Effectiveness of a Web-Based Individual Coping and Alcohol Intervention Program for Children of Parents With Alcohol Use Problems: Randomized Controlled Trial.

BACKGROUND: Children whose parents have alcohol use problems are at an increased risk of several negative consequences, such as poor school performance, an earlier onset of substance use, and poor mental health. Many would benefit from support programs, but the figures reveal that only a small proportion is reached by existing support. Digital interventions can provide readily accessible support and potentially reach a large number of children. Research on digital interventions aimed at this target group is scarce. We have developed a novel digital therapist-assisted self-management intervention targeting adolescents whose parents had alcohol use problems. This program aims to strengthen coping behaviors, improve mental health, and decrease alcohol consumption in adolescents. OBJECTIVE: This study aims to examine the effectiveness of a novel web-based therapist-assisted self-management intervention for adolescents whose parents have alcohol use problems. METHODS: Participants were recruited on the internet from social media and websites containing health-related information about adolescents. Possible participants were screened using the short version of the Children of Alcoholics Screening Test-6. Eligible participants were randomly allocated to either the intervention group (n=101) or the waitlist control group (n=103), and they were unblinded to the condition. The assessments, all self-assessed, consisted of a baseline and 2 follow-ups after 2 and 6 months. The primary outcome was the Coping With Parents Abuse Questionnaire (CPAQ), and secondary outcomes were the Center for Epidemiological Studies Depression Scale, Alcohol Use Disorders Identification Test (AUDIT-C), and Ladder of Life (LoL). RESULTS: For the primary outcome, CPAQ, a small but inconclusive treatment effect was observed (Cohen d=-0.05 at both follow-up time points). The intervention group scored 38% and 46% lower than the control group on the continuous part of the AUDIT-C at the 2- and 6-month follow-up, respectively. All other between-group comparisons were inconclusive at either follow-up time point. Adherence was low, as only 24% (24/101) of the participants in the intervention group completed the intervention. CONCLUSIONS: The findings were inconclusive for the primary outcome but demonstrate that a digital therapist-assisted self-management intervention may contribute to a reduction in alcohol consumption. These results highlight the potential for digital interventions to reach a vulnerable, hard-to-reach group of adolescents but underscore the need to develop more engaging support interventions to increase adherence. TRIAL REGISTRATION: ISRCTN Registry ISRCTN41545712; https://www.isrctn.com/ISRCTN41545712?q=ISRCTN41545712. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/1471-2458-12-35.

Drug Use Changes at the Individual Level: Results from a Longitudinal, Multisite Survey in Young Europeans Frequenting the Nightlife Scene.

BACKGROUND: Monitoring emerging trends in the increasingly dynamic European drug market is vital; however, information on change at the individual level is scarce. In the current study, we investigated changes in drug use over 12 months in European nightlife attendees. METHOD: In this longitudinal online survey, changes in substances used, use frequency in continued users, and relative initiation of use at follow-up were assessed for 20 different substances. To take part, participants had to be aged 18-34 years; be from Belgium, Italy, the Netherlands, Sweden, or the UK; and have attended at least 6 electronic music events in the past 12 months at baseline. Of 8,045 volunteers at baseline, 2,897 completed the survey at both time points (36% follow-up rate), in 2017 and 2018. RESULTS: The number of people using ketamine increased by 21% (p < 0.001), and logarithmized frequency of use in those continuing use increased by 15% (p < 0.001; 95% CI: 0.07-0.23). 4-Fluoroamphetamine use decreased by 27% (p < 0.001), and logarithmized frequency of use in continuing users decreased by 15% (p < 0.001, 95% CI: -0.48 to -0.23). The drugs with the greatest proportion of relative initiation at follow-up were synthetic cannabinoids (73%, N = 30), mephedrone (44%, N = 18), alkyl nitrites (42%, N = 147), synthetic dissociatives (41%, N = 15), and prescription opioids (40%, N = 48). CONCLUSIONS: In this European nightlife sample, ketamine was found to have the biggest increase in the past 12 months, which occurred alongside an increase in frequency of use in continuing users. The patterns of uptake and discontinuation of alkyl nitrates, novel psychoactive substances, and prescription opioids provide new information that has not been captured by existing cross-sectional surveys. These findings demonstrate the importance of longitudinal assessments of drug use and highlight the dynamic nature of the European drug landscape.

Psychometric properties of the short version of the children of alcoholics screening test (CAST-6) among Swedish adolescents.

AIMS: The Children of Alcoholics Screening Test (CAST-6) is a brief screening instrument developed to identify children with parents having problematic alcohol use. The aim of this study was to evaluate the psychometric properties of the CAST-6 among adolescents aged 15-18 years, and also to identify an optimal cut-off score for this age group. METHODS: A total of 3000 15 to18 year-olds were randomly selected from a register of postal addresses in Sweden. An invitation letter, including access information to the electronic questionnaire, was sent out by regular mail and 1450 adolescents responded with baseline data. Test-retest reliability within a 2-3-week period was calculated based on the 111 respondents who answered the same questionnaire twice. To determine an optimal cut-off score, a small treatment-seeking sample (n = 22) was recruited from a support group agency to be used as a reference group. RESULTS: The six items of the CAST-6 screening test loaded onto one latent factor with good internal consistency (alpha = 0.88), and excellent test-retest reliability (ICC = 0.93, 95% CI 0.90-0.95). The optimal cut-off score among adolescents was 2 points with a sensitivity of 55% and specificity of 79% (AUROC = 0.71, 95% CI 0.58-0.83). CONCLUSIONS: The CAST-6 has good to excellent psychometric properties among adolescents. The identified optimal cut-off score of 2 points should be treated with caution due to study limitations. The CAST-6 can be used in various settings to identify a vulnerable at-risk group of children and adolescents that may be in need of support.

Illicit Drugs in the Nightlife Setting: Changes in Employee Perceptions and Drug Use over a Fifteen-Year Period.

BACKGROUND: Illicit drug use is common in nightlife settings and associated with various public health-related problems, making this an important arena for prevention. Purpose/objectives: To assess perceived prevalence of illicit drug use in the Stockholm nightlife setting, use of and attitudes toward illicit drugs among employees at licensed premises. Also, to make comparisons with two identical measurements from 2001 and 2007/08, and to explore potential differences related to own drug use, type of licensed premise, age or gender. Methods: Cross-sectional surveys were conducted at three time-points: 2001, 2007/08, and 2016/17, comprising employees at licensed premises in Stockholm participating in STAD's Responsible Beverage Service training program. A total of 665 persons (mean age 28 years, 53% women) were included in the 2016/2017 measurement. Results: A majority of the respondents reported having observed patrons intoxicated by illicit drugs in the last six months, and agreed that patrons intoxicated by illicit drugs should be asked to leave licensed premises. The belief that one had observed patrons intoxicated by illicit drugs was more common among respondents who had themselves been using illicit drugs during the last year, and also among employees at nightclubs. Furthermore, comparisons with previous time-points showed a significant increase in the proportion of employees using illicit drugs. Almost half of the respondents in the youngest age group (18-24 years) reported illicit drug use during the last year. Conclusions/importance: Observation and use of illicit drugs are common among employees in the Stockholm nightlife setting and has increased significantly during the past decade.

Do professionals ask about children when establishing a collaborative individual plan for clients? A cross-sectional study.

Aim: To examine the extent to which structured action plans, i.e. collaborative individual plans (CIPs), used by professionals within the psychiatric care, substance use treatment services and social services, evaluate if clients have children, and if professionals take actions if clients do have children. According to Swedish law, a CIP should be established when a client is in need of care from more than one branch of the care network. Professionals who meet adult clients have the opportunity to identify children at risk. Including a question in the CIP on whether a client has a child is a good approach to identify children in need of support.Methods: Cross-sectional data from professionals were collected prior to attending a three-day CIP course. A total of 705 individuals (n = 797 invited) responded to the questionnaire.Results: More than 90% reported that they meet clients for whom a CIP should be established, and 52.6% of these (n = 346) were aware of an existing CIP template within their organization. Approximately 30% (n = 203) reported that this template included an item on whether the client has one or more children. Of these, a majority reported ensuring that the children receive adequate care (83.3%, n = 169), and that they follow up on the receipt of such care (62.6%, n = 125).Conclusions: The care network needs to implement CIPs to a higher degree, and CIP templates need to include items about the clients' children to ensure that children at risk are identified and thereby can receive adequate support.

Psychometric Properties of the AUDIT, AUDIT-C, CRAFFT and ASSIST-Y among Swedish Adolescents.

BACKGROUND/AIMS: Not enough is known about the psychometric properties of screening instruments for problematic alcohol consumption among adolescents. The aim of the current study was to evaluate and compare the performance of the screening instruments: Alcohol Use Disorders Identification Test (AUDIT), AUDIT-C, CRAFFT, and the alcohol domain of Alcohol, Smoking and Substance Involvement Screening Test-Youth (ASSIST-Y) among adolescents and to suggest optimal cut-offs indicating problematic use. METHODS: Data was collected from a general population sample (n = 1,421) and a treatment-seeking sample (n = 59) using electronic versions of the instruments. RESULTS: The internal consistencies for the instruments were fair (alpha's AUDIT 0.74, AUDIT-C 0.75, CRAFFT 0.67, ASSIST-Y 0.62), and test-retest reliabilities were good to excellent (intraclass correlation coefficients AUDIT 0.86, AUDIT-C 0.93, CRAFFT 0.77, ASSIST-Y 0.63). The CRAFFT and ASSIST-Y demonstrated reasonable construct validities while factor solutions for AUDIT and AUDIT-C could not be determined. The optimal cut-off score was 2 for both CRAFFT and ASSIST-Y (61 and 73% sensitivities and 79 and 65% specificities, respectively), while sensitivity scores were poor for AUDIT and AUDIT-C. CONCLUSION: Based on the current sample, ASSIST-Y and the CRAFFT performed better than AUDIT and AUDIT-C. Health-care clinics working with adolescents should carefully consider their choice of screening instruments.

Concurrent validity of the Alcohol Use Disorders Identification Test (AUDIT) in relation to Alcohol Use Disorder (AUD) severity levels according to the brief DSM-5 AUD diagnostic assessment screener.

Aims: The Alcohol Use Disorders Identification Test (AUDIT) is a well-established and widely used screening instrument. It has been shown that AUDIT has good criterion validity in relation to alcohol abuse and dependence according to DSM-IV, but it has not yet been validated following the introduction of the DSM-5 diagnostic system. The aim of this study was to evaluate concurrent validity for the AUDIT in relation to self-reported DSM-5 severity levels for Alcohol Use Disorder (AUD) in a Swedish general population sample. Methods: A postal questionnaire, containing the AUDIT and the 13-item brief DSM-5 AUD diagnostic assessment screener, was sent to a random sample of 1,500 persons drawn from the Swedish population, aged between 17 and 80 years and having a public residence address in Sweden. To evaluate the concurrent validity of AUDIT in relation to DSM-5 severity criteria for AUD, a Receiver Operating Characteristics (ROC) curve analysis was conducted. Results: Area under the curve (AUROC) showed excellent differentiation between AUD or not, mild (.93), moderate (.92) and severe (.99). Higher individual AUDIT scores were associated with more severe levels of AUD according to the DSM-5 screener. The optimal cutoff scores approximate earlier research on the DSM-IV and were identified as 5, 7 and 13 points, respectively, for mild, moderate and severe AUD. Conclusions: Our findings indicate that AUDIT is a valid screener for detecting concurrent AUD at three severity levels in the Swedish general population.

Alcohol habits in Sweden during 1997-2018: a repeated cross-sectional study.

Aims: This study describes changes in alcohol habits in age and gender strata among the Swedish general population during the 21-year period following the Swedish EU membership in 1995. Methods: The Alcohol Use Disorders Identification Test (AUDIT) was distributed as a postal questionnaire to randomly selected cross-sectional samples every fourth year, starting in 1997. Results: Six samples were included in this study. A comparison between 2014 and 2018 showed a tendency to decreasing average total AUDIT scores, particularly among men and in the youngest age group (Cohen's d = 0.28). Conclusion: The results should be understood in the context of declining response rates in this type of survey.

Overserving and Allowed Entry of Obviously Alcohol-Intoxicated Spectators at Sporting Events.

BACKGROUND: Alcohol intoxication among spectators at sporting events and related problems, such as violence, are of great concern in many countries around the world. However, knowledge is scarce about whether or not alcohol is served to obviously intoxicated spectators at licensed premises inside and outside the sporting arenas, and if obviously intoxicated spectators are allowed entrance to these events. The objective of this study was therefore to examine the occurrences of overserving at licensed premises inside and outside arenas, and of allowed entry of obviously intoxicated spectators into arenas. METHODS: An observational study assessing the rate of denied alcohol service and denied entry to arenas of trained professional actors portraying a standardized scene of obvious alcohol intoxication (i.e., pseudo-patrons) was conducted. The scene was developed by an expert panel, and each attempt was monitored by an observer. The settings were 2 arenas hosting matches in the Swedish Premier Football League in the largest city in Sweden and 1 arena in the second largest city, including entrances and licensed premises inside and outside the arenas. RESULTS: The rates of denied alcohol service were 66.9% at licensed premises outside the arenas (n = 151) and 24.9% at premises inside the arenas (n = 237). The rate of denied entry to the arenas (n = 102) was 10.8%. CONCLUSIONS: Overserving and allowed entry of obviously alcohol-intoxicated spectators are problematic at sporting events in Sweden and may contribute to high overall intoxication levels among spectators. The differences in server intervention rates indicate that serving staff at licensed premises inside the arenas and entrance staff are not likely to have been trained in responsible beverage service. This result underscores the need for server training among staff at the arenas.

Prevalence of children whose parents have a substance use disorder: Findings from a Swedish general population survey.

AIMS: The present study examined the prevalence of Swedish children living with at least one parent whom has a substance use disorder (SUD), i.e. either an alcohol use disorder (AUD) or a drug use disorder (DUD). METHODS: A 2013 cross-sectional survey of a nationally representative sample (n = 15,576) of the Swedish adult population 17-84 years of age was used. The response rate was 59.3%. SUDs were measured using selected parts of the Mini International Neuropsychiatric Interview (MINI), derived from the 4th edition of the diagnostic and statistical manual of mental disorders (DSM-IV). In total, 3778 parents with 7448 children under the age of 18 years participated. RESULTS: The proportion of children whose parent had a SUD was 4.6%, implying that around 90,000 children in Sweden experience this situation. Having a parent with an AUD was most common (3.7%), while 0.7% and 0.2% had a parent with a DUD and both (AUD plus DUD), respectively. CONCLUSIONS: Our results showed that a substantial number of children in Sweden have parents with a SUD and that it is important to consider both alcohol and drugs, when estimating the size of this group. Our findings call for further strategies to support these children and their families.

Alcohol prevention at sporting events: study protocol for a quasi-experimental control group study.

BACKGROUND: Alcohol intoxication and overserving of alcohol at sporting events are of great concern, given the relationships between alcohol consumption, public disturbances, and violence. During recent years this matter has been on the agenda for Swedish policymakers, authorities and key stakeholders, with demands that actions be taken. There is promising potential for utilizing an environmental approach to alcohol prevention as a strategy to reduce the level of alcohol intoxication among spectators at sporting events. Examples of prevention strategies may be community mobilization, Responsible Beverage Service training, policy work, and improved controls and sanctions. This paper describes the design of a quasi-experimental control group study to examine the effects of a multi-component community-based alcohol intervention at matches in the Swedish Premier Football League. METHODS: A baseline assessment was conducted during 2015 and at least two follow-up assessments will be conducted in 2016 and 2017. The two largest cities in Sweden are included in the study, with Stockholm as the intervention area and Gothenburg as the control area. The setting is Licensed Premises (LP) inside and outside Swedish football arenas, in addition to arena entrances. Spectators are randomly selected and invited to participate in the study by providing a breath alcohol sample as a proxy for Blood Alcohol Concentration (BAC). Actors are hired and trained by an expert panel to act out a standardized scene of severe pseudo-intoxication. Four types of cross-sectional data are generated: (i) BAC levels among ≥ 4 200 spectators, frequency of alcohol service to pseudo-intoxicated patrons attempting to purchase alcohol at LP (ii) outside the arenas (≥200 attempts) and (iii) inside the arenas (≥ 200 attempts), and (iv) frequency of security staff interventions towards pseudo-intoxicated patrons attempting to enter the arenas (≥ 200 attempts). DISCUSSION: There is an urgent need nationally and internationally to reduce alcohol-related problems at sporting events, and it is essential to test prevention strategies to reduce intoxication levels among spectators. This project makes an important contribution not only to the research community, but also to enabling public health officials, decision-makers, authorities, the general public, and the sports community, to implement appropriate evidence-based strategies.

A web-based group course intervention for 15-25-year-olds whose parents have substance use problems or mental illness: study protocol for a randomized controlled trial.

BACKGROUND: Depending on the definitions used, between 5 and 20 % of all Swedish children grow up with at least one parent suffering from alcohol problems, while 6 % have at least one parent who has received inpatient psychiatric care, conditions that may affect the children negatively. Nine out of ten Swedish municipalities therefore provide support resources, but less than 2 % of these children are reached by such support. Delivering intervention programs via the Internet is a promising strategy. However, web-based programs targeting this at-risk group of children are scarce. We have previously developed a 1.5-h-long web-based self-help program, Alcohol & Coping, which appears to be effective with regards to adolescents' own alcohol consumption. However, there is a need for a more intense program, and therefore we adapted Kopstoring, a comprehensive Dutch web-based psycho-educative prevention program, to fit the Swedish context. The purpose of the program, which in Swedish has been called Grubbel, is to strengthen protective factors, such as coping skills and psychological well-being, prevent the development of psychological disorders, and reduce alcohol consumption. METHODS/DESIGN: The aim of the current study is to evaluate the effectiveness of Grubbel, which targets 15-25-year-olds whose parents have substance use problems and/or mental illness. Specific research questions relate to the participants' own coping strategies, mental health status and substance use. The study was initiated in the spring of 2016 and uses a two-armed RCT design. Participants will be recruited via social media and also through existing agencies that provide support to this target group. The assessment will consist of a baseline measurement (t0) and three follow-ups after six (t1), 12 (t2), and 24 months (t3). Measures include YSR, CES-DC, Ladder of Life, Brief COPE, AUDIT-C, and WHOQOL-BREF. DISCUSSION: Studies have revealed that the majority of children whose parents have substance use or mental health problems are not reached by the existing support. Thus, there is an urgent need to develop, implement, and evaluate novel intervention programs and disseminate successful programs to a broader audience. This study, investigating the effects of a web-based intervention, therefore makes an important contribution to this field of research. TRIAL REGISTRATION: ISRCTN10099247 . Retrospectively registered on August 31, 2016.

Effectiveness of a Web-Based Screening and Fully Automated Brief Motivational Intervention for Adolescent Substance Use: A Randomized Controlled Trial.

BACKGROUND: Mid-to-late adolescence is a critical period for initiation of alcohol and drug problems, which can be reduced by targeted brief motivational interventions. Web-based brief interventions have advantages in terms of acceptability and accessibility and have shown significant reductions of substance use among college students. However, the evidence is sparse among adolescents with at-risk use of alcohol and other drugs. OBJECTIVE: This study evaluated the effectiveness of a targeted and fully automated Web-based brief motivational intervention with no face-to-face components on substance use among adolescents screened for at-risk substance use in four European countries. METHODS: In an open-access, purely Web-based randomized controlled trial, a convenience sample of adolescents aged 16-18 years from Sweden, Germany, Belgium, and the Czech Republic was recruited using online and offline methods and screened online for at-risk substance use using the CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) screening instrument. Participants were randomized to a single session brief motivational intervention group or an assessment-only control group but not blinded. Primary outcome was differences in past month drinking measured by a self-reported AUDIT-C-based index score for drinking frequency, quantity, and frequency of binge drinking with measures collected online at baseline and after 3 months. Secondary outcomes were the AUDIT-C-based separate drinking indicators, illegal drug use, and polydrug use. All outcome analyses were conducted with and without Expectation Maximization (EM) imputation of missing follow-up data. RESULTS: In total, 2673 adolescents were screened and 1449 (54.2%) participants were randomized to the intervention or control group. After 3 months, 211 adolescents (14.5%) provided follow-up data. Compared to the control group, results from linear mixed models revealed significant reductions in self-reported past-month drinking in favor of the intervention group in both the non-imputed (P=.010) and the EM-imputed sample (P=.022). Secondary analyses revealed a significant effect on drinking frequency (P=.037) and frequency of binge drinking (P=.044) in the non-imputation-based analyses and drinking quantity (P=.021) when missing data were imputed. Analyses for illegal drug use and polydrug use revealed no significant differences between the study groups (Ps>.05). CONCLUSIONS: Although the study is limited by a large drop-out, significant between-group effects for alcohol use indicate that targeted brief motivational intervention in a fully automated Web-based format can be effective to reduce drinking and lessen existing substance use service barriers for at-risk drinking European adolescents. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Registry: ISRCTN95538913; http://www.isrctn.com/ISRCTN95538913 (Archived by WebCite at http://www.webcitation.org/6XkuUEwBx).

Evaluation of support group interventions for children in troubled families: study protocol for a quasi-experimental control group study.

BACKGROUND: Support groups for children in troubled families are available in a majority of Swedish municipalities. They are used as a preventive effort for children in families with different parental problems such as addiction to alcohol/other drugs, mental illness, domestic violence, divorce situations, or even imprisonment. Children from families with these problems are a well-known at-risk group for various mental health and social problems. Support groups aim at strengthening children's coping behaviour, to improve their mental health and to prevent a negative psycho-social development. To date, evaluations using a control-group study design are scarce. The aim of the current study is to evaluate the effects of support groups. This paper describes the design of an effectiveness study, initially intended as a randomized controlled trial, but instead is pursued as a quasi-experimental study using a non-randomized control group. METHODS/DESIGN: The aim is to include 116 children, aged 7-13 years and one parent/another closely related adult, in the study. Participants are recruited via existing support groups in the Stockholm county district and are allocated either into an intervention group or a waiting list control group, representing care as usual. The assessment consists of questionnaires that are to be filled in at baseline and at four months following the baseline. Additionally, the intervention group completes a 12-month follow-up. The outcomes include the Strength and Difficulties Questionnaire (SDQ S11-16), the Kids Coping Scale, the "Ladder of life" which measures overall life satisfaction, and "Jag tycker jag är" (I think I am) which measures self-perception and self-esteem. The parents complete the SDQ P4-16 (parent-report version) and the Swedish scale "Familjeklimat" (Family Climate), which measures the emotional climate in the family. DISCUSSION: There is a need for evaluating the effects of support groups targeted to children from troubled families. This quasi-experimental study therefore makes an important contribution to this novel field of research. In the article various problems related to pursuing a study with children at risk are discussed. TRIAL REGISTRATION: ISRCTN52310507.

Long-term effects of an alcohol prevention program at licensed premises: a Swedish 20-year follow-up study.

Background: In 1996, a multicomponent community-based alcohol prevention program in Responsible Beverage Service (RBS) targeting licensed premises was developed by STAD (Stockholm Prevents Alcohol and Drug Problems) and implemented in Stockholm, Sweden. The program consists of community mobilization and collaboration, training, and enforcement. Early evaluations have shown a significant increase in the refusal rates of alcohol service to intoxicated patrons, from 5% in 1996 to 70% in 2001, and a 29% decrease in the frequency of police-reported violence. A cost-effectiveness analysis showed a cost-saving ratio of 1:39. The program was institutionalized by a collaborative steering group consisting of community stakeholders. This study aimed to evaluate the long-term effects over 20 years of the RBS program. The indicator chosen was the rate of alcohol overserving to obviously intoxicated patrons at licensed premises in Stockholm. Methods: A 20-year follow-up study was conducted using the same procedure as the baseline and previous follow-ups. Professional male actors (pseudopatrons) were trained by an expert panel to enact a standardized scene of obvious alcohol-intoxication. In 2016, 146 licensed premises located in the central part of Stockholm were randomly selected and visited. A review of program implementation from its initiation 1996 was conducted, examining critical events, including commitment from key actors in the community, training of bar staff, and enforcement. Results: At the 20-year follow-up, pseudopatrons were refused alcohol service in 76.7% of the attempts, which was at the same level (70%) as in the follow-up in 2001, thus indicating sustained effects of the RBS program. Compared with previous follow-ups, serving staff used more active intervention techniques in 2016 toward intoxicated patrons, such as refusing to take the order (56.9% in 2016 vs. 42.0% in 2001), and fewer passive techniques, such as ignoring patrons (6.5% in 2016 vs. 15.5% in 1999) or contacting a colleague (4.1% in 2016 vs. 25% in 2001). Conclusion: The sustained long-term effects of the RBS program are unique and can be explained by the high level of institutionalization of the multicomponent program, which is still ongoing in Stockholm. These findings can inform the dissemination of the program to other countries and settings.

Prevalence of adolescents who perceive their parents to have alcohol problems: a Swedish national survey using a web panel.

AIMS: The primary aim is to estimate the prevalence of Swedish adolescents who perceive their parent(s) to have alcohol problems. Additional research questions pertain to the prevalence of adolescents who think someone close to them drinks too much alcohol and if this has hurt them or caused them problems. METHODS: A cross-sectional design was employed using a web-based survey targeted to 1000 Swedish 16-19-year-olds randomly selected from a web panel. The questionnaire included the CAST-6 scale, used to assess whether or not participants perceived their parents' alcohol consumption as problematic, and questions relating to whether or not they think someone close to them drinks too much and if this has caused them problems. Data was weighted using a post-stratification procedure. RESULTS: The proportion of adolescents classified as having parents with alcohol problems was 20.1%. Further, 44.0% reported that they think someone close to them drinks too much alcohol and 9.6% that this has hurt them or caused them problems. CONCLUSIONS: These results indicate that the problem is widespread. Our findings are similar to previous research where a more indirect methodology has been adopted, using either psychiatric interviews or self-reported alcohol consumption of adults, to estimate the magnitude of the problem.

Police officers' perspective on doping and prevention among recreational athletes: a cross-sectional study.

Introduction: The use of anabolic androgenic steroids among recreational athletes has received growing attention in recent decades. Several countries have implemented bans on doping; however, recreational athletes and other subpopulations continue to use doping substances. Recognizing that the police play a crucial role in preventing the use and dealing of doping substances in Sweden, efforts have been made to intensify police interventions and enhance collaboration with other key actors. This study examined police officers' perceptions of doping as defined in Swedish law, related problems, and suggestions for effective prevention of doping in the society. Methods: A cross-sectional survey study was conducted using a web survey of police officers (N = 597). Data were analyzed using descriptive statistics and free-form text responses were analyzed using content analysis. Results: Participant responses to the survey (73.7% response rate) indicated that approximately 62.6% thought that doping is a societal problem, and approximately 26% perceived that the availability of doping substances has increased over the past three years. A total of 95.6% of respondents believed that doping occurred in connection with other crimes such as intimate partner violence (88.2%) and drug-related crimes (88.0%). Further, 96.3% of respondents perceived that it was their duty to prevent doping, but 63.8% indicated that doping-related work was not prioritized within their local police district. Discussion: Police officers perceived doping as a societal problem and expressed motivation to counteract it, highlighting increased knowledge, legislative changes, intensified doping prevention in gyms, and commitment from other societal actors to increase the effectiveness of doping prevention. Suggestions for increasing the efficiency of doping prevention included education and increased knowledge at all levels in the police organization, intensified prevention efforts at gyms, legislative changes to permit simplified doping test procedures, and breach of secrecy for postal items. There was also a suggestion for further engagement from other actors, such as healthcare workers, school officials, and non-governmental organizations.

Risky Sexual Behaviour and Sexual Victimization among Young People with Risky Substance Use in Europe-Perspectives from Belgium, Sweden, the Czech Republic, and Germany.

BACKGROUND: Research indicates that among the risks associated with young people's alcohol and illicit drug use are sexual risks. However, insights into co-occurrence of substance use and sexual risks in adolescent samples and possible differences across countries are limited. METHODS: A sample of 1449 adolescents from Belgium, Sweden, the Czech Republic, and Germany screened positive for risky alcohol/illicit drug use in a web-based intervention against alcohol and illicit drug use. They also reported incidents of sex while being drunk and/or high on drugs, condomless sex on these occasions, and sexualized touching and sexual victimization while being drunk or high on drugs. RESULTS: In the sample, 21.5% of the participants reported sexualized touching, 9.9% being victim to sexual assault, and 49.8% having had sex while being drunk and/or high on drugs; of the latter, 48.3% had condomless sex. Reports on having had sex while being drunk and/or high on drugs were associated with higher levels of past 30-day binge drinking. Being a victim of sexual assault was associated with past 30-day binge drinking only in young men. CONCLUSION: When devising preventive interventions against risky substance use in adolescents, an additional focus should be set on integrating steps against sexual risks.

Effects of the COVID-19 pandemic on mental health, working, and life situation of employees in the Swedish hospitality industry.

Introduction: Previous studies reported that the coronavirus disease (COVID-19) pandemic has negatively affected the mental health of employees in the hospitality industry internationally, however, its effect in Sweden has not been studied. Unlike several other countries, Sweden never enforced a lockdown. Restaurants, bars, and hotels could remain open and host a limited number of guests but had to abide by certain restrictions. Methods: A cross-sectional survey was distributed among hospitality industry employees containing questions regarding the perceived effects of the pandemic on the respondents' working and life situations and their physical and psychological health. The sample consisted of 699 individuals, with a response rate of 47.9%. Results: Although several respondents had been laid off or furloughed, the majority of the sample remained at the same employer. However, more than half of the respondents reported that their economic situation had deteriorated. Compared to before the pandemic, 38.1% experienced elevated levels of stress, 48.3% experienced elevated levels of worry, and 31.4% reported worsened mood. A deteriorating personal economy and difficulty in following COVID-19-related restrictions at work were associated with the worsening of these three mental health aspects. While the fear of becoming infected with COVID-19 was related to higher levels of stress, the fear of infecting others was related to higher levels of worry. Conclusion: Although Sweden imposed less strict measures than most other countries, the personal economy and mental health of hospitality workers were negatively affected by the COVID-19 pandemic.

Design of a Web-based individual coping and alcohol-intervention program (web-ICAIP) for children of parents with alcohol problems: study protocol for a randomized controlled trial.

BACKGROUND: It has been estimated that approximately 20% of all Swedish children grow up with parents having alcohol problems, which may result in negative outcomes among these children. Therefore, most Swedish municipalities provide resources for support, but at the same time figures reveal that not even 2% receive support, mainly due to difficulties in identifying and recruiting these children into support programs. Delivering intervention programs to children and adolescents via the Internet seems a promising strategy, but to date, the number of web-based interventions aimed at this target group is very scarce. We have therefore developed a novel internet-delivered therapist assisted self-management intervention called the web-ICAIP (Individual Coping and Alcohol Intervention Program) for adolescents having parents with alcohol problems. The purpose of the program is to strengthen adolescents' coping behavior, improve their mental health, and postponing the onset or decreasing risky alcohol consumption. This paper describes the web-ICAIP and the design of a randomized controlled trial (RCT) to measure the efficacy of this intervention. METHODS/DESIGN: The RCT will include at least 183 adolescents (15-19 year old) who will be randomly allocated to two conditions where one group has access to the web-ICAIP and the other is a waiting list control group. Participants will be recruited from websites containing information and facts for adolescents about alcohol and other drugs. Possible participants will be screened using the short version of the Children of Alcoholics Screening Test (CAST-6). The assessment consists of a baseline and two follow-up measurements taking place after two and six months, respectively. The primary outcomes include the Center for Epidemiological Studies Depression Scale (CES-DC), a coping behavior scale, and also the short version of the Alcohol Use Disorders Identification Test (AUDIT-C). Additional outcomes include the "Ladder of life" which measures overall life satisfaction and questions concerning program adherence. DISCUSSION: There is an urgent need for developing and evaluating web-based intervention programs which target children having parents with alcohol problems. This study will therefore make an important contribution to this novel field of research. TRIAL REGISTRATION: ISRCTN41545712.