The nature and characteristics of problem gaming, with a focus on ICD-11 diagnoses.

PURPOSE OF REVIEW: This review describes the diagnoses related to problem gaming that are included in ICD-11, published by the WHO in 2022. It summarizes the recent literature on the prevalence of Gaming Disorder, its structure, antecedents and comorbidities, and explores whether the range of diagnoses currently available adequately covers the range of experiences seen with problem gaming. RECENT FINDINGS: Overall, between 3 and 6% of the population worldwide are reported to have a gaming disorder as defined by ICD-11 or DSM-5. However, most studies are constrained by methodological issues such as nonrepresentative samples and the use of brief questionnaires to determine prevalence. ICD-11 Gaming Disorder is a psychometrically sound diagnosis. There is no diagnosis that currently captures the experience of harm from gaming, where the requirements for the diagnosis of Gaming Disorder are not reached. SUMMARY: There is evidence in support of the proposed new entity of 'Harmful Gaming', which encompasses mental and physical harm/impairment due to a repeated pattern of gaming, but where requirements for the diagnosis of Gaming Disorder are not met. Such a diagnosis would complete the spectrum of diagnoses available for problem or unhealthy gaming, similar to those for unhealthy substance use, and would provide a framework for a public health approach to reducing the overall harm from unhealthy gaming.

The prevalence of cannabis use disorders in people who use medicinal cannabis: A systematic review and meta-analysis.

BACKGROUND: The prevalence of cannabis use disorders (CUDs) in people who use cannabis recreationally has been estimated at 22%, yet there is a dearth of literature exploring CUDs among people who use medicinal cannabis. We aimed to systematically review the prevalence of CUDs in people who use medicinal cannabis. METHODS: In our systematic review and meta-analysis, we followed PRISMA guidelines and searched three databases (PsychInfo, Embase and PubMed) to identify studies examining the prevalence of CUDs in people who use medicinal cannabis. Meta-analyses were calculated on the prevalence of CUDs. Prevalence estimates were pooled across different prevalence periods using the DSM-IV and DSM-5. RESULTS: We conducted a systematic review of 14 eligible publications, assessing the prevalence of CUDs, providing data for 3681 participants from five different countries. The systematic review demonstrated that demographic factors, mental health disorders and the management of chronic pain with medicinal cannabis were associated with an elevated risk of CUDs. Meta-analyses were conducted on the prevalence of CUDs. For individuals using medicinal cannabis in the past 6-12 months, the prevalence of CUDs was 29% (95% CI: 21-38%) as per DSM-5 criteria. Similar prevalence was observed using DSM-IV (24%, CI: 14-38%) for the same period. When including all prevalence periods and using the DSM-5, the prevalence of CUDs in people who use medicinal cannabis was estimated at 25% (CI: 18-33%). CONCLUSIONS: The prevalence of CUDs in people who use medicinal cannabis is substantial and comparable to people who use cannabis for recreational reasons, emphasizing the need for ongoing research to monitor the prevalence of CUDs in people who use medicinal cannabis.

Cannabis use and cannabis use disorders and their treatment in the Europe.

This paper introduces the special issue on cannabis use in Europe. It describes data on the prevalence of cannabis use in Europe and the more limited data on the prevalence of cannabis use disorders, one of the most common forms of drug problem treated in many countries in Europe. It summarises what research has indicated about the adverse effects of acute and chronic cannabis use and discusses potential health system responses that may reduce some of these harms. These include public education about the risks of cannabis use; screening and brief interventions in primary medical settings; and specialist treatment for cannabis use disorders. It briefly indicates the special issues that may need to be addressed in dealing with the high rates of comorbidity between cannabis use disorders, other types of drug use disorders, and common mental disorders.

A systematic review of second-hand smoking mass media campaigns (2002-2022).

BACKGROUND: Second-hand smoking (SHS) increases the risk of chronic disease in adults and poses a serious health threat to children. Mass media campaigns are instrumental in raising awareness and reducing SHS exposure. There is a need to identify recent SHS mass media campaigns and assess their sustainability in terms of knowledge, attitudes, and behavioural changes. This systematic review summarises the characteristics and outcomes of mass media campaigns on SHS prevention. METHODS: PubMed, Embase, Web of Science, and grey literature were searched in November 2022 for SHS campaigns implemented between 2016 and 2022. The eligibility criteria included campaigns on the dangers or effects of SHS with any target group, dissemination medium, study design, or language. The database search identified 1,413 peer-reviewed titles, of which 82 full-texts were screened, with 14 meeting the eligibility criteria. The grey literature search identified 9,807 sources, of which 61 were included. We extracted data on the campaign characteristics, metrics, and smoking-related outcomes. The JBI critical appraisal tool was used to assess the risk of bias of the included studies. RESULTS: We found 73 SHS campaigns conducted between 2002 and 2022, across 50 countries. The campaigns reached 378 million people. The reported recall rates range from 8 to 76%. Of the 11 studies that reported smoking-related outcomes, 10 reported increased knowledge in understanding SHS risks (73-85%), five reported an increased prevalence of smoke-free homes, and two reported an increase in number of participants persuading others to quit smoking. Two studies reported a decrease in overall smoking, whereas three studies observed a reduction in smoking in the presence of children. CONCLUSION: The available data provide some support for the effectiveness of SHS campaigns in reducing smoking behaviours in homes and around children. However, the certainty of evidence was low due to the lack of a control group and the substantial heterogeneity in the outcomes assessed. Future campaigns need comprehensive evaluation and reporting to reduce publication bias.

Systematic review and meta-analysis of text messaging interventions to support tobacco cessation.

OBJECTIVE: To review randomised controlled trials (RCTs) investigating the effectiveness of text message-based interventions for smoking cessation, including the effects of dose (number of text messages) and concomitant use of behavioural or pharmacological interventions. DATA SOURCES: We searched seven databases (PubMed, CINAHL, PsycINFO, Scopus, EMBASE, Cochrane Library and Web of Science), Google Scholar and the reference lists of relevant publications for RCTs. Eligible studies included participants aged ≥15 years who smoked tobacco at enrolment. STUDY SELECTION: One reviewer screened titles and abstracts and two reviewers independently screened full texts of articles. DATA EXTRACTION: One of three reviewers independently extracted data on study and intervention characteristics and smoking abstinence rates using Qualtrics software. DATA SYNTHESIS: 30 of the 40 included studies reported higher rates of smoking cessation among those receiving text messaging interventions compared with comparators, but only 10 were statistically significant. A meta-analysis of seven RCTs found that participants receiving text messages were significantly more likely to quit smoking compared with participants in no/minimal intervention or 'usual care' conditions (risk ratio 1.87, 95% CI 1.52 to 2.29, p <0.001). Three trials found no benefit from a higher dose of text messages on smoking cessation. Two trials that tested the added benefit of text messaging to pharmacotherapy reported outcomes in favour of adding text messaging. CONCLUSIONS: Findings suggest that text messaging-based interventions are effective at promoting smoking cessation. Further research is required to establish if any additional benefit is gained from an increased number of text messages or concurrent pharmacotherapy or behavioural counselling.

Designing observational studies for credible causal inference in addiction research-Directed acyclic graphs, modified disjunctive cause criterion and target trial emulation.

Randomized controlled trials (RCTs) are considered the gold standard for causal inference. With a sufficient sample size, randomization removes confounding up to the time of randomization and allows the treatment effect to be isolated. However, RCTs may have limited generalizability and transportability and are often not feasible in addiction research due to ethical or logistical constraints. The importance of observational studies from real-world settings has been increasingly recognized in research on health. This paper provides an overview of modern approaches to designing observational studies that enable causal inference. It illustrates three key techniques, Directed Acyclic Graphs (DAGs), modified Disjunctive Cause Criterion and Target Trial Emulation, and discusses the strengths and limitations of their applications.

What is the hype on #MedicinalCannabis in the United States? A content analysis of medicinal cannabis tweets.

INTRODUCTION: Medicinal cannabis is now legal in 44 US jurisdictions. Between 2020 and 2021 alone, four US jurisdictions legalised medicinal cannabis. The aim of this study is to identify themes in medicinal cannabis tweets from US jurisdictions with different legal statuses of cannabis from January to June 2021. METHODS: A total of 25,099 historical tweets from 51 US jurisdictions were collected using Python. Content analysis was performed on a random sample of tweets accounting for the population size of each US jurisdictions (n = 750). Results were presented separately by tweets posted from jurisdictions where all cannabis use (non-medicinal and medicinal) is 'fully legalised', 'illegal' and legal for 'medical-only' use. RESULTS: Four themes were identified: 'Policy', 'Therapeutic value', 'Sales and industry opportunities' and 'Adverse effects'. Most of the tweets were posted by the public. The most common theme was related to 'Policy' (32.5%-61.5% of the tweets). Tweets on 'Therapeutic value' were prevalent in all jurisdictions and accounted for 23.8%-32.1% of the tweets. Sales and promotional activities were prominent even in illegal jurisdictions (12.1%-26.5% of the tweets). Fewer than 10% of tweets were about intoxication and withdrawal symptoms. DISCUSSION AND CONCLUSION: This study has explored if content themes of medicinal cannabis tweets differed by cannabis legal status. Most tweets were pro-cannabis and they were related to policy, therapeutic value, and sales and industry opportunities. Tweets on unsubstantiated health claims, adverse effects and crime warrants continued surveillance as these conversations could allow us to estimate cannabis-related harms to inform health surveillance.

How much cannabis is used in a joint in Australia? An experimental investigation into use by potency and frequency.

INTRODUCTION: Cannabis use is highly prevalent in Australia, yet current survey metrics measure tetrahydrocannabinol (THC) exposure with limited accuracy. Often survey items measure cannabis quantity by assuming specific modes of use (i.e., 'how many joints do you use?'), which fail to capture variations in cannabis use and the diverse modes of use (e.g., joints, cones, spliffs). This study investigated how much cannabis is used in these modes of administration in an Australian sample. METHODS: Participants (N = 31, Mage = 25.77; 51% university students) completed the Roll a Joint Paradigm in which they rolled joints, spliffs and packed cones as they would typically, using oregano as 'cannabis.' Participants then prepared each again but with cannabis of higher or lower potency. RESULTS: The amount of cannabis used across different modes of administration was variable: joints (range 0.10-1.25 g), spliffs (range 0.12-1.21 g) and cones (range 0.03-0.41 g). Participants who used cannabis daily rolled three times the amount of cannabis into a joint. DISCUSSION AND CONCLUSIONS: The amount of cannabis used in common modes of administration may be highly variable. Daily use may be associated using larger quantities of cannabis. Titration attempts based on potency were not proportional or consistent across modes of administration. The results indicate people may adjust the quantity of cannabis based on perceived potency, however, not proportional to THC concentration. Inconsistency in the amount of cannabis used based on potency and within different modes of administration may represent a problem for self-report metrics which ask participants to report cannabis use in joints.

A provisional evaluation of Australia's medical cannabis program.

In 2016, the Australian Government legislated to allow cannabis to be prescribed to patients as an unapproved medicine under the special access provisions of the Therapeutic Goods Act. This paper compares the Australian regulatory approach with other national approaches, outlines the main provisions of the Special Access Scheme for medical cannabis, describes how the program has evolved since 2017, includes an analysis of adverse events reported to the Therapeutic Goods Administration, and discusses the barriers that remain for patients who wish to access medical cannabis. It assesses how well the Australian program has addressed the challenges of providing patients with easier access to medical cannabis while ensuring that high-quality products are used safely and effectively under medical guidance.

Viral Vaping: A systematic review and meta analysis of e-cigarette and Tobacco-Related social media content and its influence on youth behaviours and attitudes.

AIMS: E-cigarette and tobacco-related content on social media continues to rise from lax restrictions on both personal and promotional posts. This content has been linked to various mechanisms of increased e-cigarette and tobacco use (i.e., lower risk perceptions and increased susceptibility). This study aimed to synthesis the association between exposure to e-cigarette and tobacco-related content and youth behaviours and attitudes. METHODS: A comprehensive search was conducted on PubMed, Scopus, PsycINFO and Web of Science. Studies published post-2004 reporting effect estimates for exposure or engagement with e-cigarette or tobacco content on social media and behaviour or attitude outcomes were included. RESULTS: Thirty-two studies (N = 274,283, aged 9 to 25 years) were included for synthesis. Meta-analyses revealed significant associations between engagement with tobacco content and use (OR 2.21; 95% CI = 1.27-3.82, p =.005; I2 = 96.4%), exposure to tobacco content and never users' lower risk perceptions (OR 0.68; 95% CI = 0.49-0.91; p =.011; I2 = 78.2%), and exposure to e-cigarette content and use (OR 1.37; 95% CI = 0.99-1.88; p = 0.058; I2 = 64.4%). There was no observed relationship between exposure to tobacco content and ever users' risk perceptions (OR 0.83; 95% CI = 0.61-1.13; p =.231; I2 = 83.5%). Qualitative synthesis found significant associations between tobacco exposure and increased current use and pro-tobacco attitudes; e-cigarette exposure and increased susceptibility and lower risk perceptions; tobacco engagement and increased susceptibility; e-cigarette engagement and increased use; dual exposure and increased susceptibility; and dual engagement and increased dual use. Mixed findings were identified for the influence of e-cigarette exposure on attitudes, tobacco exposure on susceptibility, dual exposure on dual use behaviours, and dual engagement on dual susceptibility. CONCLUSIONS: Findings suggest an association between exposure and engagement to e-cigarette or tobacco products on social media and use or pro-use attitudes among youth. Further substantive research in the area of youth-specific use and attitudes following exposure and engagement with e-cigarette and tobacco content is needed to quantify this association.

Longitudinal association between exposure to e-cigarette advertising and youth e-cigarette use in the United States.

BACKGROUND AND AIM: E-cigarette marketing strategies are targeting and appealing to youth, particularly through social media. This study examined the longitudinal relationship between recalled exposure to e-cigarette advertisements on social media and across five traditional advertising mediums, and e-cigarette use, a year later. DESIGN: Weighted regression analyses of waves 4 (W4; 2017), 4.5 (W4.5; 2018) and 5 (W5; 2019) from the Population Assessment of Tobacco and Health Study. SETTING: United States. PARTICIPANTS: Youth aged 12-17 years at W4 or W4.5 (N = 16,671). MEASUREMENTS: We examined the association between past 30-day recalled exposure to six different e-cigarette advertisement mediums (gas stations/convenience stores, social media/websites, newspaper/magazines, radio, billboard, TV) in W4.5 and past 30-day and past 12-month e-cigarette use in W5, while controlling for W4 e-cigarette use and covariates such as sociodemographic variables, academic performance, peer cigarette/e-cigarette use and other substance use. Associations between recalled exposure (W4.5) and lifetime use (W5) among e-cigarette naïve youth at W4.5 (N = 8,914) were also assessed. FINDINGS: Past 12-month and past 30-day e-cigarette use was significantly associated with recalled exposure to e-cigarette advertisement on social media/websites (aOR = 1.65 [99.17 %CI = 1.36,1.99; aOR = 1.49 [99.17 %CI = 1.13, 1.97]) and gas stations/convenience stores (aOR = 1.33; [99.17 %CI = 1.11,1.58]; aOR = 1.27 [99.17 %CI = 1.03,1.58]). Exposure to e-cigarette advertisement on social media/websites (aOR = 1.35 [99.17 %CI = 1.04,1.74]) and gas stations/convenience stores (aOR = 1.67 [99.17 %CI = 1.31,2.13]) was significantly associated with lifetime e-cigarette use among baseline youth who were e-cigarette naïve. CONCLUSIONS: Exposure to e-cigarette advertisement on social media/websites and gas stations/convenience stores was associated with youth e-cigarette use a year later. Stricter restrictions on marketing in these mediums is needed to limit youth exposure to e-cigarette marketing messages if we are to reduce e-cigarette use.

Predicting the long-term effects of electronic cigarette use on population health: a systematic review of modelling studies.

OBJECTIVE: To systematically review and synthesise the findings of modelling studies on the population impacts of e-cigarette use and to identify potential gaps requiring future investigation. DATA SOURCE AND STUDY SELECTION: Four databases were searched for modelling studies of e-cigarette use on population health published between 2010 and 2023. A total of 32 studies were included. DATA EXTRACTION: Data on study characteristics, model attributes and estimates of population impacts including health outcomes and smoking prevalence were extracted from each article. The findings were synthesised narratively. DATA SYNTHESIS: The introduction of e-cigarettes was predicted to lead to decreased smoking-related mortality, increased quality-adjusted life-years and reduced health system costs in 29 studies. Seventeen studies predicted a lower prevalence of cigarette smoking. Models that predicted negative population impacts assumed very high e-cigarette initiation rates among non-smokers and that e-cigarette use would discourage smoking cessation by a large margin. The majority of the studies were based on US population data and few studies included factors other than smoking status, such as jurisdictional tobacco control policies or social influence. CONCLUSIONS: A population increase in e-cigarette use may result in lower smoking prevalence and reduced burden of disease in the long run, especially if their use can be restricted to assisting smoking cessation. Given the assumption-dependent nature of modelling outcomes, future modelling studies should consider incorporating different policy options in their projection exercises, using shorter time horizons and expanding their modelling to low-income and middle-income countries where smoking rates remain relatively high.

The implementation and public health impacts of cannabis legalization in Canada: a systematic review.

AIMS: We provide a narrative summary of research on changes in cannabis arrests, cannabis products and prices, cannabis use and cannabis-related harm since legalization. METHODS: We systematically searched for research on the impacts of cannabis legalization in Canada in PubMed, Embase, Statistics Canada and government websites and Google Scholar, published between 2006 and 2021. RESULTS: Cannabis legalization in Canada has been followed by substantial reductions in cannabis-related arrests and cannabis prices. It has also increased adults' access to a diverse range of cannabis products, including edibles and extracts. The prevalence of cannabis use among young adults has increased, but there have been no marked increases or decreases in use among high school students or changes in the prevalence of daily or near-daily use. Legalization has been associated with increased adult hospital attendances for psychiatric distress and vomiting, unintentional ingestion of edible cannabis products by children and hospitalizations for cannabis use disorders in adults. There is conflicting evidence on whether cannabis-impaired driving has increased since legalization. There is suggestive evidence that presentations to emergency departments with psychoses and cannabis use disorders may have increased since legalization. CONCLUSIONS: Legalization of cannabis in Canada appears to have reduced cannabis arrests and increased access to a variety of more potent cannabis products at lower prices. Since 2019, recent cannabis use in Canada has modestly increased among adults but not among adolescents. There is evidence of increased acute adverse effects of cannabis among adults and children.

Common adverse events of electronic cigarettes compared with traditional nicotine replacement therapies: A systematic review and meta-analysis.

ISSUES: Established literature suggests that electronic cigarettes (EC) are more effective than traditional nicotine replacement therapies (NRT) as a smoking cessation aid, but the factors that mediate this difference remain poorly understood. We examine how adverse events (AE) associated with EC use relative to NRTs differ, with the view that differences in AEs experienced may drive differences in use and compliance. APPROACH: Papers for inclusion were identified via a three-tiered search strategy. Eligible articles involved healthy participants and compared nicotine ECs to non-nicotine ECs or NRTs and reported frequency of AE as an outcome. Random-effects meta-analyses were conducted to compare the likelihood for each of the AEs between nicotine ECs, non-nicotine placebo ECs and NRTs. KEY FINDINGS: A total of 3756 papers were identified, of which 18 were meta-analysed (10 cross-sectional and 8 randomised controlled trials). Meta-analytic results found no significant difference in the rates of reported AEs (i.e., cough, oral irritation, nausea) between nicotine ECs and NRTs, and between nicotine and non-nicotine placebo ECs. IMPLICATIONS: The variation in the incidence of AEs likely does not explain user preferences of ECs to NRTs. Incidence of common AEs reported because of EC and NRT use did not differ significantly. Future work will need to quantify both the adverse and favourable effects of ECs to understand the experiential mechanisms that drive the high uptake of nicotine ECs relative to established NRTs. CONCLUSIONS: There is inconclusive evidence on the incidence of AEs experience when using ECs compared to NRTs, possibly given the small sample size of studies.

Seeking order in patterns of polysubstance use.

PURPOSE OF REVIEW: This review provides an overview of recent developments in understanding polysubstance use patterns across the lifespan, and advances made in the prevention and treatment of harm arising from polysubstance use. RECENT FINDINGS: A comprehensive understanding of the patterns of polysubstance use is hampered by heterogeneity across study methods and types of drugs measured. Use of statistical techniques such as latent class analysis has aided in overcoming this limitation, identifying common patterns or classes of polysubstance use. These typically include, with decreasing prevalence, (1) Alcohol use only; (2) Alcohol and Tobacco; (3) Alcohol, Tobacco, and Cannabis; and finally (4) a low prevalence, Extended Range cluster that includes other illicit drugs, New Psychoactive Substances (NPS), and nonmedical prescription medications. SUMMARY: Across studies, there are commonalities present in clusters of substances used. Future work that integrates novel measures of polysubstance use and leverages advances in drug monitoring, statistical analysis and neuroimaging will improve our understanding of how and why drugs are combined, and more rapidly identify emerging trends in multiple substance use. Polysubstance use is prevalent but there is a paucity of research exploring effective treatments and interventions.

"Buy High, Sell Low": A Qualitative Study of Cryptocurrency Traders Who Experience Harm.

The constant, substantial price fluctuations of cryptocurrency allow traders to engage in highly speculative trading that closely resembles gambling. With significant financial loss associated with adverse mental health outcomes, it is important to investigate the impact that market participation has on mental health. Therefore, we conducted interviews with 17 participants who self-reported problems due to trading. Thematic analysis was conducted revealing themes: (1) factors in engagement, (2) impacts of trading and (3) harm reduction. Factors in engagement captured factors that motivated and sustained cryptocurrency trading. Impacts of trading outlined how cryptocurrency trading positively and negatively impacted participants. Harm reduction described methods participants employed to reduce mental distress from trading. Our study provides novel insights into the adverse impacts of cryptocurrency trading across multiple domains, especially mental health, relationships and finances. They also indicate the importance of further research on effective coping strategies for distress caused by financial loss from trading. Additionally, our study reveals the significant role social environments play on participants' expectations and intentions regarding cryptocurrency trading. These social networks extend beyond real-life relationship to include celebrity and influencer endorsement. This encourages investigation into the content of cryptocurrency promotions and the influence they have on individuals' decision to trade.

Global prevalence of heated tobacco product use, 2015-22: A systematic review and meta-analysis.

BACKGROUND AND AIMS: Heated tobacco products (HTPs) are electronic devices that heat process tobacco to release an aerosol containing nicotine and other chemicals. Limited data exist on world-wide HTP use prevalence. This meta-analytic review estimated the prevalence of HTP use by country, World Health Organization (WHO) region, year, sex/gender and age. METHODS: Five databases (Web of Science, Scopus, Embase, PubMed and PsycINFO) were searched between January 2015 and May 2022. Included studies reported the prevalence of HTP use in nationally representative samples post-modern HTP device market entry (2015). A random-effects meta-analysis was used to estimate overall prevalence for life-time, current and daily HTP use. RESULTS: Forty-five studies (n = 1 096 076) from 42 countries/areas from the European Region (EUR), Western Pacific Region (WPR), Region of the Americas (AMR) and African Region (AFR) met inclusion criteria. Estimated pooled prevalence for life-time, current and daily HTP use was 4.87% [95% confidence interval (CI) = 4.16, 5.63], 1.53% (95% CI = 1.22, 1.87) and 0.79% (95% CI = 0.48, 1.18), respectively, across all years (2015-22). Life-time HTP use prevalence significantly increased by 3.39% for WPR [0.52% (95% CI = 0.25, 0.88) in 2015 to 3.91% (95% CI = 2.30, 5.92) in 2019] and 5.58% for EUR [1.13% (95% CI = 0.59, 1.97) in 2016 to 6.98% (95% CI = 5.69, 8.39) in 2020]. Current HTP use increased by 10.45% for WPR [0.12% (95% CI = 0, 0.37) in 2015 to 10.57% (95% CI = 5.59, 16.88) in 2020] and 1.15% for EUR [0% (95% CI = 0, 0.35) in 2016 to 1.15% (95% CI = 0.87, 1.47) in 2020]. Meta-regression revealed higher current HTP use in WPR [3.80% (95% CI = 2.88, 4.98)] compared with EUR [1.40% (95% CI = 1.09, 1.74)] and AMR [0.81% (95% CI = 0.46, 1.26)] and for males [3.45% (95% CI = 2.56, 4.47)] compared with females [1.82% (95% CI = 1.39, 2.29)]. Adolescents had higher life-time HTP use prevalence [5.25% (95% CI = 4.36, 6.21) than adults [2.45% (95% CI = 0.79, 4.97)]. Most studies scored a low risk of sampling bias due to their nationally representative sampling. CONCLUSION: The prevalence of HTPs use increased in the EUR and WPR between 2015 and 2020, with nearly 5% of the included populations having ever tried HTP and 1.5% identifying as current users during the study period.

A latent class analysis of patterns of tobacco and cannabis use in Australia and their health-related correlates.

INTRODUCTION: The shifting landscape in Australia's tobacco and cannabis policies and emerging new products and modes of administration may increase experimentation and the risks of addiction to these drugs. METHODS: We analysed cross-sectional data from the 2019 National Drug Strategy and Household Survey (n = 22,015) of Australians aged 14 and above. Latent class analysis was used to identify distinct groups based on types of tobacco and cannabis products used. The socio-demographic, health-rated correlates and past-year substance use of each latent class was examined. RESULTS: A four-class solution was identified: co-use of tobacco and cannabis (2.4%), cannabis-only (5.5%), tobacco-only (8.0%) and non-user (84.0%). Males (odds ratio [OR] range 1.5-2.9), younger age (OR range 2.4-8.4), moderate to high psychological distress (OR range 1.3-3.0), using illicit substances in the last year (OR range 1.41-22.87) and high risk of alcohol use disorder (OR range 2.0-21.7) were more likely to be in the tobacco/cannabis use classes than non-users. Within the co-use class, 78.4% mixed tobacco with cannabis and 89.4% had used alcohol with cannabis at least once. DISCUSSION AND CONCLUSIONS: Approximately 16% of respondents used tobacco or cannabis, or both substances, and no major distinct subgroups were identified by the use of different product types. Mental health issues and the poly-substance use were more common in the class who were co-users of cannabis and tobacco. Existing policies need to minimise cannabis and tobacco-related harms to reduce the societal burden associated with both substances.

#TurntTrending: a systematic review of substance use portrayals on social media platforms.

AIMS: There is a growing body of literature exploring the types of substance-related content and their portrayals on various social media platforms. We aimed to summarize how content related to substances is portrayed on various social media platforms. METHODS: This systematic review was pre-registered on PROSPERO (ref: CRD42021291853). A comprehensive search was conducted in the databases of PubMed, Scopus, PsycINFO and Web of Science in April 2021. Original qualitative studies published post-2004 that included thematic and sentiment analyses of social media content on tobacco, alcohol, psychostimulant, e-cigarette, cannabis, opiate, stimulant/amphetamine, inhalant and novel psychoactive substance were included. Social media platforms were defined as online web- or application-based platforms that allowed users to generate content and interact via 'liking', comment or messaging features. Only studies that included summative and/or thematic content analyses of substance-related social media content were included. RESULTS: A total of 73 studies, which covered 15 905 182 substance-related posts on Twitter, YouTube, Instagram, Pinterest, TikTok and Weibo, were identified. A total of 76.3% of all substance-related content was positive in its depiction of substance use, with 20.2% of content depicting use negatively. Sentiment regarding opiate use however was commonly negative (55.5%). Most studies identified themes relating to Health, Safety and Harms (65.0%) of substance use. Themes relating to Promotions/Advertisements (63.3%), Informative content (55.0%) and Use behaviours (43.3%) were also frequently identified. CONCLUSIONS: Substance-related content that promotes engagement with substance use or actively depicts use appears to be widely available on social media. The large public presence of this content may have concerning influences on attitudes, behaviours and risk perceptions relating to substance use, particularly among the most vulnerable and heaviest users of social media-adolescents and young adults.