OBJECTIVE:In 2015, 193 nations adopted the United Nations' (UN) Sustainable Development Goals (SDGs). Alcohol was included as a specific focus in target 3.5 (substance abuse), highlighting its relevance in the global development agenda. It is also recognized as a cross-cutting issue and a barrier to achieving several SDGs. We aimed to examine in this research how countries in the Americas reported on alcohol use, alcohol-related harms, and alcohol policy measures in their efforts to meet the SDGs. METHOD:We conducted a content analysis of Voluntary National Reviews (VNRs) presented at the UN High-Level Political Forum between 2016 and 2022. RESULTS:Our sample included 54 documents from 32 countries. More than half (57%) of the reports from 21 countries referred to alcohol. Most of these references were listed under SDG 3, particularly target 3.5. Only six countries referred to alcohol as a cross-cutting issue. CONCLUSIONS:Reducing alcohol consumption--a leading cause of death and disability in the Americas--was not frequently acknowledged in the VNRs. Many countries may be missing an opportunity to highlight their efforts. More likely, however, they fail to recognize alcohol as an important public health issue that must be addressed to achieve the SDGs.

BACKGROUND:There is widespread misinformation about the effects of alcohol consumption on health, which was amplified during the COVID-19 pandemic through social media and internet channels. Chatbots and conversational agents became an important piece of the World Health Organization (WHO) response during the COVID-19 pandemic to quickly disseminate evidence-based information related to COVID-19 and tobacco to the public. The Pan American Health Organization (PAHO) seized the opportunity to develop a conversational agent to talk about alcohol-related topics and therefore complement traditional forms of health education that have been promoted in the past.OBJECTIVE:This study aimed to develop and deploy a digital conversational agent to interact with an unlimited number of users anonymously, 24 hours a day, about alcohol topics, including ways to reduce risks from drinking, that is accessible in several languages, at no cost, and through various devices.METHODS:The content development was based on the latest scientific evidence on the impacts of alcohol on health, social norms about drinking, and data from the WHO and PAHO. The agent itself was developed through a nonexclusive license agreement with a private company (Soul Machines) and included Google Digital Flow ES as the natural language processing software and Amazon Web Services for cloud services. Another company was contracted to program all the conversations, following the technical advice of PAHO staff.RESULTS:The conversational agent was named Pahola, and it was deployed on November 19, 2021, through the PAHO website after a launch event with high publicity. No identifiable data were used and all interactions were anonymous, and therefore, this was not considered research with human subjects. Pahola speaks in English, Spanish, and Portuguese and interacts anonymously with a potentially infinite number of users through various digital devices. Users were required to accept the terms and conditions to enable access to their camera and microphone to interact with Pahola. Pahola attracted good attention from the media and reached 1.6 million people, leading to 236,000 clicks on its landing page, mostly through mobile devices. Only 1532 users had a conversation after clicking to talk to Pahola. The average time users spent talking to Pahola was 5 minutes. Major dropouts were observed in different steps of the conversation flow. Some questions asked by users were not anticipated during programming and could not be answered.CONCLUSIONS:Our findings showed several limitations to using a conversational agent for alcohol education to the general public. Improvements are needed to expand the content to make it more meaningful and engaging to the public. The potential of chatbots to educate the public on alcohol-related topics seems enormous but requires a long-term investment of resources and research to be useful and reach many more people.

Abstract Objective: The involvement of unhealthy commodity corporations in health policy and research has been identified as an important commercial determinant contributing to the rise of non-communicable diseases. In the USA, health professional associations have been subject to corporate influence. This study explores the interactions between corporations and the Academy of Nutrition and Dietetics (AND), and their implications for the profession in the USA and globally. Design: We conducted an inductive analysis of documents (2014–2020) obtained through freedom of information requests, to assess key AND actors’ dealings with food, pharmaceutical and agribusiness corporations. We also triangulated this information with publicly available data. Setting: The USA. Participants: Not applicable. Results: The AND, AND Foundation (ANDF) and its key leaders have ongoing interactions with corporations. These include AND’s leaders holding key positions in multinational food, pharmaceutical or agribusiness corporations, and AND accepting corporate financial contributions. We found the AND has invested funds in corporations such as Nestlé, PepsiCo and pharmaceutical companies, has discussed internal policies to fit industry needs and has had public positions favouring corporations. Conclusion: The documents reveal a symbiotic relationship between the AND, its Foundation and corporations. Corporations assist the AND and ANDF with financial contributions. AND acts as a pro-industry voice in some policy venues, and with public positions that clash with AND’s mission to improve health globally.

Introduction: Unhealthy alcohol use (UAU) is a major public health challenge, particularly in low-and middle income countries. Mozambique is the fourth poorest country in the world where half of the population lives below the poverty line. UAU is frequent among drinkers in Mozambique; however, resources and infrastructure to treat UAU are very limited. This paper examines how task-shifting and a provider-facing mobile health application are being used to improve access to care. In this paper, the feasibility, acceptability and appropriateness of a provider-facing mobile health application being used under a task-shifting model to identify UAU and provide a four-session brief motivational interviewing intervention are described. Method: The study used a sequential exploratory mixed-methods design with a QUAL -> quan structure. First, 15 psychiatric technicians and primary care providers in Mozambique's Nampula Province participated in semi structured interviews. These interviews were recorded and transcribed. Then, 45 providers completed a 12 item quantitative survey on tablets. Quantitative analysis used descriptive statistic calculation and qualitative analysis used thematic analysis. Results: Nonspecialized providers found the mobile health app to be acceptable, appropriate, and feasible when delivering a 4-session brief motivational intervention under a task-shifting model. Central benefits of the technology were enhanced standardization and efficiency of sessions as well as feelings of legitimacy when interacting with patients. Main concerns were feasibility of implementing the intervention due to time constraints of workload and internet connectivity issues.Conclusions: Provider-facing technology shows promise in supporting task-shifting models that can expand alcohol intervention services and increase access to care in low-and middle-income countries. Providers without specialized training in behavioral health interventions can provide critical services to patients with UAU and provider-facing mobile health applications may help bring such models to scale.

Based on the US DARE-kiR, a version of the Keepin’ it REAL program, the Drug and Violence Resistance Educational Program (PROERD) is the most widely implemented Brazilian prevention program. It originates from the translation of the DARE-kiR, a version of the Keepin’ it REAL program. Previous results suggest its inefficiency in preventing drug use among Brazilian adolescents. Since kiR fidelity can impact program outcomes, this mixed-methods study evaluates the PROERD implementation fidelity and its effects on preventing drug use among adolescents. Data from two cluster randomized controlled trials (cRCTs) with 4,030 students from 30 public schools in São Paulo (1,727 fifth graders and 2,303 seventh graders), assessed at two-time points, were analyzed quantitatively. After implementing each lesson during the cRCT, 19 PROERD instructors answered fidelity forms. The effect of PROERD fidelity on alcohol, cigarettes, marijuana, inhalant, and cocaine use (the last two only among seventh graders) in the six months prior to follow-up assessment was analyzed by logistic regressions for fifth grade and mixed effect models for seventh graders. For qualitative analysis, semi-structured interviews were conducted with PROERD instructors and investigated by thematic analysis. Quantitative analysis showed that PROERD implementation fidelity had no impact on drug use among fifth and seventh graders. Conversely, the qualitative analysis revealed important aspects that may influence implementation fidelity and consequently program effectiveness, such as adaptations made by instructors, school infrastructure, among others, besides program application. PROERD requires cultural adaptation to improve its implementation in Brazilian public schools.

OBJECTIVE:The purpose of this study was to describe marketing violations from the cannabis industry in Washington State.METHOD:The study team obtained records of all Washington State cannabis marketing violations from October 2014 to September 2015, immediately following the legal cannabis market opening, and May 2017 to July 2019. A code book was developed based on the Washington State regulations related to marijuana advertising. Each marketing violation was coded according to ad characteristics including ad size, location, or type; content; business practices; and lack of mandatory health warnings.RESULTS:A total of 328 violations were analyzed, from 183 different businesses. Marketing violations occurred most frequently in content posted online or directly in front of cannabis stores. Community members were as likely to identify violations as officers from the Washington State Liquor and Cannabis Board (WSLCB), the state agency in charge of regulation and enforcement of cannabis businesses. Very few violations were reported from competing members of the cannabis industry. Violations reported by the community were mostly related to content appealing to minors, whereas WSLCB officers were more likely to identify violations related to ad location in public spaces and ad size.CONCLUSIONS:This study shows the conflict between prevention and profit in the nascent cannabis industry and the importance of community involvement in the regulation of cannabis marketing.

Introduction: The study's objective was to identify and analyse the responses of food industry actors in Brazil to the COVID-19 pandemic. We conducted a qualitative analysis of information available in the public domain and published between 1 March and 30 September 2020. Results: The actions of the food industry in Brazil during the first few months of the COVID-19 pandemic primarily focused on the donation of medical equipment, hygiene and food products, including ultra-processed foods, and the provision of advice and information about COVID-19, with no oversight from health bodies. Food industry actors also promoted their actions to care for their workers' health and other needs. Conclusions: In the context of a global crisis causing enormous disruption in people's lives, the involvement of different actors in the response to the pandemic may have been helpful in the short term. However, these actions could also have resulted in negative public health consequences if they were, in reality, driven by a search for profits.

From comparisons of World Health Organization statistics, it is clear that people in lower-income countries experience more harms per litre of alcohol and different types of harms compared to those from higher-income countries. Yet studies in higher-income countries dominate research on policies to prevent alcohol problems. The paper reports on results of collaborative work to map priority areas for research relevant to low- and middle-income countries. Research focus areas were identified and discussed among potential coauthors from diverse fields with relevant knowledge, with agreement reached on an initial list of seven research priority areas. Areas identified include: (1) the effects of choices (e.g., national vs. local, monopoly vs. licensing system) in organising the alcohol market; (2) involvement/separation of alcohol industry interests in decisions on public health regulation; (3) options and effectiveness of global agreements on alcohol governance; (4) choices and experience in controlling unrecorded alcohol; (5) means of decreasing harm from men’s drinking to family members; (6) strategies for reducing the effects of poverty on drinking’s role in harms; and (7) measuring and addressing key alcohol-induced low-and middle-income country (LMIC) health harms: infectious diseases, injuries, digestive diseases. Paths ahead for such research are briefly outlined.

Introduction:On 19 November 2021 the Pan American Health Organization (PAHO) developed and deployed the first-ever digital health worker dedicated to alcohol-related topics, named Pahola. This paper describes this developmental process and the first results of its uptake and interactions with the public.Methods:PAHO secured a non-exclusive worldwide license with a technology company to use their Human OS ecosystem, which enables human-like interactions between digital people and users via an application. Google Digital flow ES was used to develop the conversations of Pahola on topics related to alcohol and health, screening of alcohol risk using the AUDIT and providing a quit/cut back plan to users, along with additional treatment services and resources in each country of the Americas. A communication campaign was also implemented from launching date until 31 December 2021.Results:Pahola attracted good attention from the media, and potentially reached 1.6 million people, leading to 236,000 sessions on its landing page, mostly through mobile devices. The average time people effectively spent talking to Pahola was five minutes. Major dropouts were observed in different steps of the conversation flow.Discussion:Pahola was quickly able to connect to a large worldwide population with reliable alcohol information. It could potentially increase the delivery of SBI and improve alcohol health literacy. However, its preliminary results pointed to much needed changes to its corpus and on its accessibility, which are being currently implemented.

Correspondence to Dr Melissa Mialon; melissa_ mialon@ hotmail. fr © Author(s) (or their employer(s)) 2021. Reuse permitted under CC BYNC. No commercial reuse. See rights and permissions. Published by BMJ. The COVID19 pandemic might present opportunities for transnational food and beverage companies to further consolidate their power within global markets. 2 Some companies, for example, seem to be currying favour of governments, civil society organisations and communities by handing out free ultraprocessed products to the food insecure through heavily branded philanthropic initiatives. Other companies have used the pandemic to forge stronger alliances with government and civil society actors, which may water down or even silence criticism about the negative health impacts resulting from the consumption of their products, particularly ultraprocessed ones. This was epitomised by the WHO Foundation’s recent decision to accept funding from Nestlé, despite Nestlé’s ongoing breaches of the WHO Code of Marketing of Breastmilk Substitutes. The company’s donations for COVID19 aid even got a ‘thank you’ from WHO on social media. One need look no farther than the last global crisis, the 2007–2008 Great Recession, to understand the food and beverage industry’s behaviour during the COVID19 crisis. It is notable that the top three publicly traded food and beverage companies emerged from the Great Recession more globally dominant than before it. The CocaCola Company reported $28 857 million in 2007 revenues compared with $46 542 million in 2012 (inflationadjusted US dollar). Moreover, PepsiCo reported $39 474 million in 2007 and $66 504 in 2012. Meanwhile Nestlé maintained its revenues while consolidating its position as the global market leader. Our examination of 66 company reports (annual reports and corporate social responsibility reports) and documents (such as those posted on the United Nations Global Compact website) from CocaCola, PepsiCo and Nestlé reveals that they used common and successful strategies for leveraging the Great Recession. First, all three companies leveraged the Great Recession to deepen corporate incursion into lowincome and middleincome countries (LMICs). These companies emphasised that the crisis increased the prices of raw materials and volatility in national currencies, and undermined consumer confidence and purchasing power, thus leading to decreased demand for food products. 10 However, compared with other economic sectors, foods and beverages were appreciated as staple commodities, as CocaCola noted: ‘That is the beauty of our business: no matter the time of day or the business climate, people will be thirsty and The CocaCola Company will be there to refresh them’. Companies focused on leveraging economies that experienced limited impacts during the Great Recession: India, China, Latin America and Africa. Nestlé’s ‘unmatched geographic presence meant that we were able to ride the wave of recovery in emerging markets, whilst benefiting from the resilience of North American consumers’. Nestlé also developed ‘popularly positioned Summary box

Alcoholism: Clinical and Experimental ResearchVolume 44, Issue 10 p. 2141-2142 Letter to the Editor The Urgent Need to Advance Alcohol Marketing Regulation to Protect Children Daniela Pantani, Corresponding Author daniela.pantani@gmail.com orcid.org/0000-0002-7348-0389 From the, Departamento de Medicina Preventiva, (DP, ZMS), Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, Brazil Reprint requests: Daniela Pantani, PhD, Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo, R. Botucatu, 740, 4° andar, Vila Clementino, Sao Paulo - SP, 04023-062, Brazil. Tel.: +55 11 5576 4848; E-mail: daniela.pantani@gmail.comSearch for more papers by this authorZila M. Sanchez, orcid.org/0000-0002-7427-7956 From the, Departamento de Medicina Preventiva, (DP, ZMS), Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, BrazilSearch for more papers by this authorIlana Pinsky, orcid.org/0000-0003-1342-7225 School of Public Health, (IP), City University of New York, New York, New York, USASearch for more papers by this author Daniela Pantani, Corresponding Author daniela.pantani@gmail.com orcid.org/0000-0002-7348-0389 From the, Departamento de Medicina Preventiva, (DP, ZMS), Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, Brazil Reprint requests: Daniela Pantani, PhD, Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo, R. Botucatu, 740, 4° andar, Vila Clementino, Sao Paulo - SP, 04023-062, Brazil. Tel.: +55 11 5576 4848; E-mail: daniela.pantani@gmail.comSearch for more papers by this authorZila M. Sanchez, orcid.org/0000-0002-7427-7956 From the, Departamento de Medicina Preventiva, (DP, ZMS), Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, BrazilSearch for more papers by this authorIlana Pinsky, orcid.org/0000-0003-1342-7225 School of Public Health, (IP), City University of New York, New York, New York, USASearch for more papers by this author First published: 30 August 2020 https://doi.org/10.1111/acer.14442Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume44, Issue10October 2020Pages 2141-2142 RelatedInformation

INTRODUCTION AND AIMSResearch on corporate behaviour can contribute to the understanding of the possible adverse impacts of alcohol-industry corporate social responsibility (CSR) initiatives and their potential influence on policymaking. This study explores the association between alcohol-industry CSR activities and selected country features in Latin America and the Caribbean.DESIGN AND METHODSNine health experts evaluated 148 CSR activities using a standardised protocol; activities were classified into the categories risk management CSR (rmCSR), that is, to avoid/rectify externalities (n = 67), and strategic CSR, that is, to fulfill philanthropic responsibilities (n = 81). We evaluated the associations, separately, between the number of rmCSR and of strategic CSR actions in each country with threats from public health measures (specifically, the level of research into alcohol consumption and harms, the existence of an alcohol surveillance system and the number of governmental alcohol policy actions) and per capita alcohol consumption; we adjusted by economic indices (country income level and the gross domestic product) and population size.RESULTSMultivariate analyses showed that the higher the level of alcohol research within a country and its per capita consumption, the more likely rmSCR activities were to occur, independently of the country's economic development or population.DISCUSSION AND CONCLUSIONSResults suggest rmSCR actions could be implemented as a way to preserve markets by counteracting scientific evidence about alcohol related harms. This evidence could serve as a starting point to future research, contributing to the understanding of alcohol industry behaviour and the advancement of effective public policies.

Drug and Alcohol ReviewVolume 40, Issue 3 p. 509-510 Letter to the Editor The alcohol industry ‘smart affordability’ strategy is to reach the poor Daniela Pantani, Corresponding Author Daniela Pantani daniela.pantani@gmail.com orcid.org/0000-0002-7348-0389 Department of Preventive Medicine, Paulista School of Medicine, Federal University of São Paulo, Sao Paulo, Brazil E-mail: daniela.pantani@gmail.comSearch for more papers by this authorZila M. Sanchez, Zila M. Sanchez orcid.org/0000-0002-7427-7956 Department of Preventive Medicine, Paulista School of Medicine, Federal University of São Paulo, Sao Paulo, BrazilSearch for more papers by this authorClaire Greene, Claire Greene Program on Forced Migration and Health, Department of Population and Family Health, Columbia University, New York, USASearch for more papers by this authorIlana Pinsky, Ilana Pinsky School of Public Health, City University of New York, New York, USASearch for more papers by this author Daniela Pantani, Corresponding Author Daniela Pantani daniela.pantani@gmail.com orcid.org/0000-0002-7348-0389 Department of Preventive Medicine, Paulista School of Medicine, Federal University of São Paulo, Sao Paulo, Brazil E-mail: daniela.pantani@gmail.comSearch for more papers by this authorZila M. Sanchez, Zila M. Sanchez orcid.org/0000-0002-7427-7956 Department of Preventive Medicine, Paulista School of Medicine, Federal University of São Paulo, Sao Paulo, BrazilSearch for more papers by this authorClaire Greene, Claire Greene Program on Forced Migration and Health, Department of Population and Family Health, Columbia University, New York, USASearch for more papers by this authorIlana Pinsky, Ilana Pinsky School of Public Health, City University of New York, New York, USASearch for more papers by this author First published: 19 October 2020 https://doi.org/10.1111/dar.13195Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume40, Issue3March 2021Pages 509-510 RelatedInformation

This study aimed to evaluate the differences in gambling exposure and onset of gambling problems among male and female gamblers by comparing their demographic and behavioral profiles. This study utilized data from the gambling section of the First Brazilian National Alcohol Survey and Related Behaviors. Interviews were conducted with 3007 participants who were recruited after screening for at-risk gambling behaviors. Individuals who tested positive for at-risk gambling behaviors completed the Gambling Progression Questionnaire comprising items on games of chance, and were evaluated using the DSM-IV pathological gambling criteria. The participants’ “lifetime gambling exposure” was 12.5%, with 4% having experienced gambling problems during their lifetime. Majority of the male at-risk gamblers (78%) reported that they began gambling in their 20 s and took approximately 3 years to start experiencing gambling-related problems. Contrastingly, female at-risk gamblers started gambling in their 30 s and they took about 12 years to start experiencing gambling-related problems. The present results show that men were 2.3 times more at risk of gambling exposure and 3.6 times more likely to experience gambling-related problems. Male at-risk male gamblers seemed to be lonelier and to have a low socioeconomic status, while women seemed to have lower income and social insertion. Considering these significant differences, more studies evaluating gender differences in gambling behavior are necessary.

Corresponding author: Daniela Viganó Zanoti-Jeronymo E-mail: danielazanoti@uol.com.brr https://orcid.org/0000-0002-6131-3890 * Paper extracted from doctoral dissertation, “Associação entre história de violência sofrida na infância e transtornos relacionados ao uso de álcool na idade adulta”, presented to Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil. 1 Universidade Estadual do Centro Oeste, Centro de Ciências da Saúde, Guarapuava, PR, Brazil. 2 Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Florianópolis, SC, Brazil. 3 Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil. 4 University of Texas, School of Public Health, Dallas, TX, United States of America. Childhood violence, exposure to parental violence and alcohol dependence/abuse in adulthood*

Objective: This study compared the rates of binge drinking (BD) and alcohol use disorder (AUD) reported for 2006 with those reported for 2012, exploring their associations with unprotected sex, early pregnancy, and abortion in a representative sample of women in Brazilian households. Methods: This was a descriptive analysis of data from a cross-sectional study involving randomized multistage cluster sampling of the population ≥ 14 years of age. Weighted prevalence rates and odds ratios were estimated, and serial mediation analysis was performed. Results: A total of 4,256 women were analyzed. The BD prevalence was 35.1% and 47.1% in 2006 and 2012, respectively, a significant increase, especially among women 40-59 years of age. There was no significant difference in AUD prevalence. BD (without AUD) was found to increase the odds of unprotected sex and abortion. The path analysis showed that early pregnancy was a mediator of the relationship between alcohol consumption and abortion. Conclusion: Among women in Brazil, the harmful use of alcohol is increasing, which has an impact on female reproductive health and exposure to risks. There is a need for specific prevention initiatives focusing on alcohol-related behaviors in women.

Este artigo examina a associação entre o histórico de violência na infância e a dependência e uso nocivo de álcool na idade adulta. Uma amostra probabilística multiestagio foi usada para selecionar 3.007 indivíduos de 14 anos de idade ou mais, dos lares brasileiros, entre novembro de 2005 e abril de 2006. As análises mostraram a existência de associação entre o histórico de abuso físico e exposição à violência parental (p<0,001). O modelo de regressão multinomial mostrou uma associação entre o histórico de violência na infância e a dependência de álcool na idade adulta. As variáveis de maior impacto na chance para dependência do álcool foram sexo masculino, exposição à violência parental e histórico de abuso físico. Desta forma, observou-se que quanto maior o grau de exposição, maior a porcentagem de violência severa sofrida na infância. Os resultados corroboram com prévios achados que sugerem que um histórico positivo de violência na infância é um componente importante na etiologia dos transtornos decorrentes do consumo de álcool.