Harms associated with gambling: abbreviated systematic review protocol.

BACKGROUND: According to the Gambling Commission, in 2018, almost half of the general population aged 16 and over had participated in gambling in the 4 weeks before being surveyed. Such surveys suggest that the proportion of people who are classed as 'problem' gamblers is relatively small; however, this may be related to the ways data are collected and gambling behaviour is classified. Concern about the harms associated with gambling is rising, and in response, Public Health England (PHE) has initiated this review to identify the harms associated with this activity. Harms to the gambler, their close associates and the wider society will all be included. METHODS: Abbreviated systematic review processes will be employed. Ovid MEDLINE, Ovid Embase, Ovid Psycinfo, NICE Evidence and EBSCO SocIndex; a range of websites (for grey literature); and reference lists of included studies will be searched. Experts will be asked to identify other relevant literature. Literature published in years 2005-2019, published in English, from a country within the Organisation for Economic Development (OECD) and following an observational, qualitative or systematic review design will be included. AMSTAR2 (systematic reviews), the Newcastle-Ottawa Scale (observational studies) and the Critical Appraisal Skills Programme (CASP) qualitative checklist (qualitative studies) will be used to assess the risk of bias. A narrative synthesis will be used to summarise the results. The body of evidence will also be assessed according to the principles laid out in the CERQual approach. DISCUSSION: This protocol provides details of the framework that has been set up to guide this systematic review. The results of this review will provide an extensive assessment of the breadth and magnitude of harms associated with gambling. This will be one of the most comprehensive reviews of gambling-related harms undertaken to date. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019154757.

A rapid evidence review of the effectiveness and cost-effectiveness of alcohol control policies: an English perspective.

This paper reviews the evidence for the effectiveness and cost-effectiveness of policies to reduce alcohol-related harm. Policies focus on price, marketing, availability, information and education, the drinking environment, drink-driving, and brief interventions and treatment. Although there is variability in research design and measured outcomes, evidence supports the effectiveness and cost-effectiveness of policies that address affordability and marketing. An adequate reduction in temporal availability, particularly late night on-sale availability, is effective and cost-effective. Individually-directed interventions delivered to at-risk drinkers and enforced legislative measures are also effective. Providing information and education increases awareness, but is not sufficient to produce long-lasting changes in behaviour. At best, interventions enacted in and around the drinking environment lead to small reductions in acute alcohol-related harm. Overall, there is a rich evidence base to support the decisions of policy makers in implementing the most effective and cost-effective policies to reduce alcohol-related harm.

Using clustering techniques to identify localities with multiple health and social needs.

Development of health promoting policies requires an understanding not just of the interplay between different measures of health but also their relationship with broader education, criminal justice and other social issues. Methods to better utilise multi-sectoral data to inform policy are needed. Applying clustering techniques to 30 health and social metrics we identify 5 distinct local authority types, with poor outcomes for the majority of metrics concentrated in the same cluster. Clusters were distinguished especially by levels of: child poverty; breastfeeding initiation; children's tooth decay; teenage pregnancy; healthy eating; mental illness; tuberculosis and smoking deaths. Membership of the worst cluster (C5) was focused in Northern England which contains 15.7% of authorities analysed (n=324), but 63.0% of those in C5. The concentration of challenges in certain areas creates disproportionate pressures that may exceed the cumulative effects of individual challenges. Such distinct health clusters also raise issues of transferability of effective policies between areas with different cluster membership.

The cost of emergency hospital admissions for falls on snow and ice in England during winter 2009/10: a cross sectional analysis.

BACKGROUND: In the UK, the 2009/10 winter was characterised by sustained low temperatures; grit stocks became depleted and surfaces left untreated. We describe the relationship between temperature and emergency hospital admissions for falls on snow and ice in England, identify the age and gender of those most likely to be admitted, and estimate the inpatient costs of these admissions during the 2009/10 winter. METHODS: Hospital Episode Statistics were used to identify episodes of emergency admissions for falls on snow and ice during winters 2005/06 to 2009/10; these were plotted against mean winter temperature. By region, the logs of the rates of weekly emergency admissions for falls on snow and ice were plotted against the mean weekly temperature for winters 2005/06 to 2009/10 and a linear regression analysis undertaken. For the 2009/10 winter the number of emergency hospital admissions for falls on snow and ice were plotted by age and gender. The inpatient costs of admissions in the 2009/10 winter for falls on snow and ice were calculated using Healthcare Resource Group costs and Admitted Patient Care 2009/10 National Tariff Information. RESULTS: The number of emergency hospital admissions due to falls on snow and ice varied considerably across years; the number was 18 times greater in 2009/10 (N = 16,064) than in 2007/08 (N = 890). There is an exponential increase [Ln(rate of admissions) = 0.456 - 0.463*(mean weekly temperature)] in the rate of emergency hospital admissions for falls on snow and ice as temperature falls. The rate of admissions in 2009/10 was highest among the elderly and particularly men aged 80 and over. The total inpatient cost of falls on snow and ice in the 2009/10 winter was 42 million GBP. CONCLUSIONS: Emergency hospital admissions for falls on snow and ice vary greatly across winters, and according to temperature, age and gender. The cost of these admissions in England in 2009/10 was considerable. With responsibility for health improvement moving to local councils, they will have to balance the cost of public health measures like gritting with the healthcare costs associated with falls. The economic burden of falls on snow and ice is substantial; keeping surfaces clear of snow and ice is a public health priority.

Experiences of drug use and ageing: health, quality of life, relationship and service implications.

AIM: This paper is a report of an exploration of older people's experiences of substance use in the context of ageing, and its impact on health, quality of life, relationships and service use. BACKGROUND: Use of illicit drugs by older people is a neglected policy, research and service provision and is generally perceived as a lifestyle of younger populations. METHOD: A convenience sample of 11 people aged 49-61 years (mean 57 years) in contact with voluntary sector drug treatment services participated in qualitative semi-structured tape-recorded interviews and thematic content analysis was performed. The data were collected in 2008. FINDINGS: Drug use can have negative impacts on health status, quality of life, family relationships and social networks that accrue with age. Participants were identified as early or later onset users of drugs due to the impact of life events and relationships. A range of substances had been used currently and throughout their lives, with no single gateway drug identified as a prelude to personal drug careers. Life review and reflection were common, in keeping with ageing populations, along with regret of ever having started to use drugs. Living alone and their accommodation made them more susceptible to social isolation, and they reported experiences of death and dying of their contemporaries and family members earlier than usual in the life course. CONCLUSION: Older people who continue to use drugs and require the support of services for treatment and care are an important emerging population and their specific needs should recognized.