Associations between e-cigarette access and smoking and drinking behaviours in teenagers.

BACKGROUND: Public health concerns regarding e-cigarettes and debate on appropriate regulatory responses are focusing on the need to prevent child access to these devices. However, little is currently known about the characteristics of those young people that are accessing e-cigarettes. METHODS: Using a cross-sectional survey of 14-17 year old school students in North West England (n = 16,193) we examined associations between e-cigarette access and demographics, conventional smoking behaviours, alcohol consumption, and methods of accessing cigarettes and alcohol. Access to e-cigarettes was identified through a question asking students if they had ever tried or purchased e-cigarettes. RESULTS: One in five participants reported having accessed e-cigarettes (19.2%). Prevalence was highest among smokers (rising to 75.8% in those smoking >5 per day), although 15.8% of teenagers that had accessed e-cigarettes had never smoked conventional cigarettes (v.13.6% being ex-smokers). E-cigarette access was independently associated with male gender, having parents/guardians that smoke and students' alcohol use. Compared with non-drinkers, teenagers that drank alcohol at least weekly and binge drank were more likely to have accessed e-cigarettes (adjusted odds ratio [AOR] 1.89, P < 0.001), with this association particularly strong among never-smokers (AOR 4.59, P < 0.001). Among drinkers, e-cigarette access was related to: drinking to get drunk, alcohol-related violence, consumption of spirits; self-purchase of alcohol from shops or supermarkets; and accessing alcohol by recruiting adult proxy purchasers outside shops. CONCLUSIONS: There is an urgent need for controls on the promotion and sale of e-cigarettes to children. Findings suggest that e-cigarettes are being accessed by teenagers more for experimentation than smoking cessation. Those most likely to access e-cigarettes may already be familiar with illicit methods of accessing age-restricted substances.

Global development and diffusion of outcome evaluation research for interpersonal and self-directed violence prevention from 2007 to 2013: A systematic review.

Through a global review, we identified gaps in the geographical distribution of violence prevention evidence outcome evaluation studies and the types of violence addressed. Systematic literature searches identified 355 articles published between 2007 and 2013 that evaluated programs to prevent interpersonal or self-directed violence; focused on universal or selected populations; and reported outcomes measuring violence or closely related risk factors. The number of studies identified increased annually from 2008 (n = 37), reaching 64 in 2013. Over half (n = 203) of all studies focused on youth violence yet only one on elder maltreatment. Study characteristics varied by year and violence type. Only 9.3% of all studies had been conducted in LMICs. These studies were less likely than those in high income countries (HICs) to have tested established interventions yet more likely to involve international collaboration. Evaluation studies successfully established in LMIC had often capitalized on other major regional priorities (e.g. HIV). Relationships between violence and social determinants, communicable and non-communicable diseases, and even economic prosperity should be explored as mechanisms to increase the global reach of violence prevention research. Results should inform future research strategies and provide a baseline for measuring progress in developing the violence prevention evidence-base, especially in LMICs.

Adverse Childhood Experiences (ACEs) in Adults with Cystic Fibrosis.

Objective: This exploratory study examines the prevalence of adverse childhood experiences (ACEs) in adults with cystic fibrosis (CF). Design: Childhood exposure to 16 ACEs was measured during an annual review assessment (N = 80). Methods: CF patients (n = 80) attending the All Wales Adult CF Service for a routine annual review assessment completed an adapted version of the Centers for Disease Control and Prevention (CDC) short-form ACE questionnaire alongside measures of psychological well-being. Results: In this sample, 65 (78%) reported at least one type of childhood adversity and 11 (14%) experienced four or more ACEs. Parental divorce or separation and verbal abuse were the most frequently reported ACEs. Illness related trauma in childhood was also prevalent with 52 (64%) reporting having experienced a painful or frightening medical procedure and 23 (28%) feeling forced to have treatment or a procedure. Conclusion: Individuals with CF reported a number of childhood traumas including trauma relating to medical procedures. Those with a history of ACEs may have increased risks of emotional and physical difficulties and may benefit from additional support from the CF psychosocial team.

The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis.

BACKGROUND: A growing body of research identifies the harmful effects that adverse childhood experiences (ACEs; occurring during childhood or adolescence; eg, child maltreatment or exposure to domestic violence) have on health throughout life. Studies have quantified such effects for individual ACEs. However, ACEs frequently co-occur and no synthesis of findings from studies measuring the effect of multiple ACE types has been done. METHODS: In this systematic review and meta-analysis, we searched five electronic databases for cross-sectional, case-control, or cohort studies published up to May 6, 2016, reporting risks of health outcomes, consisting of substance use, sexual health, mental health, weight and physical exercise, violence, and physical health status and conditions, associated with multiple ACEs. We selected articles that presented risk estimates for individuals with at least four ACEs compared with those with none for outcomes with sufficient data for meta-analysis (at least four populations). Included studies also focused on adults aged at least 18 years with a sample size of at least 100. We excluded studies based on high-risk or clinical populations. We extracted data from published reports. We calculated pooled odds ratios (ORs) using a random-effects model. FINDINGS: Of 11 621 references identified by the search, 37 included studies provided risk estimates for 23 outcomes, with a total of 253 719 participants. Individuals with at least four ACEs were at increased risk of all health outcomes compared with individuals with no ACEs. Associations were weak or modest for physical inactivity, overweight or obesity, and diabetes (ORs of less than two); moderate for smoking, heavy alcohol use, poor self-rated health, cancer, heart disease, and respiratory disease (ORs of two to three), strong for sexual risk taking, mental ill health, and problematic alcohol use (ORs of more than three to six), and strongest for problematic drug use and interpersonal and self-directed violence (ORs of more than seven). We identified considerable heterogeneity (I2 of >75%) between estimates for almost half of the outcomes. INTERPRETATION: To have multiple ACEs is a major risk factor for many health conditions. The outcomes most strongly associated with multiple ACEs represent ACE risks for the next generation (eg, violence, mental illness, and substance use). To sustain improvements in public health requires a shift in focus to include prevention of ACEs, resilience building, and ACE-informed service provision. The Sustainable Development Goals provide a global platform to reduce ACEs and their life-course effect on health. FUNDING: Public Health Wales.

Computer-based programmes for the prevention and management of illicit recreational drug use: a systematic review.

The last few decades have seen increasing use of computer-based programmes to address illicit recreational drug use but knowledge about their effectiveness is limited. We conducted a systematic review to examine evidence on these programmes. Eight electronic databases were searched to identify primary research studies evaluating computer-based programmes to prevent or reduce use of illicit recreational drugs. From an initial 3413 extracted studies, 10 were identified for inclusion, covering a range of intervention types, target groups and settings. Universal drug prevention programmes were effective in reducing the frequency of recreational drug use in the mid-term (<12 months), but not immediately post intervention. Programmes targeting recreational drug users showed more inconsistent results but were generally effective in reducing use of drugs both immediately and in the mid-term. Computer-based programmes have the potential for use in addressing recreational drug use when targeted both universally and at illicit drug users, at least in the mid-term. However, longer term evaluations are needed to better understand the duration of effects. Given the benefits that computer-based programmes can have over traditional delivery methods, research is needed to better understand the value of human contact in health interventions and help inform whether, and how much, professional contact should be involved in computer-based programmes.

Dying to be famous: retrospective cohort study of rock and pop star mortality and its association with adverse childhood experiences.

OBJECTIVES: Rock and pop fame is associated with risk taking, substance use and premature mortality. We examine relationships between fame and premature mortality and test how such relationships vary with type of performer (eg, solo or band member) and nationality and whether cause of death is linked with prefame (adverse childhood) experiences. DESIGN: A retrospective cohort analysis based on biographical data. An actuarial methodology compares postfame mortality to matched general populations. Cox survival and logistic regression techniques examine risk and protective factors for survival and links between adverse childhood experiences and cause of death, respectively. SETTING: North America and Europe. PARTICIPANTS: 1489 rock and pop stars reaching fame between 1956 and 2006. OUTCOMES: Stars' postfame mortality relative to age-, sex- and ethnicity-matched populations (USA and UK); variations in survival with performer type, and in cause of mortality with exposure to adverse childhood experiences. RESULTS: Rock/pop star mortality increases relative to the general population with time since fame. Increases are greater in North American stars and those with solo careers. Relative mortality begins to recover 25 years after fame in European but not North American stars. Those reaching fame from 1980 onwards have better survival rates. For deceased stars, cause of death was more likely to be substance use or risk-related in those with more adverse childhood experiences. CONCLUSIONS: Relationships between fame and mortality vary with performers' characteristics. Adverse experiences in early life may leave some predisposed to health-damaging behaviours, with fame and extreme wealth providing greater opportunities to engage in risk-taking. Millions of youths wish to emulate their icons. It is important they recognise that substance use and risk-taking may be rooted in childhood adversity rather than seeing them as symbols of success.

Implementing child maltreatment prevention programmes: what the experts say

Child maltreatment can result in mental and physical harm to the child as well as long-term negative consequences for the individual across their life-course. Delivering measurable reductions in child maltreatment requires action at political, practitioner and public levels. Internationally, some groups and individuals have successfully pioneered programmes to prevent child maltreatment, or been instrumental in changing strategy or policy to protect the rights of the child. Although many of these successes are captured in academic papers, these can omit key learning points on how to establish and sustain successful interventions. Based on a series of interviews reflecting on the experiences of world-leading experts in child maltreatment prevention, this handbook aims to fill this gap by providing practical information to policy-makers, commissioners and practitioners on implementing prevention programmes. After outlining the wider political and cultural landscape needed to drive and sustain interventions, the handbook describes key principles for selecting and delivering programmes, and important practical considerations, resources and technical support. Expert contributors provide insights into important first steps, key questions to consider, and how to address some common challenges and barriers to successful implementation. This handbook is intended for use alongside other resources developed by WHO Regional Office for Europe and has been developed to assist countries to implement Investing in children: the European child maltreatment prevention action plan.