Study protocol for a randomised controlled trial of Allen Carr's Easyway programme versus Lambeth and Southwark NHS for smoking cessation.

INTRODUCTION: Smoking is a major cause of ill health and is associated with several diseases including cancer, coronary heart disease and stroke. Many psychological and pharmacological smoking cessation treatments are available and although they are undoubtedly the most cost-effective health interventions available, many people still fail to maintain cessation in the longer term. Recently, National Institute for Health and Care Excellence called for comparative studies to determine the short-term and long-term effectiveness of Allen Carr's Easyway (ACE) method of stopping smoking. This study will compare the efficacy of the ACE programme and a 1-1 counselling service available via the National Health Service. METHODS AND ANALYSIS: A two-arm, parallel-group, blinded, randomised controlled trial will be conducted with people who smoke tobacco cigarettes, are aged ≥18 years and are motivated to quit. Exclusion criteria comprise self-reported mental health condition, pregnancy or respiratory disease such as chronic obstructive pulmonary disease or emphysema. The primary treatment outcome is smoking cessation 26 weeks after treatment. Participants will be analysed on an intention to treat basis at the point of randomisation. Before being randomised, the research team will not inform participants which two treatments are being compared. Once randomised researchers will be blinded to participant condition, and participants will be blinded to the condition they are not assigned to. Logistic regression will be used to estimate the effectiveness of the treatment condition on smoking cessation at 26 weeks. The following covariates will be included: baseline quit efficacy (at inclusion), age (at inclusion), gender and baseline nicotine dependency. ETHICS AND DISSEMINATION: Approval was granted by London-Fulham Research Ethics Committee (ref: 16/LO/1657). The study's findings will be published in peer-reviewed journals and disseminated at national and international conferences. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier number: NCT02855255. ISRCTN registration number: ISRCTN23584477; Pre-results

Impact of alcohol-promoting and alcohol-warning advertisements on alcohol consumption, affect, and implicit cognition in heavy-drinking young adults: A laboratory-based randomized controlled trial

$\textbf{OBJECTIVES}$: There is sparse evidence regarding the effect of alcohol-advertising exposure on alcohol consumption among heavy drinkers. This study aimed to assess the immediate effects of alcohol-promoting and alcohol-warning video advertising on objective alcohol consumption in heavy-drinking young adults, and to examine underlying processes. $\textbf{DESIGN}$: Between-participants randomized controlled trial with three conditions. $\textbf{METHODS}$: Two hundred and four young adults (aged 18-25) who self-reported as heavy drinkers were randomized to view one of three sets of 10 video advertisements that included either (1) alcohol-promoting, (2) alcohol-warning, or (3) non-alcohol advertisements. The primary outcome was the proportion of alcoholic beverages consumed in a sham taste test. Affective responses to advertisements, implicit alcohol approach bias, and alcohol attentional bias were assessed as secondary outcomes and possible mediators. Typical alcohol consumption, Internet use, and television use were measured as covariates. $\textbf{RESULTS}$: There was no main effect of condition on alcohol consumption. Participants exposed to alcohol-promoting advertisements showed increased positive affect and an increased approach/reduced avoidance bias towards alcohol relative to those exposed to non-alcohol advertisements. There was an indirect effect of exposure to alcohol-warning advertisements on reduced alcohol consumption via negative affect experienced in response to these advertisements. $\textbf{CONCLUSIONS}$: Restricting alcohol-promoting advertising could remove a potential influence on positive alcohol-related emotions and cognitions among heavy-drinking young adults. Producing alcohol-warning advertising that generates negative emotion may be an effective strategy to reduce alcohol consumption.This work was jointly funded by the National Institute for Health Research School for Public Health Research, and by the Department of Health Policy Research Program (Policy Research Unit in Behaviour and Health [PR-UN-0409-10109])

Implicit and explicit drinker identities interactively predict in-the-moment alcohol placebo consumption

© 2016 The Authors.Introduction: Having an identity as a 'drinker' has been linked to increased alcohol-related harm, self-reported consumption and self-reported intention to engage in risky drinking behavior. These effects have been observed when identities have been measured using explicit measures (e.g. via questionnaires) and implicitly (e.g. using Implicit Association Tests [IATs] adapted to measure identity). Little research has used actual behavioral measures to measure alcohol consumption in-the-moment, nor compared the effects of implicit and explicit identities directly. Methods: Participants' (n = 40) implicit and explicit identities associated with being a drinker were measured. Attitudes towards one's own drinking were measured explicitly. Participants completed a Pouring Taste Preference Task [PTPT] involving the consumption and rating of non-alcoholic wine. This provided a behavioral measure of intention (pouring), a behavioral measure of consumption and a measure of the implementation of intention into behavior. Results: Results showed an interactive effect of implicit and explicit identities on attitudes and behavior. Explicit identities predicted attitudes towards drinking, but not behavior. Neither identity predicted the amount poured. Implicit identities predicted the amount consumed. A greater proportion of wine poured was predicted by higher implicit identities when explicit identities were absent. Conclusion: These results suggest that explicit identities may be associated more with those beliefs about drinking that one is aware of than behavioral intention. In addition, explicit identities may not predict behavioral enactment well. Implicit identity shows effects on actual behavior and not behavioral intention. Together this highlights the differential influence of reflective (explicit) and impulsive (implicit) identity in-the-moment behavior

Exploring the Alcohol-Behaviour Link: Myopic self-enhancement in the absence of alcohol consumption as a function of past alcohol use

Dual process accounts of the alcohol-behaviour link hypothesise that differences in drinking patterns will moderate the effects of exposure to alcohol-related cues on behaviour, such as when a placebo is administered. We test this hypothesis by adapting a paradigm used in alcohol myopia research to examine the effects of alcohol-related priming on self-enhancement behaviour among social drinkers. Participants were asked to engage in a computerised self rating task prior to being exposed to alcohol related and/or motivational primes. A staged computer error then occurred, and participants were then asked to complete their self ratings again – this method allowed for an immediate assessment of the impact of alcohol and motivational primes on self enhancement. As predicted by alcohol myopia theory, the overall effect of priming with alcohol-related cues was not significant irrespective of response-conflict manipulations. However, drinker type moderated this effect such that heavier drinkers self-enhanced more after exposure to alcohol-related cues, but only in high-conflict conditions. This suggests that the efficacy of a placebo may be significantly moderated by individual differences in reactions to alcohol-related stimuli, and that dual process accounts of the effects of alcohol on behaviour better explains this variation than alcohol myopia theory

Effect of health messages on alcohol attitudes and intentions in a sample of 16- & 17-year-old underage drinkers

Background. Responsible drinking messages (RDMs) are a key component of many education-based interventions for reducing alcohol harms. The evidence base for the effectiveness of RDMs is extremely limited, with some recent research suggesting iatrogenic effects of such messages. Objective. To examine the effects of exposure to health messages on attitudes towards drinking and drunkenness, and intentions to drink and get drunk, amongst underage drinkers. Methods. Ninety-four underage drinkers were recruited from colleges in the UK. Participants were either actively or passively exposed to one of two health messages (RDM or general wellbeing). Measures of attitudes and intentions towards drinking and drunkenness were obtained one week before and immediately after participation in the study. A unit estimation task was also included. Results. Active exposure to RDMs led to more positive attitude towards drunkenness, while passive exposure led to more negative attitudes. Passive RDM exposure led to increased intentions to get drunk in future. Wellbeing posters produced the opposite effect in some but not all of these measures. Conclusions. Exposure to RDMs may have some beneficial effects in terms of creating more negative attitudes towards alcohol consumption, but we also identified potential iatrogenic effects regarding attitudes and intentions towards drunkenness amongst an underage sample of drinkers. Further research is required to better understand optimal ways of framing RDMs to produce positive changes in attitudes, intentions and prospective drinking behaviour

Look away now! Defensive processing and unrealistic optimism by level of alcohol consumption

Objective: Health risk information is insufficient as a means of reducing alcohol use, particularly when it evokes negative emotional states amongst those for whom it is most personally relevant. Appraisal biases, or ‘defensive processing’, may be employed to mitigate the psychological discomfort posed by such information. Few studies have evaluated the role of defensive processing in people with different levels of alcohol consumption. Design: Online participants (n = 597) completed measures of defensive processing of a health risk infographic, perceived susceptibility and severity of alcohol use, efficacy for resisting alcohol use, unrealistic optimism, the Alcohol Use Disorder Identification Test–Consumption (AUDIT-C) and demographics. Results: AUDIT-C scores were positively and linearly associated with all defensive processing measures (Pearson’s correlation r from.16 to.36), threat and susceptibility (r =.16) and unrealistic optimism (r =.50). AUDIT-C scores were also negatively associated with efficacy for controlling alcohol use (r = −0.48). Conclusion: People with alcohol use disorder (AUD) engaged in much more defensive processing of alcohol-related messages, offering an explanation for why such messages are limited at eliciting behaviour change. High levels of unrealistic optimism in people with alcohol use disorder may reflect low problem recognition in order to maintain a problem-free drinking identity

Change in vaping, smoking and dual‐use identities predicts quit success and cigarette usage: A prospective study of people quitting smoking with electronic cigarette support

Objective Electronic cigarettes (ECs) are an efficacious support for some but not all people wishing to stop using tobacco. While advice and practical support have been identified as increasing quit success, little research has explored the role of changes in smoking and EC‐related social identities. Methods A prospective study following 573 people attempting to quit smoking with EC support. Self‐report measures of identification with being a smoker, non‐smoker, vaper and dual user (people using ECs and tobacco products) were taken prior to the quit attempt and at a 12‐week follow‐up. Results Baseline identifications with being a smoker, non‐smoker or dual user were not associated with smoking outcomes. Baseline vaper identity baseline was linked to more frequent tobacco abstinence at follow‐up and lower levels of cigarette smoking. Levels of social identification at follow‐up were consistently linked with outcomes, with vaper identity and non‐smoking identities being protective and dual user identity being related to lower abstinence rates but decreased tobacco usage. Changes in identity over time were the most consistent predictor of outcomes. Conclusions Findings have implications for smoking cessation practice, informing how and when identity‐based interventions may be effective and our understanding of how identity transitions occur

Impact of alcohol promoting and alcohol warning advertisements on alcohol consumption, affect, and implicit cognition in heavy drinking young adults: a laboratory-based randomized controlled trial

Objectives: There is sparse evidence regarding the effect of alcohol advertising exposure on alcohol consumption among heavy drinkers. This study aimed to assess the immediate effects of alcohol promoting and alcohol warning video advertising on objective alcohol consumption in heavy drinking young adults, and to examine underlying processes. Design: Between-participants randomized controlled trial with three conditions. Methods: Two hundred and four young adults (aged 18-25) who self-reported as heavy drinkers were randomized to view one of three sets of 10 video advertisements that included either: (i) alcohol promoting, (ii) alcohol warning, or (iii) non-alcohol advertisements. The primary outcome was the proportion of alcoholic beverages consumed in a sham taste test. Affective responses to advertisements, implicit alcohol approach bias, and alcohol attentional bias were assessed as secondary outcomes and possible mediators. Typical alcohol consumption, internet use, and television use were measured as covariates. Results: There was no main effect of condition on alcohol consumption. Participants exposed to alcohol promoting advertisements showed increased positive affect and an increased approach/reduced avoidance bias towards alcohol relative to those exposed to non-alcohol advertisements. There was an indirect effect of exposure to alcohol warning advertisements on reduced alcohol consumption via negative affect experienced in response to these advertisements. Conclusions: Restricting alcohol promoting advertising could remove a potential influence on positive alcohol-related emotions and cognitions among heavy drinking young adults. Producing alcohol warning advertising that generates negative emotion may be an effective strategy to reduce alcohol consumption

Impact of lower strength alcohol labelling on consumption: A randomised controlled trial

Objective: Labels indicating low/light versions of tobacco and foods are perceived as less harmful which may encourage people to consume more. There is an absence of evidence concerning the impact on consumption of labelling alcohol products as lower in strength. The current study tests the hypothesis that labelling wine and beer as lower in alcohol increases their consumption. Methods: Weekly wine and beer drinkers (n=264) sampled from a representative panel of the general population of England were randomised to one of three groups to taste test drinks in a bar-laboratory varying only in the label displayed; Group 1: verbal descriptor Super Low combined with 4%ABV for wine/1%ABV for beer; Group 2: verbal descriptor Low combined with 8%ABV for wine/3%ABV for beer; Group 3: No verbal descriptors of strength (Regular). Primary outcome was total volume (ml) of drink consumed. Results: The results supported the study hypothesis: the total amount of drink consumed increased as the label on the drink denoted successively lower alcohol strength, BLin=.71, p=.015, [95%CI=0.13/1.30]. Group contrasts showed significant differences between those offered drinks labelled as Super Low (M=213.77) compared to Regular (M=176.85), B=1.43, p=.019, [95%CI=0.24/2.61]. There was no significant difference in amount consumed between those offered drinks labelled as Low compared to Regular. Conclusions: These results suggest that labelling drinks as lower in strength increases the amount consumed. Further studies are warranted to test for replication in non-laboratory settings and to estimate whether any effects are at a level with the potential to harm health. Trial registration: ISRCTN1553080

Desire thinking as a predictor of drinking status following treatment for alcohol use disorder: A prospective study

© 2019 Elsevier Ltd Research has indicated that craving is one of the strongest predictors of treatment outcome and relapse in Alcohol Use Disorders (AUD) but there is little consensus on the factors that may influence its activation and escalation. Research has also shown that desire thinking is an important cognitive process which may exacerbate craving in problem drinkers. The aim of present study was to explore, for the first time, the role of desire thinking in prospectively predicting relapse, craving and binge drinking in patients receiving treatment for AUD. One hundred and thirty-five patients admitted to two rehabilitation centres and two outpatient services for addiction and mental health problems were administered baseline, treatment completion and three months follow-up measures of anxiety and depression, AUD severity, binge drinking frequency, craving and desire thinking. Results indicated that the verbal perseveration component of desire thinking at treatment completion was the only significant predictor of relapse at follow-up over and above baseline AUD severity and binge drinking frequency. Furthermore, the imaginal prefiguration component of desire thinking and craving levels at treatment completion were found to predict craving levels at follow-up independently of AUD severity and binge drinking frequency at baseline. Finally, both the imaginal prefiguration and verbal perseveration components of desire thinking at treatment completion were found to be the only predictors of binge drinking frequency at follow-up independently of AUD severity and binge drinking frequency at baseline. Treatments for AUD should aim to reduce desire thinking in people to enhance clinical outcomes and reduce relapse risk