‘unplanned’ drinking contexts suggests that the PWM provides a more satisfactory explanation of young people's drinking than a decisional model based on intentions alone. Drinking alcohol was reported by the participants as a normative teenage behaviour. Implications for an intervention programme targeting alcohol prototypes and future research are discussed.