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.

National household survey of adverse childhood experiences and their relationship with resilience to health-harming behaviors in England.

BACKGROUND: Epidemiological and biomedical evidence link adverse childhood experiences (ACEs) with health-harming behaviors and the development of non-communicable disease in adults. Investment in interventions to improve early life experiences requires empirical evidence on levels of childhood adversity and the proportion of HHBs potentially avoided should such adversity be addressed. METHODS: A nationally representative survey of English residents aged 18 to 69 (n = 3,885) was undertaken during the period April to July 2013. Individuals were categorized according to the number of ACEs experienced. Modeling identified the proportions of HHBs (early sexual initiation, unintended teenage pregnancy, smoking, binge drinking, drug use, violence victimization, violence perpetration, incarceration, poor diet, low levels of physical exercise) independently associated with ACEs at national population levels. RESULTS: Almost half (47%) of individuals experienced at least one of the nine ACEs. Prevalence of childhood sexual, physical, and verbal abuse was 6.3%, 14.8%, and 18.2% respectively (population-adjusted). After correcting for sociodemographics, ACE counts predicted all HHBs, e.g. (0 versus 4+ ACEs, adjusted odds ratios (95% confidence intervals)): smoking 3.29 (2.54 to 4.27); violence perpetration 7.71 (4.90 to 12.14); unintended teenage pregnancy 5.86 (3.93 to 8.74). Modeling suggested that 11.9% of binge drinking, 13.6% of poor diet, 22.7% of smoking, 52.0% of violence perpetration, 58.7% of heroin/crack cocaine use, and 37.6% of unintended teenage pregnancy prevalence nationally could be attributed to ACEs. CONCLUSIONS: Stable and protective childhoods are critical factors in the development of resilience to health-harming behaviors in England. Interventions to reduce ACEs are available and sustainable, with nurturing childhoods supporting the adoption of health-benefiting behaviors and ultimately the provision of positive childhood environments for future generations.

Variations in risk and protective factors for life satisfaction and mental wellbeing with deprivation: a cross-sectional study.

BACKGROUND: Improving life satisfaction (LS) and mental wellbeing (MWB) is important for better public health. Like other health issues, LS and MWB are closely related to deprivation (i.e. lack of resources). Developing public health measures that reduce inequalities in wellbeing requires an understanding of how factors associated with high and low LS and MWB vary with deprivation. Here, we examine such variations and explore which public health measures are likely to improve wellbeing while reducing related inequalities. METHODS: A self-administered questionnaire measuring LS and MWB was used with a cross-sectional sample of adults from the North West of England (n = 15,228). Within deprivation tertiles, analyses examined how demographics, health status, employment, relationships and behaviours (alcohol, tobacco, physical exercise) were associated with LS and MWB. RESULTS: Deprivation was strongly related to low LS and MWB with, for instance, 17.1% of the most deprived tertile having low LS compared to 8.9% in the most affluent. After controlling for confounders, across all deprivation tertiles, better self-assessed health status and being in a relationship were protective against low LS and MWB. Unemployment increased risks of low LS across all tertiles but only risks of low MWB in the deprived tertile. For this tertile, South Asian ethnicity and higher levels of exercise were protective against low MWB. In the middle tertile retired individuals had a reduced risk of low MWB and an increased chance of high LS even in comparison to those in employment. Alcohol's impact on LS was limited to the most deprived tertile where heavy drinkers were at most risk of poor outcomes. CONCLUSIONS: In this study, positive outcomes for LS and MWB were strongly associated with lower deprivation and good health status. Public health measures already developed to promote these issues are likely to improve LS and MWB. Efforts to increase engagement in exercise are also likely to have positive impacts, particularly in deprived communities. The development of future initiatives that address LS and MWB must take account of variations in their risk and protective factors at different levels of deprivation.

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.

National five-year examination of inequalities and trends in emergency hospital admission for violence across England.

OBJECTIVES: To examine relationships between violence, age (0-74 years), and deprivation, and to explore in which communities, age groups, and gender the potential for transmission of violent tendencies between individuals is greatest. METHODS: Five year (2004/2005 to 2008/2009) ecological study of emergency admissions resulting from violence (n=170074) into all English hospitals using trend and logistic regression analyses. RESULTS: Hospital admissions for violence peak as individuals achieve legal adulthood (18 years). Risks of admission increase exponentially with increasing quintile of deprivation of residence, with odds overall being 5.5 times higher in the poorest quintile compared with the richest. The greatest absolute difference in violence admissions by deprivation quintile is seen in males aged 18 (218/100 000, richest; 698/100 000, poorest). However, the highest deprivation rate ratios (quintile 5:1) are seen at ages 0-10 years in both sexes and at all ages after 40 years in males (40-58 years, females). In males aged 17-19 years, violence accounts for 20% of the entire gap between wealthiest and poorest quintiles in all cause emergency hospital admissions. CONCLUSIONS: Analyses identify four lifetime periods for violence: up to 10 years (prepubescent), 11-20 years (adolescence), 21-45 years (younger adults), and over 45 years (older adults). While violence is most common in adolescence, its concentration in poorer areas during prepubescence and in younger adulthood (parenting age) suggests that poorer children are exposed to much more aggressive communities. This is likely to contribute to the disproportionate escalation in violence they experience during adolescence. Effective interventions to prevent such escalations are available and need to be implemented particularly in poor communities.