Pandemics, vulnerability, and prevention: time to fundamentally reassess how we value and communicate risk?: CITIES, HEALTH and COVID-19: Initial reflections and future challenges.

For over a decade, pandemics have been on the UK National Risk Register as both the likeliest and most severe of threats. Non-infectious 'lifestyle' diseases were already crippling our healthcare services and our economy. COVID-19 has exposed two critical vulnerabilities: firstly, the UK's failure to adequately assess and communicate the severity of non-communicable disease; secondly, the health inequalities across our society, due not least to the poor quality of our urban environments. This suggests a potentially disastrous lack of preventative action and risk management more generally, notably with regards to the existential risks from the climate and ecological crises.

Childhood Risk Factors for Heavy Episodic Alcohol Use and Alcohol Problems in Late Adolescence: A Marginal Structural Model Analysis.

OBJECTIVE: This study seeks to clarify the nature of the association between five well-studied late childhood predictors and alcohol-related behaviors in adolescence. METHOD: We examined, in 7,168 subjects from the Avon Longitudinal Study of Parents and Children (ALSPAC), using linear probability and marginal structural models, the association between parental alcohol problems, peer group deviance, antisocial behavior, and low parental monitoring, and sensation seeking assessed at multiple times from ages 12.5 to 18 years and heavy episodic drinking and alcohol problems at ages 16.5, 17.5, and 20 years. RESULTS: Based on the pattern of the attenuation in the association with heavy episodic drinking and alcohol problems from the linear probability to marginal structural models, our five factors were divisible into three groups. For parental alcohol problems, no substantial attenuation was seen. For peer group deviance and antisocial behavior, the associations in the marginal structural models were modestly attenuated (10%-20%). By contrast, for low parental monitoring and sensation seeking, moderate attenuations of 41% and 35%, respectively, were observed. CONCLUSIONS: Our results are consistent with the hypothesis that all or nearly all of the association between parental alcohol problems and heavy episodic drinking and alcohol problems in mid to late adolescence is causal. For peer group deviance and antisocial behavior, the large majority of the associations appear to be causal, but confounding influences are also present. However, for low parental monitoring and sensation seeking, our findings suggest that a substantial proportion of the observed association with alcohol outcomes reflects confounding rather than causal influences.

Socioeconomic status and alcohol-related behaviors in mid- to late adolescence in the Avon Longitudinal Study of Parents and Children.

OBJECTIVE: Prior studies of the relationship between socioeconomic status (SES) and alcohol consumption and problems in adolescence have been inconclusive. Few studies have examined all three major SES indicators and a broad range of alcohol-related outcomes at different ages. METHOD: In the Avon Longitudinal Study of Parents and Children cohort, we examined (by logistic regression, with differential weighting to control for attrition) the relationship between family income and parental education and occupational status, and five alcohol outcomes assessed at ages 16 and 18 years. RESULTS: At age 16, high SES-as indexed by income and education-significantly predicted frequent alcohol consumption. Low SES-as measured by education and occupational status-predicted alcohol-related problems. At age 18, high SES-particularly income and education-significantly predicted frequent alcohol consumption and heavy episodic drinking and, more weakly, symptoms of alcohol dependence. All three measures of SES were inversely related to high-quantity consumption and alcohol behavioral problems. CONCLUSIONS: In adolescents in the United Kingdom, the relationship between SES and alcohol-related behaviors is complex and varies as a function of age, SES measure, and specific outcome. High SES tends to predict increased consumption and, in later adolescence, heavy episodic drinking and perhaps symptoms of alcohol dependence. Low SES predicts alcohol-related behavioral problems and, in later adolescence, high-quantity alcohol consumption.