Objective: Historically, alcohol use and related harms are more prevalent in men than in women. However, emerging evidence suggests the epidemiology of alcohol use is changing in younger cohorts. The current study aimed to systematically summarise published literature on birth cohort changes in male-tofemale ratios in indicators of alcohol use and related harms. Methods:We identified 68 studies that met inclusion criteria. We calculated male-to-female ratios for 3 broad categories of alcohol use and harms (any alcohol use, problematic alcohol use and alcoholrelated harms) stratified by 5-year birth cohorts ranging from 1891 to 2001, generating 1568 sex ratios. Random-effects meta-analyses produced pooled sex ratios within these 3 categories separately for each birth cohort.Findings: There was a linear decrease over time in the sex ratio for all 3 categories of alcohol use and related harms. Among those born in the early 1900s, males were 2.2 (95% CI 1.9 to 2.5) times more likely than females to consume alcohol, 3.0 (95% CI 1.5 to 6.0) times more likely to drink alcohol in ways suggestive of problematic use and 3.6 (95% CI 0.4 to 30.3) times more likely to experience alcohol-related harms. Among cohorts born in the late 1900s, males were 1.1 (95% CI 1.1 to 1.2) times more likely than females to consume alcohol, 1.2 (95% CI 1.1 to 1.4) times more likely to drink alcohol in ways suggestive of problematic use and 1.3 (95% CI 1.2 to 1.3) times more likely to experience alcohol-related harms.Conclusions: Findings confirm the closing malefemale gap in indicators of alcohol use and related harms. The closing male-female gap is most evident among young adults, highlighting the importance of prospectively tracking young male and female cohorts as they age into their 30s, 40s and beyond.Alcohol use and alcohol-related harms are among the most significant risk factors for burden of disease. Overall, they resulted in around 5 million deaths globally in 2010, and were responsible for more than 161 million years of life lost, equating to 5% of total global health burden.1 Historically, the prevalence of alcohol use and related harms has been between 2 and 12 times higher in men than women.2-7 However, there is emerging evidence to suggest that the gap between men and women in alcohol use and related harms is closing among recently born cohorts. [8][9][10][11] Understanding sex-specific birth cohort trends in the epidemiology of alcohol use is vital as they point to key environmental and social mechanisms associated with population shifts in alcohol use patterns. For example, studies have attributed these generational shifts in sex-specific drinking to changes in traditional gender roles over Strengths and limitations of this study ▪ Prior to this study, the evidence around gender convergence in alcohol use and alcohol-related harms was fragmented. This study systematically summarised all available literature and provided a quantification of the rate of gender convergence through the derivation of a single metric -the m...

Background Lifestyle risk behaviours typically emerge during adolescence, track into adulthood, and commonly co-occur. Interventions targeting multiple risk behaviours in adolescents have the potential to efficiently improve health outcomes, yet further evidence is required to determine their effect. We reviewed the effectiveness of eHealth school-based interventions targeting multiple lifestyle risk behaviours. Methods In this systematic review and meta-analysis, we searched Ovid MEDLINE, Embase, PsycINFO, and the Cochrane Library databases between Jan 1, 2000, and March 14, 2019, with no language restrictions, for publications on school-based eHealth multiple health behaviour interventions in humans. We also screened the grey literature for unpublished data. Eligible studies were randomised controlled trials of eHealth (internet, computers, tablets, mobile technology, or tele-health) interventions targeting two or more of six behaviours of interest: alcohol use, smoking, diet, physical activity, sedentary behaviour, and sleep. Primary outcomes of interest were the prevention or reduction of unhealthy behaviours, or improvement in healthy behaviours of the six behaviours. Outcomes were summarised in a narrative synthesis and combined using random-effects meta-analysis. This systematic review is registered with PROSPERO, identifier CRD42017072163. Findings Of 10 571 identified records, 22 publications assessing 16 interventions were included, comprising 18 873 students, of whom on average 56•2% were female, with a mean age of 13•41 years (SD 1•52). eHealth schoolbased multiple health behaviour change interventions significantly increased fruit and vegetable intake (standard mean difference 0•11, 95% CI 0•03 to 0•19; p=0•007) and both accelerometer-measured (0•33, 0•05 to 0•61; p=0•02) and self-reported (0•14, 0•05 to 0•23; p=0•003) physical activity, and reduced screen time (-0•09,-0•17 to-0•01; p=0•03) immediately after the intervention; however, these effects were not sustained at follow-up when data were available. No effect was seen for alcohol or smoking, fat or sugar-sweetened beverage or snack consumption. No studies examined sleep or used mobile health interventions. The risk of bias in masking of final outcome assessors and selective outcome reporting was high or unclear across studies and overall we deemd the quality of evidence to be low to very low. Interpretation eHealth school-based interventions addressing multiple lifestyle risk behaviours can be effective in improving physical activity, screen time, and fruit and vegetable intake. However, effects were small and only evident immediately after the intervention. Further high quality, adolescent-informed research is needed to develop eHealth interventions that can modify multiple behaviours and sustain long-term effects.

The 6-item Kessler Psychological Distress Scale (K6; Kessler et al., 2002) is a screener for psychological distress that has robust psychometric properties among adults. Given that a significant proportion of adolescents experience mental illness, there is a need for measures that accurately and reliably screen for mental disorders in this age group. This study examined the psychometric properties of the K6 in a large general population sample of adolescents (N = 4,434; mean age = 13.5 years; 44.6% male). Factor analyses were conducted to examine the dimensionality of the K6 in adolescents and to investigate sex-based measurement invariance. This study also evaluated the K6 as a predictor of scores on the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997). The K6 demonstrated high levels of internal consistency, with the 6 items loading primarily on 1 factor. Consistent with previous research, females reported higher mean levels of psychological distress when compared with males. The identification of sex-based measurement noninvariance in the item thresholds indicated that these mean differences most likely represented reporting bias in the K6 items rather than true differences in the underlying psychological distress construct. The K6 was a fair to good predictor of abnormal scores on the SDQ, but predictive utility was relatively low among males. Future research needs to focus on refining and augmenting the K6 scale to maximize its utility in adolescents. (PsycINFO Database Record