Aim: To evaluate the effectiveness of a universal parent-oriented alcohol prevention programme ("Effekt") in Estonia. The main objective of the programme was to delay and reduce adolescents' alcohol consumption by maintaining parental restrictive attitudes towards adolescents' alcohol use over time.Methods: A matched-pair cluster randomised controlled trial with a three-year assessment period (baseline (T1), 18-months (T2) and 30-months (T3) follow-ups) was undertaken in 2012-2015 among 985 fifth grade adolescents and 790 parents in sixty-six schools (34 intervention, 32 control). The primary outcome measure was adolescents' alcohol use initiation. Secondary outcome measures were lifetime drunkenness and alcohol use in the past year. Intermediate outcomes were restrictive parental attitudes towards adolescents' alcohol use reported by parents and perceived restrictive parental attitudes and parental alcohol supply reported by adolescents.Results: There were no significant differences in adolescents' alcohol use initiation, lifetime drunkenness, alcohol use in the past year, parental alcohol supply, and adolescent's perception of parental restrictive attitudes between intervention and control school participants at T2 and T3. There were significant differences in parental attitudesthe odds of having restrictive attitudes were 2.05 (95% confidence interval (CI)=1.32-3.17) times higher at T2 and 1.92 (95% CI=1.31-2.83) times higher at T3 in the intervention group than in the control group.Conclusions: The Estonian version of the "Effekt" programme had a positive effect on parental attitudes, but it did not succeed in delaying or reducing adolescents' alcohol consumption.

AimsThe main aim was to assess the relationship between parental attitudes towards children's alcohol use and their child's alcohol use. Secondary aims included assessing the relationship between attitudes reported by parents and those perceived by children, and between perceived parental attitudes and children's alcohol use. Methods Meta-analysis of studies reporting on the associations between parental attitudes towards children's alcohol use and children's self-reported alcohol use. Published, peerreviewed cross-sectional and longitudinal studies were identified from the following databases up to April 2018: Medline, PsycINFO, EMBASE, Scopus and Web of Science. Quality assessment was done by using guidelines developed by Hayden, Cote and Bombardier. Pooled effect sizes were calculated by using random-effects meta-analyses, if there were at least two studies that could be included per analysis. Out of 7,479 articles screened, 29 were included comprising data from 16,477 children and 15,229 parents. ResultsLess restrictive parental attitudes towards children's alcohol use were related to higher rates of alcohol use initiation (odds ratio (OR)=1.45, 95% confidence interval (CI) 1.17-1.80), alcohol use frequency (OR=1.52, 95% CI 1.24-1.86) and drunkenness (OR=1.58, 95% CI 1.35-1.85) among children. Less perceived restrictive parental attitudes were related to higher alcohol use frequency (OR=1.76 (95% CI 1.29-2.40). Perceived parental attitudes were not clearly related to alcohol use initiation. Parent-reported attitudes and perceived parental attitudes were weakly positively correlated (r=0.27, p=≤0.001). The strength of the relationship between parental attitudes and children's alcohol use frequency attenuated with children's age. Study design, sample size, study location and levels of alcohol use frequency did not have a detectable effect on the relationship. ConclusionsLess restrictive parental attitudes towards children's alcohol use are associated with increases in children's alcohol use onset, alcohol use frequency and drunkenness. Children's perception of less restrictive parental attitudes is associated with children's alcohol use.

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BACKGROUND Although mental ill-health is more prevalent among people from lower socioeconomic groups, digital mental well-being innovations are often developed for people from higher socioeconomic groups, who already have resources to maintain good mental and physical health. To decrease health inequalities and ensure that available solutions are appealing and accessible to people with fewer resources, new approaches should be explored. We developed the app Wakey!, which focused on creating engaging mental health content that is accessible, particularly among lower socioeconomic groups in the United Kingdom. OBJECTIVE The aim of this study is to assess engagement with the app, investigate initial effectiveness data for 6 well-being outcomes, and explore participants’ subjective experiences of using Wakey! METHODS The app Wakey! was publicly launched on January 20, 2020, and was free to download from Apple Store and Google Play. The app provided its users with entertaining and educational content related to mental well-being. Concurrently, a single-arm mixed methods feasibility trial was carried out from January to April 2020 among people who had downloaded the app and created an account. The primary outcome was engagement, which was collected passively from data logs. Secondary outcome measures were 6 well-being outcomes collected from self-report questionnaires. Individual interviews with 19 app users were carried out in April 2020. RESULTS In total, 5413 people fit the inclusion criteria and were included in the final sample—65.62% (3520/5364) women, 61.07% (3286/5381) aged between 25 and 44 years, 61.61% (2902/4710) in employment, 8.92% (420/4710) belonging to the lower socioeconomic group, and 8.09% (438/5413) were engaged users. There was no evidence of a difference in engagement regarding sociodemographic and socioeconomic characteristics. There was evidence that users with a higher average daily sleep score, who joined the study more recently, who had higher baseline self-report of sleep quality, and who found episodes more entertaining were more likely to be engaged users. Among 230 users who provided follow-up data, there was evidence of improvements on four of the six well-being outcomes: life satisfaction (<i>P</i>&lt;.001), feeling that life is worthwhile (<i>P</i>=.01), ease of getting up in the morning (<i>P</i>&lt;.001), and self-efficacy (<i>P</i>=.04). The app and its content were well received by those who were interviewed, and several people perceived a positive change in their mental well-being. CONCLUSIONS This study shows that the app Wakey! could potentially be engaging across different socioeconomic groups, and there is an indication that it could positively impact the mental well-being of those engaged with the app. However, this study was a pragmatic trial with a limited sample, and the selection bias was present in the qualitative and quantitative study. Further work is needed to make any generalizable conclusions. CLINICALTRIAL ClinicalTrials.gov NCT04287296; https://clinicaltrials.gov/ct2/show/NCT04287296

Background Although mental ill-health is more prevalent among people from lower socioeconomic groups, digital mental well-being innovations are often developed for people from higher socioeconomic groups, who already have resources to maintain good mental and physical health. To decrease health inequalities and ensure that available solutions are appealing and accessible to people with fewer resources, new approaches should be explored. We developed the app Wakey!, which focused on creating engaging mental health content that is accessible, particularly among lower socioeconomic groups in the United Kingdom. Objective The aim of this study is to assess engagement with the app, investigate initial effectiveness data for 6 well-being outcomes, and explore participants’ subjective experiences of using Wakey! Methods The app Wakey! was publicly launched on January 20, 2020, and was free to download from Apple Store and Google Play. The app provided its users with entertaining and educational content related to mental well-being. Concurrently, a single-arm mixed methods feasibility trial was carried out from January to April 2020 among people who had downloaded the app and created an account. The primary outcome was engagement, which was collected passively from data logs. Secondary outcome measures were 6 well-being outcomes collected from self-report questionnaires. Individual interviews with 19 app users were carried out in April 2020. Results In total, 5413 people fit the inclusion criteria and were included in the final sample—65.62% (3520/5364) women, 61.07% (3286/5381) aged between 25 and 44 years, 61.61% (2902/4710) in employment, 8.92% (420/4710) belonging to the lower socioeconomic group, and 8.09% (438/5413) were engaged users. There was no evidence of a difference in engagement regarding sociodemographic and socioeconomic characteristics. There was evidence that users with a higher average daily sleep score, who joined the study more recently, who had higher baseline self-report of sleep quality, and who found episodes more entertaining were more likely to be engaged users. Among 230 users who provided follow-up data, there was evidence of improvements on four of the six well-being outcomes: life satisfaction (P<.001), feeling that life is worthwhile (P=.01), ease of getting up in the morning (P<.001), and self-efficacy (P=.04). The app and its content were well received by those who were interviewed, and several people perceived a positive change in their mental well-being. Conclusions This study shows that the app Wakey! could potentially be engaging across different socioeconomic groups, and there is an indication that it could positively impact the mental well-being of those engaged with the app. However, this study was a pragmatic trial with a limited sample, and the selection bias was present in the qualitative and quantitative study. Further work is needed to make any generalizable conclusions. Trial Registration ClinicalTrials.gov NCT04287296; https://clinicaltrials.gov/ct2/show/NCT04287296

Several studies have found that the level of alcohol use among minors both in Europe generally and in Estonia is relatively high. However, we have less knowledge of issues related to age estimations in this field. Therefore, research was conducted to examine how accurate sales personnel in Estonia are in estimating the age of young people and, in addition, to compare salespersons and laypersons (i.e., persons not working in shops that sell food and alcohol) with regard to their ability to make accurate age estimations. For this purpose, 20 salespersons and 20 laypersons participated in an experiment in which they estimated the age of people whose faces were presented to them in images. Salespersons’ estimation of young persons’ age from the photos was more accurate than laypersons’ estimation. However, both groups tended to overestimate the age of the people shown, especially when the focus was on the difference between minors of age 17 and young adults of age 18 or 19. It can be concluded that accurately discriminating between minors’ and adults’ faces by using only facial cues is difficult. One solution for addressing this issue in practice would be to raise the age threshold for asking for ID. While many shops already pursue this approach, it is on a voluntary basis; in Estonia, there is no legal requirement to do so.

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