Melissa Oldham

Aims: To examine oral nicotine pouch use among United States (U.S.) middle and high school students by (1) estimating prevalence in 2025 across demographic and other tobacco/nicotine product use subgroups, (2) assessing trends from 2021 to 2025, and (3) identifying factors independently associated with current pouch use. Design: Annual cross‐sectional survey. Setting: United States. Participants: 124 264 middle and high school students (typically aged 11–18 years) in the National Youth Tobacco Survey 2021–2025 (n = 20 413, 28 291, 22 069, 29 861 and 23 630). 117 864 students with classifiable pouch use were included in the trend analyses and 22 854 in the 2025 analyses. Measurements: We estimated annual survey‐weighted prevalence of ever, current (≥1 day in the past 30 days) and current frequent (≥20 days) pouch use, overall and by sex, school level, race/ethnicity, and by current use of cigarettes, e‐cigarettes, other non‐pouch products and any non‐pouch product, each analysed separately. Trends were assessed with survey‐weighted Poisson regression using orthogonal linear and quadratic year contrasts, the quadratic testing departure from a constant multiplicative trend. Using 2025 data we estimated adjusted prevalence ratios (APRs) for current pouch use. Results: In 2025, 3.8% [95% confidence interval (CI): 3.1–4.6] of students reported ever using pouches, 1.7% (1.4–2.1) current use, and 0.4% (0.3–0.6) frequent use. Current use rose from 0.8% (0.6–1.0) in 2021 to 1.6% (1.1–2.2) in 2023 then changed little at 1.8% (1.5–2.1) in 2024 and 1.7% in 2025. The quadratic year term was 0.75 (0.57–0.99), consistent with deceleration but imprecise. Ever use rose across all five waves from 2.1% (1.7–2.5) with no departure from linearity (quadratic 1.00, 0.81–1.22). Increases were consistent across subgroup levels with reliable estimates in all years. In 2025, current pouch use was higher among males (2.4% vs. 1.0%) and among current users of any other product (20.6% vs. 0.4%). Most current pouch users (77.4%) also currently used another product, though 11.1% reported no lifetime use. In fully adjusted models, associations were strongest for other non‐pouch product use (APR = 13.78, 95% CI: 8.39–22.65), then e‐cigarette (4.32, 2.75–6.80) and cigarette use (1.49, 1.08–2.07). Summary: Oral nicotine pouch use among United States middle and high school students remains uncommon. Current use rose between 2021 (0.8%) and 2023 (1.6%) and has since levelled off, while ever use continued to increase. Use is largely concentrated among users of other tobacco or nicotine products, but a minority report no current or lifetime use of other products.

Background/aims: In England, the proportion of adults not in work due to long‐term illness or disability has risen sharply in recent years. This study examined differences in trends in health‐related economic inactivity between 2014 and 2025 by level of alcohol consumption. Design: Repeated cross‐sectional analysis of data from a nationally representative, monthly survey conducted between March 2014 and May 2025. Setting: England. Participants: 162 935 adults aged 18–64. Measurements: Health‐related economic inactivity was defined as self‐reporting being out of work due to long‐term illness or disability. Alcohol consumption was classified using the Alcohol Use Disorders Identification Test‐Consumption (AUDIT‐C) into five risk levels: non‐drinker (score of 0), low risk (1–4), increasing risk (5–7), higher risk (8–10) and possible dependence (11–12). Logistic regression was used to model time trends adjusted for age and gender. Modelled estimates were then extrapolated to the adult population of England using national population and drinking prevalence estimates. Secondary analyses were conducted using the full AUDIT and a measure of heavy episodic drinking. Results: Between 2014 and 2025, the prevalence of health‐related economic inactivity more than doubled among non‐drinkers (from 4.9% to 10.0%; a 104% increase) and low‐risk drinkers (from 2.3% to 4.7%; a 104% increase), and increased by 50% among those drinking at increasing‐risk levels (from 1.8% to 2.7%). In contrast, it remained relatively stable among those drinking at high‐risk levels (from 3.2% to 2.9%; a 9% decrease) and declined among those drinking at levels indicating possible dependence (from 5.4% to 3.4%; a 37% decrease). This pattern of results was consistent across different measures of alcohol use (AUDIT‐C classifications, full AUDIT, heavy episodic drinking). However, when accounting for population growth and increases in the overall prevalence of riskier drinking, the absolute numbers of increasing‐ and high‐risk drinkers and those with possible dependence who reported health‐related economic inactivity increased from 229 000 to 318 000. Summary: The prevalence of economic inactivity due to long‐term illness and disability among working‐age adults in England between 2014 and 2025 more than doubled among non‐drinkers and low‐risk drinkers while remaining stable or declining among those drinking at higher‐risk levels, likely reflecting reverse causality and broader shifts in the population composition of drinkers in recent years.

Introduction: Alcohol-related harm is more prevalent among people experiencing homelessness, but national data often overlook this group. This study examined alcohol use and receipt of support and compared this group with the general population. Methods: We analysed data from the Homeless Health Needs Audit (2015–2021; cross-sectional survey of a convenience sample of people experiencing homelessness in England), and for general population estimates, from the nationally representative Health Survey for England (2022). Outcomes included any alcohol use, exceeding drinking guidelines (>14 units per week), possible alcohol use disorder (men: >50 units per week; women: >35 units per week), self-identified alcohol problem and receipt of support for their drinking. We estimated the prevalence for each of the outcomes and odds of receiving support and type of support by age, gender and type of homelessness. Results: Among people experiencing homelessness (n=2652), 78.4% (95% CI 76.5% to 80.2%) consumed alcohol, 31.1% (95% CI 29.3% to 33.3%) exceeded drinking guidelines and 19.2% (95% CI 17.4% to 20.9%) had possible alcohol use disorder, compared with 83.4% (95% CI 82.4% to 84.4%), 23.9% (95% CI 22.7% to 25.1%) and 4.8% (95% CI 4.2% to 5.5%) in the general population, respectively. For the latter two outcomes, prevalence was highest among people sleeping rough (47.4% (95% CI 40.8% to 54.1) and 37.8% (95% CI 31.4% to 44.2%), respectively). Overall, 28.3% (95% CI 26.5% to 30.0%) self-identified ever having an alcohol problem; of these, 58.4% (95% CI 54.7% to 62.1%) received support. People sleeping rough had lower odds of receiving support than those in their own tenancy at risk of homelessness (OR adjusted for age and gender: 0.26 (95% CI 0.12 to 0.54)). Conclusions: Similar proportions of people experiencing homelessness and those in private households reported drinking alcohol in the past year. However, people experiencing homelessness were more likely to exceed drinking guidelines and had approximately fourfold higher prevalence of alcohol use disorder. Although nearly two in three individuals self-identifying as having had an alcohol problem received support, access was unequal, with substantially lower odds of support among people sleeping rough.

Background and aims: Alcohol consumption at high levels is common among people experiencing homelessness and contributes to inequalities. In relative terms these individuals are underrepresented in substance use services. This study captured common trajectories and identified barriers and facilitators to accessing treatment among a group of people currently experiencing homelessness and who have used or have been eligible for alcohol treatment. Methods: Qualitative study in which we conducted 32 semi‐structured ‘journey‐mapping’ interviews with individuals currently experiencing homelessness and currently or previously using alcohol harmfully. Interviews were conducted in London homeless centres (UK), audio‐recorded and transcribed verbatim. We used a life course‐informed, journey‐mapping thematic analysis (with elements of reflexive thematic analysis) to capture how participants made sense of their trajectories of alcohol use and recovery. Results: Overall, we generated six themes describing participants' journeys: ‘Early access & exposure to alcohol’, ‘Drivers and vulnerabilities for heavy alcohol use’, ‘Sustained heavy alcohol use: coping mechanisms, consequences and compounding challenges’, ‘Systemic, interpersonal and environmental barrier to recovery’, ‘Internal path towards recovery: growth, relationships and motivation’ and ‘Recovery through external support systems and structures’. Participants often situated the onset of heavy drinking in childhood trauma and adverse family environments, describing alcohol as a coping mechanism for emotional pain. Homelessness was narrated as both a consequence and driver of drinking, with environmental factors such as sleeping rough and shared identities around heavy drinking reinforcing consumption. Recovery was portrayed as a deeply personal process requiring internal motivation, autonomy and supportive relationships. Barriers of accessing care included long waiting times, administrative hurdles and negative service experiences, while facilitating factors comprised stable housing, personalised care and peer support. Transformative shifts in perspective and the development of self‐compassion were described as pivotal turning points. Conclusions: Among people experiencing homelessness, heavy drinking appears to be commonly rooted in childhood trauma and adverse family environments, with homelessness described as both a consequence and a reinforcing driver of alcohol use. Recovery is portrayed as a highly personal process supported by stable housing, personalised care and meaningful relationships, including peer support.

Background: Changes in population alcohol use are shaped not only by how much people drink, but also by how many people do not drink at all. We estimated the prevalence, sociodemographic patterning, and recent trends in non-drinking among adults in Great Britain.Methods: We analysed data from the Alcohol Toolkit Study, a monthly cross-sectional household survey, collected via telephone between October 2020 and March 2026 (n=146,347 adults ≥18 years). Non-drinking was defined as reporting no alcohol consumption in the past 6 months.Results: Non-drinking prevalence was stable between October 2020 and December 2022 (mean=23.8% [95%CI 23.4-24.3%]) then increased to 29.7% (28.9-30.5%) by March 2026. Abstinence was persistently more common among women, among more disadvantaged socioeconomic groups, and among minority ethnic groups. For example, in March 2026, prevalence was 32.9% in women vs. 26.3% in men, 42.7% in the most vs. 23.0% in the least disadvantaged social grades, and 65.3% in Asian vs. 25.7% White adults. Increases were observed across most subgroups but varied in magnitude, with the largest relative increases among middle-aged adults (e.g., +44.6% at age 45) and smaller increases among younger adults (e.g., +8.0% at age 18), among whom prevalence was already higher, resulting in a narrowing of the age gradient over time. There were no notable differences across nations or English regions.Conclusions: Non-drinking increased in Great Britain between 2022 and 2026, particularly among middle-aged adults, while remaining strongly socially patterned by gender, socioeconomic position, and ethnicity.

Background and aims: Gypsy and Traveller communities in the United Kingdom (UK) face substantial health challenges. Smoking tobacco and drinking alcohol likely contribute to health disparities, but there is little national data on the prevalence or heaviness of smoking and drinking among these communities. We aimed to estimate the prevalence and heaviness of smoking and drinking among the UK Gypsy and Traveller communities compared with people from other UK ethnic groups. Design/setting: Observational study using data collected between 2013 and 2025 in a series of monthly cross‐sectional surveys of representative samples of the adult population in England. Participants: Adults aged 18+, between 2013 and 2025 (total n = 226 339; Gypsy or Traveller n = 213). Measurements: Marginal means were derived from regression models and used to estimate the prevalence of current smoking and drinking (both of which includes daily and non‐daily), and the heaviness of smoking (cigarettes per day) and drinking [Alcohol Use Disorders Identification Test‐Consumption (AUDIT‐C) score, units per week and estimated weekly alcohol consumption] by ethnicity; adjusted for age, gender and survey year. Findings: Current smoking prevalence was markedly higher among Gypsy and Travellers [33.0%, 95% confidence interval (CI) = 26.3–39.8%, n = 81] than among the “Other White” ethnic group (18.7%, 95% CI = 18.5–18.9%; P < 0.001), and exceeded estimates observed across other ethnic groups (range: 9.4–19.9%; all P < 0.001). Among those who smoked, Gypsy and Travellers reported smoking more cigarettes per day (geometric mean = 12.5, 95% CI = 8.9–17.6) than the “Other White” group (geometric mean = 9.0, 95% CI = 8.8–9.1; P = 0.59), with other ethnic groups ranging from 6.8–9.7, although not all comparisons reached significance. The proportion reporting any current alcohol consumption was lower among Gypsy and Travellers (61.5%, 95% CI = 53.8–69.2%, n = 126) than ‘Other White’ ethnicities (77.1%, 95% CI = 76.8–77.3%; P < 0.001). Prevalence of high risk drinking was similar among Gypsy and Travellers (11.3%, 95% CI = 6.7–15.8%) and “Other White” ethnic groups (10.7%, 95% CI = 10.5–10.9%; P = 0.808) but exceeded estimates observed across all other ethnic groups (range: 1.3–7.1%; all P < 0.05). Prevalence of possible dependence was higher among Gypsy and Travellers (3.5%, 95% CI = 0.4–6.6%) compared with the “Other White” (1.3%, 95% CI = 1.2–1.3%; P = 0.027) and all other ethnic groups (range: 0.3–0.8%; all P < 0.05). Conclusions: People from Gypsy and Traveller communities in the United Kingdom appear to be more likely to smoke compared with other UK ethnic groups, and those who smoke and/or drink do so at more harmful levels compared with other UK ethnic groups.

Introduction: Feelings of guilt and remorse after drinking alcohol may act as barriers to seeking support. This study aimed to estimate the prevalence and frequency of such feelings among adults in England who drink at increasing and higher‐risk levels, and differences by socio‐demographic and drinking subgroups. Methods: We analysed data from 40,708 adults (≥ 18 years) who drink at increasing and higher‐risk levels (AUDIT‐C score ≥ 5) from a monthly cross‐sectional survey in England from 2014 to 2022. Feelings of guilt and remorse after drinking in the past 6 months were assessed using the AUDIT. Logistic regression models were used to examine associations with socio‐demographic characteristics, alcohol consumption and harm to oneself or others as a result of drinking. Results: Overall, 13.3% (95% CI 12.9%–13.6%) reported experiencing feelings of guilt or remorse after drinking in the past 6 months. Among those who reported such feelings, 95.3% (95% CI 91.4%–94.9%) experienced them less than once a month. The prevalence of guilt and remorse increased non‐linearly with higher AUDIT‐C scores from 9.3% (95% CI 8.8%–9.9%) among those drinking at the lightest levels within the increasing/higher‐risk range [AUDIT‐C = 5] to 20.9% (95% CI 17.2%–24.8%) among the heaviest [AUDIT‐C = 12]. After adjusting for alcohol consumption and alcohol‐related injury, these feelings were more common among women (aOR 1.38; 95% CI 1.31–1.46) and people from more advantaged social grades (aOR 1.27; 95% CI 1.20–1.36), and much less common among older than younger adults (e.g., ≥ 65 vs. 16–24 years: aOR 0.23; 95% CI 0.20–0.26). Discussion and Conclusions: In England, around one in eight adults who drink at increasing and higher‐risk levels report experiencing guilt or remorse after drinking. These feelings are more common in women, younger adults and those of a more advantaged social grade.

Aim: 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. Design: Monthly representative surveys were conducted through face‐to‐face interviews until February 2020, and then by telephone. Setting: England, March 2014 to December 2024. Participants: 208 010 adults aged 18+ living in private households. Measurements: 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. Findings: 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 5.0 units to 6.6 units). 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. Conclusions: 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.

Introduction: Sales and availability of alcohol-free and low alcohol drinks have increased in the UK since 2020. This study aimed to assess trends in the use of alcohol-free and low alcohol drinks to reduce alcohol consumption among people who drink at increasing and higher risk in Great Britain. The study compared trajectories across different subgroups from 2020 to 2024. Methods: Data were drawn from the Smoking and Alcohol Toolkit Study, which surveys adults monthly across Great Britain about their drinking behaviour. The study included 9397 adults with an AUDIT-C score of 5 or above who attempted to reduce their alcohol consumption in the past year. The analysis used regression analyses to assess time trends in using alcohol-free and low alcohol drinks to cut down overall and among subgroups (eg, gender and age), and in using evidence-based support compared with alcohol-free and low alcohol drinks in attempts to cut down alcohol consumption. Results: The proportion reporting the use of alcohol-free and low alcohol drinks to reduce alcohol consumption increased from 35.0% (95% confidence interval (CI): 31.8, 38.4) in October 2020 to 43.9% (95% CI: 40.9, 46.9) in August 2024 in serious attempts and from 25.5% (95% CI: 23.2, 28.0) to 38.8% (95% CI: 37.2, 40.4) in any attempt to cut down. Among subgroups, trajectories were mostly comparable. Noticeably, older adults first had lower prevalence of using alcohol-free and low alcohol drinks than young and middle-aged adults but had larger increases over time. While the proportion of participants using alcohol-free and low alcohol drinks in attempts to cut down consumption increased, the proportion using neither alcohol-free/low alcohol drinks nor evidence-based support decreased, and the proportion using evidence-based support, either alone or in combination with alcohol-free/low alcohol drinks, remained low. Conclusion: The growing use of alcohol-free/low alcohol drinks to reduce alcohol consumption among people at risk of increasing and higher risk drinking in Great Britain highlights the urgent need for more research to establish their effectiveness for alcohol reduction and to inform public health policy. While the use of alcohol-free/low alcohol drinks to cut down rose, the use of evidence-based support remained limited.

Objectives: To explore whether people ‘other’ when making judgements about ‘harmful’ drinking and the drinking contexts (e.g., pub with friends) and features of drinking contexts (e.g., location, company) perceived as being indicative of harmful drinking. Design: Focus group design with arts‐based methods. Methods: Risky drinkers (AUDIT‐C ≥ 5; n = 20) in four focus groups, drew and discussed contexts and features of contexts they thought indicated harmful drinking. Reflexive thematic analysis was conducted alongside content analysis of drawings informed by themes and prior research. Findings: There are three deductive themes. The first theme semblance of control referred to people's tendency to differentiate their own drinking practices as controlled and safe in relation to the out‐of‐control behaviours of a harmful drinker. This was seen in the content analysis of drawings where participants tended to draw drinking contexts which were different to those they drank in. The drinking practices perceived as being indicative of harmful drinking were further explored in the second theme harmful drinking contexts. This theme was made up of four subthemes: mental harms, physical harms, social harms and societal harms which were discussed as being differentially associated with different types of drinking contexts. The final theme, features which make drinking ‘harmful’, focused on the features of drinking contexts which participants felt were more indicative of harm. There were seven subthemes: alone, home, amount, drink type, having responsibilities, reason for drinking and timing/pattern. Conclusions: Drinking contexts fed into the construction of othering narratives among risky drinkers. This has implications for alcohol harm reduction campaigns.