The Behaviouralist (United Kingdom)

To determine whether alcohol consumption in England had returned to pre-pandemic levels by December 2024, after the initial rise in 2020 across the total population and subgroups. Monthly representative surveys were conducted through face-to-face interviews until February 2020, and then by telephone. England, March 2014 to December 2024. 208 010 adults aged 18+ living in private households. Mean weekly alcohol consumption (in UK units), prevalence of risky drinking (Alcohol Use Disorders Identification Test for Consumption [AUDIT-C] score≥5), and possible dependence (AUDIT-C ≥ 11). Further measures included age, gender, and social grade. All outcomes increased in April 2020: prevalence of risky drinking by 30.3% (95% confidence interval [CI]: 26.8, 33.8, from 26.2% in February 2020 to 34.0% in April 2020), prevalence of possible dependence by 90.2% (95% CI: 62.2, 122.9, from 0.9% to 1.7%) and mean weekly alcohol consumption by 34.5% (95% CI: 31.0, 38.0, from 5.0units to 6.6units). When adjusting for the survey mode change from face-to-face to telephone interviews, the step changes between February and April 2020 remained but were substantially attenuated. The post-pandemic trend declined more quickly than the pre-pandemic trend for the prevalence of risky drinking (difference: -1.5%/year, 95% CI: -2.4, -0.6) and mean weekly alcohol consumption (difference: -2.4%/year, 95% CI: -3.3, -1.6), indicating a slow but incomplete return to pre-pandemic levels. The trend in prevalence of possible dependence was similarly stable before and after the pandemic (difference: -1.3%/year, 95% CI: -6.2, 3.8). Alcohol consumption declined more slowly among people from less advantaged than from more advantaged social grades. The prevalence of risky drinking and mean weekly alcohol consumption in England appear to be trending towards pre-pandemic levels but the prevalence of dependent drinking in England appears to have increased since the start of the pandemic and remains elevated compared with pre-pandemic levels. Alcohol-related inequalities may be worsening due to slower declines in consumption following the pandemic among less advantaged drinkers.

BackgroundSmoking poses health risks to women across the lifespan. This study aimed to examine age-related differences in smoking, quit attempts, and cessation outcomes among women in Great Britain, overall and by socioeconomic position.MethodsWe analysed cross-sectional data from 30,519 women (≥ 16 years) in Great Britain participating in a nationally representative survey between 2023 and 2025. We used logistic regression with restricted cubic splines to obtain age-specific estimates of smoking prevalence, the quit attempt rate, the success rate of quit attempts, and the overall quit rate, among all women and by socioeconomic position (indexed by occupational social grade; ABC1 = more advantaged, C2DE = less advantaged). We calculated prevalence ratios (PR; C2DE/ABC1) to illustrate the extent of socioeconomic disparities.ResultsOverall, smoking prevalence was highest among women in their 20s and 30s and declined with age. However, there were notable differences by socioeconomic position. While it declined steadily with age among more advantaged women, smoking prevalence peaked in the early 40s among less advantaged women and was more than twice that of more advantaged women in mid-life (PR range = 2.02–2.47 between ages 35 and 60). Quit attempts decreased linearly with age, with similar prevalence and trends across socioeconomic groups. The success rate of quit attempts was highest among women in their 20s and 30s, but dropped in mid-life and further in older age. Women from less advantaged backgrounds had lower success rates, particularly between ages 45 and 60 (PR range = 0.70–0.73). The overall quit rate among past-year smokers was highest at age 31 for more advantaged women (23.3%) and at age 25 for less advantaged women (22.9%). Quit rates were substantially lower between ages 40 and 60 among less advantaged women (PR range = 0.65–0.69).ConclusionsSmoking behaviours and cessation outcomes among women in Great Britain vary by both age and socioeconomic position, with particularly high smoking prevalence and low quit rates among less advantaged women in mid-life, corresponding with perimenopause and the menopausal transition. These disparities highlight the need for tailored smoking cessation strategies to improve quit success and reduce smoking prevalence across the lifespan.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12916-025-04574-1.

Compared with adults who smoke cigarettes, adults who vape nicotine are exposed to similar levels of nicotine and significantly lower levels of tobacco-specific nitrosamines (TSNAs). Little research outside the USA has included youth who vape, particularly those using newer disposable vapes. We investigated exposure to nicotine and the TSNA NNK (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol) among youth in England who vape, smoke, do both (dual) or do neither. In 2023, youth aged 16-19 years from England completed a survey and provided a urine sample (n=201). Linear regressions examined associations of creatinine-normalised urinary concentrations of total nicotine equivalents (TNE-2) and NNAL (a metabolite of NNK) with past 7-day smoking/vaping status and self-reported recency of vaping. All analyses were adjusted for age, sex at birth, ethnicity and any past 7-day cannabis use. Over three-quarters (77%) of those vaping were using the newer disposable vapes. Urinary TNE-2 concentrations among those who exclusively vaped in the past 7 days (n=83, geometric mean (GM)=5.09 nmol/mg creatinine (95% CI 3.19 to 8.12)) did not differ significantly from those who smoked (n=9, GM=1.74 nmol/mg creatinine (95% CI 0.64 to 4.72), p=0.426) or those who dual used (n=55, GM=5.60 nmol/mg creatinine (95% CI 3.32 to 9.43), p=0.953). Levels of NNAL among those who exclusively vaped (GM=1.87 pg/mg creatinine (95% CI 1.62 to 2.17)) were significantly lower than those who smoked (GM=4.87 pg/mg creatinine (95% CI 2.45 to 9.68), p=0.001) or those who dual used (GM=3.67 pg/mg creatinine (95% CI 2.76 to 4.86), p<0.001) and not significantly different from youth who neither vaped nor smoked (GM=1.84 pg/mg creatinine (95% CI 1.52 to 2.24), p=0.887). Youth who vape are exposed to similar levels of nicotine as those who smoke or who dual use. NNAL exposure among youth who vape is much lower than among those who smoke and indistinguishable from youth who do not vape or smoke.

Multimodal machine learning with missing modalities is an increasingly relevant challenge arising in various applications such as healthcare. This paper extends the current research into missing modalities to the low-data regime, i.e., a downstream task has both missing modalities and limited sample size issues. This problem setting is particularly challenging and also practical as it is often expensive to get full-modality data and sufficient annotated training samples. We propose to use retrieval-augmented in-context learning to address these two crucial issues by unleashing the potential of a transformer’s in-context learning ability. Diverging from existing methods, which primarily belong to the parametric paradigm and often require sufficient training samples, our work exploits the value of the available full-modality data, offering a novel perspective on resolving the challenge. The proposed data-dependent framework exhibits a higher degree of sample efficiency and is empirically demonstrated to enhance the classification model’s performance on both full- and missing-modality data in the low-data regime across various multimodal learning tasks. When only 1% of the training data are available, our proposed ICL-CA method outperforms the best baseline by 5.9%, 5.9%, 5.3% and 10.8% on four datasets across various missing states. Notably, our method also reduces the performance gap between full-modality and missing-modality data compared with the baseline. Code is available 1 1 GitHub repository . . • We address data scarcity in missing-modality tasks, highlighting the limitations of existing parametric approaches, where adequate sample sizes are essential. Our study reveals that focusing adaptively on both missing- and full-modality data improves performance. • We introduce a novel, data-dependent in-context learning method to enhance sample efficiency and optimize learning across missing- and full-modality data. • Experiments on four datasets (medical and vision-language tasks) show that our method boosts performance by 5.9%, 5.9%, 5.3% and 10.8% over the best baseline in the low-data regime.

BackgroundInterventional research has shown that cultural activities, such as singing and dancing, can bring about improved health outcomes, including improvements in indicators of biological dysregulation. However, large-scale quantitative analyses on cultural engagement and biomarkers are lacking to date. As a result, the potential mechanisms through which cultural activities may become biologically embedded, or lead to changes in health, are unclear. This research therefore examines associations between cultural engagement patterns (including active and passive engagement in arts, sports and heritage activities) and indicators of biological dysregulation in a large, representative dataset.MethodsData from the Understanding Society dataset were used to conduct cross-sectional linear regression analyses between a data-driven latent class model of cultural engagement (previously published) and indicators of anthropometric, cardiovascular, metabolic, immune, and neuroendocrine function. Analyses were adjusted for age, gender, ethnicity, childcare responsibility, urbanicity, leisure time satisfaction, capacity-related factors, socioeconomic position, social and economic capital indicators, and sensitivity analyses further adjusted for physical activity and medication use.ResultsOverall, participants who were more culturally active were found to have better indicators of biological health, including lower blood pressure, waist circumference, and fibrinogen blood concentration than participants who were culturally disengaged. Additionally, a range of specific associations between cultural engagement patterns and the different biological outcomes were observed. Although the associations were explained in part by socioeconomic, demographic and access related factors, cultural engagement patterns were found to be independently correlated with the biomarker outcomes. For some outcomes, clinically meaningful differences were observed between the cultural engagement groups.ConclusionThe data suggest that patterns of cultural engagement are associated with indicators of biological health, although the sociodemographic characteristics of people who engage with culture is an important consideration when interpreting this research. Although the analyses were cross-sectional, the findings are relevant to the UK’s social prescribing movement and other international arts-on-prescription type initiatives and policies.

In March 2024, the UK government announced plans to introduce a Vaping Products Duty that will tax e-liquids based on their nicotine strength. This study examined trends in the nicotine strength of e-liquids used by adult vapers and differences in those currently used across relevant subgroups. Nationally-representative, cross-sectional household survey, July 2016 to January 2024. Great Britain. 7981 adult vapers. Participants were asked whether the e-cigarette they mainly use contains nicotine (yes/no) and the e-liquid strength (no nicotine, >0-≤ 6, 7-11, 12-19 or ≥20 mg/ml). We also collected information on the main device type used (disposable/refillable/pod), age, gender, occupational social grade, history of ≥1 mental health conditions, smoking status and (among past-year smokers) level of cigarette addiction. The proportion of vapers in England using high-strength (≥20 mg/ml) e-liquids increased from an average of 3.8% (95% confidence interval [CI] = 2.9-5.0) up to June 2021 to 32.5% (CI = 27.9-37.4) in January 2024 (the vast majority of whom [93.3% in January 2024] reported using exactly 20 mg/ml; the legal limit). This rise was most pronounced among those using disposable e-cigarettes, those aged 18-24 years and all smoking statuses (including never smokers) except long-term (≥1y) ex-smokers. Of those surveyed in 2022-2024 in Great Britain, overall, 89.5% (CI = 88.1-90.8) said they usually used e-cigarettes containing nicotine, 8.7% (CI = 7.5-10.0) used nicotine-free e-cigarettes, and 1.8% (CI = 1.2-2.4) were unsure. The proportion using ≥20 mg/ml was higher among those mainly using disposable (47.9%) compared with pod (16.3%) or refillable (11.5%) devices; never smokers (36.0%), current smokers (28.8%) or recent (<1y) ex-smokers (27.4%), compared with long-term ex-smokers (13.9%); and younger (16-24y; 44.2%) compared with older (≥25y; range 9.4-25.1%) age groups. There were no notable differences across other subgroups of interest. Use of high-strength nicotine e-liquids in England appears to have increased sharply in recent years. Most adult vapers in Great Britain appear to use e-cigarettes that contain nicotine but different subgroups use different strengths: nicotine strengths tend to be higher among those who mainly use disposable devices and those aged 16-24y, and lower among long-term ex-smokers.

IntroductionMedical students have been shown to experience mental health problems more frequently compared to their non-medical student peers. This can manifest in pathological levels of stress and depression, and can lead to substance abuse, reduced academic performance, or even suicide.ObjectivesA credit course on professional socialization is offered for medical students at the University of Debrecen in the form of peer education. Our goal was to evaluate experiences of this course delivered in the past 5 academic years.MethodsAfter reviewing the relevant literature, the structure of a focus group interview was developed. The focus group consisted of 8 participants and was moderated by the course supervisor with the help of an assistant moderator. The group summarized the number of students completing the course, and narratives of teaching experiences between 2018/19 and 2022/23. They also revised relevant versions of the tutors’ handbook containing the topics and methodology of the course. The duration of the interview was 90 minutes, and it was tape recorded by the assistant moderator, who also made notes in case the tape is inaudible.ResultsBetween 2018/19 and 2022/23 61 students finished the course with the help of 23 tutors. The course is offered for students of general medicine, dentistry and pharmacy to improve their positive professional attitudes and social skills through group work and practical exercises. The medical curriculum includes mandatory courses with practical opportunities for developing professional and social skills, but due to the limited number of contact hours and the varying levels of student interest and motivation, these skills are difficult to master. The credit course was developed using the concept of Bálint groups, offering peer-supervised opportunities for motivated students above year 2 to practice their professional skills in controlled conditions while also receiving feedback from their peer group leaders. The course complements the traditional medical curriculum and sensitizes students in a protected environment in which they can observe their own communication more consciously and recognize unfavourable behaviour patterns. Developing the ability to work in a team, learning to listen, and practicing assertiveness during study years can also reduce performance-related stress and future medical errors along with increasing job satisfaction and patient adherence.ConclusionsBased on the narrative summary of the focus group, both the experiences of participating students and peer teachers are positive, the handbook is a useful tool. The structured focus group provides a suitable method to evaluate the credit course which should be held once every academic year to evaluate the implemented course and explore options to improve future courses.Disclosure of InterestNone Declared

IntroductionSpeech and language therapists (SLTs) worldwide report challenges with providing recommended, evidence-based intervention intensity for children with speech sound disorder (SSD). Challenges such as service constraints and/or family contexts impact on access to optimal therapy intensity. Existing research indicates that empowering and training parents to deliver intervention at home, alongside SLT support, offers one possible solution to increasing the intensity of intervention children with SSD receive. Digital health could increase accessibility to intensive home practice and help sustain engagement with therapy activities. Further exploration is needed around what makes parent-implemented interventions for children with SSD effective, for who and in which situations. This paper outlines the protocol for a realist review which aims to explore the active ingredients and contextual factors of effective digital parent-led interventions.Methods and analysisA realist review will explore the research question, following six stages. The scope of the review will be determined, and initial programme theories will be developed about what works in digital parent-implemented interventions for SSD, for whom, how, why and in what circumstances. Relevant secondary data, identified through a formal search strategy, will be selected, appraised, analysed and synthesised using realist principles to test and further refine the initial programme theories. This process will develop refined underpinning explanatory theories which capture the interaction between contexts, mechanisms and outcomes of the intervention. An expert steering group will provide insight to inform explanatory theories, searches, and dissemination.Ethics and disseminationEthical approval is not required for this review. The refined programme theories from the review will inform the next stages of a wider study. A subsequent realist evaluation will test and further refine theories with key stakeholders. Following this, the underpinning programme theory will be used to coproduce a digital tool, to support parents to deliver home intervention alongside SLT support.

Background: Self-care in diabetes management is not a one-size-fits-all approach. It requires individualization based on factors such as age, lifestyle, social support, and overall health. Objective: This study aimed to qualitatively explore psychosocial aspects such as information, motivation &amp; behavioral factors concerning diabetes self-care among people with type 2 Diabetes Mellitus (T2DM). Method: Purposive sampling was used to select patients with Type 2 Diabetes Mellitus from government health facilities in Klang, Selangor. They participated in an In-Depth Interview (IDI) session, which included a semi-structured guide questionnaire. All data were analyzed thematically. Results: A total of 21 IDIs consisting of nine females and twelve males T2DM patients were conducted with an average age of 56 years. The qualitative analysis identified three major themes: Information, Motivation, and Behavior. Conclusions: It is crucial to understand individual needs, capabilities, and the factors that affect type 2 diabetes patients' capacity to perform these self-care behaviors. Recommendation: Psychosocial aspects should be embedded in diabetes care settings to delay or prevent the progression of complications associated with Diabetes

BackgroundConsumers have difficulty understanding alcoholic units and low risk drinking guidelines (LRDG). Labelling may improve comprehension. The aims of this rapid evidence review were to establish the effectiveness of on-bottle labelling for (i) improving comprehension of health risks; (ii) improving comprehension of unit and/or standard drink information and/or LRDG, and (iii) reducing self-reported intentions to drink/actual drinking.MethodsElectronic database searches were carried out (January 2008-November 2018 inclusive). Papers were included if they were: published in English; from an Organization for Economic Co-operation and Development country; an experimental/quasi-experimental design. Papers were assessed for quality using the Effective Public Health Practice Project Quality Assessment tool. Ten papers were included. Most studies were moderate quality (n = 7).ResultsFive themes emerged: comprehension of health risks; self-reported drinking intentions; comprehension of unit/standard drink information and/or LRDG; outcome expectancies; and label attention. Labelling can improve awareness, particularly of health harms, but is unlikely to change behaviour. Improved comprehension was greatest for labels with unit information and LRDG.ConclusionsAlcohol labelling can be effective in improving people’s comprehension of the health risks involved in drinking alcohol enabling them to make informed consumption decisions, and perhaps thereby provide a route to changing behaviour. Thus, effective alcohol labelling is an intervention that can be added to the broader suite of policy options. That being said, the literature reviewed here suggests that the specific format of the label matters, so careful consideration must be given to the design and placement of labels.