Implications of nicotine vaping products for tobacco control in ASEAN low-income and middle-income countries: in-depth interviews with experts from the region.

OBJECTIVES: The use of nicotine vaping products (NVPs) has increased in low-income and middle-income countries (LMICs) in the Association of Southeast Asian Nations (ASEAN) region; however, it is uncertain what implications the presence and use of NVPs have for tobacco control. DESIGN: In-depth interviews were conducted to explore ASEAN tobacco control experts' (n=11) views on the rise of NVP use in ASEAN LMICs, current NVP policies, the potential harm reduction and smoking cessation utilities of these devices, and what implications they may have for tobacco control. Data were analysed using inductive, reflexive thematic analysis. RESULTS: Five themes emerged: (1) NVPs threaten tobacco control in ASEAN LMICs; (2) commercial factors influence youth appeal and access: product attributes, marketing, supply chains; (3) opposition to the smoking cessation and harm reduction utilities of NVPs; (4) policies are inconsistent and fragmented in the region; and (5) tobacco industry power and tactics have been used to capture NVP markets. CONCLUSIONS: ASEAN tobacco control experts believe that NVPs pose a threat to youth and non-smokers in LMICs in the region, largely because of tobacco industry NVP marketing activities. They do not support the use of NVPs for smoking cessation or harm reduction and call for more restrictions and consistent policy enforcement across the region to protect young people, while also cautiously recognising that use of NVPs may have some benefits for smokers.

Uncovering the advertising and promotional strategies of tobacco companies in Cambodia: recall of below-the-line marketing among young male smokers.

INTRODUCTION: Tobacco companies have used below-the-line marketing in novel ways to promote their brands to youth in low/middle-income countries in Southeast Asia. This study explores how young male smokers in Cambodia experience below-the-line marketing strategies. METHODS: Convenience sampling was used to recruit 147 young male smokers (18-24 years) in Cambodia in early 2020. Local research assistants conducted mixed-methods interviews with participants in Khmer or English. Participants recalled exposure to below-the-line marketing strategies and provided in-depth descriptions about their experiences with individual sales promotions. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using thematic analysis. RESULTS: 54% of participants recalled exposure to at least one below-the-line marketing strategy, including point-of-sale promotions (32.7%), individual sales promotions (27.9%) and online advertising (14.3%). Participants described individual sales promotions in public settings, and recalled that promoters were mostly female, attractive and targeted young males. Tactics used to encourage young people to accept promotional offers included free cigarettes and sample packets, swapping current cigarettes for new brands and collecting consumer details after interviewing. The brands and product features of cigarettes being promoted were readily described by participants. CONCLUSION: This study provides evidence that illegal below-the-line marketing is still occurring in Cambodia, and increased monitoring and enforcement of advertising restrictions is needed.

Tobacco industry influence in low- and middle-income countries in the ASEAN region: Qualitative interviews with tobacco control experts during the COVID-19 pandemic.

INTRODUCTION: While most Association of Southeast Asian Nations (ASEAN) countries have adopted the Framework Convention on Tobacco Control (FCTC), implementation and enforcement of measures are lacking in some low- and middle-income countries (LMICs) in the region. This study aimed to describe: 1) how the tobacco industry has undermined tobacco control efforts and adapted its tactics in response to the COVID-19 pandemic and other external factors, 2) the political factors that hinder progress, and 3) the expert recommendations to overcome challenges of tobacco control in the ASEAN region. METHODS: During the COVID-19 pandemic, qualitative interviews were conducted with tobacco control experts to explore their perspectives and recommendations to address the barriers and challenges of tobacco control in ASEAN LMICs. RESULTS: Eleven tobacco control experts participated in interviews. Five themes emerged from the data: 1) a shift to below-the-line marketing and digital technologies to target youth; 2) industry develops new tactics to undermine tobacco control; 3) cigarette packet branding - the last remaining marketing channel; 4) political factors hindering tobacco control; and 5) broader involvement and collaboration in tobacco control. CONCLUSIONS: The tobacco industry continues to undermine tobacco control in ASEAN LMICs, shifting its marketing, corporate social responsibility (CSR) and lobbying tactics in response to changing regulations, digital technologies, and the COVID-19 pandemic. While lack of government leadership also hinders progress, full adoption of the FCTC and increased collaboration in tobacco control are recommended to overcome these issues.

Influence of cigarette packet branding and colours on young male smokers' recognition, appeal and harm perceptions of tobacco brands in Cambodia: a mixed-methods study.

OBJECTIVES: To explore how cigarette packet branding and colours influence young male smokers' perceptions of tobacco brands in Cambodia. DESIGN: Mixed-methods study. SETTING: Worksites, living accommodations, a university and public locations in Phnom Penh, Cambodia. PARTICIPANTS: 147 male Cambodian smokers (18-24 years). INTERVENTIONS: Participants were shown mock-up pictures of different cigarette packet branding and colour variations and asked to respond to close-ended and short-response questions. OUTCOME MEASURES: Brand recognition, appeal and harm perceptions of cigarette packet branding and colours. RESULTS: When shown three packets with brand names removed, 98.6% of participants recognised packet one as Mevius brand, 21.1% recognised packet two as Marlboro and 38.8% recognised packet three as 555. For the three fully-branded and three matching plain packets, most participants selected a fully-branded packet as the most appealing taste (83.0%) and most appealing to youth (81.7%). Participants described their chosen brand as appealing due to beliefs about its superior taste/quality, reduced harm and symbolic attitudes surrounding tobacco brands and smokers of different brands in a social status hierarchy. When shown six different colours of unbranded packets, participants selected the blue packet (51.0%) as the most appealing for taste, the white packet as the least harmful (25.2%), and the red (15.0%) and black (12.9%) packets as the most harmful to health. They described their associations of packet colours with abstract imagery concerning smoking-related harms and their future well-being. CONCLUSIONS: Findings suggest that packet branding and colours influence young male smokers' recognition, appeal and harm perceptions of tobacco brands in Cambodia and remain an influential marketing tool for tobacco companies where advertising is banned. Consequently, Cambodia and other low and middle-income countries in Southeast Asia should implement plain packaging.

A comparison of penalised regression methods for informing the selection of predictive markers.

BACKGROUND: Penalised regression methods are a useful atheoretical approach for both developing predictive models and selecting key indicators within an often substantially larger pool of available indicators. In comparison to traditional methods, penalised regression models improve prediction in new data by shrinking the size of coefficients and retaining those with coefficients greater than zero. However, the performance and selection of indicators depends on the specific algorithm implemented. The purpose of this study was to examine the predictive performance and feature (i.e., indicator) selection capability of common penalised logistic regression methods (LASSO, adaptive LASSO, and elastic-net), compared with traditional logistic regression and forward selection methods. DESIGN: Data were drawn from the Australian Temperament Project, a multigenerational longitudinal study established in 1983. The analytic sample consisted of 1,292 (707 women) participants. A total of 102 adolescent psychosocial and contextual indicators were available to predict young adult daily smoking. FINDINGS: Penalised logistic regression methods showed small improvements in predictive performance over logistic regression and forward selection. However, no single penalised logistic regression model outperformed the others. Elastic-net models selected more indicators than either LASSO or adaptive LASSO. Additionally, more regularised models included fewer indicators, yet had comparable predictive performance. Forward selection methods dismissed many indicators identified as important in the penalised logistic regression models. CONCLUSIONS: Although overall predictive accuracy was only marginally better with penalised logistic regression methods, benefits were most clear in their capacity to select a manageable subset of indicators. Preference to competing penalised logistic regression methods may therefore be guided by feature selection capability, and thus interpretative considerations, rather than predictive performance alone.

Childhood social environmental and behavioural predictors of early adolescent onset cannabis use.

INTRODUCTION AND AIMS: This study prospectively investigates behavioural and social antecedents of different patterns of adolescent cannabis use, specifically, early adolescent onset cannabis use and late onset occasional use. DESIGN AND METHODS: The sample comprised 852 adolescents (53% female) drawn from the Australian arm of the International Youth Development Study. Data were collected via self-report surveys. Risk and protective factors from a modified version of the Communities That Care youth survey were measured in fifth grade (mean [M] = 10.9 years, SD = 0.4). Frequency of cannabis use was measured at six time-points throughout adolescence (ages 12-19 years). RESULTS: Early adolescent onset cannabis use (10.7% of the sample [n = 91]) was predicted by childhood family-related factors including poor family management, family history of antisocial behaviour and attachment to parents. Cigarette use and drinking until drunk were the strongest predictors of early adolescent onset cannabis use. Cumulative risks associated with community, family, peer/individual environments and early substance use (cigarettes, alcohol) in childhood were predictive of early adolescent onset cannabis use (e.g. relative risk ratio = 2.64; 95% confidence interval 1.40-4.97 for early substance use). Family and early substance use-related cumulative risks were predictive of late adolescent onset occasional cannabis use (n = 231; 27%). Cumulative early substance use risk was the strongest independent predictor of both early adolescent onset and late adolescent onset occasional cannabis use. DISCUSSION AND CONCLUSIONS: Primary prevention efforts should focus on reducing exposure and access to licit substances during late childhood and delaying the onset of use. Prevention and intervention targeted toward the family environment also appears likely to be important in the prevention of early adolescent onset cannabis use.

Predicting hazardous drinking in late adolescence/young adulthood from early and excessive adolescent drinking - a longitudinal cross-national study of Norwegian and Australian adolescents.

BACKGROUND: Research has consistently shown that early onset of drinking (EOD) is associated with alcohol-related problems in adulthood. However, recent reviews have identified several limitations in the early onset literature, including the use of retrospective reports, insufficient control for potential confounders, ambiguous definitions of the concept, and an assumption that early onset is independent of cultural norms and national alcohol policies. This study addresses these limitations by examining whether EOD, independent of early onset of excessive drinking (EOE), prospectively predicts hazardous drinking in late adolescence/young adulthood in Norway and Australia, two countries with different drinking cultures. METHODS: Data were drawn from two population-based longitudinal studies; the Norwegian Tracking Opportunities and Problems Study (n = 329) and the Australian International Youth Development Study (n = 786). Data were collected prospectively from mid adolescence (14-16 years) to late adolescence/young adulthood (18-25 years) and a modified Poisson regression approach was used to estimate prevalence ratios. Adolescent self-reports included measures of EOD and EOE. Young adults completed the Alcohol Use Disorders Identification Test (AUDIT). The results were adjusted for adolescent factors; age, gender, impulsivity, hyperactivity, conduct problems, smoking, early sexual intercourse and friends' substance use, and family factors; alcohol and drug use in the family, maternal education, family management and monitoring. RESULTS: Hazardous drinking was identified in 46.8 and 38.9% of young adults in Norway and Australia, respectively. Both EOD and EOE in adolescence were significantly related to an increased risk of alcohol-related problems in late adolescence/young adulthood in both studies, even when adjusting for possible confounders. CONCLUSION: Our findings indicate that adolescent drinking behaviour is an indicator of alcohol-related problems in late adolescence/young adulthood, even when controlling for a variety of covariates. This finding is in contrast to previous research on older adults, where no association between adolescent drinking and later alcohol-related problems were found when controlling for covariates. The divergence in findings may suggest that the impact of EOD/EOE is limited to the late adolescent and young adult period. Preventing drinking in early adolescence may thus have some impact on the drinking patterns in late adolescence/young adulthood.

Community intervention to prevent adolescent health behavior problems: Evaluation of communities that care in Australia.

OBJECTIVE: A major challenge for health psychologists is to ensure the implementation of evidence-based interventions to improve population health. To reduce high rates of adolescent alcohol use and related health problems, trials of the Communities That Care (CTC) prevention process were implemented in Australia beginning in 2001. The process assists communities to strategically plan and monitor implementation of evidence-based preventative interventions. This article reports an evaluation of the effects in the first four Australian communities that completed the process. METHOD: Trends were examined based on self-report surveys completed by 41,328 adolescents (average age 13.5 years, 51.7% female) across 109 municipal localities between 1999 and 2015. Multilevel modeling compared the 5 localities where the 4 coalitions completed the CTC process with the remaining 104 localities for trends in adolescent reports of lifetime alcohol, tobacco, and cannabis use and past year antisocial behavior. RESULTS: Relative to Australian trends, adolescents in CTC localities reported significantly steeper annual reductions in any lifetime alcohol (Adjusted odds ratio [AOR] = 0.94, 95% confidence intervals [CI] = [0.93, 0.95]), tobacco (AOR = 0.97, CI [0.96, 0.99]), cannabis use (AOR = 0.96, CI [0.93, 0.98]) and antisocial behavior (unstandardized regression coefficient [B] = -0.001, CI [-0.002, 0.000]). CONCLUSION: Implementation of the CTC process in Australia was associated with more rapid community reductions in adolescent health behavior problems. Supporting community coalitions to adopt evidence-based interventions appears a feasible means for health psychologists to improve the health of large adolescent populations and prevent related chronic health problems in later life. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Outcomes of Early Adolescent Sexual Behavior in Australia: Longitudinal Findings in Young Adulthood.

PURPOSE: Limited longitudinal research has examined the adult health and behavioral outcomes associated with early adolescent sexual behavior. This paper examined whether adolescent sexual behavior predicted young adult health and social outcomes within longitudinal cohorts in Victoria, Australia. METHODS: Adolescents were recruited in 2002 to be state-representative of school students in Victoria, Australia, and resurveyed in 2003 and 2004. The sample responded to a web-based survey as young adults in 2010/2011. Multivariate negative binomial regression models examined the predictive effect of sex by age 15 on young adult outcomes (average age 21) of sexual risk taking, substance use, antisocial behavior, and psychological distress (N = 2,147). RESULTS: After adjustment for other factors, sex at age 15 or younger (early sex) predicted higher rates of young adult sexual risk taking such as pregnancy, lifetime partners, and sex without using a condom. Early sex also predicted higher rates of young adult substance use (alcohol, tobacco, and/or illicit substance use) and antisocial behavior, but rates of adult psychological distress were not affected. CONCLUSIONS: This study found that early adolescent sex had unique predictive effects on a range of adverse young adulthood outcomes. Public health policies should synthesize longitudinal data on the risks of early sexual behavior, while advocating evidence-based adolescent sexual health promotion interventions.

Student survey trends in reported alcohol use and influencing factors in Australia.

INTRODUCTION AND AIMS: There is a need to explain reported trends of reduced alcohol and drug (substance) use in school-aged children in Australia. This study used student survey data collected in the states of Victoria, Western Australia and Queensland to examine trends in substance use and associated influencing factors. DESIGN AND METHODS: Youth self-reports were examined from 11 cross-sectional surveys completed by 41 328 adolescents (average age 13.5 years, 52.5% female) across 109 Australian communities between 1999 and 2015. Multi-level modelling was used to identify trends in adolescent reports of lifetime alcohol, tobacco and cannabis use, adjusted for age, gender, social disadvantage and minority status. Trends in influencing factors were also examined that included: individual attitudes, and family, school and community environments. Multivariate analyses estimated the main contributors to alcohol use trends. RESULTS: Alcohol, tobacco and cannabis use all fell significantly from 1999 to 2015. Higher levels of use were observed in Victoria compared to Western Australia or Queensland. Multivariate analyses identified reductions in favourable parent attitudes and lower availability of substances as direct contributors to reducing alcohol use trends. Indicators of school and family adjustment did not show similar trend reductions. DISCUSSION AND CONCLUSIONS: Reductions in adolescent alcohol, tobacco and cannabis use from 1999 to 2015 were associated with similar reductions in parent favourable attitudes and availability of substances. It is plausible that a reduced tendency for parents and other adults to supply adolescent alcohol are implicated in the reductions in adolescent alcohol use observed across Australia.

Developmental trajectories of adolescent cannabis use and their relationship to young adult social and behavioural adjustment: A longitudinal study of Australian youth.

This study aimed to identify distinct developmental trajectories (sub-groups of individuals who showed similar longitudinal patterns) of cannabis use among Australian adolescents, and to examine associations between trajectory group membership and measures of social and behavioural adjustment in young adulthood. Participants (n=852, 53% female) were part of the International Youth Development Study. Latent class growth analysis was used to identify distinct trajectories of cannabis use frequency from average ages 12 to 19, across 6 waves of data. Logistic regression analyses and analyses of covariance were used to examine relationships between trajectory group membership and young adult (average age: 21) adjustment, controlling for a range of covariates. Three trajectories were identified: abstainers (62%), early onset users (11%), and late onset occasional users (27%). The early onset users showed a higher frequency of antisocial behaviour, violence, cannabis use, cannabis-related harms, cigarette use, and alcohol harms, compared to the abstinent group in young adulthood. The late onset occasional users reported a higher frequency of cannabis use, cannabis-related harms, illicit drug use, and alcohol harms, compared to the abstinent group in young adulthood. There were no differences between the trajectory groups on measures of employment, school completion, post-secondary education, income, depression/anxiety, or alcohol use problems. In conclusion, early onset of cannabis use, even at relatively low frequency during adolescence, is associated with poorer adjustment in young adulthood. Prevention and intervention efforts to delay or prevent uptake of cannabis use should be particularly focussed on early adolescence prior to age 12.

Adolescent substance use and educational attainment: An integrative data analysis comparing cannabis and alcohol from three Australasian cohorts.

BACKGROUND: The relative contributions of cannabis and alcohol use to educational outcomes are unclear. We examined the extent to which adolescent cannabis or alcohol use predicts educational attainment in emerging adulthood. METHODS: Participant-level data were integrated from three longitudinal studies from Australia and New Zealand (Australian Temperament Project, Christchurch Health and Development Study, and Victorian Adolescent Health Cohort Study). The number of participants varied by analysis (N=2179-3678) and were assessed on multiple occasions between ages 13 and 25. We described the association between frequency of cannabis or alcohol use prior to age 17 and high school non-completion, university non-enrolment, and degree non-attainment by age 25. Two other measures of alcohol use in adolescence were also examined. RESULTS: After covariate adjustment using a propensity score approach, adolescent cannabis use (weekly+) was associated with 1½ to two-fold increases in the odds of high school non-completion (OR=1.60, 95% CI=1.09-2.35), university non-enrolment (OR=1.51, 95% CI=1.06-2.13), and degree non-attainment (OR=1.96, 95% CI=1.36-2.81). In contrast, adjusted associations for all measures of adolescent alcohol use were inconsistent and weaker. Attributable risk estimates indicated adolescent cannabis use accounted for a greater proportion of the overall rate of non-progression with formal education than adolescent alcohol use. CONCLUSIONS: Findings are important to the debate about the relative harms of cannabis and alcohol use. Adolescent cannabis use is a better marker of lower educational attainment than adolescent alcohol use and identifies an important target population for preventive intervention.

Longitudinal effects of school drug policies on student marijuana use in Washington State and Victoria, Australia.

OBJECTIVES: We examined the longitudinal effect of schools' drug policies on student marijuana use. METHODS: We used data from the International Youth Development Study, which surveyed state-representative samples of students from Victoria, Australia, and Washington State. In wave 1 (2002), students in grades 7 and 9 (n = 3264) and a school administrator from each participating school (n = 188) reported on school drug policies. In wave 2 (2003), students reported on their marijuana use. We assessed associations between student-reported and administrator-reported policy and student self-reported marijuana use 1 year later. RESULTS: Likelihood of student marijuana use was higher in schools in which administrators reported using out-of-school suspension and students reported low policy enforcement. Student marijuana use was less likely where students reported receiving abstinence messages at school and students violating school policy were counseled about the dangers of marijuana use. CONCLUSIONS: Schools may reduce student marijuana use by delivering abstinence messages, enforcing nonuse policies, and adopting a remedial approach to policy violations rather than use of suspensions.

A longitudinal study of the association of adolescent polydrug use, alcohol use and high school non-completion.

AIMS: Failure to complete high school predicts substantial economic and social disadvantage in adult life. The aim of this study was to determine the longitudinal association of mid-adolescent polydrug use and high school non-completion, relative to other drug use profiles. DESIGN: A longitudinal analysis of the relationship between polydrug use in three cohorts at grade 9 (age 14-15 years) and school non-completion (reported post-high school). SETTING: A State-representative sample of students across Victoria, Australia. PARTICIPANTS: A total of 2287 secondary school students from 152 high schools. The retention rate was 85%. MEASUREMENTS: The primary outcome was non-completion of grade 12 (assessed at age 19-23 years). At grade 9, predictors included 30-day use of eight drugs, school commitment, academic failure and peer drug use. Other controls included socio-economic status, family relationship quality, depressive symptoms, gender, age and cohort. FINDINGS: Three distinct classes of drug use were identified-no drug use (31.7%), mainly alcohol use (61.8%) and polydrug use (6.5%). Polydrug users were characterized by high rates of alcohol, tobacco and cannabis use. In the full model, mainly alcohol users and polydrug users were less likely to complete school than non-drug users [odds ratio (OR) = 1.54, 95% confidence interval (CI) = 1.17-2.03) and OR = 2.51, 95% CI = 1.45-4.33), respectively, P < 0.001]. These effects were independent of school commitment, academic failure, peer drug use and other controls. CONCLUSIONS: Mid-adolescent polydrug use in Australia predicts subsequent school non-completion after accounting for a range of potential confounding factors. Adolescents who mainly consume alcohol are also at elevated risk of school non-completion.

Social norms in the development of adolescent substance use: a longitudinal analysis of the International Youth Development Study.

Identifying specific aspects of peer social norms that influence adolescent substance use may assist international prevention efforts. This study examines two aggregated measures of social norms in the school setting and their predictive association with substance (alcohol, tobacco and marijuana) use 2 years later in a large cross-national population-based cohort of adolescents. The primary hypothesis is that in Grade 7 both "injunctive" school norms (where students associate substance use with "coolness") and "descriptive" norms (where student substance use is common) will predict Grade 9 substance use. Data come from the International Youth Development Study, including 2,248 students (51.2% female) in the US and Australia attending 121 schools in Grade 7. Independent variables included injunctive norms (aggregating measures of school-wide coolness ratings of each substance use) and descriptive norms (aggregating the prevalence of school substance use) in Grade 7. Dependent variables included binge drinking and current use of alcohol, tobacco and marijuana in Grade 9. Associations between each type of school-wide social norm and substance use behaviors in Grade 9 were tested using multilevel logistic regression, adjusting for covariates. In unadjusted models, both injunctive and descriptive norms each significantly predicted subsequent substance use. In fully adjusted models, injunctive norms were no longer significantly associated with Grade 9 use, but descriptive norms remained significantly associated with tobacco and marijuana use in the expected direction. The findings identify descriptive social norms in the school context as a particularly important area to address in adolescent substance use prevention efforts.

Adolescent predictors and environmental correlates of young adult alcohol use problems.

AIMS: To examine the rates of young adult alcohol and drug use and alcohol problems, adolescent predictors of young adult alcohol problems and correlations with young adult social, work and recreational environments. DESIGN: Adolescents were followed longitudinally into young adulthood. Predictors were measured in grade 9 (average age 15), and environmental correlates and outcomes in young adulthood (average age 21). SETTING: Students recruited in Victoria, Australia in 2002, were resurveyed in 2010/11. PARTICIPANTS: Analytical n=2309, 80% retention. MEASUREMENTS: Adolescent self-report predictors included past-month alcohol use. Young adults completed the Alcohol Use Disorders Identification Test (AUDIT) together with reports of environmental influences. FINDINGS: Comparisons to United States national school graduate samples revealed higher rates of alcohol, tobacco and illicit drug use (other than cannabis) in Victoria. For example, rates of past month use at age 21-22 were: alcohol 69.3% US versus 84.9%, 95% confidence interval (CI) 81.3-88.6% Victoria; illicit drugs (other than cannabis) 8.8 versus 12.7%, CI 9.7-15.7%. AUDIT alcohol problems (scored 8+) were identified for 41.2%, CI 38.8-43.6% of young adults in Victoria. The likelihood of young adult alcohol problems was higher for frequent adolescent alcohol users and those exposed to environments characterized by high alcohol use and problems in young adulthood. CONCLUSIONS: High rates of alcohol problems are evident in more than two in five Australian young adults, and these problems appear to be influenced both by earlier patterns of adolescent alcohol use and by young adult social, work and recreational environments.

Prevention of common mental disorders: what can we learn from those who have gone before and where do we go next?

OBJECTIVE: Prevention strategies have made a major contribution to the considerable successes in reductions in cardiovascular disease and cancer mortality seen in recent decades. However, in the field of psychiatry, similar population-level initiatives in the prevention of common mental disorders, depression and anxiety, are noticeably lacking. This paper aims to provide a brief overview of the existing literature on the topic of the prevention of common mental disorders and a commentary regarding the way forward for prevention research and implementation. METHODS: This commentary considers what we currently know, what we might learn from the successes and failures of those working in prevention of other high prevalence health conditions, and where we might go from here. Taking cognisance of previous preventive models, this commentary additionally explores new opportunities for preventive approaches to the common mental disorders. RESULTS: The consensus from a large body of evidence supports the contention that interventions to prevent mental disorders across the lifespan can be both effective and cost-effective. However, funding for research in the area of prevention of common mental disorders is considerably lower than that for research in the areas of treatment, epidemiology and neurobiology. Thus, there is a clear imperative to direct funding towards prevention research to redress this imbalance. Future prevention interventions need to be methodologically rigorous, scalable to the population level and include economic evaluation. Evidence-based knowledge translation strategies should be developed to ensure that all stakeholders recognise preventing mental disorders as an imperative, with appropriate resources directed to this objective. CONCLUSION: There has been a recent expansion of research into potentially modifiable risk factors for depression, and it is now timely to make a concerted effort to advance the field of prevention of common mental disorders.

Does school suspension affect subsequent youth nonviolent antisocial behavior? A longitudinal study of students in Victoria, Australia and Washington State, United States.

School suspension has been not only associated with negative behaviours but is predictive of future poor outcomes. The current study investigates a) whether school suspension is a unique predictor of youth nonviolent antisocial behaviour (NVAB) relative to other established predictors, and b) whether the predictors of NVAB are similar in Australia and the United States (U.S.). The data analysed here draws on two state-wide representative samples of Grade 7 and 9 students in Victoria, Australia and Washington State, U.S., resurveyed at 12-month follow-up (N = 3,677, 99% retention). School suspension did not uniquely predict NVAB in the final model. The predictors of NVAB, similar across states, included previous student NVAB; current alcohol and tobacco use; poor family management; association with antisocial friends; and low commitment to school. An implication of the findings is that U.S. evidence-based prevention programs targeting the influences investigated here could be trialled in Australia.