TY - JOUR AB - AIM: To test the association of alcohol consumption with total and cause-specific mortality risk DESIGN: Prospective observational multicentre population-based study SETTING: Sixteen cohorts (15 from Europe) in the MOnica Risk, Genetics, Archiving and Monograph (MORGAM) Project PARTICIPANTS: A total of 142,960 individuals (mean age 50±13 y, 53.9% men) MEASUREMENTS: Average alcohol intake by food frequency questionnaire. Total and cause-specific mortality FINDINGS: In comparison with lifetime abstainers, consumption of alcohol less than 10 gr/d was associated with an average 11% (95%CI: 7%-14%) reduction in the risk of total mortality, while intake >20 gr/d was associated with a 13% (7%-20%) increase in the risk of total mortality. Comparable findings were observed for cardiovascular (CV) deaths. As far as cancer is concerned, drinking up to 10 gr/d was not associated with either mortality risk reduction or increase, while alcohol intake >20 gr/d was associated with a 22% (10%-35%) increased risk of mortality. The association of alcohol with fatal outcomes was similar in men and women, differed somewhat between Countries and was more apparent in individuals preferring wine, suggesting that benefits may not be due to ethanol but other ingredients. Mediation analysis showed that HDLc explained 2.9% and 18.7% of the association between low alcohol intake and total as well as CV mortality, respectively. CONCLUSIONS: In comparison with lifetime abstainers, consuming less than 1 drink per day (nadir at 5 gr/d) was associated with a reduced risk of total, cardiovascular and other causes mortality, except cancer. Intake of more than 2 drinks per day was associated with an increased risk of total, cardiovascular and especially cancer mortality. AU - Di Castelnuovo, A.* AU - Costanzo, S.* AU - Bonaccio, M.* AU - McElduff, P.* AU - Linneberg, A.* AU - Salomaa, V.* AU - Männistö, S.* AU - Moitry, M.* AU - Ferrieres, J.* AU - Dallongeville, J.* AU - Thorand, B. AU - Brenner, H.* AU - Ferrario, M.* AU - Veronesi, G.* AU - Pettenuzzo, E.* AU - Tamosiunas, A.* AU - Njølstad, I.* AU - Drygas, W.* AU - Nikitin, Y.* AU - Söderberg, S.* AU - Kee, F.* AU - Grassi, G.* AU - Westermann, D.* AU - Schrage, B.* AU - Dabboura, S.* AU - Zeller, T.* AU - Kuulasmaa, K.* AU - Blankenberg, S.* AU - Donati, M.B.* AU - de Gaetano, G.* AU - Iacoviello, L.* C1 - 62350 C2 - 50801 CY - 111 River St, Hoboken 07030-5774, Nj Usa SP - 312-325 TI - Alcohol intake and total mortality in 142,960 individuals from the MORGAM project: A population-based study. JO - Addiction VL - 117 IS - 2 PB - Wiley PY - 2021 SN - 0965-2140 ER - TY - JOUR AB - Background and aimsPrevious research indicates that compared with individuals with lower socio-economic status (SES), individuals in higher SES groups are more often drinkers but those who drink report drinking smaller amounts more frequently. We aimed to decompose trends in self-reported alcohol consumption in Germany into age, period and birth cohort effects and examine whether these effects varied by SES.DesignAge-period-cohort (APC) analysis using data from eight waves of the cross-sectional German Epidemiological Survey of Substance Abuse (ESA) collected between 1995 and 2015.SettingGermany.ParticipantsThe analytical sample included n=65821 individuals aged 18-64years reporting alcohol use within the last 30days.MeasurementsAlcohol measures included drinking prevalence, alcohol volume and prevalence of episodic heavy drinking (EHD). Educational attainment was used as an indicator of SES. A series of generalized linear and logistic regression models, including both main and interaction effects of age, period and cohort with SES, were estimated.FindingsRegression models revealed significant interactions between APC effects and SES on two alcohol consumption measures. Higher SES was consistently associated with drinking prevalence across age (P<0.001), period (P=0.016) and cohort (P=0.016), and with volume of drinking in younger cohorts (P=0.002) and 50+-year-olds (P=0.001). Model results were inconclusive as to whether or not APC effects on EHD prevalence differed by SES.ConclusionsIn Germany, there are positive associations between socio-economic status and alcohol consumption during the life-course, over time and among birth cohorts. Three groups appear vulnerable to risky drinking: high socio-economic status young birth cohorts who drink high average quantities, low socio-economic status young birth cohorts who show a risky drinking pattern and high socio-economic status adults in their 50s and older who increase their drinking volume beyond that age. AU - Pabst, A.* AU - Van der Auwera, S.* AU - Piontek, D.* AU - Baumeister, S. AU - Kraus, L.* C1 - 56323 C2 - 47006 CY - 111 River St, Hoboken 07030-5774, Nj Usa SP - 1359-1368 TI - Decomposing social inequalities in alcohol consumption in Germany 1995-2015: An age-period-cohort analysis. JO - Addiction VL - 114 IS - 8 PB - Wiley PY - 2019 SN - 0965-2140 ER - TY - JOUR AB - Aims To use the rs1229984 variant associated with alcohol consumption as an instrument for alcohol consumption to test the causality of the association of alcohol consumption with hay fever, asthma, allergic sensitization and serum total immunoglobulin (Ig) E. Design Observational and Mendelian randomization analyses using genetic variants as unbiased markers of exposure to estimate causal effects, subject to certain assumptions. Setting Europe. Participants We included a total of 466 434 people aged 15-82 years from 17 population-based studies conducted from 1997 to 2015. Measurements The rs1229984 (ADH1B) was genotyped; alcohol consumption, hay fever and asthma were selfreported. Specific and total IgE were measured from serum samples. Findings Observational analyses showed that ever-drinking versus non-drinking, but not amount of alcohol intake, was positively associatedwith hay fever and inversely associated with asthma but not with allergic sensitization or serum total immunoglobulin (Ig) E. However, Mendelian randomization analyses did not suggest that the observational associations are causal. The causal odds ratio (OR) per genetically assessed unit of alcohol/week was an OR = 0.907 [ 95% confidence interval (CI) = 0.806, 1.019; P = 0.101] for hay fever, an OR = 0.897 (95% CI = 0.790, 1.019; P = 0.095) for asthma, an OR = 0.971 (95% CI = 0.804, 1.174; P = 0.763) for allergic sensitization and a 4.7% change (95% CI = -5.5%, 14.9%; P = 0.366) for total IgE. Conclusions In observational analyses, ever-drinking versus not drinking was positively associated with hay fever and negatively associated with asthma. However, the Mendelian randomization results were not consistent with these associations being causal. AU - Skaaby, T.* AU - Kilpeläinen, T.O.* AU - Taylor, A.E.* AU - Mahendran, Y.* AU - Wong, A.* AU - Ahluwalia, T.S.* AU - Paternoster, L.* AU - Trompet, S.* AU - Stott, D.J.* AU - Flexeder, C. AU - Zhou, A.* AU - Brusselle, G.G.* AU - Sajjad, A.* AU - Lahousse, L.* AU - Tiemeier, H.* AU - Have, C.T.* AU - Thuesen, B.H.* AU - Kårhus, L.L.* AU - Møllehave, L.T.* AU - Leth-Møller, K.B.* AU - Shabanzadeh, D.M.* AU - Gonzalez-Quintela, A.* AU - Power, C.* AU - Hyppönen, E.* AU - Kuh, D.* AU - Hardy, R.* AU - Meitinger, T. AU - Jukema, J.W.* AU - Völker, U.* AU - Nauck, M.* AU - Völzke, H.* AU - Friedrich, N.* AU - Bonten, T.N.* AU - Noordam, R.* AU - Mook-Kanamori, D.O.* AU - Tolstrup, J.S.* AU - Taube, C.* AU - Peters, A. AU - Grallert, H. AU - Strauch, K. AU - Schulz, H. AU - Grarup, N.* AU - Hansen, T.* AU - Pedersen, O.* AU - Burgess, S.* AU - Munafò, M.R.* AU - Linneberg, A.* C1 - 54315 C2 - 45480 CY - 111 River St, Hoboken 07030-5774, Nj Usa SP - 216-225 TI - Association of alcohol consumption with allergic disease and asthma: A multi-centre Mendelian randomization analysis. JO - Addiction VL - 114 IS - 2 PB - Wiley PY - 2019 SN - 0965-2140 ER - TY - JOUR AB - BACKGROUND AND AIM: The cost-effectiveness of internet-based smoking cessation interventions is difficult to determine when they are provided as a complement to current smoking cessation services. The aim of this study was to evaluate the cost-effectiveness of such an alternate package compared with existing smoking cessation services alone (current package). METHODS: A literature search was conducted to identify internet-based smoking cessation interventions in the Netherlands. A meta-analysis was then performed to determine the pooled effectiveness of a (web-based) computer-tailored intervention. The mean cost of implementing internet based interventions was calculated using available information, while intervention reach was sourced from an English study. We used EQUIPTMOD, a Markov-based state-transition model, to calculate the incremental cost-effectiveness ratios [expressed as cost per quality-adjusted life years (QALYs) gained] for different time horizons to assess the value of providing internet-based interventions to complement the current package.). Deterministic sensitivity analyses tested the uncertainty around intervention costs per smoker, relative risks, and the intervention reach. RESULTS: Internet-based interventions had an estimated pooled relative risk of 1.40; average costs per smoker of €2.71; and a reach of 0.41% of all smokers. The alternate package (i.e. provision of internet-based intervention to the current package) was dominant (cost-saving) compared with the current package alone (0.14 QALY gained per 1000 smokers; reduced health-care costs of €602.91 per 1000 smokers for the life-time horizon). The alternate package remained dominant in all sensitivity analyses. CONCLUSION: Providing internet-based smoking cessation interventions to complement the current provision of smoking cessation services could be a cost-saving policy option in the Netherlands. AU - Cheung, K.L.* AU - Wijnen, B.F.M.* AU - Hiligsmann, M.* AU - Coyle, K.* AU - Coyle, D.* AU - Pokhrel, S.* AU - de Vries, H.* AU - Präger, M. AU - Evers, S.M.A.A.* C1 - 52551 C2 - 44030 CY - Po Box 211, 1000 Ae Amsterdam, Netherlands SP - 97-95 TI - Is it cost-effective to provide internet-based interventions to complement the current provision of smoking cessation services in the Netherlands? An analysis based on the EQUIPTMOD. JO - Addiction VL - 113 PB - Elsevier Science Bv PY - 2018 SN - 0965-2140 ER - TY - JOUR AB - BACKGROUND AND AIMS: Although clear benefits are associated with reducing smoking, there is increasing pressure on public health providers to justify investment in tobacco control measures. Decision-makers need tools to assess the Return on Investment (ROI)/cost-effectiveness of programmes. The EQUIPT project adapted an ROI tool for England to four European countries (Germany, the Netherlands, Spain and Hungary). EQUIPTMOD, the economic model at the core of the ROI tool, is designed to assess the efficiency of packages of smoking cessation interventions. The objective of this paper is to describe the methods for EQUIPTMOD and identify key outcomes associated with continued and cessation of smoking. METHODS: EQUIPTMOD uses a Markov model to estimate life-time costs, quality-adjusted life years (QALYs) and life years associated with a current and former smoker. It uses population data on smoking prevalence, disease prevalence, mortality and the impact of smoking combined with associated costs and utility effects of disease. To illustrate the tool's potential, costs, QALYs and life expectancy were estimated for the average current smoker for five countries based on the assumptions that they continue and that they cease smoking over the next 12 months. Costs and effects were discounted at country-specific rates. RESULTS: For illustration, over a life-time horizon, not quitting smoking within the next 12 months in England will reduce life expectancy by 0.66, reduce QALYs by 1.09 and result in £4961 higher disease-related health care costs than if the smoker ceased smoking in the next 12 months. For all age-sex categories, costs were lower and QALYs higher for those who quit smoking in the 12 months than those who continued. CONCLUSIONS: EQUIPTMOD facilitates assessment of the cost effectiveness of smoking cessation strategies. The demonstrated results indicate large potential benefits from smoking cessation at both an individual and population level. AU - Coyle, K.* AU - Coyle, D.* AU - Lester-George, A.* AU - West, R.* AU - Nemeth, B.* AU - Hiligsmann, M.* AU - Trapero-Bertran, M.* AU - Leidl, R. AU - Pokhrel, S.* C1 - 51806 C2 - 43352 CY - Po Box 211, 1000 Ae Amsterdam, Netherlands SP - 7-18 TI - Development and application of an economic model (EQUIPTMOD) to assess the impact of smoking cessation. JO - Addiction VL - 113 PB - Elsevier Science Bv PY - 2018 SN - 0965-2140 ER - TY - JOUR AB - Aims To evaluate costs, effects and cost‐effectiveness of increased reach of specific smoking cessation interventions in Germany. Design A Markov‐based state transition return on investment model (EQUIPTMOD) was used to evaluate current smoking cessation interventions as well as two prospective investment scenarios. A health‐care perspective (extended to include out‐of‐pocket payments) with life‐time horizon was considered. A probabilistic analysis was used to assess uncertainty concerning predicted estimates. Setting Germany. Participants Cohort of current smoking population (18+ years) in Germany. Interventions Interventions included group‐based behavioural support, financial incentive programmes and varenicline. For prospective scenario 1 the reach of group‐based behavioral support, financial incentive programme and varenicline was increased by 1% of yearly quit attempts (= 57 915 quit attempts), while prospective scenario 2 represented a higher reach, mirroring the levels observed in England. Measurements EQUIPTMOD considered reach, intervention cost, number of quitters, quality‐of‐life years (QALYs) gained, cost‐effectiveness and return on investment. Findings The highest returns through reduction in smoking‐related health‐care costs were seen for the financial incentive programme (€2.71 per €1 invested), followed by that of group‐based behavioural support (€1.63 per €1 invested), compared with no interventions. Varenicline had lower returns (€1.02 per €1 invested) than the other two interventions. At the population level, prospective scenario 1 led to 15 034 QALYs gained and €27 million cost‐savings, compared with current investment. Intervention effects and reach contributed most to the uncertainty around the return‐on‐investment estimates. At a hypothetical willingness‐to‐pay threshold of only €5000, the probability of being cost‐effective is approximately 75% for prospective scenario 1. Conclusions Increasing the reach of group‐based behavioural support, financial incentives and varenicline for smoking cessation by just 1% of current annual quit attempts provides a strategy to German policymakers that improves the population's health outcomes and that may be considered cost‐effective.   AU - Huber, M.B. AU - Präger, M. AU - Coyle, K.* AU - Coyle, D.* AU - Lester-George, A.* AU - Trapero-Bertran, M.* AU - Nemeth, B.* AU - Cheung, K.L.* AU - Stark, R.G. AU - Vogl, M. AU - Pokhrel, S.* AU - Leidl, R. C1 - 52552 C2 - 44029 CY - Po Box 211, 1000 Ae Amsterdam, Netherlands SP - 52-64 TI - Cost-effectiveness of increasing the reach of smoking cessation interventions in Germany: Results from the EQUIPTMOD. JO - Addiction VL - 113 PB - Elsevier Science Bv PY - 2018 SN - 0965-2140 ER - TY - JOUR AB - AIMS: To evaluate potential health and economic returns from implementing smoking cessation interventions in Hungary. METHODS: The EQUIPTMOD, a Markov-based economic model, was used to assess the cost-effectiveness of three implementation scenarios: (a) introducing a social marketing campaign; (b) doubling the reach of existing group-based behavioural support therapies and proactive telephone support; and (c) a combination of the two scenarios. All three scenarios were compared with current practice. The scenarios were chosen as feasible options available for Hungary based on the outcome of interviews with local stakeholders. Life-time costs and quality-adjusted life years (QALYs) were calculated from a health-care perspective. The analyses used various return on investment (ROI) estimates, including incremental cost-effectiveness ratios (ICERs), to compare the scenarios. Probabilistic sensitivity analyses assessed the extent to which the estimated mean ICERs were sensitive to the model input values. RESULTS: Introducing a social marketing campaign resulted in an increase of 0.3014 additional quitters per 1 000 smokers, translating to health-care cost-savings of €0.6495 per smoker compared with current practice. When the value of QALY gains was considered, cost-savings increased to €14.1598 per smoker. Doubling the reach of existing group-based behavioural support therapies and proactive telephone support resulted in health-care savings of €0.2539 per smoker (€3.9620 with the value of QALY gains), compared with current practice. The respective figures for the combined scenario were €0.8960 and €18.0062. Results were sensitive to model input values. CONCLUSIONS: According to the EQUIPTMOD modelling tool, it would be cost-effective for the Hungarian authorities introduce a social marketing campaign and double the reach of existing group-based behavioural support therapies and proactive telephone support. Such policies would more than pay for themselves in the long term. AU - Németh, B.* AU - Józwiak-Hagymásy, J.* AU - Kovács, G.* AU - Kovács, A.L.* AU - Demjén, T.* AU - Huber, M.B. AU - Cheung, K.L.* AU - Coyle, K.* AU - Lester-George, A.* AU - Pokhrel, S.* AU - Vokó, Z.* C1 - 52804 C2 - 44195 CY - Po Box 211, 1000 Ae Amsterdam, Netherlands SP - 76-86 TI - Cost-effectiveness of possible future smoking cessation strategies in Hungary: Results from the EQUIPTMOD. JO - Addiction VL - 113 PB - Elsevier Science Bv PY - 2018 SN - 0965-2140 ER - TY - JOUR AB - BACKGROUND AND AIMS: Modelling return on investment (ROI) from smoking cessation interventions requires estimates of their costs and benefits. This paper describes a standardized method developed to source both economic costs of tobacco smoking and costs of implementing cessation interventions for a Europe-wide ROI model [European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD)]. DESIGN: Focused search of administrative and published data. A standardized checklist was developed in order to ensure consistency in methods of data collection. SETTING AND PARTICIPANTS: Adult population (15+ years) in Hungary, Netherlands, Germany, Spain and England. For passive smoking-related costs, child population (0-15 years) was also included. MEASUREMENTS: Costs of treating smoking-attributable diseases; productivity losses due to smoking-attributable absenteeism; and costs of implementing smoking cessation interventions. FINDINGS: Annual costs (per case) of treating smoking attributable lung cancer were between €5074 (Hungary) and €52 106 (Germany); coronary heart disease between €1521 (Spain) and €3955 (Netherlands); chronic obstructive pulmonary disease between €1280 (England) and €4199 (Spain); stroke between €1829 (Hungary) and €14 880 (Netherlands). Costs (per recipient) of smoking cessation medications were estimated to be: for standard duration of varenicline between €225 (England) and €465 (Hungary); for bupropion between €25 (Hungary) and €220 (Germany). Costs (per recipient) of providing behavioural support were also wide-ranging: one-to-one behavioural support between €34 (Hungary) and €474 (Netherlands); and group-based behavioural support between €12 (Hungary) and €257 (Germany). The costs (per recipient) of delivering brief physician advice were: €24 (England); €9 (Germany); €4 (Hungary); €33 (Netherlands); and €27 (Spain). CONCLUSIONS: Costs of treating smoking-attributable diseases as well as the costs of implementing smoking cessation interventions vary substantially across Hungary, Netherlands, Germany, Spain and England. Estimates for the costs of these diseases and interventions can contribute to return on investment estimates in support of national or regional policy decisions. AU - Trapero-Bertran, M.* AU - Leidl, R.* AU - Muñoz, C.* AU - Kulchaitanaroaj, P.* AU - Coyle, K.* AU - Präger, M. AU - Józwiak-Hagymásy, J.* AU - Cheung, K.L.* AU - Hiligsmann, M.* AU - Pokhrel, S.* C1 - 53249 C2 - 44442 CY - Po Box 211, 1000 Ae Amsterdam, Netherlands SP - 32-41 TI - Estimates of costs for modelling return on investment from smoking cessation interventions. JO - Addiction VL - 113 PB - Elsevier Science Bv PY - 2018 SN - 0965-2140 ER - TY - JOUR AB - Ambient inhalable particulate matter (PM) is a serious health concern worldwide, but especially so in China where high PM concentrations affect huge populations. Atmospheric processes and emission sources cause spatial and temporal variations in PM concentration and chemical composition, but their influence on the toxicological characteristics of PM are still inadequately understood.In this study, we report an extensive chemical and toxicological characterization of size-segregated urban air inhalable PM collected in August and October 2013 from Nanjing, and assess the effects of atmospheric processes and likely emission sources. A549 human alveolar epithelial cells were exposed to day- and nighttime PM samples (25, 75, 150, 200, 300 mu g/ml) followed by analyses of cytotoxicity, genotoxicity, cell cycle, and inflammatory response.PM10-2.5 and PM0.2 caused the greatest toxicological responses for different endpoints, illustrating that particles with differing size and chemical composition activate distinct toxicological pathways in A549 cells. PM10-2.5 displayed the greatest oxidative stress and genotoxic responses; both were higher for the August samples compared with October. In contrast, PM0.2 and PM2.5-1.0 samples displayed high cytotoxicity and substantially disrupted cell cycle; August samples were more cytotoxic whereas October samples displayed higher cell cycle disruption. Several components associated with combustion, traffic, and industrial emissions displayed strong correlations with these toxicological responses. The lower responses for PM1.0-0.2 compared to PM0.2 and PM2.5-1.0 indicate diminished toxicological effects likely due to aerosol aging and lower proportion of fresh emission particles rich in highly reactive chemical components in the PM1.0-0.2 fraction.Different emission sources and atmospheric processes caused variations in the chemical composition and toxicological responses between PM fractions, sampling campaigns, and day and night. The results indicate different toxicological pathways for coarse-mode particles compared to the smaller particle fractions with typically higher content of combustion-derived components. The variable responses inside PM fractions demonstrate that differences in chemical composition influence the induced toxicological responses. AU - Trapero-Bertran, M.* AU - Muñoz, C.* AU - Coyle, K.* AU - Coyle, D.* AU - Lester-George, A.* AU - Leidl, R. AU - Németh, B.* AU - Cheung, K.L.* AU - Pokhrel, S.* AU - Lopez-Nicolás,* C1 - 53270 C2 - 44443 CY - Po Box 211, 1000 Ae Amsterdam, Netherlands SP - 65-75 TI - Cost-effectiveness of alternative smoking cessation scenarios in Spain: Results from the EQUIPTMOD. JO - Addiction VL - 113 PB - Elsevier Science Bv PY - 2018 SN - 0965-2140 ER -