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  • 1.
    Ahlberg, Rickard
    et al.
    Örebro University, School of Medical Sciences.
    Skårberg, Kurt
    Örebro University, School of Medical Sciences. Addiction Center.
    Brus, Ole
    Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Kjellin, Lars
    Örebro University, School of Health Sciences.
    Auricular acupuncture for substance use: a randomized controlled trial of effects on anxiety, sleep, drug use and use of addiction treatment services2016In: Substance Abuse Treatment, Prevention, and Policy, ISSN 1747-597X, E-ISSN 1747-597X, Vol. 11, no 1, article id 24Article in journal (Refereed)
    Abstract [en]

    Background: A common alternative treatment for substance abuse is auricular acupuncture. The aim of the study was to evaluate the short and long-term effect of auricular acupuncture on anxiety, sleep, drug use and addiction treatment utilization in adults with substance abuse.

    Method: Of the patients included, 280 adults with substance abuse and psychiatric comorbidity, 80 were randomly assigned to auricular acupuncture according to the NADA protocol, 80 to auricular acupuncture according to a local protocol (LP), and 120 to relaxation (controls). The primary outcomes anxiety (Beck Anxiety Inventory; BAI) and insomnia (Insomnia Severity Index; ISI) were measured at baseline and at follow-ups 5 weeks and 3 months after the baseline assessment. Secondary outcomes were drug use and addiction service utilization. Complete datasets regarding BAI/ISI were obtained from 37/34 subjects in the NADA group, 28/28 in the LP group and 36/35 controls. Data were analyzed using Chi-square, Analysis of Variance, Kruskal Wallis, Repeated Measures Analysis of Variance, Eta square (η(2)), and Wilcoxon Signed Ranks tests.

    Results: Participants in NADA, LP and control group improved significantly on the ISI and BAI. There was no significant difference in change over time between the three groups in any of the primary (effect size: BAI, η(2) = 0.03, ISI, η(2) = 0.05) or secondary outcomes. Neither of the two acupuncture treatments resulted in differences in sleep, anxiety or drug use from the control group at 5 weeks or 3 months.

    Conclusion: No evidence was found that acupuncture as delivered in this study is more effective than relaxation for problems with anxiety, sleep or substance use or in reducing the need for further addiction treatment in patients with substance use problems and comorbid psychiatric disorders. The substantial attrition at follow-up is a main limitation of the study.

    Trial registration: Clinical Trials NCT02604706 (retrospectively registered).

  • 2.
    Baker, Jessica H.
    et al.
    Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
    Brosof, Leigh C.
    Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA.
    Munn-Chernoff, Melissa A.
    Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Maes, Hermine H.
    Department of Genetics, Virginia Commonwealth University, Richmond, Virginia, USA.
    Kendler, Kenneth S.
    Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA.
    Associations Between Alcohol Involvement and Drive for Thinness and Body Dissatisfaction in Adolescent Twins: A Bivariate Twin Study2018In: Alcoholism: Clinical and Experimental Research, ISSN 0145-6008, E-ISSN 1530-0277, Vol. 42, no 11, p. 2214-2223Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Alcohol involvement has familial associations with bulimic symptoms (i.e., binge eating, inappropriate compensatory behaviors), with several studies indicating a genetic overlap between the two. It is unclear whether overlapping familial risk with alcohol involvement extends to other eating disorder symptoms. Understanding the genetic overlap between alcohol involvement and other eating disorder symptoms may aid in more targeted interventions for comorbid alcohol use-eating disorder symptoms. Thus, we investigated associations between alcohol involvement and 2 core eating disorder symptoms: drive for thinness and body dissatisfaction in adolescent female and male twins.

    METHODS: We assessed 3 levels of alcohol involvement: alcohol use in the last month, having ever been intoxicated, and alcohol intoxication frequency via self-report. The Eating Disorder Inventory-II assessed drive for thinness and body dissatisfaction. Sex-specific biometrical twin modeling examined the genetic overlap between alcohol involvement and eating disorder symptoms.

    RESULTS: Phenotypic associations between alcohol involvement, drive for thinness, and body dissatisfaction were significantly greater in girls compared with boys. A majority of the associations between alcohol involvement, drive for thinness, and body dissatisfaction in girls, but not boys, met our threshold for twin modeling (phenotypic r > 0.20). Moderate genetic correlations were observed between the 3 aspects of alcohol involvement and drive for thinness. Moderate genetic correlations were observed between alcohol use and intoxication frequency and body dissatisfaction.

    CONCLUSIONS: Together with the literature on alcohol involvement and bulimic symptoms, these findings suggest a generalized association between alcohol involvement and eating disorder symptoms in girls, whereas this association may be symptom specific in boys. Genetic correlations indicate that the amount and direction of this genetic overlap differs across specific symptoms. When intervening on comorbid alcohol involvement and eating disorder symptoms, it may be important to target-specific eating disorder symptoms.

  • 3.
    Baker, Jessica H.
    et al.
    Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill North Carolina, USA.
    Johnson, Nicole K.
    Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill North Carolina, USA; Department of Psychology, Illinois Institute of Technology, Chicago Illinois, USA.
    Munn-Chernoff, Melissa A.
    Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill North Carolina, USA.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Maes, Hermine H.
    Department of Genetics, Virginia Commonwealth University, Richmond Virginia, USA.
    Kendler, Kenneth S.
    Department of Psychiatry, Virginia Commonwealth University, Richmond Virginia, USA.
    Illicit Drug Use, Cigarette Smoking, and Eating Disorder Symptoms: Associations in an Adolescent Twin Sample2018In: Journal of Studies on Alcohol and Drugs, ISSN 1937-1888, E-ISSN 1938-4114, Vol. 79, no 5, p. 720-724Article in journal (Refereed)
    Abstract [en]

    Objective: Twin studies have shown that genetic factors in part explain the established relation between alcohol use (i.e., problematic use or abuse/dependence) and eating disorder symptoms in adolescent and adult females. However, studies have yet to elucidate if there are similar shared genetic factors between other aspects of substance involvement, such as illicit drug use and repeated cigarette smoking.

    Method: For those sex-specific phenotypic correlations above our threshold of.20, we used a behavioral genetic design to examine potential shared genetic overlap between self-reported lifetime illicit drug use and repeated cigarette smoking and the eating disorder symptoms of drive for thinness (DT), bulimia (BU), and body dissatisfaction (BD), as assessed with the Eating Disorder Inventory-II in 16- to 17-year-old female and male twin pairs.

    Results: Only phenotypic correlations with illicit drug use met our threshold for twin modeling. Small to moderate genetic correlations were observed between illicit drug use and BU in both girls and boys and between illicit drug use and in girls.

    Conclusions: Similar etiological factors are at play in the overlap between illicit drug use and certain eating disorder symptoms in girls and boys during adolescence, such that genetic factors are important for covariance. Specifically, illicit drug use was associated with bulimia nervosa symptoms in girls and boys, which parallels previous substance use research finding a genetic overlap between alcohol use and bulimia nervosa symptoms. Future research should prospectively examine developmental trajectories to further understand the etiological overlap between substance involvement and eating disorder symptoms.

  • 4. Bejerot, Susanne
    et al.
    Bejerot, Nils
    Representativitet i en studie av intravenöst missbruk bland arrestanter i Stockholm1984In: SCI: de två första verksamhetsåren / [ed] J. Ewers, J. Hartelius, Markaryd: Scipio , 1984, p. 90-97Chapter in book (Refereed)
  • 5.
    Brunnberg, Elinor
    et al.
    Örebro University, Department of Behavioural, Social and Legal Sciences.
    Lindén Boström, Margareta
    Örebro University, Department of Health Sciences.
    Berglund, Mats
    Lund University.
    School adjustment, self-rated health and substance use in -16 year old hard-of-hearing students: a comparative study : life and health : young people 20052007Conference paper (Other academic)
  • 6.
    Capusan, Andrea J.
    et al.
    Department of Psychiatry and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Bendtsen, Preben
    Department of Medical Specialist and Department of Medicine and Health Sciences, Linköping University, Motala, Sweden.
    Marteinsdottir, Ina
    Centre for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Larsson, Henrik
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Comorbidity of Adult ADHD and Its Subtypes With Substance Use Disorder in a Large Population-Based Epidemiological Study2019In: Journal of Attention Disorders, ISSN 1087-0547, E-ISSN 1557-1246, Vol. 23, no 12, p. 1416-1426Article in journal (Refereed)
    Abstract [en]

    Objective: The objective of the study is to explore the role and possible substance preference in ADHD and subtypes in substance use disorder (SUD).

    Method: Using self-report data on ADHD Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) symptoms and SUD (alcohol, illicit drugs, and nicotine) in 18,167 Swedish twins, aged 20 to 45 years, we obtained odds ratios (OR) from mixed effect logistic regression, controlling for age, sex, education, and nonindependence of twin data.

    Results: Increased ADHD symptoms were significantly associated with increased odds for all SUD. ORs ranged between 1.33 for regular nicotine (95% confidence interval [CI] = [1.12, 1.59]); 2.54 for multiple drug use (95% CI = [2.00, 3.23]), and 3.58 for alcohol dependence (95% CI = [2.86, 4.49]).

    Conclusion: ADHD symptoms and subtypes in the population are associated with increased risks for all SUD outcomes, with no difference between ADHD subtypes, no substance preference, and no sex differences for the comorbidity. Clinicians need to consider ADHD evaluation and treatment as part of management of SUD in adults.

  • 7.
    Cederlöf, Martin
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Kuja-Halkola, Ralf
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Sjölander, Arvid
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Östberg, Per
    Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Lundström, Sebastian
    Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden; Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Gothenburg, Sweden.
    Kelleher, Ian
    Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    A longitudinal study of adolescent psychotic experiences and later development of substance use disorder and suicidal behavior2017In: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 181, p. 13-16Article in journal (Refereed)
    Abstract [en]

    Introduction: Psychotic experiences are associated with later substance use disorder and suicidal behavior, but individual psychotic experiences have not been examined in a longitudinal data set. Also, the potential dose-response relationship between these phenomena remains unknown.

    Method: Cohort study including 9242 adolescents who participated in The Child and Adolescent Twin Study in Sweden (CATSS). At ages 15 and/or 18, seven psychotic experiences (auditory and visual hallucinations, and five delusions) were assessed via questionnaires. Outcomes at follow-up were physician-assigned diagnoses of substance use disorder and suicide attempts ascertained from the Swedish Patient Register. Associations were estimated with Cox regressions and expressed as hazard ratios.

    Results: All psychotic experiences were associated with later substance use disorder and/or suicide attempts, with hazard ratios ranging from 1.6 to 3.0. A dose-response relationship was observed between psychotic experiences and later substance use disorder, and suicide attempt.

    Discussion: Auditory and visual hallucinations as well as delusions in adolescence are associated with later development of substance use disorder and suicide attempt, and there is a dose-response relationship between the load of psychotic experiences and these adverse outcomes. Clinicians should assess subclinical hallucinations as well as delusions in psychiatric evaluations of adolescents.

  • 8.
    Edwards, Alexis C.
    et al.
    Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond VA, USA.
    Larsson, Henrik
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Center for Neurodevelopmental Disorders, Karolinska Institutet, Stockholm, Sweden.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Kendler, Kenneth S.
    Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond VA, USA.
    Early environmental influences contribute to covariation between internalizing symptoms and alcohol intoxication frequency across adolescence2011In: Addictive Behaviours, ISSN 0306-4603, E-ISSN 1873-6327, Vol. 36, no 3, p. 175-182Article in journal (Refereed)
    Abstract [en]

    The association between alcohol use and internalizing symptoms during adolescence varies across studies, and the causes underlying this association remain unclear. The current study examines the relationship between symptoms of anxiety and depression and intoxication frequency in a sample of Swedish twins assessed longitudinally from ages 13-14 to 19-20. The objectives of the study were to assess the stability of genetic and environmental influences on each trait across adolescence; to investigate whether these traits share genetic and/or environmental liabilities; and to explore quantitative changes in the shared liability over time. We found that the magnitude of genetic influences on internalizing symptoms remained relatively stable across adolescence, while their impact on intoxication frequency was dynamic. Symptoms of anxiety and depression were influenced by unique environmental factors, while both shared and unique environmental factors influenced intoxication frequency. Genetic and environmental innovation and attenuation were observed for both traits. While no significant genetic correlation was observed between traits, unique environmental factors did contribute to a shared liability. This environmental correlation was positive and moderate (r(E)=0.41) in the early assessment, but decreased and changed direction at later waves (r(E)=-.04 to -.01). The genetic and environmental factors underlying internalizing symptoms and intoxication frequency appear to be developmentally dynamic. Early environmental factors contribute to the association between these traits, but this shared liability diminishes across adolescence.

  • 9.
    Geidne, Susanna
    et al.
    Örebro University, School of Health Sciences.
    Beckman, Linda
    School of Health Sciences, Örebro University, Örebro, Sweden.
    Edvardsson, Ingrid
    School of Health Sciences, Örebro University, Örebro, Sweden.
    Hulldin, Johanna
    Örebro University, School of Health Sciences.
    Prevalence and risk factors of electronic cigarette use among adolescents: Data from four Swedish municipalities2016In: Nordic Studies on Alcohol and drugs, ISSN 1458-6126, Vol. 33, no 3, p. 225-240Article in journal (Refereed)
    Abstract [en]

    Aims: To assess the prevalence rates and risk factors of electronic cigarette (e-cigarette) use, with special focus on e-cigarettes containing nicotine, among grade 9 students (aged 15–16 years) in four different municipalities in Sweden.

    Methods: A cross-sectional sample of 665 adolescents was collected in April 2014. The data was analysed using binary logistic regression analysis.

    Results: The results show that 26% of adolescents in this study have smoked e-cigarettes (have ever used), while 19% have smoked e-cigarettes with nicotine or do not know whether or not they contained nicotine. The strongest risk factor for ever having used e-cigarettes (any type or with nicotine) was smoking conventional cigarettes. Having tried cigarettes and having tried snus, as well as using or having used alcohol and having smoked a water pipe were also statistically significant risk factors for ever use of any type of e-cigarettes but not for use of e-cigarettes with nicotine. There was no gender difference.

    Conclsuisons: Our result show that the use of ecigarettes tends to cluster with the use of other substances, such as other tobacco products and alcohol. As a relatively large share of the participating adolescents, more than a fourth, had smoked e-cigarettes, this rather new phenomenon requires monitoring as a part of the tobacco control.

  • 10.
    Glatz, Terese
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Koning, Ina M.
    Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands.
    The Outcomes of an Alcohol Prevention Program on Parents' Rule Setting and Self-efficacy: a Bidirectional Model2016In: Prevention Science, ISSN 1389-4986, E-ISSN 1573-6695, Vol. 17, no 3, p. 377-385Article in journal (Refereed)
    Abstract [en]

    Most adolescents have their first encounter with alcohol in early or middle adolescence. Parents' rule setting about alcohol has been shown to be important to delay the onset and reduce the frequency of adolescents' alcohol drinking, but less is known about the potential role of parents' beliefs about their competence in and ability to influence their adolescents' drinking habits (i.e., parental self-efficacy [PSE], Bandura (Psychological Review, 84, 191-215, 1977). In this study, we examined the direction of influence between parents' rule setting and PSE as outcomes of the program "Prevention of Alcohol use in Students" (PAS), a prevention program aiming to reduce underage drinking by targeting parents and adolescents both separately and in a combined intervention. We tested two mediation processes in which the program would (a) have a direct effect on PSE, which in turn would increase parents' rule setting or (b) have a direct effect on parents' rule setting, which in turn would increase PSE. To examine these processes, we used a sample of 2562 parent-adolescent dyads (age 12 at baseline), followed annually over 3 years. The results showed that the combined intervention increased PSE via an increase in parents' rule setting. No significant effect of the intervention on rules about alcohol via PSE was found. This is the first study to test the mediation processes involving PSE and parental rule setting in an experimental context where parenting practices are being actively changed. The results suggest that giving parents concrete advice on how to deal with alcohol drinking in their adolescents and at the same time helping adolescents to develop healthy attitudes about alcohol drinking have a positive influence on parents' self-efficacy.

  • 11.
    Kennedy, Beatrice
    et al.
    Örebro University, School of Medical Sciences. Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Ruoqing, Chen
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Fang, Fang
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Valdimarsdottir, Unnur
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Department of Epidemiology and Public Health, University College London, London, UK; Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Fall, Katja
    Örebro University, School of Medical Sciences.
    Low stress resilience in late adolescence and risk of smoking, high alcohol consumption and drug use later in life2019In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 73, no 6, p. 469-501Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: While compromised stress resilience constitutes a recognised risk factor for somatic and psychiatric disease development in general, the knowledge about how individual variation in vulnerability to stress may specifically influence the long-term risks of disadvantageous health behaviours is limited.

    METHODS: In this Swedish cohort study, we aimed to investigate the association between stress resilience in late adolescence and adult use of addictive substances. We included 9381 men with information on psychological stress resilience measured during military conscription examinations, who later responded to an extensive health survey (mean age 34.0±7.2 years) including detailed information on substance use. We modelled continuous outcomes using linear regression, binary outcomes with logistic regression and other categorical outcomes with multinomial logistic regression.

    RESULTS: We found that low stress resilience in adolescence conferred increased risks of all studied measures of addictive behaviour. After adjusting for childhood socioeconomic information, low stress resilience was associated with adult current regular smoking (relative risk ratio: 5.85, 95% CI 4.32 to 7.93), higher nicotine dependence scores (beta: 0.76, 95% CI 0.29 to 1.23), hazardous use of alcohol (>14 alcoholic drink-equivalents per week, OR: 1.72, 95% CI 1.37 to 2.16), DSM-IV criteria for alcohol dependence (OR: 1.74, 95% CI 1.35 to 2.25), and drug use (OR: 1.77, 95% CI 1.51 to 2.08). The results remained largely unchanged after further adjustments for adult educational attainment and occupation as well as for additional conscription covariates.

    CONCLUSION: Low stress resilience in late adolescence appears to be associated with an increased risk of disadvantageous and addictive health behaviours in adulthood.

  • 12.
    Khemiri, Lotfi
    et al.
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden.
    Larsson, Henrik
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Kuja-Halkola, Ralf
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    D'Onofrio, Brian M.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Jayaram-Lindström, Nitya
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden.
    Latvala, Antti
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.
    Association of parental substance use disorder with offspring cognition: a population family-based study2020In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 115, no 2, p. 326-336Article in journal (Refereed)
    Abstract [en]

    AIMS: To assess whether parental substance use disorder (SUD) is associated with lower cognitive ability in offspring, and whether the association is independent of shared genetic factors.

    DESIGN: A population family-based cohort study utilizing national Swedish registries. Linear regression with increased adjustment of covariates was performed in the full population. In addition, the mechanism of the association was investigated with children-of-sibling analyses using fixed-effects regression with three types of sibling parents with increasing genetic relatedness (half-siblings, full siblings and monozygotic twins).

    SETTING AND PARTICIPANTS: A total of 3 004 401 people born in Sweden between 1951 and 1998.

    MEASUREMENTS: The exposure variable was parental SUD, operationalized as having a parent with life-time SUD diagnosis or substance-related criminal conviction in the National Patient Register or Crime Register, respectively. Outcomes were cognitive test score at military conscription and final school grades when graduating from compulsory school. Covariates included in the analyses were sex, birth year, parental education, parental migration status and parental psychiatric comorbid diagnoses.

    FINDINGS: In the full population, parental SUD was associated with decreased cognitive test stanine scores at conscription [4.56, 95% confidence interval (CI) = 4.55-4.57] and lower Z-standardized school grades (-0.43, 95% CI = -0.43 to -0.42) compared to people with no parental SUD (cognitive test: 5.17, 95% CI = 5.17-5.18; grades: 0.09, 95% CI = 0.08-0.09). There was evidence of a dose-response relationship, in that having two parents with SUD (cognitive test: 4.17, 95% CI = 4.15-4.20; grades: -0.83, 95% CI = -0.84 to -0.82) was associated with even lower cognitive ability than having one parent with SUD (cognitive test: 4.60, 95% CI = 4.59-4.60; grades: -0.38, 95% CI = -0.39 to -0.380). In the children-of-siblings analyses when accounting for genetic relatedness, these negative associations were attenuated, suggestive of shared underlying genetic factors.

    CONCLUSIONS: There appear to be shared genetic factors between parental substance use disorder (SUD) and offspring cognitive function, suggesting that cognitive deficits may constitute a genetically transmitted risk factor in SUD.

  • 13.
    Larsson, Matz
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Cardiology-Lung Clinic, Örebro University Hospital, Örebro, Sweden.
    Damberg, Mattias
    Primärvård, psykiatri och habiliteringsverksamhet stab, Region Västmanland, Västerås, Sweden.
    Tobaksberoende2017In: Läkemedelsboken, Läkemedelsverket , 2017Chapter in book (Other academic)
  • 14.
    Latvala, Antti
    et al.
    Department of Public Health, University of Helsinki, Helsinki, Finland; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Kuja-Halkola, Ralf
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    D'Onofrio, Brian M.
    Department of Psychological and Brain Sciences, Indiana University, Bloomington IN, USA.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Cognitive ability and risk for substance misuse in men: genetic and environmental correlations in a longitudinal nation-wide family study2016In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 111, no 10, p. 1814-1822Article in journal (Refereed)
    Abstract [en]

    Aims: To investigate the association in males between cognitive ability in late adolescence and subsequent substance misuse-related events, and to study the underlying genetic and environmental correlations.

    Design: A population-based longitudinal study with three different family-based designs. Cox proportional hazards models were conducted to investigate the association at the individual level. Bivariate quantitative genetic modelling in (1) full brothers and maternal half-brothers, (2) full brothers reared together and apart and (3) monozygotic and dizygotic twin brothers was used to estimate genetic and environmental correlations.

    Setting: Register-based study in Sweden.

    Participants: The full sample included 1 402 333 Swedish men born 1958-91 and conscripted at mean age 18.2 [standard deviation (SD) = 0.5] years. A total of 1 361 066 men who had no substance misuse events before cognitive assessment at mandatory military conscription were included in the Cox regression models, with a follow-up time of up to 35.6 years.

    Measures Cognitive ability was assessed at conscription with the Swedish Enlistment Battery. Substance misuse events included alcohol- and drug-related court convictions, medical treatments and deaths, available from governmental registries.

    Findings: Lower cognitive ability in late adolescence predicted an increased risk for substance misuse events [hazard ratio (HR) for a 1-stanine unit decrease in cognitive ability: 1.29, 95% confidence interval (CI) = 1.29-1.30]. The association was somewhat attenuated within clusters of full brothers (HR = 1.21, 95% CI = 1.20-1.23). Quantitative genetic analyses indicated that the association was due primarily to genetic influences; the genetic correlations ranged between -0.39 (95% CI = -0.45, -0.34) and -0.52 (95% CI -0.55, -0.48) in the three different designs.

    Conclusions: Shared genetic influences appear to underlie the association between low cognitive ability and subsequent risk for substance misuse events among Swedish men.

  • 15.
    Maghsoudlou, Siavash
    et al.
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute Solna, Stockholm, Sweden.
    Cnattingius, Sven
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute Solna, Stockholm, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Örebro University Hospital. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Solna, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Aarabi, Mohsen
    Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
    Semnani, Shahriar
    Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
    Wikström, Anna-Karin
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute Solna, Stockholm, Sweden; Department of Women’s and Children ’s Health, Uppsala University, Uppsala, Sweden.
    Bahmanyar, Shahram
    Clinical Epidemiology Unit & Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institute Solna, Stockholm, Sweden.
    Opium use during pregnancy and risk of preterm delivery: A population-based cohort study2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 4, article id e0176588Article in journal (Refereed)
    Abstract [en]

    Background: Use of narcotic or "recreational" drugs has been associated with adverse pregnancy outcomes such as preterm delivery. However, the associations might be confounded by other factors related to high-risk behaviours. This is the first study to investigate the association between traditional opium use during pregnancy and risk of preterm delivery.

    Method and findings: We performed a population-based cohort study in the rural areas of the Golestan province, Iran between 2008 and 2010. We randomly selected 920 women who used (usually smoked) opium during pregnancy and 920 women who did not. Logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) for the associations between the opium use during pregnancy and preterm delivery and adjustment was made for potential confounding factors. This study shows compared with non-use of opium and tobacco, use of only opium during pregnancy was associated with an increased risk of preterm delivery (OR = 1.56; 95% CI 1.05-2.32), and the risk was more than two-fold increased among dual users of opium and tobacco (OR = 2.31; 95% CI 1.37-3.90). We observed that opium use only was associated with a doubled risk for preterm caesarean delivery (OR = 2.05; 95% CI 1.10-3.82) but not for preterm vaginal delivery (OR = 1.25; 95% CI 0.75-2.07). Dual use of opium and tobacco was associated with a substantially increased risk of vaginal preterm delivery (OR = 2.58; 95% CI 1.41-4.71).

    Conclusions: Opium use during pregnancy among non-tobacco smokers is associated with an increased risk of preterm caesarean delivery, indicating an increased risk of a compromised foetus before or during labour. Women who use both opium and smoked during pregnancy have an increased risk of preterm vaginal delivery, indicating an increased risk of spontaneous preterm delivery.

  • 16.
    Nylander, Ingrid
    et al.
    Department of Pharmaceutical Bioscience, Uppsala University, Uppsala, Sweden.
    Todkar, Aniruddha
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Granholm, Linnea
    Department of Pharmaceutical Bioscience, Uppsala University, Uppsala, Sweden.
    Vrettou, Maria
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Bendre, Megha
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Boon, Wout
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Andershed, Henrik
    Örebro University, School of Law, Psychology and Social Work.
    Tuvblad, Catherine
    Örebro University, School of Law, Psychology and Social Work. Department of Psychology, University of Southern California, Los Angeles, USA.
    Nilsson, Kent W.
    Centre for Clinical Research, Västerås Central Hospital, Västerås, Sweden.
    Comasco, Erika
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Evidence for a Link Between Fkbp5/FKBP5, Early Life Social Relations and Alcohol Drinking in Young Adult Rats and Humans2017In: Molecular Neurobiology, ISSN 0893-7648, E-ISSN 1559-1182, Vol. 54, no 8, p. 6225-6234Article in journal (Refereed)
    Abstract [en]

    Alcohol misuse has been linked to dysregulation of stress, emotion, and reward brain circuitries. A candidate key mediator of this association is the FK506-binding protein (FKBP5), a negative regulator of the glucocorticoid receptor. The aim of the present study was to further understand the Fkbp5/FKBP5-related genetic underpinnings underlying the relationship between early life social relations and alcohol drinking. The effect of maternal separation and voluntary alcohol drinking on Fkbp5 expression was investigated in the brain of young adult rats, whereas the interaction effect of the functional FKBP5 single nucleotide polymorphism rs1360780 genotype and parent-child relationship on problematic drinking was examined in young adult humans. In rats, Fkbp5 expression in the nucleus accumbens and ventral tegmental area, core regions of the reward system, was affected in a region-dependent manner and in opposite direction by maternal separation and alcohol drinking. Fkbp5 expression in the cingulate cortex was affected by the combined effect of maternal separation and alcohol drinking. In humans, the TT genotype, in the presence of a poor relationship between the child and parents, was associated with problematic drinking behavior. The present findings suggest that Fkbp5 expression in mesocorticolimbic dopaminergic regions associates with early life stress-mediated sensitivity to alcohol drinking and that FKBP5 genotype interacts with parent-child relationship to influence alcohol drinking. These findings are the first to point to a role of FKBP5 in propensity to alcohol misuse and call for studies of the underlying molecular mechanisms to identify potential drug targets.

  • 17.
    Schölin, Lisa
    et al.
    Nursing Studies, School of Health in Social Science, University of Edinburgh, Edinburgh, UK; Public Health Institute, John Moores University, Liverpool, UK.
    Hughes, Karen
    Public Health Wales, Cardiff University, Cardiff, UK.
    Bellis, Mark A.
    Public Health Wales, Cardiff University, Cardiff, UK.
    Eriksson, Charli
    Örebro University, School of Health Sciences.
    Porcellato, Lorna
    Public Health Institute, John Moores University, Liverpool, UK.
    Exploring practices and perceptions of alcohol use during pregnancy in England and Sweden through a cross-cultural lens2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no 3, p. 533-537Article in journal (Refereed)
    Abstract [en]

    Background: Qualitative studies have aimed to understand why some women continue to drink during pregnancy; however, there is a lack of comparative cross-cultural research. We aimed to explore perceptions and practices of alcohol use during pregnancy in England and Sweden.

    Methods: Semi-structured interviews were conducted with 21 parents in Merseyside, England and 22 parents in Örebro County, Sweden. Interviews were audio recorded, transcribed verbatim and translated. Data were analyzed using thematic analysis.

    Results: The majority of women in both countries abstained from alcohol when they found out they were pregnant, despite alcohol being part of many social contexts before pregnancy. Nine of the seventeen English women drank at some point during pregnancy, typically on special occasions. Most parents felt women should modify their alcohol intake when they become mothers, though several English parents argued that responsible motherhood did not necessarily equate to abstinence. Swedish parents held strong opinions against drinking during pregnancy and argued that any amount of alcohol could harm the foetus. English parents' opinions were divided; some were skeptical of whether low to moderate drinking was associated with risks.

    Conclusions: Practices and attitudes towards alcohol use during pregnancy and views on foetal rights and responsibilities of pregnant women differed in England and Sweden. Shared social norms around drinking may be shaped within the policy context of pregnancy drinking guidelines, determining whether women consume alcohol or not.

  • 18.
    Schückher, Fides
    et al.
    Örebro University, School of Medical Sciences. University Health Care Research Centre, Region Örebro County, Örebro, Sweden.
    Sellin, Tabita
    University Health Care Research Centre, Region Örebro County, Örebro, Sweden.
    Berglund, Kristina
    Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
    Berggren, Ulf
    Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden.
    Balldin, Jan
    Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.
    Engström, Ingemar
    Örebro University, School of Medical Sciences.
    Fahlke, Claudia
    Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
    The Importance of Age at Onset of Excessive Alcohol Use with Regard to Psychiatric Symptoms and Personality Characteristics2017In: Alcoholism Treatment Quarterly, ISSN 0734-7324, E-ISSN 1544-4538, Vol. 35, no 4, p. 328-343Article in journal (Refereed)
    Abstract [en]

    Psychiatric symptoms and personality characteristics were studied in men (n=252) and women (n=86) as they commenced treatment for excessive alcohol use. The Addiction Severity Index, Symptom Check List, and Temperament and Character Inventory were used. ANOVA with early/late onset and gender as covariates showed significantly lower scores for psychiatric symptoms and more mature personality characteristics in the late-onset group compared to early onset. Men described more depression and anxiety, and women higher persistence. Results indicate the importance of considering age at onset of excessive alcohol use when patients enter treatment because different treatment approaches may be required.

  • 19.
    Schückher, Fides
    et al.
    Örebro University, School of Medical Sciences.
    Sellin, Tabita
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Fahlke, Claudia
    Engström, Ingemar
    Örebro University, School of Medical Sciences.
    The Impact of Childhood Maltreatment on Onset Age of Alcohol Use Disorder in Women Seeking Treatment2018Conference paper (Refereed)
  • 20.
    Skårberg, Kurt
    et al.
    Örebro University, School of Health and Medical Sciences.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    Troubled social background of male anabolic-androgenic steroid abusers in treatment2007In: Substance abuse treatment, prevention, and policy, ISSN 1747-597X, Vol. 2, p. 20-Article in journal (Refereed)
    Abstract [en]

    Background

    The aim of this study was to investigate the social background and current social situation of male abusers of anabolic-androgenic steroids (AAS).

    Methods

    We compared thirty-four AAS-abusing patients from an Addiction Centre (AC) with two groups, 18 users and 259 non-users of AAS from a public gym in Orebro, Sweden. The study is based on semi-structured interviews and questionnaires.

    Results

    Histories of a troubled childhood as well as current social disadvantage were both more frequent among the AAS users. Users also reported poor relationships with their parents and almost half of them had experienced physical or mental abuse. The AC group's experiences from school were mostly negative, and included concentration problems, boredom and learning difficulties. Their current circumstance included abuse of other drugs, battering of spouses and other criminality such as assault, illegal possession of weapons and theft.

    Conclusion

    In conclusion, this study shows that abusers of AAS often have a troubled social background. This underlines the importance of making a thorough social assessment as a part of the treatment programme. The results of the study may help in directing appropriate questions relevant to the abuse of AAS.

  • 21.
    Skårberg, Kurt
    et al.
    Örebro University, School of Health and Medical Sciences. Addiction Centre, Örebro County Council, Örebro, Sweden.
    Nyberg, Fred
    Department of Pharmaceutical Bioscience, Uppsala University, Uppsala, Sweden .
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    Is there an association between the use of anabolic-androgenic steroids and criminality?2010In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 16, no 4, p. 213-219Article in journal (Refereed)
    Abstract [en]

    Aims The aim of this study was to improve our understanding of the proposed association between anabolic-androgenic steroids (AAS) and criminality.

    Methods: The study was based on interviews and criminality data involving 32 users of AAS who had sought treatment for AAS-related problems at a psychiatric addiction clinic in Sweden. A score derived from the number of crimes, their level of severity and the relevant time periods was computed to allow comparisons between subgroups sorted according to type and timing of drug use.

    Results: The criminal activity level increased for 69% of the individuals after having started to use drugs. This was particularly obvious in the group who had started its involvement with drugs by using AAS. Crimes of violence and weapon offences showed a great increase in incidence after drug use had been initiated. The study also showed a significant decrease in criminality after treatment, particularly among individuals who had started their drug use with AAS.

    Conclusions: The results suggest that there is an association between the use of AAS and criminality, especially with regard to crimes of violence and weapon offences, and that this criminality may be enhanced when AAS are combined with other drugs of abuse.

  • 22.
    Skårberg, Kurt
    et al.
    Örebro University, School of Health and Medical Sciences.
    Nyberg, Fred
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    The development of multiple drug use among anabolic-androgenic steroid users: six subjective case reports2008In: Substance Abuse Treatment, Prevention, and Policy, ISSN 1747-597X, Vol. 3, p. 24-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The inappropriate use of anabolic androgenic steroids (AAS) was originally a problem among athletes but AAS are now often used in nonsport situations and by patients attending regular addiction clinics. The aim of this study was to improve understanding of the development of multiple drug use in patients seeking treatment at an addiction clinic for AAS-related problems. METHODS: We interviewed six patients (four men and two women) with experience of AAS use who were attending an addiction clinic for what they believed were AAS-related problems. The patients were interviewed in-depth about their life stories, with special emphasis on social background, substance use, the development of total drug use and subjective experienced psychological and physical side effects. RESULTS: There was significant variation in the development of drug use in relation to social background, onset of drug use, relationship to AAS use and experience of AAS effects. All patients had initially experienced positive effects from AAS but, over time, the negative experiences had outweighed the positive effects. All patients were dedicated to excess training and took AAS in combination with gym training, indicating that the use of these drugs is closely related to this form of training. Use of multiple drugs was common either in parallel with AAS use or serially. CONCLUSIONS: The study shows the importance of understanding how AAS use can develop either with or without the concomitant use of other drugs of abuse. The use of AAS can, however, progress to the use of other drugs. The study also indicates the importance of obtaining accurate, comprehensive information about the development of AAS use in designing treatment programmes and prevention strategies in this area.

  • 23.
    Vrettou, Maria
    et al.
    Department of Neuroscience, Science for Life Laboratory, BMC, Uppsala University, Uppsala, Sweden.
    Nilsson, Kent W.
    Centre for Clinical Research Västerås, Västmanland County Hospital Västerås, Uppsala University, Uppsala, Sweden.
    Tuvblad, Catherine
    Örebro University, School of Law, Psychology and Social Work. Department of Psychology, University of Southern California, Los Angeles, USA.
    Rehn, Mattias
    Centre for Clinical Research Västerås, Västmanland County Hospital Västerås, Uppsala University, Uppsala, Sweden.
    Åslund, Cecilia
    Centre for Clinical Research Västerås, Västmanland County Hospital Västerås, Uppsala University, Uppsala, Sweden.
    Andershed, Anna-Karin
    Örebro University, School of Law, Psychology and Social Work.
    Wallén-Mackenzie, Åsa
    Department of Organismal Biology, Uppsala University, Uppsala, Sweden.
    Andershed, Henrik
    Örebro University, School of Law, Psychology and Social Work.
    Hodgins, Sheilagh
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Institut Universitaire en Santé Mentale de Montréal, Université de Montréal, Montreal, Canada.
    Nylander, Ingrid
    Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden.
    Comasco, Erika
    Department of Neuroscience, Science for Life Laboratory, BMC, Uppsala University, Uppsala, Sweden.
    VGLUT2 rs2290045 genotype moderates environmental sensitivity to alcohol-related problems in three samples of youths2019In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 28, no 10, p. 1329-1340Article in journal (Refereed)
    Abstract [en]

    The importance of Vesicular Glutamate Transporter 2 (VGLUT2)-mediated neurotransmission has been highlighted in studies on addiction-related phenotypes. The single nucleotide polymorphism rs2290045 in VGLUT2 has been associated with alcohol dependence, but it is unknown whether or how this association is affected by environmental factors. The present study determined whether the association of alcohol-related problems with the rs2290045 in the VGLUT2 gene was modified by negative and positive environmental factors. Three samples were included: a clinical sample of 131 adolescents followed from age 17 to 22; a general population sample of 1794 young adults; and a general population sample of 1687 adolescents followed from age 14 to 17. DNA was extracted from saliva and the rs2290045 (T/C) was genotyped. Alcohol-related problems were assessed using the Alcohol Use Disorders Identification Test. Stressful life events (SLE) and parenting were assessed by questionnaires. Gene-environment interactions were investigated using a dual statistical approach. In all samples (effect sizes 0.6-6.2%), and consistent with the differential susceptibility framework, T carriers exposed to SLE reported more alcohol-related problems if they had experienced poor parenting, and lower alcohol-related problems if they had received supportive parenting. T carriers not exposed to SLE reported higher alcohol-related problems if they had received supportive parenting and lower alcohol-related problems if they had received poor parenting. Among CC carriers, alcohol-related problems did not vary as a function of negative and positive environmental factors. In conclusion, in three samples of youths, alcohol-related problems were associated with an interaction of VGLUT2 rs2290045, SLE, and parenting.

  • 24.
    Westerdahl, Elisabeth
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital. Centre for Assessment of Medical Technology in Örebro, Region Örebro County, Örebro, Sweden; Department of Physiotherapy, University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Engman, Kjell Ola
    Sörmland County Council, Medical Advisory Committee, Nyköping, Sweden.
    Arne, Mats
    Centre for Clinical Research, Region Värmland, Karlstad, Sweden; Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Larsson, Matz
    Örebro University, School of Medical Sciences. Örebro University Hospital. Clinical Health Promotion Centre, Lund University, Lund, Sweden; The Heart, Lung and Physiology Clinic, Örebro University Hospital, Örebro, Sweden.
    Spirometry to increase smoking cessation rate: A systematic review2019In: Tobacco Induced Diseases, ISSN 1617-9625, E-ISSN 1617-9625, Vol. 17, article id 31Article, review/survey (Refereed)
    Abstract [en]

    INTRODUCTION: Addressing tobacco use is an important issue in general health care. In order to improve smoking cessation advice, spirometry values can be displayed to the smoker to demonstrate possible lung function impairment. The estimate of so-called lung age may show a decrease in lung function associated with smoking. It has been suggested that performing spirometry on patients who smoke but are asymptomatic can be a useful way to show the adverse effects of smoking. The aim of this systematic review was to determine if providing spirometry results in combination with smoking cessation counselling can increase smoking cessation rates compared to what is achieved through counselling alone.

    METHODS: In this systematic review, we included randomized controlled trials (RCTs) evaluating smoking cessation interventions for adult smokers. The systematic search was performed in PubMed, Medline, Cochrane Library, Cinahl, Embase, Amed and PsycInfo.

    RESULTS: The literature search resulted in 946 studies, which, after reading by two independent reviewers, were reduced to seven trials that matched the inclusion criteria. Two RCTs showed significant improvement in smoking cessation when giving patients feedback on spirometry results in combination with smoking cessation counselling, compared to patients who received only smoking cessation counselling. In both studies, the spirometry results were expressed as lung age. In the other five studies no difference was found. Five further published study protocols for ongoing RCT studies in the field have been found, and therefore this systematic overview will likely need to be updated within a few years.

    CONCLUSIONS: Few studies have been undertaken to examine the efficacy of spirometry in increasing smoking quit rates. Studies conducted to date have shown mixed results, and there is currently limited evidence in the literature that smoking cessation counselling that includes feedback from spirometry and a demonstration of lung age promotes quit rates.

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