Introduction: Late-night alcohol trading hours are generally associated with increased alcohol-related harm. Since 2018, two Scottish cities have allowed extensions in late-night alcohol trading hours with the aim of revitalising the night-time economy. This is the first study to directly observe whether and how bars and nightclubs use these extensions, and collect rich qualitative data about venue environment and staff behaviour. Methods: Trained, paired fieldworkers, behaving as customers, completed semi-structured observation schedules on mobile devices during repeated visits to 15 purposively sampled venues in 2023-24 (5 venues in Glasgow and 10 in Aberdeen: total of 313 h of observation). In-depth qualitative fieldnotes were completed within 48 h of visits. Results: Half of the venues closed early on at least one fieldworker visit without using all of their later trading hours. Venues using their extended hours were observed to be at low occupancy on at least one visit. Fieldworkers observed bar staff serving alcohol to intoxicated customers in every venue. In half of the venues, 'shot girls' were observed persistently approaching customers, including those who appeared intoxicated. Conclusions: Extensions in late-night alcohol trading hours granted in two Scottish cities were not used consistently by venues due to lack of demand by customers. The late-night sale of alcohol to intoxicated customers was routine. Our findings challenge the assumption that later trading hours benefit the night-time economy and highlight the likelihood of associated alcohol-related harms.

The World Health Organization (WHO) Global Action Plan for the Prevention and Control of Noncommunicable Diseases calls for a 10% relative reduction in the harmful use of alcohol by 2025. We assessed progress across 45 sub-Saharan African countries between 2010 and 2019 using WHO data on alcohol per capita consumption (APC) and heavy episodic drinking (HED). Trends were analysed for both the total population and past-year drinkers, using population-weighted averages and non-parametric methods. Regionally, both total APC (+6.6%) and HED per capita (+4.0%) increased slightly between 2010 and 2019. Among drinkers, APC also rose (+4.9%), while HED prevalence remained stable at around 51%. Central Africa was the only subregion to show meaningful declines in both APC and HED per-capita, although it continued to report the highest levels of HED per capita (around 30%). One-third of countries met or exceeded the 10% reduction target in APC per-drinker, while 44% saw increases. Sub-Saharan Africa is not on track to have met the alcohol reduction target, but trends vary markedly by country, with some signs of progress in Central Africa. Harmful drinking remains widespread and unevenly distributed, underscoring the need for stronger, context-specific alcohol policy and targeted interventions, particularly where consumption is rising or HED remains high.

INTRODUCTION:Between 2017 and 2019, different policy processes in two large Scottish cities led to local authorities granting licences for later on-premises alcohol trading hours. As a part of a wider mixed methods study, we examine news media reporting of these licencing changes to understand the content and progression of arguments at the time they were being discussed through to, and after, implementation. METHODS:Forty-four news articles were identified through online searches (published 01/01/2015-01/01/2023) supplemented with hand searches of local publications. A qualitative thematic analysis was then conducted using NVivo. RESULTS:Trade and local government actors were foregrounded in the media. Sectors within the alcohol retail trade responded differently, depending on their business interests. In Aberdeen, stakeholders stated that the changes were primarily intended to support businesses and in response to consumer trends. In Glasgow, stakeholders stated that the changes were needed to boost the economy and compete with other European cities. A diverse range of stakeholders framed their arguments in health terms, expressing concerns that increased hours would lead to increased consumption and harm. DISCUSSION AND CONCLUSIONS:In media reports of extended late-night trading hours, stakeholders who were both for and against the changes put forward arguments about business and health impacts. There appeared to be little consensus about the value of extended trading hours amongst trade stakeholders who responded in line with their specific business interests, sometimes drawing on health arguments to do so. This counters the assumption of unity in trade views on liberalisation of opening hours.

Introduction Alcohol-related harms are prevalent late at night, especially on weekends, when high levels of intoxication contribute to increased rates of injury and violence. Reducing or increasing alcohol trading hours late at night in bars and clubs is generally associated with reduced and increased harms, respectively. This study evaluates the impact of later alcohol trading hours in the Scottish cities of Aberdeen and Glasgow on alcohol-related ambulance call-outs and crimes. Under local policy changes, 38 bars in Aberdeen had trading hours extended between 1 and 3 h up to 3am, and 10 nightclubs in Glasgow had a 1-h extension to 4am.Methods Following a natural experiment evaluation framework, we used a controlled interrupted time series design to compare outcomes before and after policy changes, from May 2015 to March 2020. The primary outcome was a count of total weekend night-time alcohol-related ambulance call-outs. Secondary outcomes included weekend night-time crimes.Results In Aberdeen, the policy led to a significant relative increase of 11.4% (effect size=4.643; 95% CI 0.292 to 8.994; p=0.036) in alcohol-related ambulance call-outs, and 8.5% (effect size=3.442; 95% CI 0.239 to 6.645; p=0.035) in reported crimes, at weekend night-times compared with Edinburgh (control). Findings were not significant and robust across analyses for Glasgow.Conclusion Later alcohol trading hours had a significant negative impact on alcohol-related ambulance call-outs and reported crimes in Aberdeen (where more premises had longer extensions) but not in Glasgow, suggesting the number, capacity and type of premises moderated outcomes. This is important for the design of future national and local licensing policies and regulations.

BACKGROUND:South Africa is reported to have one of the highest per capita rates of alcohol consumption among drinkers globally, with alcohol harms exacerbating socio-economic inequalities in the country. The Draft Liquor Amendment Bill 2016 proposed new restrictions on alcohol advertising, availability, and liability of retailers and manufacturers for harm related to any contravention of the regulations. To date, the Bill has not progressed through the legislative process. The alcohol industry is known to use a diverse set of strategies to delay evidence-based policies globally. METHODS:We aimed to explore Bill-related activity by industry within the National Economic and Development Labour Council, a multi-stakeholder forum that assesses socio-economic policies before they reach parliament. On 06 July 2023 we made a Request for Access to Record, using form two of the Promotion of Access to Information Act (PAIA), no. 2 of 2000 to the National Economic and Development Labour Council for access to minutes of all meetings, reports, and any other publications related to the Bill between January 2016 and December 2022. Informed by Ulucanlar et al's (2023) model and taxonomies of corporate political activity, we extracted data on industry Bill-related activity and thematically analysed key events, presented here as a narrative synthesis. RESULTS:We identified activity by 14 alcohol industry organisations related to the Bill between 2016 and 2022. Industry representation on five National Economic and Development Labour Council-related committees identified between 2017 and 2021 facilitated their involvement in Bill-related discussions and supported access to other government departments. Community representation was low in all committees compared to industry, labour, and government. Industry funded two socio-economic assessments of the Bill in 2017 and 2022, despite an independent socio-economic impact assessment having already been completed. The 2017 report delayed progress of the Bill, and the 2022 're-evaluation' was more critical of the proposed measures, with the differing conclusions attributed to different methodologies. During the covid-19 pandemic, industry used a 'carrot and stick' approach of legal threats and donations to attempt to move towards self-regulation via a social compact. The National Economic and Development Labour Council confirmed in 2023 that the social compact was unsuccessful. CONCLUSIONS:Early 'regulatory capture' gave the alcohol industry the opportunity to shape assessment of the Bill within the National Economic and Development Labour Council. Our findings are in line with previous studies on corporate influence on policy globally, and support calls for a reassessment of the role and proportion of industry representation within the National Economic and Development Labour Council locally.

Access to reliable, accurate, and up-to-date health information is a crucial component of global population health. Like other health-harming industries, the alcohol industry is known to provide misinformation to the public, including on alcohol, pregnancy, and infant health. It is unknown whether industry information changes following independent public health analysis. We extracted data using the homepage, menu, and search tool functions (where available) from seven industry-funded charity and nonprofit company websites (Aware, South Africa; Drinkaware, Ireland; Drinkaware, United Kingdom; Éduc’alcool, Canada; DrinkWise, Australia; Foundation for Advancing Alcohol Responsibility, United States; and International Alliance for Responsible Drinking) that have previously been found to misrepresent the evidence on alcohol, pregnancy, and infant health. We conducted a qualitative, thematic analysis using a published framework of ‘dark nudges and sludge’ misinformation techniques. Omission of information, functionality problems, and the positioning and sequencing of information in ways that framed or obfuscated its meaning were the most common forms of misinformation identified. These types of misinformation were often mixed with (limited) relevant information and were most often found in combination. We found pregnancy and infant health information for the consumer on five of the seven websites studied (Drinkaware, Ireland; Drinkaware, United Kingdom; DrinkWise; Éduc’alcool; and Aware). Information on pregnancy and fetal alcohol spectrum disorder was found on these five sites, although they did not all provide information on miscarriage, breastfeeding, or fertility. We could not find any pregnancy and infant health information directed to the consumer on the remaining sites (Foundation for Advancing Alcohol Responsibility and International Alliance for Responsible Drinking). Six of the seven websites had a search tool function; these often produced irrelevant information. Following independent public health analysis of their informational outputs, misinformation about pregnancy and infant health remains present on alcohol industry-funded websites. Warnings to the public to avoid alcohol industry-funded information sources should form an essential part of the global effort to tackle health misinformation.

Aims: This study aimed to explore the nature and extent of alcohol sports sponsorship in Uganda and the activities involved. Methods: Utilising an exploratory case study methodology to document examples of alcohol industry activity related to sports sponsorship in Uganda. This study employed desk-based reviews of publicly available examples of sponsorship activities from websites and social media sites as well as visits to sporting venues to observe alcohol sponsorship practices. Results: Sports sponsorship by alcohol companies was found to be a common practice in Uganda. Across the sample of data included in this study, we observed multiple sponsorship deals within a range of professional sports, including football, basketball and golf. Across these sponsorship arrangements, several activities explicitly promoted products or subtly blended them amongst other stimulating content. This included: a presence on social media channels; limited edition products; alcohol brand logos on match strips; advertising and promotion at various locations inside and outside the sporting venues; and alcohol industry representatives featuring in news reports. Conclusion: Alcohol sports sponsorship in Uganda is widespread and multi-faceted. The types of sponsorship activities observed in this study mirror those used around the world. The transnational companies involved use sports sponsorship to position themselves as central to Ugandan economy, culture, heritage and the sustainability of sports across the country. Understanding how sports sponsorship is used to promote alcohol brands across Uganda is important to inform future policy decisions regarding alcohol marketing.

Background: Late-night opening of alcohol venues is associated with increased intoxication, social disorder and burden on public services. From 2017, two Scottish cities—Aberdeen and Glasgow—extended venue trading hours, to 3am and 4am, respectively. This study aimed to explore (i) public perceptions of harms and benefits of later trading hours, and (ii) how related public health evidence is assessed and used by the public. Methods: Eight groups of residents and venue-goers (n = 42) participated in two deliberative focus groups over a two-week period. Evidence on the pros and cons of later hours was presented and discussed. Reflexive thematic analysis was used to analyze data. Results: Participants associated later hours with increased alcohol consumption and increased harms such as violence, antisocial behavior, crime and public disturbance. Harms were discussed more frequently than benefits. Venue-goers highlighted cultural and social benefits and suggested staggered closing times might reduce harms. Following consideration of public health evidence, participants’ focus shifted from individual to societal impacts, such as increased burden on police, ambulance, and hospital services. Conclusion: Exposing lay participants to public health evidence fostered more reflection on societal impacts of later trading hours, potentially providing policy-makers with strategies to increase public support for alcohol policies.

Background: Harmful alcohol consumption has significant public health implications across Africa and disproportionately affects vulnerable populations. In Malawi, the emergence of alcohol sachets - small, affordable plastic packets containing high-strength spirits - and their consumption, has raised substantial public health concerns. In particular, the resulting access and consumption amongst young people, led to a ban on those products by the Malawi Government in 2017. This study focuses on the policy process of the sachets ban, from agenda setting, to formulation and covers the modalities for implementation. Methods: Retrospective policy case study involving a documentary analysis of all key regulatory documents and in-depth interviews with thirteen policy stakeholders and key informants. The Advocacy Coalition Framework was used to guide the analysis. Results: The findings reveal a long and contested process involving two primary coalitions. The pro-ban coalition (NGOs, civil society organizations, religious leaders, and government representatives), which used empirical and local evidence on sachet alcohol-related harms, particularly among young people, to emphasize the need to regulate. The opposing coalition (spearheaded by alcohol and plastics manufacturers) mounted multiple legal challenges, stalling the policy formulation of the ban. Ultimately, a strong enduring public health coalition, a high court ruling and a decisive government decision facilitated a final and complete ban in 2017. Conclusion: This analysis demonstrates how public health advocates successfully countered industry interference through evidence-based advocacy, community engagement, and strategic coalition-building. The Malawi case offers valuable lessons for other African countries considering similar alcohol control measures, highlighting the role of coalitions, the importance of framing alcohol regulations as public health protections, and of developing robust implementation mechanisms.

BackgroundIn Great Britain, local authorities responsible for alcohol premises licensing produce a statement of licensing policy setting out how they intend to exercise their statutory licensing functions including on trading hours. We aimed to describe and compare these policies on alcohol trading hours, including their interpretation and application of laws and guidance.MethodsPolicies were obtained from the websites of all 366 local licensing authorities and uploaded to NVivo. Using content analysis, relevant text was located through manual searching and coded inductively.ResultsMany local authorities do not explicitly seek to place controls on trading hours, while others create complex circumstances under which extended hours may be granted. Setting out core or matrix hours is the best example in the findings of local authorities applying their limited discretion to implement the law in ways that suit their needs.ConclusionAlthough licensing is ostensibly a policy system devolved to local areas, power remains at the centre in national legislation and guidance. Resultantly, local discretion is highly constrained especially in England/Wales. There is a need to attend to the details of statutory instruments to understand how headline principles and objectives can be made workable in practice for local authorities and boards.

Background and aims: Permitting alcohol outlets to trade later at night is associated with increased intoxication, violence and burden on public services. Between 2017 and 2019 two processes led to later trading hours in 10 nightclubs in Glasgow (1-hour pilot extension, to 4am) and 38 bars in Aberdeen (1-3 hours extension, to 3am). We explored stakeholder views on the impact of these later hours against the backdrop of the Covid-19 pandemic and UK cost of living crisis.   Methods: Semi-structured interviews conducted March 2022 to March 2023 with 39 stakeholders (10 public health/community/police; 14 frontline services; 9 licensing stakeholders (non-trade); and 6 venue owners/managers), analysed using framework analysis. Results: Participants across both cities reported mixed consumer demand for extended trading hours. Consequently, later hours were used irregularly and unpredictably by venues and economic benefits were at best smaller than anticipated. Low demand was attributed to the pandemic, cost of living crisis and changing drinking patterns. Frontline workers were more likely than those in other/more senior roles in policing, health and local government to report increased violence and disorder during the later hours. In Aberdeen, changes were perceived broadly negatively, due to greater demand from often vulnerable drinkers later at night, which outstripped the capacity of ambulance, policing, transport and voluntary services. In Glasgow, impact on services was more often described as mixed or neutral, although some transport and voluntary services were not available to cover the extra hour. Conclusions: Night-time economy stakeholders in Glasgow and Aberdeen perceived little or no economic benefits from the introduction of later trading hours, lower than anticipated consumer demand and increased demand for services, which often outstripped service capacity. Policymakers should treat with scepticism claims of benefits from later trading hours and consider other measures which address alcohol harms and pressure on services. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This project is funded by the National Institute for Health and Care Research (NIHR) [Public Health Research programme (129885)]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved by the University of Stirling Ethics Committee for NHS, Invasive or Clinical Research (NICR 0457). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors

Abstract Background Acute leukaemias (AL) are life-threatening blood cancers that can be potentially cured with treatment involving myelosuppressive, multiagent, intensive chemotherapy (IC). However, such treatment is associated with a risk of serious infection, in particular invasive fungal infection (IFI) associated with prolonged neutropenia. Current practice guidelines recommend primary antifungal (AF) prophylaxis to be administered to high-risk patients to reduce IFI incidence. AFs are also used empirically to manage prolonged neutropenic fever. Current strategies lead to substantial overuse of AFs. Galactomannan (GM) and β-D-glucan (BG) biomarkers are also used to diagnose IFI. Combining both biomarkers may enhance the predictability of IFI compared to administering each test alone. Currently, no large-scale randomised controlled trial (RCT) has directly compared a biomarker-based diagnostic screening strategy without AF prophylaxis to AF prophylaxis (without systematic biomarker testing). Methods BioDriveAFS is a multicentre, parallel, two-arm RCT of 404 participants from UK NHS Haematology departments. Participants will be allocated on a 1:1 basis to receive either a biomarker-based antifungal stewardship (AFS) strategy, or a prophylactic AF strategy, which includes existing standard of care (SoC). The co-primary outcomes will be AF exposure in the 12-month post randomisation and the patient-reported EQ-5D-5L measured at 12-month post randomisation. Secondary outcomes will include total AF exposure, probable/proven IFI, survival (all-cause mortality and IFI mortality), IFI treatment outcome, AF-associated adverse effects/events/complications, resource use, episodes of neutropenic fever requiring hospital admission or outpatient management, AF resistance in fungi (non-invasive and invasive) and a Desirability of Outcome Ranking. The trial will have an internal pilot phase during the first 9 months. A mixed methods process evaluation will be integrated in parallel to the internal pilot phase and full trial, aiming to robustly assess how the intervention is delivered. Cost-effectiveness analysis will also be performed. Discussion The BioDriveAFS trial aims to further the knowledge of strategies that will safely optimise AF use through comparison of the clinical and cost-effectiveness of a biomarker-led diagnostic strategy versus prophylactic AF to prevent and manage IFI within acute leukaemia. The evidence generated from the study will help inform global clinical practice and approaches within antifungal stewardship. Trial registration ISRCTN11633399. Registered 24/06/2022.

There is ongoing scientific and policy debate about the role e-cigarettes play in tobacco control, with concerns centring around unknown long-term effects, and the potential industry co-option of harm reduction efforts, including marketing to youths. There is substantial evidence of the influence of conventional cigarette promotion on smoking behaviours in Anglophone countries, and the popularity of social networking sites, as well as the lack of marketing regulations on the commercial promotion of electronic cigarettes online, suggest an urgent need to explore this topic further. This scoping review aims to map the existing evidence related to the influence of e-cigarette commercial promotion on social media on positive perceptions of vaping and vaping behaviours in core Anglophone countries. Searches were conducted in CENTRAL, Cochrane Database of Systematic Reviews (CDSR), Embase, Epistemonikos, MEDLINE, PsycINFO and Science Citation Index, on the 21st of July 2022. From 1,385 studies, 11 articles were included in the final review, using diverse study designs, including focus groups, content analysis, cross-sectional studies, and experiments. The studies were primarily based in the U.S. and evidenced the association between the commercial promotion of e-cigarettes on social media with positive perceptions of vaping and vaping behaviours, particularly among young people, addressing diverse themes including celebrities' sponsorship, e-liquid appeal (including flavours and nicotine levels), users' engagement with ads, and other marketing strategies. Further, social networking sites commercially promoting e-cigarettes might increase positive attitudes towards vaping and vaping behaviours, particularly among youths. Future research should be conducted in broader settings, incorporate larger and diverse sample sizes, ensure research transparency, cover multiple social networking sites, emphasize ecological validity, and foment longitudinal studies.

Introduction: Alcohol use is a major global health risk, with Global South countries experiencing greater harm per litre of alcohol consumed than those in the Global North. In Burundi, a country with a low-income economy, 16.6% of people aged 15 and above binge drink, and over 30% of women drink during pregnancy. This paper examines current alcohol policies in Burundi, how well they match the WHO ‘best buy’ policy options, and stakeholder views on their implementation. Methods: We searched for policy documents via online searches, visits to government offices, and snowball sampling from contact with key stakeholders. Semi-structured interviews were conducted with ten stakeholders. The WHO-European Action Plan to Reduce the Harmful Use of Alcohol (EAPA) tool was used to analyse the extent to which Burundi has adopted recommended policy standards. Interviews were thematically analysed using NVivo software. Results: Only nine of the 34 WHO-EAPA indicators are addressed, seven out of 34 indicators are mentioned with no clear actions, and 18 are not addressed in the eight policy documents that met our inclusion criteria. The large proportion of indicators absent from Burundi policy relate to availability, pricing and taxation, drinking-driving, taxation, and marketing. An absence of legislation to support existing policies, industry interference, corruption, and cultural norms around alcohol were identified as key barriers to implementation. Conclusions: Burundi should enact laws to support existing policies and design regulations targeting marketing and advertising. Government and civil society coalitions should report and address any alcohol industry influence in policymaking and implementation.

Background Later opening hours for licensed premises is associated with increased harms from alcohol, including assaults and injuries. As such, measures addressing the availability of alcohol (including temporal availability) have been identified as instrumental to reducing alcohol-related harms. Premises opening hours are governed by national legislation in Scotland which is implemented by local Licensing Boards made up of elected councillors. Between 2017 and 2019, two different processes led to local decisions to permit later opening hours in 10 nightclubs in Glasgow (a 1-hour extension) and 40 bars in Aberdeen (up to 2 hours extension). As part of a wider mixed methods study of this natural experiment, we examine representations of the extended hours changes in the Scottish local and national news media to understand the content and evolution of public and stakeholder sentiment at the time the changes were being discussed through to and after implementation. Methods Two separate searches were conducted in Lexis Nexis to capture media reporting on temporal availability and the licensing changes in Glasgow and Aberdeen, between January 2015 and January 2023, supplemented with hand searches of local news media publications (e.g., Glasgow Live). Descriptive content analysis was undertaken in NVivo to identify sentiment (i.e., support for or opposition to extending hours), the content of the arguments being put forward, the sources contributing to the debate and the anticipated or reported impact of the changes. Results Preliminary searches retrieved 400 relevant articles. Findings will examine the arguments for and against the changes, as well as the evolution of support as the changes were implemented. Differences between Glasgow and Aberdeen will be examined as well as similarities in the narratives on the impact of temporal availability on the night-time economy. Given the sample period overlapped with COVID-19 restrictions which greatly reshaped the night-time economy, discourse relating to the licensing changes will be analysed separately to changes arising from COVID-19. Conclusion Findings will be considered in light of broader debates on licensing and temporal availability in Scotland including changes arising due to COVID-19 restrictions. Implications for research and policy making on temporal availability across the UK will be discussed. It is expected that the analysis will highlight specific limitations and opportunities in Scottish licensing law that can inform future reforms in Scotland and the rest of the UK.

Objective: The purpose of this study was to examine the extent and nature of email interactions between National Institute on Alcohol Abuse and Alcoholism (NIAAA) leaders and the alcohol industry from 2013 to 2020. Method: We performed a thematic content analysis of 4,784 pages of email correspondence obtained from Freedom of Information Act requests to the National Institutes of Health on three senior NIAAA staff members. Results: A total of 43 NIAAA staff were identified interacting with 15 industry bodies (companies and other organizations). NIAAA leaders provided industry with extensive information about scientific and policy developments. Discussions were facilitated by the willingness of NIAAA leaders to meet with industry and have other informal contacts, as well as NIAAA leadership presence at industry-sponsored and other events. Key industry actors asked NIAAA leaders for help on science and policy issues. At times, NIAAA leaders heavily criticized public health research and researchers in correspondence with industry. Conclusions: Institutional practices of engagement with the alcohol industry have been sustained by NIAAA leaders’ activity. There is an urgent need to better understand the extent to which commercial rather than public health interests have shaped alcohol research agendas, both within and beyond NIAAA.