Evaluating the effects of minimum unit pricing in Scotland on the prevalence of harmful drinking: a controlled interrupted time series analysis.

OBJECTIVES: In May 2018, the Scottish Government introduced a minimum unit price (MUP) for alcohol of £0.50 (1 UK unit = 8 g ethanol) to reduce alcohol consumption, particularly among people drinking at harmful levels. This study aimed to evaluate MUP's impact on the prevalence of harmful drinking among adults in Scotland. STUDY DESIGN: This was a controlled interrupted monthly time series analysis of repeat cross-sectional data collected via 1-week drinking diaries from adult drinkers in Scotland (N = 38,674) and Northern England (N = 71,687) between January 2009 and February 2020. METHODS: The primary outcome was the proportion of drinkers consuming at harmful levels (>50 [men] or >35 [women] units in diary week). The secondary outcomes included the proportion of drinkers consuming at hazardous (≥14-50 [men] or ≥14-35 [women] units) and moderate (<14 units) levels and measures of beverage preferences and drinking patterns. Analyses also examined the prevalence of harmful drinking in key subgroups. RESULTS: There was no significant change in the proportion of drinkers consuming at harmful levels (ß = +0.6 percentage points; 95% confidence interval [CI] = -1.1, +2.3) or moderate levels (ß = +1.4 percentage points; 95% confidence interval = -1.1, +3.8) after the introduction of MUP. The proportion consuming at hazardous levels fell significantly by 3.5 percentage points (95% CI = -5.4, -1.7). There were no significant changes in other secondary outcomes or in the subgroup analyses after correction for multiple testing. CONCLUSIONS: Introducing MUP in Scotland was not associated with reductions in the proportion of drinkers consuming at harmful levels but did reduce the prevalence of hazardous drinking. This adds to previous evidence that MUP reduced overall alcohol consumption in Scotland and consumption among those drinking above moderate levels.

Stakeholder Engagement in the Development of Public Health Economic Models: An Application to Modelling of Minimum Unit Pricing of Alcohol in South Africa.

BACKGROUND: Health economic models aim to provide decision makers with information that is contextually relevant, understandable and credible. This requires ongoing engagement throughout the research project between the modeller and end-users. OBJECTIVES: We aim to reflect on how a public health economic model of minimum unit pricing of alcohol in South Africa benefited from, and was shaped by, stakeholders. We outline how engagement activities were used during the development, validation and communication phases of the research with input gathered at each stage to inform future priorities. METHODS: A stakeholder mapping exercise was completed to identify stakeholders with the required knowledge, for example academics with expertise in modelling alcohol harm in South Africa, members of civil society organisations with lived experience of informal alcohol outlets, and policy professionals working at the forefront of alcohol policy development in South Africa. The stakeholder engagement consisted of four phases: developing a detailed understanding of the local policy context; co-producing model focus and structure; scrutinising model development and communication planning; and communicating research evidence to end-users. The first phase utilised 12 individual semi-structured interviews. Phases two to four centred around face-to-face workshops (two online) with both individual and group-based exercises employed to achieve required outputs. RESULTS: Phase one provided key learning on policy context and initiated working relationships. Phases two to four provided a conceptualisation of the problem of alcohol harm in South Africa and the choice of policy to model. Stakeholders chose population subgroups of interest and advised on both economic and health outcomes. They provided input on critical assumptions, data sources, priorities for future work, and communication strategies. The final workshop provided a platform to communicate the results of the model to a largely policy audience. These activities led to the production of highly contextualised research methods and findings that were able to be communicated widely beyond academia. CONCLUSIONS: Our programme of stakeholder engagement was fully integrated into the research programme. It resulted in a number of benefits including creating positive working relationships, guiding modelling decisions, tailoring the research to the context, and providing ongoing opportunities for communication.

Interdisciplinary working in public health research: a proposed good practice checklist.

Background: Guidance on how different disciplines from the natural, behavioural and social sciences can collaborate to resolve complex public health problems is lacking. This article presents a checklist to support researchers and principle investigators to develop and implement interdisciplinary collaborations. Methods: Fourteen individuals, representing 10 disciplines, participated in in-depth interviews to explore the strengths and challenges of working together on an interdisciplinary project to identify the determinants of substance use and gambling disorders, and to make recommendations for future interdisciplinary teams. Data were analysed thematically and a checklist was derived from insights offered by participants during interview and discussion among the authors on the implications of findings. Results: Participants identified 18 scientific, interactional and structural strengths and challenges of interdisciplinary research. These findings were used to develop an 18-item BASICS checklist to support future interdisciplinary collaborations. The five domains of the checklist are: (i) Blueprint, (ii) Attitudes, (iii) Staffing, (iv) Interactions and (v) Core Science. Conclusion: Interdisciplinary work has the potential to advance public health science but the numerous challenges should not be underestimated. Use of a checklist, such as BASICS, when planning and managing projects may help future collaborations to avoid some of the common pitfalls of interdisciplinary research.

Alcohol consumption after health deterioration in older adults: a mixed-methods study.

OBJECTIVE: To examine if and how older adults modify their drinking after health deterioration, and the factors that motivate changing or maintaining stable drinking behaviour. STUDY DESIGN: Explanatory follow-up mixed-methods research. METHODS: The association between health deterioration and changes in alcohol consumption was examined using secondary data from the English Longitudinal Study of Ageing, a biennial prospective cohort study of a random sample of adults aged 50 years and older living in England. Data were collected through a personal interview and self-completion questionnaire across three waves between 2004 and 2009. The sample size (response rate) across the three waves was 8781 (49.9%), 7168 (40.3%) and 6623 (37.3%). The Chi-squared test was used to examine associations between diagnosis with a long-term condition or a worsening of self-rated health (e.g. from good to fair or fair to poor) and changes in drinking frequency (e.g. everyday, 5-6 days per week, etc.) and volume (ethanol consumed on a drinking day) between successive waves. In-depth interviews with 19 older adults recently diagnosed with a long-term condition were used to explore the factors that influenced change or maintenance in alcohol consumption over time. A purposive sampling strategy was used to recruit a diverse sample of current and former drinkers from voluntary and community organizations in the north of England. An inductive approach was used to analyze the data, facilitating the development of an a posteriori framework for understanding drinking change. RESULTS: There was no significant relationship between health deterioration and changes in drinking volume over time. There was however a significant association between health deterioration and changes in drinking frequency between successive waves (χ2 = 15.24, P < 0.001 and χ2 = 17.28, P < 0.001). For example, of participants reporting health deterioration between the first two waves, 47.6% had stable drinking frequency, 23.4% increased their drinking frequency and 29% reported decreased drinking frequency. In comparison, of participants reporting no health deterioration, 52.7% reported stable frequency, 20.8% increased frequency and 26.4% decreased frequency. In qualitative interviews, older adults described a wide range of factors that influence changes in drinking behaviour: knowledge gained from talking to healthcare professionals, online and in the media; tangible negative experiences that were attributed to drinking; mood and emotions (e.g. joy); the cost of alcohol; pub closures; and changes in social roles and activities. Health was just one part of a complex mix of factors that influenced drinking among older adults. CONCLUSION: Patterns of drinking change after health deterioration in older adults are diverse, including stable, increasing and decreasing alcohol consumption over time. Although health motivations to change drinking influence behaviour in some older adults, social and financial motivations to drink are also important in later life and thus a holistic approach is required to influence behaviour.

Development of public health guidance on the prevention of alcohol misuse and cardiovascular disease: the work of the National Institute for Health and Clinical Excellence, England.

In 2005, the National Institute for Health and Clinical Excellence in England was asked to extend its work from clinical practice to public health. It has since produced 35 pieces of public health guidance on interventions ranging from the specific (such as the use of pedometers to promote exercise) to major public health issues (such as behaviour change and community engagement). The workshop agreed that research on many public health interventions was lacking, particularly for population-level interventions, which might be more powerful than those targeted at individuals. Epidemiology could make a particular contribution to the evaluation of natural experiments, which have great potential for contributing to this evidence base.

Dual diagnosis competency among addiction treatment staff: Training levels, training needs and the link to retention.

BACKGROUND: Dually diagnosed clients are described as one of the most challenging treatment populations, often leading to staff frustration, helplessness and negative attitudes. As yet it is unclear whether dual diagnosis (DD)-specific competency and therapeutic optimism among staff are related to client outcomes. METHODS: The study used a 3-month follow-up design involving 124 DD clients starting treatment at 6 UK addiction services. Practitioners (n = 46) treating these clients were assessed regarding their DD specialisation levels. Cox regression analyses were performed to examine predictors of clients' 3-month retention rates. RESULTS: Staff reported a median of 7 years work experience with DD clients, and 80% had received co-morbidity-specific training. Practitioners provided high average ratings on both the DD competency and the therapeutic optimism scale. Nevertheless, 78% of the sample indicated additional support needs in dealing with this client group. Higher levels of DD competencies among staff predicted better client retention. CONCLUSION: The increased provision of support packages for practitioners is vital for improving competency levels in dealing with DD clients, which in turn may lead to improved client outcomes.