An exploration of alcohol advertising on social networking sites: an analysis of content, interactions and young people's perspectives http://researchonline.ljmu.ac.uk/id/eprint/3857/ Article LJMU has developed LJMU Research Online for users to access the research output of the University more effectively. AbstractYoung people increasingly communicate and interact via social digital media such as Social Network Sites (SNS) where they discuss and display alcohol-related content. SNS have also become an important aspect of the alcohol industry's multi-platform marketing strategies, which may contribute to the creation of intoxigenic digital spaces in which young people learn about alcohol. This paper presents findings of a content analysis of the extent, nature, and user interaction with SNS-based alcohol marketing for brands popular among young people in the UK. It provides a systematic analysis of both official and user generated marketing content on brand Facebook and Twitter profiles, and user interaction with such content.Findings from peer group interviews (N=14) also present young people's (N=70) perspectives and experiences regarding alcohol marketing on SNS. New SNS engagement marketing strategies extended existing multi-platform brand marketing. Young people interacted with such strategies as part of their identity-making practices, yet through a discourse of immaturity distanced themselves from certain brands, online marketing practices and the idea that their own actions were influenced by marketing. Local night life economy marketing appeared more meaningful and relevant to young people and led to further interaction with brand marketing.Implications of the findings are discussed in relation to the influence of alcohol marketing on young people, and the implications for current regulatory frameworks.

A systematic review investigating the behaviour change strategies in interventions to prevent misuse of anabolic steroids.http://researchonline.ljmu.ac.uk/7477/ Article LJMU has developed LJMU Research Online for users to access the research output of the University more effectively. Copyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Users may download and/or print one copy of any article(s) in LJMU Research Online to facilitate their private study or for non-commercial research. You may not engage in further distribution of the material or use it for any profit-making activities or any commercial gain.The version presented here may differ from the published version or from the version of the record. Please see the repository URL above for details on accessing the published version and note that access may require a subscription. Astract:This review aimed to examine strategies applied in interventions to prevent image and performance enhancing drug use in the context of intervention effectiveness. Comprehensive searches identified 14 interventions that met review inclusion criteria. Interventions were predominantly educational and delivered within school sport settings, but targeted a wide range of mediating factors. Identification of effective components was limited across studies by brief or imprecise descriptions of intervention content, lack of behavioural outcome measures and short-term follow up times; however studies with components in addition to information provision may be more promising. Interventions are required outside of sport settings to reflect the transition of this form of substance use to the general population. 2 Introduction Anabolic steroidsAnabolic steroids (AS) are the most prominent of a range of substances used to modify appearance and performance known as image and performance enhancing drugs (IPEDs).Globally the lifetime prevalence of AS has been estimated at 3.3%, with higher prevalence amongst males (6.4%) (Sagoe et al., 2014b), and it is suggested that nearly one third of AS users will develop a form of dependence (Pope et al., 2014a). Although AS can be used without adverse consequences, such as when used therapeutically, risk of harm increases with the far greater doses observed when AS are used outside of clinical settings (Harmer, 2010).Additionally, the quality of illicitly produced AS cannot be controlled and those using them frequently do so as part of complex IPED regimens. This misuse of AS is associated with a range of acute and chronic adverse consequences (Pope et al., 2014b) that range greatly from cosmetic (e.g. acne) to critical (e.g. cardiovascular disease, liver function) with evidence of potential psychological harms (e.g. increased aggression, mania) (ACMD, 2010b). Harms appear to increase with long-term use, which may be characterised by polypharmacy, long or continuous cycles of use, body image disturbance and obsession with training and diet (Kanayama et al., 2009).The majority of th...

Anabolic steroids in the UK: an increasing issue for public health http://researchonline.ljmu.ac.uk/4614/ Article LJMU has developed LJMU Research Online for users to access the research output of the University more effectively. Copyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Users may download and/or print one copy of any article(s) in LJMU Research Online to facilitate their private study or for non-commercial research. You may not engage in further distribution of the material or use it for any profit-making activities or any commercial gain.http://researchonline.ljmu.ac.uk/ Citation (please note it is advisable to refer to the publisher's version if you intend to cite from this work) McVeigh LJMU Research OnlineThe version presented here may differ from the published version or from the version of the record. Please see the repository URL above for details on accessing the published version and note that access may require a subscription. Conclusions: Key changes in our knowledge during the 20 years, in particular in relation to HIV prevalence, changes in the market and patterns of use make anabolic steroid use a public health concern. In the context of increasing numbers of injectors, there is a need for comprehensive interventions.

Introduction and Aims Historically, people who inject image and performance enhancing drugs (IPED) were not perceived as being at high risk of HIV or hepatitis C virus (HCV) infection. However, recent studies indicate HCV and HIV prevalences are elevated, with many HCV infections undiagnosed. Design and Methods Men who inject IPEDs recruited from community settings and specialist services, including needle‐syringe programs, across UK during 2016 self‐completed a questionnaire. Multivariate analyses examined factors associated with HCV/HIV testing. Results The participants' (n=562; 24% service recruited) median age was 31 years, 4% identified as gay or bisexual, 18% had ever been imprisoned and 6% had ever injected a psychoactive drug. Those community recruited more often reported sharing drugs vials (16% vs. 8%, P=0.021) and, among those with 2+ sexual partners, poor condom use (50% vs. 36%, P=0.063), than those service recruited. Overall, one‐third had ever been tested for HCV (31%) and/or HIV (34%). Testing uptake was associated with other risk factors for HCV/HIV, being recruited through services and having received metabolic tests. Participants' motivations for using IPEDs were associated with recruitment setting and HIV/HCV testing uptake. Discussion and Conclusions The majority were untested for HCV/HIV. HCV/HIV testing and risks were associated with recruitment through services. Previous needle and syringe program‐based studies have potentially overestimated testing uptake and underestimated risk. Targeted interventions are needed, particularly for those not accessing services. The association between HCV/HIV testing uptake and receipt of metabolic tests suggests that developing a combined offer of these tests as part of health monitoring could improve uptake.

Assessing the impact of laws controlling the online availability of 25I-NBOMe, AH-7921, MDPV and MXE -outcomes of a semi-automated e-shop monitoring http://researchonline.ljmu.ac.uk/5432/ Article LJMU has developed LJMU Research Online for users to access the research output of the University more effectively. Copyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Users may download and/or print one copy of any article(s) in LJMU Research Online to facilitate their private study or for non-commercial research. You may not engage in further distribution of the material or use it for any profit-making activities or any commercial gain.The version presented here may differ from the published version or from the version of the record. Please see the repository URL above for details on accessing the published version and note that access may require a subscription. Aims: The indicator of availability has been used in the risk assessment (RA) of new psychoactive substances (NPS). This paper aims to examine the pre-and post-control availability of 25I-NBOMe, AH-7921, MDPV and MXE, which were assessed by the EMCDDA. Methods: Data were collected by a semi-automated software tool (I-TREND SASF) on e-shops in national languages (Czech, French, Dutch, Polish and English) that offered shipping of these compounds into the respective countries; frequency analysis was used. Findings: The number of e-shops selling these substances decreased between III/2014 and XII/2015 (except for AH-7921). Both increases and decreases were found on the country-level for all the compounds (except for an overall decrease for MXE). In one instance an NPS disappeared from this market in 2015 (25I-NBOMe in NL); 25I-NBOMe and AH-7921 in France and AH-7921 in Poland appeared for the first time in 2015. The shops listing AH-7921, 25I-NBOMe and MDPV in XII/2015 ranked higher in terms of ''popularity'' than in III/2014. The IP addresses were more likely to be outside the EU in 2015 than in 2014. Conclusions: We found no evidence that national-level compound bans contributed to the changes in online NPS markets. Indicators of the accessibility, availability, popularity, and IP origin should be considered in RA. Data triangulation with street markets and the darknet is needed as well as more research into the ''displacement'' and ''replacement'' effects of control laws.

Background Treating Chronic Non-Cancer Pain (CNCP) with long-term, high dose and more potent opioids puts patients at increased risk of harm, whilst providing limited pain relief. Socially deprived areas mapped from Index of Multiple Deprivation (IMD) scores show higher rates of high dose, strong opioid prescribing compared to more affluent areas. Objective To explore if opioid prescribing is higher in more deprived areas of Liverpool (UK) and assess the incidence of high dose prescribing to improve clinical pathways for opioid weaning. Design and setting This retrospective observational study used primary care practice and patient level opioid prescribing data for N = 30,474 CNCP patients across Liverpool Clinical Commissioning Group (LCCG) between August 2016 and August 2018. Method A Defined Daily Dose (DDD) was calculated for each patient prescribed opioids. DDD was converted into a Morphine Equivalent Dose (MED) and patients stratified according to high (≥120mg) MED cut off. The association between prescribing and deprivation was analysed by linking GP practice codes and IMD scores across LCCG. Results 3.5% of patients were prescribed an average dose above 120mg MED/day. Patients prescribed long-term, high dose, strong opioids were more likely to be female, aged 60+, prescribed three opioids and reside in the North of Liverpool where there is a higher density of areas in the IMD most deprived deciles. Conclusion A small but significant proportion of CNCP patients across Liverpool are currently prescribed opioids above the recommended dose threshold of 120mg MED. Identification of fentanyl as a contributor to high dose prescribing resulted in changes to prescribing practice, and reports from NHS pain clinics that fewer patients require tapering from fentanyl. In conclusion, higher rates of high dose opioid prescribing continue to be evident in more socially deprived areas further increasing health inequalities.

Introduction: Pain disrupts attentional processing across a range of tasks and pain types. This effect is changed by stimulus salience, such that stimuli such as pain-related words or emotional expressions are attended to differently. This study aimed to further explore this effect using the attentional blink across two studies.Method: In the ABT, participants are presented with a stream of stimuli and asked to identify two targets. T1 is presented in a different text colour to the stimulus stream, and participants are asked to identify and remember T1. In half of trials, participants are also asked to identify a second target (T2), which appears after T1 and remains consistent throughout. T2 is presented in one of three positions in the stimulus stream; immediately after T1, 3 places after T1, or 7 places after T1. Typically, T2 is detected with high accuracy when presented in position 1 or 3, but accuracy drops at position 2. This deficit is the attentional blink effect. This research consists of two studies using the ABT; one using letter stimuli, the second using affective words. In both studies, participants completed the ABT twice, once normally and once whilst experiencing a headache (experimental condition).Results: In the standard task, the blink window is shifted whilst in pain such that accuracy is poorer in position 1 and 3 compared to no-pain. In the emotional-word task, there was no effect of stimulus salience, although the same effect on blink performance was present, suggesting a top-down, rather than bottom-up, influence of pain on attention.Conclusions: Pain disrupts attentional processing, with a particular disruptive effect in early attentional processing, and disrupts lateattentional recovery. This creates a 'lag sparing' effect. There is no influence of stimulus salience on this disruption.

IntroductionAround 30%–50% of adults suffer moderate to severe chronic pain not caused by cancer. Significant numbers are treated with opioids which over time may cease to be effective and produce side effects (eg, nausea, drowsiness and constipation). Stopping taking opioids abruptly can cause unpleasant withdrawal effects. Tapering in small steps is recommended, though some patients might struggle and need support, particularly if they have limited access to pain management alternatives. Awareness of the potential risks as well as benefits of tapering should be explored with patients.Methods and analysisA randomised controlled pilot feasibility study to investigate the effectiveness and feasibility of reducing high doses of opioids through a tapering protocol, education and support in primary care. Working with NHS Knowsley Place, we will identify patients taking 50 mg or above morphine equivalent dose of opioids per day to be randomly allocated to either the tapering group or tapering with support group. At an initial joint appointment with a pain consultant and General Practitioner (GP) GP tapering will be discussed and negotiated. Both groups will have their opioid reduced by 10% per week. The taper with support group will have access to additional support, including motivational counselling, realistic goal setting and a toolkit of resources to promote self-management. Some patients will successfully reduce their dose each week. For others, this may be more difficult, and the tapering reduction will be adjusted to 10% per fortnight. We assess opioid use, pain and quality of life in both groups at the start and end of the study to determine which intervention works best to support people with chronic pain who wish to stop taking opioids.Ethics and disseminationThe Behavioural Intervention for Opioid Reduction feasibility study has been granted full approval by Liverpool Central Research Ethics Committee on 7 April 2022 (22/NW/0047). The current protocol version is V.1.1, date 6 July 2022. Results will be published in peer-reviewed journals and disseminated to patient stakeholders in a lay summary report available on the project website and in participating GP surgeries.Trial registration numberISRCTN 30201337.