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Tobacco use, a major preventable risk factor for premature death and morbidity, profoundly shapes individual and household decision-making. Tobacco spending in lower-income economies exacerbates economic strain of the households. To accommodate tobacco costs, many households are forced to reduce essential expenditures on health and education—a phenomenon known as the crowding out effect. This study uses data from Albania’s national Household Budget Survey and applies a three-stage least squares method with instrumental variables to estimate Engel curves to shed light on how tobacco use influences household financial decisions. The findings reveal that tobacco spending significantly reduces expenditures on essential needs such as health, education, housing, and clothing. Additionally, tobacco use shows a positive correlation with alcohol spending, revealing another negative influence of an addictive behavior on household resource allocation. The results emphasize the urgent need for stronger tobacco control measures promote better economic decision-making within households. Such measures would enhance public health, improve economic stability, and encourage more equitable resource distribution.

Economic evaluations of new youth mental health interventions require preference-based outcome measures that capture the broad benefits these interventions can have for adolescents. The Abbreviated Self Completion Teen-Addiction Severity Index (ASC T-ASI) was developed to meet the need for such a broader measure. It assesses self reported problems in seven important domains of adolescents' lives, including school performance and family relationships, and is intended for use in economic evaluations of relevant interventions. The aim of the current study was to present the ASC T-ASI and examine its validity as well as its ability to distinguish between adolescents with and without problems associated with substance use and delinquency. The validation study was conducted in a sample of adolescents (n = 167) aged 12-18 years, who received in- or outpatient care in a youth mental health and (enclosed) care facility in the Netherlands. To examine its feasibility, test-retest reliability, and convergent validity, respondents completed the ASC T-ASI, as well as the EQ-5D-3L and SDQ at baseline and after a two-week interval using a counterbalanced method. The ASC T-ASI descriptive system comprises seven domains: substance use, school, work, family, social relationships, justice, and mental health, each expressing self reported problems on a five-point Likert scale (ranging from having 'no problem' to having a 'very large problem'). The majority of respondents (>70%) completed the ASC T-ASI within 10 minutes and appraised the questions as (very) easy and (very) comprehensible. Test-retest reliability was adequate (Kw values 0.26-0.55). Correlations with the supplementary measures were moderate to high (rs 0.30-0.50), suggesting convergent validity. The ASC T-ASI is a promising and valid measure for assessing self reported problems in important domains in adolescents' lives, allowing benefits beyond health and health-related quality of life to be included in economic evaluations of youth mental health interventions. Future studies of the ASC T-ASI should consider the comprehensiveness of its domains and sensitivity to change.

In October 2008 all three major banks in Iceland went bankrupt with serious consequences for Icelandic society. The national currency lost more than half of its value and there was a sharp increase in household debts and prices for domestic goods. Very little is known about the potential effects of economic recessions on gambling participation and problem gambling. This study reports on the results of three national prevalence studies conducted before and after the economic collapse in Iceland. The same methodology and measures were used in all three studies to ensure their comparability and the studies included in total N = 8.249 participants. There was an increase in past year gambling participation which extended across most gambling types. Only participation on EGMs declined significantly after the economic collapse. Past year prevalence of problematic gambling increased but further examination revealed that this increase is most probably explained by an increase in card and internet gambling among young men. Moreover, those who experienced financial difficulties due to the economic recession were 52 % more likely to have bought a lottery ticket during the recession compared to those who were not affected financially. Overall, the results indicate that serious national economic recessions have differential effects on gambling behavior.

The role of craving in nicotine dependence remains controversial and may be a function of measurement challenges. The current study used behavioral economic approach to test the hypotheses that subjective craving from acute withdrawal and exposure to tobacco cues dynamically increases the relative value of cigarettes. Using a 2 (1-hr/12-hr deprivation) × 2 (neutral/tobacco cues) within-subjects design, 33 nicotine dependent adults completed 2 laboratory sessions. Assessment included subjective craving and behavioral economic indices of cigarette demand, namely Intensity (i.e., cigarette consumption at zero cost), O(max) (i.e., maximum total expenditure), Breakpoint (i.e., highest acceptable price for cigarettes), P(max) (i.e., price at which consumption becomes sensitive to price), and elasticity (i.e., price sensitivity). Behavioral economic indices were generated using a Cigarette Purchase Task in which participants selected between cigarettes for a subsequent 2-hr self-administration period and money. Main effects of deprivation and tobacco cues were present for subjective craving and multiple behavioral economic indices of cigarette demand. Interestingly, deprivation significantly increased Breakpoint (p ≤ .01) and P(max) (p ≤ .05) and had trend-level effects on Intensity and O(max) (p ≤ .10); whereas cues significantly reduced elasticity (p ≤ .01), reflecting lower sensitivity to increasing prices. Heterogeneous associations were evident among the motivational variables but with aggregations suggesting variably overlapping motivational channels. These findings further support a behavioral economic approach to craving and a multidimensional conception of acute motivation for addictive drugs. Methodological considerations, including potential order effects, and the need for further refinement of these findings are discussed.

Social casino games are online gambling-like games found on social networking sites. They are initially free to play, however, players are encouraged to make micro-transactions (i.e., in-game purchases) for additional game credits or functionality. As a result, they generate billions of dollars in revenue. Yet, little is known as to who purchases virtual credits, let alone why. In the present research, we assessed whether there are individual differences (impulsivity, reward sensitivity, competitiveness, and problem gambling severity) between who is and who is not likely to make micro-transactions during social casino game play. Moreover, we examined possible motivations for making micro-transactions (e.g., extend play, win back lost credits) and whether the individual difference variables of interest predict reported motivation(s) for making micro-transactions. Results showed that social casino gamers who engaged in micro-transactions reported significantly higher levels of impulsivity, reward sensitivity and problem gambling severity, but not competitiveness. In terms of motivation to make micro-transactions, desire to extend play was endorsed most frequently, followed by a desire to access additional features, chasing lost credits, and to speed up play. Lastly, among participants who made micro-transactions, reward sensitivity predicted making micro-transactions to chase lost credits. These results suggest the personality make-up of social casino gamers is important to understand who is likely to make micro-transactions as well as their motivation to do so--information that could prove useful for regulation of the industry.

Giving a gift or a cash incentive to someone to give up an addiction sounds like a prize for behaving badly, but the practice works. The real challenge is deciding who should pay for it.

Objective: Public Health Ontario and the Institute for Clinical Evaluative Sciences have collaborated to estimate the burden of illness attributable to mental disorder and addictions in Ontario. Methods: Health-adjusted life years were used to estimate burden. It is conceptually similar to disability-adjusted life years that were used in the global burden of disease studies. Data sources for the mental illnesses and addictions used in our study included health administrative data for the province of Ontario, survey data from Statistics Canada and the Centre for Addiction and Mental Health, vital statistics data from the Ontario Office of the Registrar General, and US epidemiologic survey data. Results: The 5 conditions with the highest burden are: major depression, bipolar affective disorder, alcohol use disorders (AUDs), social phobia, and schizophrenia. The burden of depression is double the next highest mental health condition (that is, bipolar affective disorder) and is more than the combined burden of the 4 most common cancers in Ontario. AUDs were the only disease group that had a substantial proportion of burden attributable to early death. The burden estimates for the other conditions were primarily due to disability. Conclusions: The burden of these conditions in Ontario is as large or larger than other conditions, such as cancer and infectious diseases, owing in large part to the high prevalence, chronicity, and age of onset for most mental disorders and addiction problems. The findings serve as an important baseline for future evaluation of interventions intended to address the burden of mental health and addictions.

Background Many jurisdictions regularly conduct surveys to estimate the prevalence of problem gambling in their adult populations. However, the comparison of such estimates is problematic due to methodological variations between studies. Total consumption theory suggests that an association between mean electronic gaming machine (EGM) and casino gambling losses and problem gambling prevalence estimates may exist. If this is the case, then changes in EGM losses may be used as a proxy indicator for changes in problem gambling prevalence. To test for this association this study examines the relationship between aggregated losses on electronic gaming machines (EGMs) and problem gambling prevalence estimates for Australian states and territories between 1994 and 2016. Methods A Bayesian meta-regression analysis of 41 cross-sectional problem gambling prevalence estimates was undertaken using EGM gambling losses, year of survey and methodological variations as predictor variables. General population studies of adults in Australian states and territory published before 1 July 2016 were considered in scope. 41 studies were identified, with a total of 267,367 participants. Problem gambling prevalence, moderate-risk problem gambling prevalence, problem gambling screen, administration mode and frequency threshold were extracted from surveys. Administrative data on EGM and casino gambling loss data were extracted from government reports and expressed as the proportion of household disposable income lost. Results Money lost on EGMs is correlated with problem gambling prevalence. An increase of 1% of household disposable income lost on EGMs and in casinos was associated with problem gambling prevalence estimates that were 1.33 times higher [95% credible interval 1.04, 1.71]. There was no clear association between EGM losses and moderate-risk problem gambling prevalence estimates. Moderate-risk problem gambling prevalence estimates were not explained by the models ( I 2  ≥ 0.97; R 2  ≤ 0.01). Conclusions The present study adds to the weight of evidence that EGM losses are associated with the prevalence of problem gambling. No patterns were evident among moderate-risk problem gambling prevalence estimates, suggesting that this measure is either subject to pronounced measurement error or lacks construct validity. The high degree of residual heterogeneity raises questions about the validity of comparing problem gambling prevalence estimates, even after adjusting for methodological variations between studies.

Background Low socioeconomic status (SES) exacerbates the high rate of smoking relapse in women following childbirth. Purpose This study examined multiple models of potential mechanisms linking SES and postpartum smoking relapse among women who quit smoking due to pregnancy. Methods Participants were 251 women enrolled in a randomized clinical trial of a new postpartum smoking relapse prevention intervention. Four models of the prepartum mechanisms linking SES and postpartum smoking relapse were evaluated using a latent variable modeling approach. Results Each of the hypothesized models were a good fit for the data. As hypothesized, SES indirectly influenced postpartum smoking relapse through increased prepartum negative affect/stress, reduced sense of agency, and increased craving for cigarettes. However, the model that included craving as the sole final pathway between SES and relapse demonstrated superior fit when compared with all other models. Conclusions Findings have implications for future interventions that aim to reduce postpartum relapse.

Evidence about social costs of gambling is scarce and the methodology for their calculation has been a subject to strong criticism. We aimed to estimate Social Costs of Gambling in the Czech Republic 2012. This retrospective, prevalence based cost of illness study builds on the revised methodology of Australian Productivity Commission. Social costs of gambling were estimated by combining epidemiological and economic data. Prevalence data on negative consequences of gambling were taken from existing national epidemiological studies. Economic data were taken from various national and international sources. Consequences of problem and pathological gambling only were taken into account. In 2012, the social costs of gambling in the Czech Republic were estimated to range between 541,619 and 619,608 thousands EUR. While personal and family costs accounted for 63% of all social costs, direct medical costs were estimated to range from 0.25 to 0.28% of all social costs only. This is the first study which estimates social costs of gambling in any of the Central and East European countries. It builds upon the solid evidence about prevalence of gambling related problems in the Czech Republic and satisfactorily reliable economic data. However, there is a number of limitations stemming from assumptions that were made, which suggest that the methodology for the calculation of the social costs of gambling needs further development.