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1.
Artículo en Inglés | MEDLINE | ID: mdl-34639647

RESUMEN

Zero and low alcohol products, particularly beer, are gaining consideration as a method to reduce consumption of ethanol. We do not know if this approach is likely to increase or decrease health inequalities. The aim of the study was to determine if the purchase and consumption of zero and low alcohol beers differs by demographic and socio-economic characteristics of consumers. Based on British household purchase data from 79,411 households and on British survey data of more than 104,635 adult (18+) respondents, we estimated the likelihood of buying and drinking zero (ABV = 0.0%) and low alcohol (ABV > 0.0% and ≤ 3.5%) beer by a range of socio-demographic characteristics. We found that buying and consuming zero alcohol beer is much more likely to occur in younger age groups, in more affluent households, and in those with higher social grades, with gaps in buying zero alcohol beer between households in higher and lower social grades widening between 2015 and 2020. Buying and drinking low alcohol beer had less consistent relationships with socio-demographic characteristics, but was strongly driven by households that normally buy and drink the most alcohol. Common to many health-related behaviours, it seems that it is the more affluent that lead the way in choosing zero or low alcohol products. Whilst the increased availability of zero and low alcohol products might be a useful tool to reduce overall ethanol consumption in the more socially advantageous part of society, it may be less beneficial for the rest of the population. Other evidence-based alcohol policy measures that lessen health inequalities, need to go hand-in-hand with those promoting the uptake of zero and low alcohol beer.

2.
J Stud Alcohol Drugs ; 82(5): 638-646, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34546911

RESUMEN

OBJECTIVE: The purpose of this study was to report the "Outcome Reporting in Brief Intervention Trials: Alcohol" (ORBITAL) recommended core outcome set (COS) to improve efficacy and effectiveness trials/evaluations for alcohol brief interventions (ABIs). METHOD: A systematic review identified 2,641 outcomes in 401 ABI articles measured by 1,560 different approaches. These outcomes were classified into outcome categories, and 150 participants from 19 countries participated in a two-round e-Delphi outcome prioritization exercise. This process prioritized 15 of 93 outcome categories for discussion at a consensus meeting of key stakeholders to decide the COS. A psychometric evaluation determined how to measure the outcomes. RESULTS: Ten outcomes were voted into the COS at the consensus meeting: (a) typical frequency, (b) typical quantity, (c) frequency of heavy episodic drinking, (d) combined consumption measure summarizing alcohol use, (e) hazardous or harmful drinking (average consumption), (f) standard drinks consumed in the past week (recent, current consumption), (g) alcohol-related consequences, (h) alcohol-related injury, (i) use of emergency health care services (impact of alcohol use), and (j) quality of life. CONCLUSIONS: The ORBITAL COS is an international consensus standard for future ABI trials and evaluations. It can improve the synthesis of new findings, reduce redundant/selective reporting (i.e., reporting only some, usually significant outcomes), improve between-study comparisons, and enhance the relevance of trial and evaluation findings to decision makers. The COS is the recommended minimum and does not exclude other, additional outcomes.

3.
BMJ Open ; 11(8): e046842, 2021 08 24.
Artículo en Inglés | MEDLINE | ID: mdl-34429309

RESUMEN

OBJECTIVE: To synthesise the published literature on practitioner, patient and carer views and experiences of shared medical appointments (SMAs) for the management of long-term conditions in primary care. DESIGN: Systematic review of qualitative primary studies. METHODS: A systematic search was conducted using MEDLINE (Ovid), PsycINFO (Ovid), CINAHL (EBSCOhost), Web of Science, Social Science Premium Collection (Proquest) and Scopus (SciVerse) from database starting dates to June 2019. Practitioner, patient and carer perspectives were coded separately. Deductive coding using a framework approach was followed by thematic analysis and narrative synthesis. Quality assessment was conducted using the Critical Appraisal Skills Programme for qualitative studies. RESULTS: We identified 18 unique studies that reported practitioner (n=11), patient (n=14) and/or carer perspectivs(n=3). Practitioners reported benefits of SMAs including scope for comprehensive patient-led care, peer support, less repetition and improved efficiency compared with 1:1 care. Barriers included administrative challenges and resistance from patients and colleagues, largely due to uncertainties and unclear expectations. Skilled facilitators, tailoring of SMAs to patient groups, leadership support and teamwork were reported to be important for successful delivery. Patients' reported experiences were largely positive with the SMAs considered a supportive environment in which to share and learn about self-care, though the need for good facilitation was recognised. Reports of carer experience were limited but included improved communication between carer and patient. CONCLUSION: There is insufficient evidence to indicate whether views and experiences vary between staff, medical condition and/or patient characteristics. Participant experiences may be subject to reporting bias. Policies and guidance regarding best practice need to be developed with consideration given to resource requirements. Further research is needed to capture views about wider and co-occurring conditions, to hear from those without SMA experience and to understand which groups of patients and practitioners should be brought together in an SMA for best effect. PROSPERO REGISTRATION NUMBER: CRD42019141893.


Asunto(s)
Citas Médicas Compartidas , Cuidadores , Comunicación , Humanos , Atención Primaria de Salud , Investigación Cualitativa
4.
PLoS One ; 16(8): e0255594, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34352012

RESUMEN

INTRODUCTION: Implementation of evidence-based care for heavy drinking and depression remains low in global health systems. We tested the impact of providing community support, training, and clinical packages of varied intensity on depression screening and management for heavy drinking patients in Latin American primary healthcare. MATERIALS AND METHODS: Quasi-experimental study involving 58 primary healthcare units in Colombia, Mexico and Peru randomized to receive: (1) usual care (control); (2) training using a brief clinical package; (3) community support plus training using a brief clinical package; (4) community support plus training using a standard clinical package. Outcomes were proportion of: (1) heavy drinking patients screened for depression; (2) screen-positive patients receiving appropriate support; (3) all consulting patients screened for depression, irrespective of drinking status. RESULTS: 550/615 identified heavy drinkers were screened for depression (89.4%). 147/230 patients screening positive for depression received appropriate support (64%). Amongst identified heavy drinkers, adjusting for country, sex, age and provider profession, provision of community support and training had no impact on depression activity rates. Intensity of clinical package also did not affect delivery rates, with comparable performance for brief and standard versions. However, amongst all consulting patients, training providers resulted in significantly higher rates of alcohol measurement and in turn higher depression screening rates; 2.7 times higher compared to those not trained. CONCLUSIONS: Training using a brief clinical package increased depression screening rates in Latin American primary healthcare. It is not possible to determine the effectiveness of community support on depression activity rates due to the impact of COVID-19.


Asunto(s)
Consumo de Bebidas Alcohólicas/psicología , Alcohólicos/psicología , Depresión/terapia , Adulto , Consumo de Bebidas Alcohólicas/efectos adversos , Consumo de Bebidas Alcohólicas/prevención & control , Intoxicación Alcohólica/psicología , Alcoholismo/diagnóstico , Colombia/epidemiología , Comorbilidad , Atención a la Salud , Depresión/psicología , Trastorno Depresivo/psicología , Trastorno Depresivo/terapia , Femenino , Humanos , Masculino , Tamizaje Masivo/métodos , México/epidemiología , Persona de Mediana Edad , Perú/epidemiología , Atención Primaria de Salud/métodos , Atención Primaria de Salud/tendencias , Derivación y Consulta , Detección de Abuso de Sustancias/métodos
5.
BMJ Open ; 11(6): e044634, 2021 06 03.
Artículo en Inglés | MEDLINE | ID: mdl-34083333

RESUMEN

OBJECTIVE: To explore the perceived reasons underlying high mortality rates among people with multiple and complex needs. DESIGN: Qualitative study using peer research. SETTING: North East of England. PARTICIPANTS: Three focus group discussions were held involving (1) people with lived experience of multiple and complex needs (n=5); (2) front-line staff from health, social care and voluntary organisations that support multiple and complex needs groups (n=7); and (3) managers and commissioners of these organisations (n=9). RESULTS: Findings from this study provide valuable perspectives of people with multiple complex needs and those that provide them with support on what may be perceived factors underlying premature mortality. Mental ill health and substance misuse (often co-occurring dual diagnosis) were perceived as influencing premature mortality among multiple and complex needs groups. Perceptions of opportunities to identify people at risk included critical life events (eg, bereavement, relationship breakdown) and transitions (eg, release from prison, completion of drug treatment). Early prevention, particularly supporting young people experiencing adverse childhood experiences, was also highlighted as a priority. CONCLUSION: High mortality in multiple and complex needs groups may be reduced by addressing dual diagnosis, providing more support at critical life events and investing in early prevention efforts. Future interventions could take into consideration the intricate nature of multiple and complex needs and improve service access and navigation.


Asunto(s)
Salud Mental , Apoyo Social , Adolescente , Diagnóstico Dual (Psiquiatría) , Inglaterra/epidemiología , Humanos , Investigación Cualitativa
6.
Addiction ; 2021 Jun 09.
Artículo en Inglés | MEDLINE | ID: mdl-34109685

RESUMEN

AIMS: To investigate changes in alcohol consumption during the first months of the COVID-19 pandemic in Europe as well as its associations with income and experiences of distress related to the pandemic. DESIGN: Cross-sectional on-line survey conducted between 24 April and 22 July 2020. SETTING: Twenty-one European countries. PARTICIPANTS: A total of 31 964 adults reporting past-year drinking. MEASUREMENTS: Changes in alcohol consumption were measured by asking respondents about changes over the previous month in their drinking frequency, the quantity they consumed and incidence of heavy episodic drinking events. Individual indicators were combined into an aggregated consumption-change score and scaled to a possible range of -1 to +1. Using this score as the outcome, multi-level linear regressions tested changes in overall drinking, taking into account sampling weights and baseline alcohol consumption [Alcohol Use Disorder Identification Test (AUDIT-C)] and country of residence serving as random intercept. Similar models were conducted for each single consumption-change indicator. FINDINGS: The aggregated consumption-change score indicated an average decrease in alcohol consumption of -0.14 [95% confidence interval (CI) = -0.18, -0.10]. Statistically significant decreases in consumption were found in all countries, except Ireland (-0.08, 95% CI = -0.17, 0.01) and the United Kingdom (+0.10, 95% CI = 0.03, 0.17). Decreases in drinking were mainly driven by a reduced frequency of heavy episodic drinking events (-0.17, 95% CI = -0.20, -0.14). Declines in consumption were less marked among those with low- or average incomes and those experiencing distress. CONCLUSIONS: On average, alcohol consumption appears to have declined during the first months of the COVID-19 pandemic in Europe. Both reduced availability of alcohol and increased distress may have affected consumption, although the former seems to have had a greater impact in terms of immediate effects.

7.
Lancet Public Health ; 6(8): e557-e565, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34058125

RESUMEN

BACKGROUND: As a policy option to reduce consumption of alcohol and the harm it does, on May 1, 2018, Scotland introduced a minimum price of 50 British pence (p) per unit of alcohol (8 g) sold; Wales followed suit on March 2, 2020, with the same minimum unit price (MUP). We analysed household purchase data based on bar codes to assess the impact of these policy options in the medium term for Scotland and in the immediate term for Wales. METHODS: For these location-controlled, interrupted time series regression analyses, the data source was Kantar WorldPanel's household shopping panel, which, at the time of our analysis, included 35 242 British households providing detailed information on 1·24 million separate alcohol purchases in 2015-18 and the first half of 2020. With no data exclusions, we analysed the impact of introducing MUP in Scotland, using purchases in northern England as control, and in Wales, using western England as control. The studied changes associated with MUP were price paid per gram of alcohol purchased, grams of alcohol purchased, and amount of money spent on alcohol. FINDINGS: In Scotland, price increases and purchase decreases following the introduction of MUP in 2018 were maintained during the first half of 2020. The difference between Scotland and northern England in 2020 was a price increase of 0·741 p per gram (95% CI 0·724-0·759), a 7·6% increase, and a purchase decrease of 7·063 g per adult per household per day that an alcohol purchase was made (6·656-7·470), a 7·7% decrease. In Wales, the introduction of MUP led to similar results. The difference between Wales and western England was a price increase 0·841 of 0·841 p per gram (0·732-0·951), an 8·2% increase, and a purchase decrease of 7·052 g per adult per household per day that an alcohol purchase was made (6·463-7·640), an 8·6% decrease. For both Scotland and Wales, reductions in overall purchases of alcohol were largely restricted to households that bought the most alcohol. The introduction of MUP was not associated with an increased expenditure on alcohol by households that generally bought small amounts of alcohol and, in particular, those with low incomes. The changes were not affected by the introduction of COVID-19 confinement in the UK on March 26, 2020. INTERPRETATION: The evidence base supporting the positive, targeted impact of MUP is strengthened by the comparable results for Scotland and Wales. The short-term impact of MUP in Scotland during 2018 is maintained during the first half of 2020. MUP is an effective alcohol policy option to reduce off-trade purchases of alcohol and should be widely considered. FUNDING: None.


Asunto(s)
Bebidas Alcohólicas/economía , Comercio/legislación & jurisprudencia , Comercio/estadística & datos numéricos , Política Pública , Consumo de Bebidas Alcohólicas/prevención & control , Humanos , Análisis de Series de Tiempo Interrumpido , Escocia , Gales
8.
Health Sociol Rev ; 30(2): 111-126, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34018913

RESUMEN

Amphetamine Type Stimulants (ATS) are increasingly used drugs globally. There is limited evidence about what shapes ATS use at critical turning points located within drug using pathways. Using turning point theory, as part of a life course approach, the ATTUNE study aimed to understand which social, economic and individual factors shape pathways into and out of ATS use. Qualitative, semi-structured interviews (n = 70) were undertaken with individuals who had used ATS, or had been exposed to them at least once. Our findings show that turning points for initiation were linked to pleasure, curiosity, boredom and declining mental health; increased use was linked to positive effects experienced at initiation and multiple life-stressors, leading to more intense use. Decreased use was prompted by pivotal events and sustained through continued wellbeing, day-to-day structure, and non-using social networks. We argue that the heterogeneity of these individuals challenges stereotypes of stimulant use allied to nightclubs and 'hedonism'. Further, at critical turning points for recovery, the use of services for problematic ATS consumption was low because users prioritised their alcohol or opioid use when seeking help. There is a need to develop service provision, training, and better outreach to individuals who need support at critical turning points.

9.
Subst Abuse Treat Prev Policy ; 16(1): 36, 2021 04 26.
Artículo en Inglés | MEDLINE | ID: mdl-33902668

RESUMEN

BACKGROUND: SARS-CoV-2 reached Europe in early 2020 and disrupted the private and public life of its citizens, with potential implications for substance use. The objective of this study was to describe possible changes in substance use in the first months of the SARS-CoV-2 pandemic in Europe. METHODS: Data were obtained from a cross-sectional online survey of 36,538 adult substance users from 21 European countries conducted between April 24 and July 22 of 2020. Self-perceived changes in substance use were measured by asking respondents whether their use had decreased (slightly or substantially), increased (slightly or substantially), or not changed during the past month. The survey covered alcohol (frequency, quantity, and heavy episodic drinking occasions), tobacco, cannabis, and other illicit drug use. Sample weighted data were descriptively analysed and compared across substances. RESULTS: Across all countries, use of all substances remained unchanged for around half of the respondents, while the remainder reported either a decrease or increase in their substance use. For alcohol use, overall, a larger proportion of respondents indicated a decrease than those reporting an increase. In contrast, more respondents reported increases in their tobacco and cannabis use during the previous month compared to those reporting decreased use. No distinct direction of change was reported for other substance use. CONCLUSIONS: Our findings suggest changes in use of alcohol, tobacco and cannabis during the initial months of the pandemic in several European countries. This study offers initial insights into changes in substance use. Other data sources, such as sales statistics, should be used to corroborate these preliminary findings.


Asunto(s)
COVID-19/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Adulto , Alcoholismo/epidemiología , Estudios Transversales , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Abuso de Marihuana/epidemiología , Persona de Mediana Edad , Pandemias , SARS-CoV-2 , Factores Socioeconómicos , Adulto Joven
10.
Subst Abus ; : 1-9, 2021 Apr 13.
Artículo en Inglés | MEDLINE | ID: mdl-33849396

RESUMEN

Background: Screening for unhealthy alcohol use in routine consultations can aid primary health care (PHC) providers in detecting patients with hazardous or harmful consumption and providing them with appropriate care. As part of larger trial testing strategies to improve implementation of alcohol screening in PHC, this study investigated the motivational (role security, therapeutic commitment, self-efficacy) and organizational context (leadership, work culture, resources, monitoring, community engagement) factors that were associated with the proportion of adult patients screened with AUDIT-C by PHC providers in Colombia, Mexico and Peru. Additionally, the study investigated whether the effect of the factors interacted with implementation strategies and the country. Methods: Pen-and-paper questionnaires were completed by 386 providers at the start of their study participation (79% female, Mage = 39.5, 37.6% doctors, 15.0% nurses, 9.6% psychologists, 37.8% other professional roles). They were allocated to one of four intervention arms: control group; short training only; short training in presence of municipal support; and standard (long) training in presence of municipal support. Providers documented their screening practice during the five-month implementation period. Data were collected between April 2019 and March 2020. Results: Negative binomial regression analysis found an inverse relationship of role security with the proportion of screened patients. Self-efficacy was associated with an increase in the proportion of screened patients only amongst Mexican providers. Support from leadership (formal leader in organization) was the only significant organizational context factor, but only in non-control arms. Conclusion: Higher self-efficacy is a relevant factor in settings where screening practice is already ongoing. Leadership support can enhance effects of implementation strategies.

11.
J Gen Intern Med ; 36(9): 2663-2671, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-33469752

RESUMEN

PURPOSE: We aimed to test the effects of providing municipal support and training to primary health care providers compared to both training alone and to care as usual on the proportion of adult patients having their alcohol consumption measured. METHODS: We undertook a quasi-experimental study reporting on a 5-month implementation period in 58 primary health care centres from municipal areas within Bogotá (Colombia), Mexico City (Mexico), and Lima (Peru). Within the municipal areas, units were randomized to four arms: (1) care as usual (control); (2) training alone; (3) training and municipal support, designed specifically for the study, using a less intensive clinical and training package; and (4) training and municipal support, designed specifically for the study, using a more intense clinical and training package. The primary outcome was the cumulative proportion of consulting adult patients out of the population registered within the centre whose alcohol consumption was measured (coverage). RESULTS: The combination of municipal support and training did not result in higher coverage than training alone (incidence rate ratio (IRR) = 1.0, 95% CI = 0.6 to 0.8). Training alone resulted in higher coverage than no training (IRR = 9.8, 95% CI = 4.1 to 24.7). Coverage did not differ by intensity of the clinical and training package (coefficient = 0.8, 95% CI 0.4 to 1.5). CONCLUSIONS: Training of providers is key to increasing coverage of alcohol measurement amongst primary health care patients. Although municipal support provided no added value, it is too early to conclude this finding, since full implementation was shortened due to COVID-19 restrictions. TRIAL REGISTRATION: Clinical Trials.gov ID: NCT03524599; Registered 15 May 2018; https://clinicaltrials.gov/ct2/show/NCT03524599.


Asunto(s)
Consumo de Bebidas Alcohólicas , Atención Primaria de Salud , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Humanos , América Latina/epidemiología
12.
Prim Health Care Res Dev ; 22: e4, 2021 01 28.
Artículo en Inglés | MEDLINE | ID: mdl-33504413

RESUMEN

BACKGROUND: Providing alcohol screening and brief advice (SBA) in primary health care (PHC) can be an effective measure to reduce alcohol consumption. To aid successful implementation in an upper middle-income country context, this study investigates the perceived appropriateness of the programme and the perceived barriers to its implementation in PHC settings in three Latin American countries: Colombia, Mexico and Peru, as part of larger implementation study (SCALA). METHODS: An online survey based on the Tailored Implementation for Chronic Diseases (TICD) implementation framework was disseminated in the three countries to key stakeholders with experience in the topic and/or setting (both health professionals and other roles, for example regional health administrators and national experts). In total, 55 respondents participated (66% response rate). For responses to both appropriateness and barriers questions, frequencies were computed, and country comparisons were made using Chi square and Kruskal-Wallis non-parametric tests. RESULTS: Alcohol SBA was seen as an appropriate programme to reduce heavy alcohol use in PHC and a range of providers were considered suitable for its delivery, such as general practitioners, nurses, psychologists and social workers. Contextual factors such as patients' normalised perception of their heavy drinking, lack of on-going support for providers, difficulty of accessing referral services and lenient alcohol control laws were the highest rated barriers. Country differences were found for two barriers: Peruvian respondents rated SBA guidelines as less clear than Mexican (Mann-Whitney U = -18.10, P = 0.001), and more strongly indicated lack of available screening instruments than Colombian (Mann-Whitney U = -12.82, P = 0.035) and Mexican respondents (Mann-Whitney U = -13.56, P = 0.018). CONCLUSIONS: The study shows the need to address contextual factors for successful implementation of SBA in practice. General congruence between the countries suggests that similar approaches can be used to encourage widespread implementation of SBA in all three studied countries, with minor tailoring based on the few country-specific barriers.


Asunto(s)
Atención Primaria de Salud , Adolescente , Adulto , Anciano , Colombia , Intervención en la Crisis (Psiquiatría) , Estudios Transversales , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Perú , Adulto Joven
13.
Soc Sci Med ; 270: 113690, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33461035

RESUMEN

BACKGROUND: The introduction of lower strength alcohol products results in less absolute alcohol purchased. This paper estimates the potential impact of price in shifting British household purchases from higher to lower strength beers and ciders. METHODS: Descriptive statistics and controlled interrupted time series analyses using Kantar Worldpanel's British household purchase data from 70,303 households during 2015-2018 and the first half of 2020. FINDINGS: No and low-alcohol products were less likely to be on price promotion than higher strength products. No and low-alcohol beers were cheaper per volume than higher strength beers; the reverse was the case for ciders. With the exception of low strength ciders (which had very few purchases) a higher volume was purchased when the product was on price promotion than when not. Again, with the exception of low strength ciders, the cheaper the cost, the greater the volume of purchase, more so when the product was on price promotion. The introduction of minimum unit price in Scotland (when controlling for changes in Northern England) and in Wales (when controlling for changes in Western England) shifted purchases from higher to lower strength products, more so for ciders than beers. In relative terms, the alcohol by volume of beer dropped by 2% and of cider by 7%. Changes did not differ by household income or the age of the main shopper. INTERPRETATION: There are opportunities for governments and alcohol producers and retailers to facilitate shifts of purchases from higher to lower alcohol strength products. Alcohol producers and retailers can ensure that the price of lower strength products is competitive vis a vis higher strength products. Governments can introduce minimum unit prices for the sale of alcohol, as has been done in Scotland and Wales. FUNDING: No funding was received for this study.


Asunto(s)
Bebidas Alcohólicas , Cerveza , Comercio , Inglaterra , Etanol , Humanos , Análisis de Series de Tiempo Interrumpido , Escocia , Gales
14.
Alcohol Alcohol ; 56(3): 307-316, 2021 Apr 29.
Artículo en Inglés | MEDLINE | ID: mdl-33211796

RESUMEN

AIMS: To investigate if COVID-19 confinement led to excess alcohol purchases by British households. METHODS: We undertake controlled interrupted time series analysis of the impact of COVID-19 confinement introduced on 26 March 2020, using purchase data from Kantar Worldpanel's of 23,833 British households during January to early July 2020, compared with 53,428 British households for the same time period during 2015-2018. RESULTS: Excess purchases due to confinement during 2020 were 178 g of alcohol per 100 households per day (adjusted for numbers of adults in each household) above an expected base of 438 g based on averaged 2015-2018 data, representing a 40.6% increase. However, when adjusting for expected normal purchases from on-licenced premises (i.e. bars, restaurants, etc.), there was evidence for no excess purchases of grams of alcohol (a 0.7% increase). With these adjustments, beer purchases dropped by 40%, wine purchases increased by 15% and spirits purchases by 22%. Excess purchases increased the richer the household and the lower the age of the main shopper. Confinement was associated with a shift in purchases from lower to higher strength beers. CONCLUSION: During the COVID-19 confinement, the evidence suggests that households did not buy more alcohol for the expected time of the year, when adjusting for what they normally would have purchased from on-licenced premises.


Asunto(s)
Bebidas Alcohólicas , COVID-19 , Comportamiento del Consumidor/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Anciano , Cerveza , Control de Enfermedades Transmisibles , Femenino , Humanos , Renta/estadística & datos numéricos , Análisis de Series de Tiempo Interrumpido , Masculino , Persona de Mediana Edad , Política Pública , Restaurantes , SARS-CoV-2 , Clase Social , Reino Unido , Vino , Adulto Joven
15.
BMJ Open ; 10(10): e036371, 2020 10 12.
Artículo en Inglés | MEDLINE | ID: mdl-33046462

RESUMEN

OBJECTIVE: To assess the impact of new low and no alcohol beers and reformulated beers in Great Britain on household purchases of grams of alcohol. DESIGN: Interrupted time series analysis. SETTING: Purchase data from Kantar Worldpanel's household shopping panel for 2015-2018. PARTICIPANTS: 64 286 British households. INTERVENTIONS: Introduction of new no and low alcohol beers during 2017-2018 and reformulation of existing beers to contain less alcohol during 2018. MAIN OUTCOME MEASURES: Average alcoholic strength of beer and number of grams of alcohol purchased by households. RESULTS: As assessed by British household purchase data, 46 new low and no alcohol beer products were introduced during 2015-2018, with a step-jump in volume purchased occurring at the beginning of March 2017 (event 1). During 2015-2018, 33 beer products were reformulated to contain less alcohol, with a step-jump in volume purchased occurring during mid-March 2018 (event 2). Interrupted time series analyses found a combined associated impact of both events with relative reductions of alcohol by volume of beer between 1.2% and 2.3%; purchases of grams of alcohol within beer between 7.1% and 10.2%; and purchases of grams of alcohol as a whole between 2.6% and 3.9%. The reductions were greater for reformulation than for the introduction of new low and no alcohol products. Reductions were independently higher for younger age groups of shoppers and for households that bought the most alcohol. CONCLUSIONS: Even though the events were associated with significant beneficial changes, the volume of purchases of new low and no alcohol beer products (2.6% of the volume of all beers purchased during 2018) and of new reformulated beer products (6.9% of the volume of all beers purchased during 2018) was very small. This indicates that there are future opportunities to increase the volume of such products so as to reduce the harm done by alcohol.


Asunto(s)
Cerveza , Comportamiento del Consumidor , Composición Familiar , Humanos , Análisis de Series de Tiempo Interrumpido , Reino Unido
17.
BMC Fam Pract ; 21(1): 68, 2020 04 22.
Artículo en Inglés | MEDLINE | ID: mdl-32321440

RESUMEN

BACKGROUND: Despite evidence supporting the effectiveness of alcohol screening and brief advice to reduce heavy drinking, implementation in primary healthcare remains limited. The challenges that clinicians experience when delivering such interventions are well-known, but we have little understanding of the patient perspective. We used Normalization Process Theory (NPT) informed interviews to explore patients' views on alcohol screening and brief advice in routine primary healthcare. METHODS: Semi-structured qualitative interviews with 22 primary care patients who had been screened for heavy drinking and/or received brief alcohol advice were analysed thematically, informed by Normalisation Process Theory constructs (coherence, cognitive participation, collective action, reflexive monitoring). RESULTS: We found mixed understanding of the adverse health consequences of heavy drinking, particularly longer-term risks. There was some awareness of current alcohol guidelines but these were viewed flexibly, depending on the individual drinker and drinking context. Most described alcohol screening as routine, with clinicians viewed as trustworthy and objective. Patients enacted a range of self-regulatory techniques to limit their drinking but perceived such strategies as learned through experience rather than based on clinical advice. However, most saw alcohol advice as a valuable component of preventative healthcare, especially those experiencing co-occurring health conditions. CONCLUSIONS: Despite strong acceptance of the screening role played by primary care clinicians, patients have less confidence in the effectiveness of alcohol advice. Primary care-based alcohol brief advice needs to reflect how individuals actually drink, and harness strategies that patients already commonly employ, such as self-regulation, to boost its relevance.


Asunto(s)
Consumo de Bebidas Alcohólicas , Alcoholismo/diagnóstico , Actitud Frente a la Salud , Educación del Paciente como Asunto , Atención Primaria de Salud , Adulto , Anciano , Consumo de Bebidas Alcohólicas/efectos adversos , Alcoholismo/complicaciones , Alcoholismo/prevención & control , Consejo , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Investigación Cualitativa
18.
BMC Public Health ; 20(1): 283, 2020 Mar 04.
Artículo en Inglés | MEDLINE | ID: mdl-32131793

RESUMEN

BACKGROUND: This study evaluated and compared the extent, duration, contents, experiences and effects of alcohol conversations in healthcare in the Netherlands and Sweden in 2017. METHODS: Survey data in the Netherlands and Sweden were collected through an online web panel. Subjects were 2996 participants (response rate: 50.8%) in Sweden and 2173 (response rate: 82.2%) in the Netherlands. Data was collected on socio-demographics, alcohol consumption, healthcare visits in the past 12 months, number of alcohol conversations, and characteristics of alcohol conversations (duration, contents, experience, effects). RESULTS: Results showed that Swedish respondents were more likely to have had alcohol conversations (OR = 1.99; 95%CI = 1.64-2.41; p = < 0.001) compared to Dutch respondents. In Sweden, alcohol conversations were more often perceived as routine (p = < 0.001), were longer (p = < 0.001), and more often contained verbal information about alcohol's health effects (p = 0.007) or written information (p = 0.001) than in the Netherlands. In Sweden, 40+ year-olds were less likely to report a positive effect compared to the youngest respondents. In the Netherlands, men, sick-listed respondents, and risky drinkers, and in Sweden those that reported "other" occupational status such as parental leave, were more likely to have had alcohol conversations. CONCLUSIONS: The results suggest that alcohol conversations are more common in healthcare practice in Sweden than in the Netherlands. However, positive effects of alcohol conversations were less likely to be reported among older respondents in Sweden. Our results indicate that alcohol preventative work should be improved in both countries, with more focus on risky drinkers and the content of the conversations in Sweden, and expanding alcohol screening in the Netherlands.


Asunto(s)
Consumo de Bebidas Alcohólicas/prevención & control , Comunicación , Atención a la Salud/estadística & datos numéricos , Personal de Salud/psicología , Relaciones Profesional-Paciente , Adolescente , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Estudios Transversales , Femenino , Encuestas de Atención de la Salud , Personal de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Suecia/epidemiología , Adulto Joven
20.
Artículo en Inglés | MEDLINE | ID: mdl-31938551

RESUMEN

Background: Identifying and addressing heavy drinking represents a major public health priority worldwide. Whilst the majority of alcohol screening and brief intervention (ASBI) research has been conducted in western, high-income countries, evidence is growing that ASBI can also impact positively on heavy drinkers in low- and middle-income country populations. This mixed methods study aims to assess the feasibility of conducting a fully randomised controlled trial of the effectiveness of ASBI in primary care in Kazakhstan and explore the feasibility and acceptability of implementing ASBI in this setting from patients' and physicians' perspectives. Methods: Six primary health care units in the region of Pavlodar will be cluster randomised to either an intervention (WHO manualised 5 min alcohol brief intervention plus alcohol leaflet) or control group (simple feedback plus alcohol leaflet). Primary feasibility measures will be rates of participation at baseline and retention of eligible patients at the 3-month follow-up point. Patient/physician questionnaires and physician focus groups will assess additional dimensions of feasibility, as well as acceptability, according to the RE-AIM framework: Reach (rates of eligible patients screened/received advice); Effectiveness (change in AUDIT-C score); Adoption (rate/representativeness of participating physicians); Implementation (quality of ASBI/barriers and facilitators to delivery); and Maintenance (potential sustainability of intervention). Discussion: This is the first trial of the feasibility and acceptability of ASBI in Kazakhstan. As the planning and assessment of implementation determinants is based on the RE-AIM framework, the project outcomes will be relevant for the future development, tailoring and implementation of ASBI in Kazakhstan. Trial registration: DRKS, DRKS00015882, Registered 17 December 2018.

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