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In medicine, it is common to observe improvement after intervention, at least partly because patients present for care in extremis and would have improved without intervention. Controlling for this counterfactual explanation for improvement is the principle reason to conduct a trial in which patients are randomised to treatment or a control group. Accordingly, it is not reasonable to infer that both interventions are effective when the groups show similar improvements in outcome.

Participant reports of their own behaviour are critical for the provision and evaluation of behavioural interventions. Recent developments in brief alcohol intervention trials provide an opportunity to evaluate longstanding concerns that answering questions on behaviour as part of research assessments may inadvertently influence it and produce bias. The study objective was to evaluate the size and nature of effects observed in randomized manipulations of the effects of answering questions on drinking behaviour in brief intervention trials. Multiple methods were used to identify primary studies. Between-group differences in total weekly alcohol consumption, quantity per drinking day and AUDIT scores were evaluated in random effects meta-analyses. Ten trials were included in this review, of which two did not provide findings for quantitative study, in which three outcomes were evaluated. Between-group differences were of the magnitude of 13.7 (-0.17 to 27.6) grams of alcohol per week (approximately 1.5 U.K. units or 1 standard U.S. drink) and 1 point (0.1 to 1.9) in AUDIT score. There was no difference in quantity per drinking day. Answering questions on drinking in brief intervention trials appears to alter subsequent self-reported behaviour. This potentially generates bias by exposing non-intervention control groups to an integral component of the intervention. The effects of brief alcohol interventions may thus have been consistently under-estimated. These findings are relevant to evaluations of any interventions to alter behaviours which involve participant self-report.

Background Employing waiting list control designs in psychological and behavioral intervention research may artificially inflate intervention effect estimates. This exploratory randomized controlled trial tested this proposition in a study employing a brief intervention for problem drinkers, one domain of research in which waiting list control designs are used. Methods All participants (N = 185) were provided with brief personalized feedback intervention materials after being randomly allocated either to be told that they were in the intervention condition and that this was the intervention or to be told that they were in the waiting list control condition and that they would receive access to the intervention in four weeks with this information provided in the meantime. Results A total of 157 participants (85%) were followed-up after 4 weeks. Between-group differences were found in one of four outcomes (proportion within safe drinking guidelines). An interaction was identified between experimental manipulation and stage of change at study entry such that participant change was arrested among those more ready to change and told they were on the waiting list. Conclusions Trials with waiting list control conditions may overestimate treatment effects, though the extent of any such bias appears likely to vary between study populations. Arguably they should only be used where this threat to valid inference has been carefully assessed.

Young people may have elevated risk for poorer mental health during the coronavirus disease 2019 (COVID-19) pandemic, yet longitudinal studies documenting this impact are lacking. This study assessed changes in mental health and help-seeking since COVID-19 restrictions in young Australians, including gender differences. Data were drawn from a recent subsample ( = 443; 60% female; = 22.0) of a prospective cohort originally recruited in secondary school to complete annual surveys. The subsample completed an additional COVID-19 survey during COVID-19 restrictions (May-June 2020), which was compared to responses from their latest annual survey (August 2019-March 2020). Mixed effect models with time and gender as the primary predictors were conducted for: (i) scores on the Patient Health Questionnaire Depression 9-item (PHQ-9) and Generalised Anxiety Disorder 7-item (GAD-7) modules assessed before and during COVID-19 restrictions, and (ii) self-reported help-seeking from a health professional in February 2020, and the month preceding May-June 2020. Mean symptom scores increased from before to during COVID-19 restrictions on the PHQ-9 (coefficient: 1.29; 95% CI 0.72-1.86) and GAD-7 (0.78; 95% CI 0.26-1.31), but there was no increase in help-seeking over time (odds ratio 0.50; 95% CI 0.19-1.32). There was no evidence of differential changes by gender. This study found increases in depression and anxiety symptoms but not greater help-seeking among young Australian adults during the first wave of the pandemic. Increasing availability and awareness of accessible treatment options and psychoeducation is critical, as well as further research into risk and protective factors to help target treatment to this vulnerable age group.

Background Parents play a critical role in their children’s introduction to alcohol. A range of parenting factors have been associated with the progression to risky drinking among adolescents, and have recently formed the basis of the Australian ‘Parenting Guidelines for Adolescent Alcohol Use’ designed to help parents delay or reduce their adolescents’ alcohol use. Methods This study aimed to explore the experiences and attitudes of parents of adolescents to gain insight into: (1) the extent to which the behaviours of parents follow the recommendations made in the guidelines; and (2) approaches to reduce hazardous drinking among adolescents. Thirty-two telephone and face-to-face interviews were conducted with parents, and the content of discussions was examined using thematic analysis. Results Parents used approaches they thought would minimise harm and promote healthy development in their children. The guidelines address key areas of concern for parents but their adherence to these approaches is low in certain areas. Many parents provided some alcohol to their adolescents and often cited the social norm of drinking among their adolescents’ peers as a source of pressure to supply. Conclusions Further dissemination of the guidelines may be the first step in a public health strategy, but it is likely that parents will require support to effectively adopt the recommendations. Understanding the influences on parents’ beliefs about their children’s drinking and the functions of social networks in the creation of behavioural norms relating to alcohol consumption and supply may be necessary to address adolescent risky drinking.

Governments commonly fund research with specific applications in mind. Such mechanisms may facilitate 'research translation' but funders may employ strategies that can also undermine the integrity of both science and government. We estimated the prevalence and investigated correlates of funder efforts to suppress health behaviour intervention trial findings. Our sampling frame was lead or corresponding authors of papers (published 2007-2017) included in a Cochrane review, reporting findings from trials of interventions to improve nutrition, physical activity, sexual health, smoking, and substance use. Suppression events were based on a previous survey of public health academics. Participants answered questions concerning seven suppression events in their efforts to report the trial, e.g., [I was…] \"asked to suppress certain findings as they were viewed as being unfavourable.\" We also examined the association between information on study funder, geographical location, targeted health behaviour, country democracy rating and age of publication with reported suppression. We received responses from 104 authors (50%) of 208 eligible trials, from North America (34%), Europe (33%), Oceania (17%), and other countries (16%). Eighteen percent reported at least one of the seven suppression events relating to the trial in question. The most commonly reported suppression event was funder(s) expressing reluctance to publish because they considered the results 'unfavourable' (9% reported). We found no strong associations with the subject of research, funding source, democracy, region, or year of publication. One in five researchers in this global sample reported being pressured to delay, alter, or not publish the findings of health behaviour intervention trials. Regulation of funder and university practices, establishing study registries, and compulsory disclosure of funding conditions in scientific journals, are needed to protect the integrity of public-good research.

Response rates for surveys of alcohol use are declining for all modes of administration (postal, telephone, face-to-face). Low response rates may result in estimates that are biased by selective non-response. We examined non-response bias in the NZ GENACIS survey, a postal survey of a random electoral roll sample, with a response rate of 49.5% (n = 1924). Our aim was to estimate the magnitude of non-response bias in estimating the prevalence of current drinking and heavy episodic (binge) drinking. We used the \"continuum of resistance\" model to guide the investigation. In this model the likelihood of response by sample members is related to the amount of effort required from the researchers to elicit a response. First, the demographic characteristics of respondents and non-respondents were compared. Second, respondents who returned their questionnaire before the first reminder (early), before the second reminder (intermediate) or after the second reminder (late) were compared by demographic characteristics, 12-month prevalence of drinking and prevalence of binge drinking. Demographic characteristics and prevalence of binge drinking were significantly different between late respondents and early/intermediate respondents, with the demographics of early and intermediate respondents being similar to people who refused to participate while late respondents were similar to all other non-respondents. Assuming non-respondents who did not actively refuse to participate had the same drinking patterns as late respondents, the prevalence of binge drinking amongst current drinkers was underestimated. Adjusting the prevalence of binge drinkers amongst current drinkers using population weights showed that this method of adjustment still resulted in an underestimate of the prevalence. The findings suggest non-respondents who did not actively refuse to participate are likely to have similar or more extreme drinking behaviours than late respondents, and that surveys of health compromising behaviours such as alcohol use are likely to underestimate the prevalence of these behaviours.

Jim McCambridge and colleagues reflect on how the concept of harm reduction may be being usurped by the alcohol industry. Please see later in the article for the Editors' Summary.Jim McCambridge and colleagues reflect on how the concept of harm reduction may be being usurped by the alcohol industry. Please see later in the article for the Editors' Summary.

'Responsible drinking' campaigns emerged in the early 1970s as a means of addressing hazardous drinking and its related consequences. While these were initially the product of public health agencies and health-related NGOs, they are increasingly being developed and disseminated by the alcohol industry. There is considerable debate as to whether industry-generated campaigns are designed to reduce hazardous drinking and related problems (as argued by their developers) or are designed to avoid government regulation or even to increase sales. The aim of the present study was to explore the way that recent industry-developed responsible drinking campaigns are perceived and interpreted by the general public. That is, do they promote low-risk drinking, promote risky drinking, or just muddy the waters. Two sub-studies were conducted. The first, a mall intercept study with 180 adults in two Australian shopping districts, explored participants' understanding of slogans/taglines. The second, an online survey with 480 Australian adults, explored understandings and interpretations of television/online commercials. The results of the two studies revealed diversity in participants' interpretation of the 'responsible drinking' advertisements. Terminology utilised in industry-developed advertisements was found to be ambiguous; for example, what age group was being referred to in the tagline 'Kids and alcohol don't mix', and whether 'Drink Properly' meant not drinking to excess or drinking in a way that made you look more sophisticated. In Study Two, the government-developed campaign ('Know when to say when') was clearly interpreted as warning against risky consumption of alcohol; whereas the industry-developed campaigns ('How to drink properly', 'Kids absorb your drinking', 'Friends are waiting') were interpreted to have a range of different meanings, including some seemingly unrelated to alcohol. These findings are consistent with the literature evaluating anti-smoking campaigns developed by the tobacco industry, and previous research showing that industry communications serve to soften public opinion and create the impression of a 'socially responsible' industry but are likely to be less effective than initiatives focused on the availability and promotion of alcohol.

Background The Miller Brewing Company (MBC) was wholly owned by Phillip Morris (PM), between 1970 and 2002. Tobacco industry document studies identify alliances between the alcohol and tobacco industries to counter U.S. policies in the 1980s and 1990s. This investigation sought to study in-depth inter-relationships between MBC and PM, with a particular focus on alcohol policy issues. We used the Truth Tobacco Industry Documents library to trace the evolution of corporate affairs and related alcohol policy orientated functions within and between MBC and PM. Results MBC was structured and led by PM senior executives from soon after takeover in 1970. Corporate Affairs sought to influence public perceptions of alcohol to align them with business interests. Alcohol education was specifically designed to prevent the adoption of policies inimical to those interests (e.g., raising excise taxes). Strategic consideration of alcohol policy issues was integrated within company-wide thinking, which sought to apply lessons from tobacco to alcohol and vice versa. PM directly led key alcohol industry organisations nationally and globally, which have successfully delayed the adoption and implementation of known effective policy measures in the U.S. and worldwide. Conclusions PM has been a key architect of alcohol industry political strategies. This study builds on earlier work on alcohol companies in the tobacco documents, and offers historical data on how tobacco companies have used commercial involvements in other sectors to influence wider public health policy. We are only beginning to appreciate how multi-sectoral companies internally develop political strategies across product categories. Global health and national governmental policy-making needs to be better protected from business interests that fundamentally conflict with public health goals.