Understanding the relationship between people's lifetime alcohol use and their awareness of the risk of common chronic diseases from alcohol use is important for informing health messaging efforts. This paper aimed to 1) assess the level of awareness that alcohol use increases the risk of cancer, diabetes, hypertension, and 2) examine the association between lifetime drinking patterns and levels of awareness. We used data from the 2019-2020 National Alcohol Survey (NAS) that included awareness that cancer, hypertension and diabetes could result from drinking too much alcohol (yes/no/unsure), past-year alcohol use, and lifetime alcohol use operationalized as peak lifetime drinking pattern and ever having 2+ symptoms of alcohol use disorder (AUD). We conducted multinomial regressions to examine associations between lifetime alcohol use and awareness of alcohol as a risk factor for each health outcome, controlling for past-year use. Overall, 42.1% acknowledged the link between alcohol use and cancer, 52.2% between alcohol use and diabetes, and 61.3% between alcohol use and hypertension. Nearly all peak lifetime drinking pattern levels were associated with a lower likelihood of awareness of the alcohol-cancer link. Conversely, nearly all levels were associated with a higher likelihood of awareness of the link between alcohol use and hypertension, and only one level was associated with awareness of the alcohol-diabetes link. Awareness of alcohol's effects on chronic diseases varies by type of disease. Lifetime alcohol use is a relevant factor for understanding levels of awareness of alcohol's health effects.

Association of Lead in Drinking Water With Head and Neck Cancer in the United States.

Anxiety symptoms may be affected by environmental factors. Changes in weather patterns have been linked to various mental health outcomes, but research focusing on wintertime and anxiety is still sparse. Thus, we investigate longitudinal associations between solar radiation, precipitation, and snow days during winter-time and self-reported anxiety symptoms in the following spring.We used data from 14,237 participants of the Swedish Longitudinal Survey of Health who responded to surveys in spring 2016 and 2018. Symptoms of anxiety was assessed using SCL-ANX4, a subscale of the Symptom Checklist-25. Data on the daily solar radiation and precipitation was averaged over November to January and linked to the health data and residence at municipal level for each participant. For snow days, sum of days with snow over the 3-month period was used. Within-individual design using conditional logistic regression was used. Models were adjusted for age, region, and the remaining meteorological variables.Although odds ratios for anxiety in association with 3-month average solar radiation (OR 0.90, 95% CI 0.65-1.24) and precipitation (OR 0.91, 95% CI 0.79-1.05) were on the protective side, these associations were not statistically significant. We neither observed associations between snow days and anxiety symptoms, nor any significant effect modification by age, sex, civil status, job strain, occupational position, region, type of questionnaire, alcohol use, or physical activity (p-values for interactions > 0.05).Our findings do not demonstrate associations between wintertime weather conditions and symptoms of anxiety and call for further research from different geographical areas and populations.

This study was aimed at determining the prevalence of difficult-to-treat (D2T) axial spondyloarthritis (axSpA) and identifying main associated factors for D2T axSpA. This multicenter observational cross-sectional study included axSpA patients from the BioSTaR (Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drugs Registry) from February 1, 2019, to January 1, 2025. Data from 1800 axSpA patients who have previously used or are currently using at least one biologic/targeted synthetic disease-modifying antirheumatic drug were analyzed. Patient data included demographic characteristics, body mass index (BMI), marital status, smoking and alcohol use, family history of SpA, and presence of comorbidities. The parameters related to SpA such as disease duration, type of axSpA (radiographic/non-radiographic), HLA-B27 status, the presence of extra-musculoskeletal manifestations (uveitis, psoriasis, and inflammatory bowel disease), arthritis, enthesitis, and dactylitis were also recorded. Comorbidities including hypertension, cardiovascular disease, diabetes, obesity, and hyperlipidemia were recorded, and Charlson Index scores were evaluated. Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and disease activity in means of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP) were also recorded. All medication history and currently used medications for axSpA and other diseases were noted. D2T and non-D2T axSpA patients were classified according to the suggested extrapolated definition. Of the 1800 axSpA patients recorded in the BioSTaR database, 204 (11.3%) were classified as D2T axSpA. Data of these patients were compared to the data from 1596 non-D2T axSpA patients. Disease duration was longer in D2T patients (p = 0.025). The presence of radiographic disease was more frequent in the D2T group (p = 0.047). In means of MASES and ASDAS-CRP, higher scores were recorded in the D2T group (both p < 0.001). Enthesitis and psoriasis were more frequent in the D2T group (p = 0.002 and p = 0.006). Regarding comorbidities, hypertension and cardiovascular diseases were more frequent in the D2T group (p < 0.001 and p = 0.009). The risk of D2T axSpA increased 2.37-fold with the presence of r-axSpA (p = 0.018), 1.92-fold with the presence of hypertension (p = 0.006), 2.12-fold with the presence of obesity (p = 0.024), and 3.63-fold with the presence of psoriasis (p = 0.004). Every 1-point increase in MASES increased D2T risk 1.08-fold (p = 0.017), and every 1-point increase in ASDAS-CRP increased D2T risk 1.62-fold (p < 0.001). In conclusion, 11.3% of patients with axSpA met the proposed criteria for D2T axSpA. This subgroup was characterized by longer disease duration, higher frequency of r-axSpA, enthesitis, and psoriasis, as well as elevated MASES, CRP, ASDAS-CRP, and BASDAI scores. Hypertension and cardiovascular comorbidities were also significantly more prevalent among D2T patients. These parameters represent potential contributors to treatment complexity and should be carefully considered in therapeutic decision-making. In cases of suboptimal treatment response, reassessment and optimal management of comorbidities are essential, as comorbid conditions can increase disease burden and diminish therapeutic efficacy. Comprehensive care for axSpA should therefore include targeted management of accompanying comorbidities in parallel with disease-specific therapy. Monitoring blood pressure, optimizing body weight, and encouraging smoking cessation are particularly important. Additionally, concomitant rheumatic diseases such as psoriasis, uveitis, or inflammatory bowel disease should be actively evaluated and treated, given their association with more severe disease and reduced treatment response. Key Points • Prospectively collected data of 1800 axial spondyloarthritis patients were assessed for this cross-sectional study. • 11.3% of axial spondyloarthritis patients were identified as difficult-to-treat. • Longer disease duration and presence of radiographic axial spondyloarthritis, enthesitis, and psoriasis are more prevalent in difficult-to-treat axial spondyloarthritis patients. • Factors and comorbidities complicating axial spondyloarthritis treatment should be considered in treatment plans.

The efficacy of orthobiologic therapies, such as platelet-rich plasma (PRP) and concentrated bone marrow aspirate (cBMA), is influenced by not only the biologic product but also the patient's systemic biological milieu. Emerging preclinical and clinical evidence suggests that modifiable metabolic factors, including obesity, insulin resistance, chronic low-grade inflammation, inflammaging, sarcopenia, dysbiosis, poor sleep, and lifestyle behaviors such as smoking and alcohol use, can impair tissue regeneration and reduce the effectiveness of orthobiologics. A structured approach guided article selection. Searches in PubMed, Embase, and Scopus through July 2025 were supplemented by reference checking. Terms included "metabolic optimization," "obesity," "insulin resistance," "inflammation," "sarcopenia," "dysbiosis," "sleep," "orthobiologics," "PRP," and "bone marrow aspirate." Preclinical and clinical studies, mechanistic reviews, and meta-analyses assessing the impact of metabolic factors on musculoskeletal regeneration and orthobiologic outcomes were included. Only English-language articles relevant to mechanisms, clinical implications, or patient optimization were considered. Narrative review. Level 5. Evidence-based strategies to optimize metabolic health include targeted exercise, nutritional optimization, pharmacologic interventions, sleep regulation, microbiome support, and behavioral counseling for tobacco and alcohol cessation. While clinical evidence remains limited and of low methodological rigor, preclinical and available clinical studies support the plausibility, safety, and potential efficacy of these interventions. Optimizing metabolic factors can enhance tissue responsiveness, reduce interpatient variability, and improve orthobiologic therapy outcomes. Optimizing metabolic health before orthobiologic therapy improves the biological environment and regenerative outcomes. Screening and managing factors such as insulin resistance, chronic inflammation, and poor sleep are essential. Further randomized controlled trials and biomarker-guided studies are needed to validate strategies and personalize interventions.Strength-of-Recommendation Taxonomy (SORT):C: Supported mostly by preclinical and indirect clinical evidence.

A study published in JAMA Network Open this month has found that medications for alcohol use disorder (MAUD) are underused in substance use disorder (SUD) treatment facilities. While MAUD increased from 2017 to 2021, growth since then has plateaued, according to the study, “Medication Availability for Alcohol Use Disorder in Substance Use Disorder Treatment Facilities” by Yuji Mizushima, Ph.D., and colleagues. The researchers urge expanding MAUD‐providing facilities, especially in underserved counties.

In the UK, alcohol-related deaths are increasing and there are also inequalities in alcohol-related health consequences among lower socioeconomic position groups. National and regional governmental organisations in the UK have responsibility for improving public health and reducing health inequalities. However, there is limited research which has explored the experiences of those developing alcohol public health interventions. Therefore, this study had two research questions: What are public health professionals' experiences and perspectives on the development of public health interventions to reduce alcohol use? How are health inequalities considered in their work? Semi-structured interviews were conducted with 16 public health professionals who reported involvement in the development and delivery of alcohol public health interventions, mainly at a local level (e.g., in a local authority public health department). Reflexive thematic analysis was used. The first theme refers to systemic constraints affecting alcohol public health intervention development. Opinions were varied on whether they had sufficient data access. Some additional data sources were desired (e.g., alcohol-related ambulance callouts) and some data sources were seen as difficult to access (e.g., primary care alcohol risk assessments) due to limited documentation in primary care records. Participants wanted an increased prevention focus (e.g., addressing alcohol licensing, availability, and promotion), but suggested that their capacity for preventative interventions was hindered by national priorities from political decisions and funding restrictions. The second theme refers to alcohol interventions addressing community needs, which includes principles for effective alcohol interventions. Participants highlighted that effective interventions should be delivered within local communities and based on an understanding of the reasons for and influences on their alcohol use. The third theme refers to drivers of inequalities in alcohol harms, in which participants suggested factors such as alcohol-related social norms and stress may be particularly important to target in interventions. The findings of this study highlight systemic constraints which affect the development process for alcohol public health interventions. Findings also highlight principles for effective community-based alcohol interventions. Proposed factors affecting alcohol-related inequality may represent intervention targets. These insights can be used to improve the intervention development process for alcohol public health interventions, as well as better accounting of health inequalities within such interventions.

ABSTRACT Alcohol consumption is associated with nearly 200 health conditions. As cannabis-infused beverages emerge in the legal market, their potential as a substitute for alcohol is of growing interest. This study investigates whether cannabis beverages may reduce alcohol use. A total of 438 anonymous adults who used cannabis in the past year completed a survey including cannabis use and alcohol consumption items from the Behavioral Risk Factor Surveillance System (BRFSS). Chi-square and t-tests compared alcohol use between cannabis beverage users and non-users, and before vs. after cannabis beverage initiation. About one-third (33.6%) of respondents used cannabis beverages, typically consuming one per session. Users were more likely to report substituting cannabis for alcohol (58.6%) than non-users (47.2%). They also reported fewer weekly alcoholic drinks after starting cannabis beverages (M = 3.35) compared to before (M = 7.02), and binge drank less frequently (80.7% reported less than monthly or never, vs. 47.2% before). Those who cited reducing other substance use were more likely to use cannabis beverages (45.8%). Findings suggest cannabis beverages may support alcohol substitution and reduce alcohol-related harms, offering a promising alternative for individuals seeking to lower alcohol intake.

BackgroundSexual minorities, including lesbian, gay, and bisexual individuals, often face higher substance use rates due to societal stressors. Recent societal changes, including the COVID-19 pandemic and rising hate crimes in the UK, may have impacted these disparities across sexual orientations. This study aims to examine changes in vaping, smoking, and alcohol use disparities across sexual orientations in the UK from 2014 to 2021.MethodData from the UK Longitudinal Household Survey (2014–2021) were analyzed, covering 42,052 participants aged 16 + . Sexual orientation categories included heterosexual, gay/lesbian, bisexual, and other sexual minorities. The outcomes were smoking, vaping, and harmful alcohol drinking. Longitudinal logit models with generalized estimating equations were used, adjusting for demographic factors. Predictive prevalences were calculated and used to examine the disparities between each sexual minority group and the heterosexual group over time.ResultsWe did not find consistent increases in substance use disparities across sexual orientation groups in the UK from 2014 to 2021. Small differences were observed among bisexual individuals who had a higher predicted prevalence of harmful alcohol drinking in 2019–2020 (~11–13% higher), while gay/lesbian individuals showed higher vaping prevalence in 2019 (~5% higher) than heterosexual individuals. For smoking, no disparities were observed.ConclusionUnlike prior studies that reported disparities, our longitudinal analysis found little to no evidence that sexual minorities had elevated or widening substance use disparities. While some subgroups exhibited elevated risks in specific years, these patterns were not sustained over time. Future research should explore how social stressors, policy contexts, and community norms interact to inform targeted, inclusive interventions that reflect the diversity within LGBTQ+ populations.

Introduction: The COVID-19 pandemic had significant effects on mental health and lifestyle behaviours, especially among university students who experienced academic disruptions, social isolation, and fewer social interactions. Alcohol consumption has long been part of student culture. Still, the influence of post-pandemic academic reintegration on drinking patterns and psychological distress remains relatively unexplored, particularly in countries like Portugal, where student traditions heavily shape consumption habits. This study aimed to describe the prevalence of alcohol consumption, depression, anxiety, and stress in a sample of Portuguese university students during the post-pandemic academic period, and to explore associations with sociodemographic variables. Methods: A cross-sectional study was conducted in November 2021 with 90 students from a private higher education institution in northern Portugal. Data were collected via an online questionnaire including sociodemographic information, the Alcohol Use Disorders Identification Test (AUDIT), and the Depression, Anxiety and Stress Scale (DASS-21). Result: The majority of the participants were not at risk of alcohol addiction (95.3%). In total, 15.1% of students reported anxiety symptoms ranging from severe to extremely severe. A binomial logistic regression was performed to ascertain the effects of being away from home and psychological distress (DASS-42 score), on the likelihood that participants were at risk of alcohol addiction (Level 3 and 4 in the AUDIT scale). The logistic regression model was statistically significant, χ2(2) = 9.20, p = 0.010. Living away from home was associated with a substantially lower likelihood of high-risk status (B = −2.79, p = 0.034), corresponding to an odds ratio of 0.06, indicating a strong protective effect. DASS-42 total score was positively associated with high-risk status (B = 0.04, p = 0.039), such that higher psychological distress increased the odds of being classified as high risk. Conclusions: The findings reveal a low prevalence of alcohol risk but heightened symptoms of anxiety, depression, and stress. Psychological distress notably increases the likelihood of hazardous alcohol use, emphasising the importance of targeted mental health and alcohol-use interventions among university students.

BackgroundMaternal and neonatal morbidities and mortality remain a global public health concern. Although preconception risk assessment has been found to enhance maternal, fetal, neonatal, and child health outcomes, few studies have explored preconception risks among premarital couples. The purpose of this study was to investigate the prevalence and predictors of preconception medical and behavioral risks among soon-to-be-married couples.MethodsA quantitative cross-sectional survey of 623 couples attending prenuptial meetings in rural and urban settings (churches and sector offices) was conducted from May to June 2024 using multistage cluster and purposive sampling. Data in the form of self-reported information were collected via structured interviewer-administered questionnaires. The Statistical Package for the Social Sciences (SPSS), version 29, was used to analyze the data.ResultsMost participants (64%) were aged 21–30, with 81.5% from rural areas. Nearly half (49.3%) were classified as high-risk. Common medical risks included mental stress (46%), underweight (21.7%), use of teratogenic medications (16.1%), diabetes (12.5%), and hypertension (9.9%). Over 90% had never been screened for syphilis, hepatitis, anemia, or taken folic acid. Behavioral risks included inadequate nutrition (41%), heavy alcohol use (29%), use of non-prescribed/herbal medications, exposure to hazardous environments (20%), and inadequate physical activity. Males (OR = 1.28, p = .033) and urban residents (OR = 1.37, p = .011) had higher odds of risk. Shorter time until marriage was linked to increased risks (OR = 0.59, p < .001), while awareness of preconception care (OR = 0.09, p = .023) and medium-to-high income (OR = 0.79, p = .042) were associated with reduced risk.ConclusionThe overall prevalence of preconception risks among engaged couples was found to be high, indicating a need for targeted clinical and educational interventions for early prevention and management.

Abstract Aim Adolescence is a critical period during which health behaviors and school participation intersect, influencing long-term health outcomes. This study examines the associations between health behaviors, mental well-being, health outcomes, and reading and writing difficulties (RWDs) among Danish adolescents. Subject and methods This cross-sectional study analyzed data from the 2017 Future Occupation of Children and Adolescents (FOCA) cohort, including 13,100 ninth-grade students across Denmark. All data except sex were self-reported. Logistic regression models estimated odds ratios (ORs), adjusted for socioeconomic status and sex. Results Poorer self-rated health (OR = 1.50; 99% confidence interval [CI] 1.25–1.80), poor mental health (OR = 1.99; 99% CI 1.57–2.52), increased smoking (OR = 1.14; 99% CI 1.02–1.28), lower life satisfaction (OR = 1.15; 99% CI 1.10–1.19), lower self-efficacy (OR = 1.08; 99% CI 1.05–1.12), higher body mass index (BMI) (OR = 1.06; 99% CI 1.04–1.08), and lower levels of leisure-time physical activity (OR = 1.05; 99% CI 1.03–1.08) were all associated with higher odds of reporting having RWDs. No associations with alcohol use were found. Socioeconomic status and sex did not substantially confound the results, except for regular drug and hash use. Conclusion RWDs and health-related outcomes appear to be associated among adolescents. Prospective studies are needed to determine whether the associations imply a causal relation that could inform the development of targeted interventions addressing both educational challenges and health risks.

IntroductionIllicit alcohol (illegally brewed alcohol) consumption among adolescents is an increasing public health problem worldwide, with major impacts on individuals, families, and communities. It’s effects may lead to blindness, poisoning, infection, and other health problems. In Zambia, evidence on the burden of illicit alcohol intake and associated factors is limited, particularly in socioeconomically deprived communities. This study estimated the prevalence and examined the socio- demographic, socio-cultural and socio-economic factors that influence illicit alcohol consumption among adolescents between 10–17 years old in selected unplanned settlements in the city of Lusaka, Zambia.MethodsA cross-sectional study was conducted in December 2023, among 331 adolescents who reported alcohol use in 24 selected densely populated peri-urban communities of Lusaka, Zambia. Total enumeration was employed to select participants who met the age criteria and were enrolled in the Screening, Brief Intervention, and Referral to Treatment (SBIRT) program. Face-to-face questionnaire interviews were conducted to collect data on socio-demographic, socio-cultural, socio-economic, and illicit alcohol intake characteristics. Descriptive statistics and graphical presentations were generated, and an investigator-led stepwise multiple logistic regression analysis was performed to identify factors influencing illicit alcohol consumption, with variables with p-values >0.2 removed from the model. Data were analyzed using STATA version 16 MP, and statistical significance was set at p < 0.05.ResultsThe prevalence of illicit alcohol consumption among adolescent alcohol users in the selected Lusaka communities was 42.9% (142/331), with the majority being male (75%). The median age of participants was 16 years (IQR: 15–17). Most adolescents (98.8%, 327/331) had attended school, though only 32% (102/331) had reached secondary level. A large proportion (77.3%, 256/331) lived with their biological parents, while 73.7% (244/331) belonged to large households (more than 10 members). After adjusting for potential confounders, males were more than twice as likely to engage in illicit alcohol intake compared to females (aOR = 2.08, 95% CI: 1.22–3.55, p = 0.005). Conversely, unemployed adolescents were significantly less likely to consume illicit alcohol compared to their employed peers (aOR = 0.52, 95% CI: 0.28–0.90, p = 0.048).ConclusionIllicit alcohol intake among adolescents in peri-urban communities of Lusaka, Zambia, is high and linked to a broad range of risk factors, particularly sex and employment status. Early initiation of comprehensive, multisectoral, community-based strategies with active stakeholder involvement may help mitigate this growing public health problem.

Background Lip and oral cavity cancer (LOC) is a major public health challenge in Asia. Nevertheless, a critical gap remains in understanding the epidemiological burden of LOC among young people (15–44 years) in the region. This study aims to analyze the burden and risk factors of LOC in this age group across the four Global Burden of Disease (GBD) Asian regions from 1990 to 2021 and projects trends to 2030. Methods Data on the incidence, deaths, disability-adjusted life years (DALYs), and risk factors of LOC from 1990 to 2021 were obtained from the GBD 2021 study for East, South, Southeast Asia, and High-income Asia Pacific. This study assessed the LOC burden among young people (15–44 years) through age- and sex-stratified analyses, evaluated temporal trends via joinpoint regression, examined risk factor contributions, and projected trends to 2030 using the Nordpred age-period-cohort model. Results From 1990 to 2021, the age-standardized incidence rate (ASIR) increased across all subregions, with the largest rise in East Asia. In contrast, age-standardized mortality rate (ASMR) and age-standardized DALYs rate declined everywhere except South Asia. In 2021, South Asia bore the heaviest LOC burden among young people in the four Asian subregions. India reported the highest incident cases, deaths, and DALYs in 2021, and Pakistan had the highest ASR for all three metrics. Taiwan (Province of China) showed the largest increase in ASRs over the period. In 2021, smoking had the highest contribution in East Asia, alcohol use in High-income Asia Pacific, and chewing tobacco in South Asia. Projections to 2030 indicate rising ASIR in East, South, and Southeast Asia but declines in High-income Asia Pacific; decreasing ASMR everywhere except South Asia; and increasing age-standardized DALYs rate in East and South Asia but decreases elsewhere. Conclusions LOC imposes a substantial and growing burden on young people in South, East, and Southeast Asia, marked by rising ASIR since 1990 and projected increases through 2030. South Asia faces the most urgent challenge with concurrent rises in incidence, mortality, and DALYs—most notably in the 20–24 age group. Region-specific interventions targeting predominant risk factors are critically needed.

Introduction: Substance use is a significant public health concern that is particularly prevalent among individuals experiencing homelessness. This literature review examines the effectiveness of various substance use interventions targeting this population. Methods: A comprehensive search of academic databases was conducted to identify U.S.-based studies, published between 2020 and 2025, that examined substance use interventions among individuals experiencing homelessness. After applying inclusion and exclusion criteria, studies were screened for relevance and quality. The final selection encompassed a range of study designs (e.g., randomized controlled trials, cohort studies, and qualitative research) and diverse intervention strategies (e.g., supportive housing models, harm reduction approaches, and pharmacological treatments). Results: To address the variability of outcomes measured, coding was used to identify commonalities. Three outcome themes were identified: (1) frequency and amount of alcohol and drug use, (2) treatment retention and program adherence, and (3) self-efficacy and participant perceptions. The results demonstrated short-term reductions in substance use and improvements in participant engagement and psychological well-being. However, long-term outcomes were less consistent with reports of high relapse rates, poor treatment retention, and limited program adherence. Conclusions: Given the mixed and inconsistent findings across studies, there is a critical need to explore alternative approaches to treat substance use among homeless individuals. Occupational therapy (OT) is a promising yet underutilized profession in addressing substance use through holistic, meaningful, occupation-based interventions. To develop effective interventions that support sustained recovery, future research should prioritize longitudinal studies that incorporate objective and subjective measures to fully capture the lived experiences of homeless individuals who use substances.

Intimate partner domestic violence exposure and the onset of hazardous alcohol use: A population-based longitudinal study of married adults in South Korea (2009-2024).

Objectives Alcoholic liver disease is the leading cause of cirrhosis and liver failure in Japan. We assessed hepatologist-led interventions stratified using the alcohol use disorder identification test. Methods This was a single-center, prospective study. Outcomes included total alcohol consumption, number of heavy drinking days, drinking risk level, and liver function over 24 weeks. Patients Patients with chronic liver disease were stratified into three groups according to alcohol use disorder identification test scores: <10 (education only), 10-19 (hepatologist-led intervention), and ≥20 (psychiatric referral). Patients in the hepatologist-led group received drinking guidance, psychosocial support, and nalmefene, when indicated. Results Between August 2022 and September 2025, 932 patients were screened; 823, 78, and 31 had alcohol use disorder identification test scores of <10, 10-19, and ≥20 points, respectively. Of the 78 patients in the hepatologist-led intervention group, 74 completed follow-up. In this group, median total alcohol consumption decreased from 63.1 to 35.1 g/day (p=0.001) and heavy-drinking days from 17.0 to 11.3 days/month (p=0.002). Drinking risk level downstaging was achieved in 52 patients (70.2%), who showed significant improvements in aspartate aminotransferase (p=0.027) and γ-GTP (p=0.014) levels and experienced fewer cirrhosis-related complications in comparison to patients without downstaging. Logistic regression identified baseline hepatocellular carcinoma as an independent predictor of drinking risk-level downstaging (odds ratio, 5.23; 95% confidence interval, 1.10-15.3). Conclusions Hepatologist-led alcohol use disorder identification test-based management of alcoholic liver disease reduces alcohol intake. Drinking risk-level downstaging has been linked to improved liver biochemistry and clinical outcomes, offering a practical strategy in which psychiatric resources are limited.

To report the prevalence of mental health symptoms and influencing factors in retired professional high contact team sport (HCTS) athletes. Mixed-methods systematic review. PsycINFO, Embase, Medline, SPORTDiscus and Scopus were searched in July 2023 and March 2025. Studies that investigated mental health and/or influencing factors within retired professional HCTS athletes were included. Studies that were non-peer-reviewed, could not obtain full text, used secondary data or focused on non-elite/individual/low-contact sports were excluded. 85 studies were included in the final review, comprising 53 996 participants (females; n=247, 0.46%) from six sports (Australian Football League, Canadian Football League, football/soccer, ice hockey, National Football League and rugby). Prevalence ranges varied for each condition; smoking (0.9%-16%), depression (3%-49%), anxiety (4.3%-42%), cannabis use (5%-15.7%), adverse alcohol use (6.4%-68.8%), opioid use (7%-23.6%), stress (8.7%-26.9%), illicit drug use (10%-63.2%), anxiety/depression (10.2%-39%) and adverse nutritional behaviour (23.8%-64.5%). Of the studies including M and SD of validated scales, scores for depression, anxiety and sleep disturbance were equivalent to population norms, whereas mild or higher scores were reported for stress and adverse alcohol use. Concussion, pain, injury, neurological factors and declined physical function were shown to have a negative influence on mental health. Both negative and positive influences were observed for: athletic identity, psychosocial support, retirement autonomy, life events, osteoarthritis, retirement and cognitive function. 48% of studies had good methodological quality; however, most studies were cross-sectional, relied on self-report measures and lacked follow-up data and female athletes. Retired HCTS athletes experience high levels of psychological distress and adverse alcohol use, but depression, anxiety and sleep disturbance were similar to population norms. These results call for greater support measures for retired athletes. CRD42023449114.

Objective This pilot study, which was designed to inform mobile health intervention development, assessed the frequency of various microaggressions and explored associations among microaggressions, alcohol use, depression, and anxiety in Black young adults. Methods Ninety-two Black adults (mean age = 22.2 [SD = 1.9]) who regularly consume alcohol were recruited through social media to complete a survey on microaggressions, depression, anxiety, and alcohol use. Microaggression frequencies were calculated and a Cochran–Mantel–Haenszel test was used to model interrelationships among microaggressions, depression, and anxiety with respect to binge drinking. Results Past-30-day microaggression experiences were reported by 82.6% of participants. Stratified analyses signaled that the association between moderate/severe depression and binge drinking exclusively among individuals who had past-30-day microaggression experiences, approached statistical significance (OR = 2.58, 95% CI:0.94, 7.01; Cohen’s d = 0.52). Conclusion Findings highlight the pervasiveness of microaggressions and suggest that they may play a key contextual role in shaping binge drinking behaviors among Black young adults experiencing depression.

ABSTRACT Understanding late-onset alcohol use disorder (AUD) requires examining individuals’ life histories and their relationship with alcohol. Few studies, however, have detailed the developmental process of late-onset AUD. This multiple case study explored the life stories and cultural influences of four older Japanese adults diagnosed with late-onset AUD. Life story interviews traced their experiences from childhood to the present. Commonalities emerged regarding early drinking and feelings of existential emptiness, while diverse family relationships and patterns of progression of the disorder were observed. These findings have important implications for developing more effective support strategies for older patients, particularly within Japan’s unique drinking culture.