Solitary drinkers in Great Britain: How do their sociodemographic characteristics, consumption patterns, and drinking occasions differ from those who drink with others?

OBJECTIVE: Inequalities in alcohol-related harm may arise partly from differences in drinking practices between population groups. One under-researched practice associated with harm is consuming alcohol alone. We identify sociodemographic characteristics associated with drinking alone and the occasion-level characteristics associated with occasions when people drink alone. METHOD: A cross-sectional analysis of one-week drinking diaries collected between 2015 and 2019 was conducted using event-level data on 271,738 drinking occasions reported by 83,952 adult drinkers in Great Britain. Our two dependent variables were a binary indicator of reporting at least one solitary drinking occasion in the diary-week at the individual-level and a binary indicator of drinking alone at the occasion-level (event-level). RESULTS: Individual-level characteristics associated with solitary drinking were being a man (OR 1.88, 95%CI [1.80,1.96]), aged over 50 (OR 2.60, 95%CI [2.40,2.81]), not in a relationship (OR 3.39, 95%CI [3.20, 3.59]), living alone (OR 2.51, 95%CI [2.37, 2.66]), and a high-risk drinker (OR 1.54, 95%CI [1.52,1.59]). Occasion-level characteristics associated with solitary drinking were that they were more likely to occur in the off-trade (OR 3.08, 95%CI [2.95,3.21]), Monday-Thursday (OR 1.36, 95%CI [1.27,1.47]), and after 10pm (OR 1.36, 95%CI [1.27,1.47]) controlling for geographic region and the month the interview took place. CONCLUSIONS: Characteristics of solitary drinking largely align with characteristics we associated with drinking problems. Those who partake in at least one solitary drinking occasion are overall more likely to consume alcohol at risky levels, however, the number of drinks consumed in each occasion was lower during a solitary drinking occasion.

How is alcohol consumption and heavy episodic drinking spread across different types of drinking occasion in Great Britain: An event-level latent class analysis.

BACKGROUND: This paper aimed to (i) update a previous typology of British alcohol drinking occasions using a more recent and expanded dataset and revised modelling procedure, and (ii) estimate the average consumption level, prevalence of heavy drinking, and distribution of all alcohol consumption and heavy drinking within and across occasion types. METHODS: The paper uses a cross-sectional latent class analysis of event-level diary data that includes characteristics of 43,089 drinking occasions in 2019 reported by 17,821 adult drinkers in Great Britain. The latent class indicators are characteristics of off-trade only (e.g. home), on-trade only (e.g. bar) and mixed trade (e.g. home and bar) drinking occasions. These describe companions, locations, purpose, motivation, accompanying activities, timings, consumption volume in units (1 UK unit = 8g ethanol) and beverages consumed. RESULTS: The analysis identified four off-trade only, eight on-trade only and three mixed-trade occasion types (i.e. latent classes). Mean consumption per occasion varied between 4.4 units in Family meals to 17.7 units in Big nights out with pre-loading. It exceeded ten units in all mixed-trade occasion types and in Off-trade get togethers, Big nights out and Male friends at the pub. Three off-trade types accounted for 50.8% of all alcohol consumed and 51.8% of heavy drinking occasions: Quiet drink at home alone, Evening at home with partner and Off-trade get togethers. For thirteen out of fifteen occasion types, more than 25% of occasions involved heavy drinking. Conversely, 41.7% of Big nights out and 16.4% of Big nights out with preloading were not heavy drinking occasions. CONCLUSIONS: Alcohol consumption varies substantially across and within fifteen types of drinking occasion in Great Britain. Heavy drinking is common in most occasion types. However, moderate drinking is also common in occasion types often characterised as heavy drinking practices. Mixed-trade drinking occasions are particularly likely to involve heavy drinking.

Change and stability in British drinking practices and culture between 2009 and 2019: A longitudinal latent class analysis of drinking occasions.

Rationale: Theories of practice can support understanding of health-related behaviours, but few studies use quantitative methods to understand time-trends in practices. This paper describes changes in the prevalence and performance of alcohol drinking practices in Great Britain between 2009 and 2019. Methods: Latent class analyses of annual cross-sectional data collected between 2009 and 2019. The dataset come from a one-week retrospective diary survey of adults resident in Great Britain. It contains 604,578 drinking occasions reported by 213,470 adults (18+) who consumed alcohol in the diary-week. The measures describe occasion characteristics including companions, location, motivation, timings, accompanying activities and alcohol consumed. We estimate separate latent class models for each year and for off-trade only (e.g. home), on-trade only (e.g. bar) and mixed-trade occasions. Results: We identified fifteen practices; four off-trade only, eight on-trade only and three mixed-trade. The prevalence of practices was largely stable over time except for shifts away from drinking with a partner and towards drinking alone in the off-trade, and shifts away from Big nights out and towards other forms of heavy drinking in the on-trade. We identified five key trends in the performance of practices: (i) spirits increasingly replaced wine as the main beverage consumed in occasions; (ii) home-drinking moved away from routinised wine-drinking with meals on weekdays and towards spirits-drinking on weekends; (iii) the Male friends at the pub practice changed less than other pub-drinking practices; (iv) Big nights out started later, often in nightclubs, and involved less pub-drinking or heavy drinking and (v) the meal-based and Going out with partner practice formats showed few changes over time. Conclusion: Key recent trends in British drinking practices include a decline in routinised wine-drinking at home, a transformation of big nights out and a mixture of stability and change in pub- and meal-based practices.

Relationship Between Standardized Measures of Chronic Kidney Disease-associated Pruritus Intensity and Health-related Quality of Life Measured with the EQ-5D Questionnaire: A Mapping Study.

Chronic kidney disease-associated pruritus is linked with decreased health-related quality of life assessed using disease-specific instruments. The extent to which worsening pruritus reduces generic quality of life assessed using the EQ-5D instrument is unknown. Prevalent kidney failure patients receiving in-centre haemodialysis from 5 centres completed the EQ-5D-5L quality of life measure, worst Itching Intensity Numerical Rating Scale and 5-D itch pruritus instruments. Latent class models were used to identify clusters of patients with similarly affected body parts, and mixture models were used to map the pruritus measures to the EQ-5D. Data on 487 respondents were obtained. Latent class analysis identified 3 groups of patients who had progressively worsening severity and an increasing number of body parts affected. Although the worst itching intensity numerical rating scale and 5-D itch instruments correlated with each other, only the latter had a strong relationship with EQ-5D. When controlling for age, sex, diabetes and years receiving dialysis, the meanpredicted EQ-5D utility (1: perfect health, 0: dead) decreased progressively from 0.69 to 0.41. These findings suggest that pruritus instruments that include domains capturing how the individual is physically, mentally and socially affected by their pruritus, in addition to severity, more closely approximate the EQ-5D generic quality of life measure.

Situated drinking: The association between eating and alcohol consumption in Great Britain.

Aims: This paper examines the co-occurrence of drinking alcohol and eating in Great Britain. Applying a practice-theoretical framework, it attends primarily to the nature and characteristics of events - to social situations. It asks whether drinking events involving food are significantly different from those without, whether differences are the same at home as on commercial public premises, and whether differences are the same for men and women. The focus is especially on episodes of drinking with meals at home, an infrequently explored context for a substantial proportion of contemporary alcohol consumption. Data: Employing a secondary analysis of commercial data about the British population in 2016, we examine reports of 47,645 drinking events, on commercial premises and at other locations, to explore how eating food and consumption of alcoholic beverages affect one another. Three types of event are compared - drinking with meals, with snacks, and without any food. Variables describing situations include group size and composition, temporal and spatial parameters, beverages, purposes, and simultaneous activities. Basic sociodemographic characteristics of respondents are also examined, with a special focus on the effects of gender. Results: Behaviours differ between settings. The presence of food at a drinking episode is associated with different patterns of participation, orientations, and quantities and types of beverage consumed. Gender, age, and class differences are apparent. Conclusions: Patterns of alcohol consumption are significantly affected by the accompaniment of food. This is a much-neglected topic that would benefit from further comparative and time series studies to determine the consequences for behaviour and intervention.

Cost Effectiveness of Difelikefalin Compared to Standard Care for Treating Chronic Kidney Disease Associated Pruritus (CKD-aP) in People with Kidney Failure Receiving Haemodialysis.

BACKGROUND: Chronic kidney disease-associated pruritus (CKD-aP) is associated with an increased risk of depression, poor sleep and reduced health-related quality of life. Two phase III studies (KALM-1 and KALM-2) of difelikefalin showed reduced CKD-aP severity and improved itch-related health-related quality of life in patients with moderate and severe CKD-aP receiving haemodialysis for kidney failure. OBJECTIVE: We aimed to estimate the cost effectiveness of difelikefalin for patients with CKD-aP receiving haemodialysis for kidney failure compared to standard care from a UK National Health Service perspective. METHODS: A cohort model was developed with four health states representing levels of pruritus intensity over time, based on the KALM trials augmented with longer term CKD-aP severity data from another haemodialysis trial (SHAREHD) for standard care. Utilities were estimated from a mapping study of 5-D Itch to EQ-5D-5L in 487 patients receiving haemodialysis, costs were estimated based on resource use alongside the SHAREHD and 2018 unit costs, and inflated to 2021 costs. Costs and quality-adjusted life-years were discounted at 3.5% per annum. A de novo economic model was developed in Microsoft Excel with scenario analyses performed using a range of assumptions. RESULTS: In the base-case analysis over a time horizon of 64 weeks, using a placeholder cost of £75 per 28-days for difelikefalin, the incremental cost-effectiveness ratio of difelikefalin compared with standard care was £19,558/quality-adjusted life-year (QALY). Scenario analyses resulted in incremental cost-effectiveness ratios that ranged from £10,154/QALY (severe only) to £16,957/QALY (5-year horizon) for difelikefalin compared to standard care. Probabilistic sensitivity analyses suggested difelikefalin has a 48.6% probability of being cost effective at a threshold of £20,000/QALY and a 57.2% probability of being cost effective at a threshold of £30,000/QALY. CONCLUSIONS: The cost effectiveness of difelikefalin in a range of scenarios could make it an important pharmacotherapy to address the high burden of disease and unmet need for treatments associated with CKD-aP in the UK.

A model-based economic analysis of the CFHealthHub intervention to support adherence to inhaled medications for people with cystic fibrosis in the UK.

BACKGROUND: Adherence to preventative inhaled therapies in people with cystic fibrosis (CF) is low, resulting in potentially avoidable health losses and the need for costly rescue therapies. OBJECTIVES: To estimate the cost-effectiveness of the CFHealthHub (CFHH) intervention to support adherence to inhaled medications. METHODS: A state transition model was developed to assess the cost-effectiveness of the CFHH intervention versus usual care from the perspective of the UK National Health Service and Personal Social Services over a lifetime horizon. Costs and health outcomes were discounted at a rate of 3.5 percent per annum. Costs were valued at 2021/22 prices. The model structure includes health states defined by survival status, level of lung function, and transplant history. Treatment effects were modeled by changing the probabilities of transitioning between lung function states and reducing exacerbation rates. Model parameters were informed by the CFHH trial, CF Registry data, routine cost databases, literature, and expert opinion. Deterministic and probabilistic sensitivity analyses were undertaken to assess uncertainty. RESULTS: The CFHH intervention is expected to generate additional health gains and cost savings compared with usual care. Assuming that it is delivered for 10 years, the CFHH intervention is expected to generate 0.17 additional quality-adjusted life years and cost savings of GBP 1,600 (EUR 1,662) per patient. CONCLUSIONS: The CFHH intervention is expected to dominate usual care, irrespective of the duration over which the intervention is delivered. The modeled benefits and cost savings are smaller than initially expected and are sensitive to relative treatment effects on lung function.

Understanding changes in the locations of drinking occasions in Great Britain: An age-period-cohort analysis of repeat cross-sectional market research data, 2001-2019.

INTRODUCTION: The 21st century has seen wide-ranging changes in drinking locations in Great Britain, with on-trade alcohol sales decreasing and off-trade sales increasing. To better understand the underlying time-trends in consumer behaviour, we examine age-period-cohort (APC) effects related to changes in the share of individuals' drinking occasions taking place in: (i) on-trade versus off-trade locations; and (ii) specific on-trade or off-trade locations, that is traditional/community pubs, modern pubs/bars/café bars, nightclubs/late-night venues, restaurants/pub restaurants, social/working men's clubs, golf/other sports clubs/venues, at home (social setting) and at home (non-social setting). METHODS: Repeat cross-sectional 1-week drinking diary data, collected 2001-2019. APC analysis via negative binomial regression models for each gender (N = 162,296 men, 138,452 women). RESULTS: A smaller/declining proportion of occasions took place in on-trade compared to off-trade locations. Recent cohorts tended to have a larger share of on-trade occasions than previous cohorts, driven by their larger share of occasions in modern pubs/bars/café bars and nightclubs/late-night venues. Meanwhile, occasions in social/working men's clubs, golf/other sports clubs/venues and traditional/community pubs tended to be popular among older men, but have declined. Finally, the growth of off-trade drinking appears to be driven by a growth of off-trade drinking in non-social settings, in particular by older people/cohorts. DISCUSSION AND CONCLUSION: Our findings highlight the declining prominence of certain on-trade locations, and increasing prominence of home drinking in non-social settings, within British drinking practices. While rising non-social home drinking is concerning, it is positive from a public health perspective that it does not appear to be shared by recent cohorts.

Strategies to cut down drinking, alcohol consumption, and usual drinking frequency: Evidence from a British online market research survey.

BACKGROUND: Relatively little is known about how risky drinkers attempt to moderate their drinking in the absence of specialist support. The broader literature has identified multiple potential strategies that people use to cope with temptation when trying to control health-risk behaviours. This study aims to identify types of alcohol moderation strategies used by British adults, and to explore how concurrent alcohol consumption differs across moderation strategies, focusing on the important role of usual drinking frequency. METHODS: We use a continuous repeat cross-sectional survey and one-week drinking diary collected by the market research company Kantar; these provide detailed information on alcohol consumption during a diary week and on how individuals try to moderate alcohol use for 49,204 British adults trying to reduce their drinking from 2013 to 2019. We use Latent Class Analysis (LCA) to identify predominant types of moderation strategies. With a three-step method, we also analyse the associations between adopting different moderation strategies, measures of frequency and intensity of drinking events, and usual drinking frequency. RESULTS: We found evidence of four alcohol moderation strategies: 29% of individuals use a pre-commitment-focused strategy (having fewer drinking occasions), two set of individuals adopt self-control strategies within drinking occasions (specifically 28% select smaller drinks and 5% have fewer drinks), while 38% adopt a mixed strategy that involves all three. Those using commitment tend to have a higher average consumption per drinking occasion but lower overall weekly consumption compared to those using self-control. Weekly alcohol consumption is particularly high among individuals who are usual everyday drinkers and use self-control to cut down drinking. CONCLUSION: This analysis provides a useful platform for further work, using prospective or intervention designs, to test the relative effectiveness of different moderation strategies for alcohol consumers who want to reduce their alcohol consumption.

The impact of changes in COVID-19 lockdown restrictions on alcohol consumption and drinking occasion characteristics in Scotland and England in 2020: an interrupted time-series analysis.

BACKGROUND AND AIMS: Early evidence suggests that COVID-19 lockdown restrictions affect alcohol consumption. However, existing studies lack data on how drinking practices changed as restrictions disrupted people's work, family life and socializing routines. We examined changes in consumption and drinking occasion characteristics during three periods of changing restrictions in Scotland/England. DESIGN: Interrupted time-series analysis of repeat cross-sectional market research data (assessing step-level changes). SETTING: Scotland/England, January 2009-December 2020. PARTICIPANTS: Scotland: 41 507 adult drinkers; England: 253 148 adult drinkers. MEASUREMENTS: Three intervention points: March 2020 lockdown, July 2020 easing of restrictions and October 2020 re-introduction of some restrictions. PRIMARY OUTCOME: mean units consumed per week (total/off-trade/on-trade; 1 unit = 8 g ethanol). SECONDARY OUTCOMES: drinking > 14 units per week, heavy drinking, drinking days per week, solitary drinking, drinking with family/partners, drinking with friends/colleagues, own-home drinking, drinking in someone else's home and drinking start times. FINDINGS: In Scotland, March 2020's lockdown was associated with a 2.32 [95% confidence interval (CI) = 0.61, 4.02] increase in off-trade (i.e. shop-bought) units per week, a -2.84 (95% CI = -3.63, -2.06) decrease in on-trade (i.e. licensed venues) units per week, but no statistically significant change in total units per week. July 2020's easing of restrictions was associated with a 1.33 (95% CI = 0.05, 2.62) increase in on-trade units per week, but no statistically significant total/off-trade consumption changes. October 2020's re-introduction of some restrictions was not associated with statistically significant consumption changes. Results for England were broadly similar. Lockdown restrictions were also associated with later drinking start times, fewer occasions in someone else's home and with friends/colleagues, more own-home drinking and (in Scotland only) more solitary drinking. CONCLUSIONS: Reductions in on-trade alcohol consumption following COVID-19 lockdown restrictions in Scotland/England in 2020 were mainly offset by increased own-home drinking. This largely persisted in periods of greater/lesser restrictions. The shift towards off-trade drinking involved significant changes in the characteristics of drinking occasions.

What Proportion of On-Trade Alcohol Is Served to Those Who Are Already Potentially Intoxicated? An Analysis of Event-Level Data.

OBJECTIVE: Overservice (i.e., venues serving alcohol to intoxicated drinkers) is a major contributor to alcohol-related harm. This article estimates the proportion of all alcohol sold in on-trade premises in Great Britain that is drunk by people likely to already be intoxicated. Secondary analyses explore variations by age and gender and from 2009 to 2017. METHOD: We used cross-sectional data from 1-week drinking diaries collected continuously from 2009 to 2017 via a nationally representative stratified quota sample of 90,968 adults resident in Britain who consumed alcohol in the on-trade across 139,938 occasions. We first identify the amount of pure alcohol consumed in occasions after individuals reach each of three consumption thresholds indicating potential intoxication: at least increasing risk (>48/64 g for women/men), at least high risk (>96/128 g), and very high risk (>144/192 g). We then calculate the proportion of all alcohol consumed in the on-trade each year that is accounted for by consumption beyond these thresholds. RESULTS: In 2017, of all on-trade alcohol consumed, an estimated 43.3% was drunk by those who had already drunk to increasing risk levels, 20.5% by those who had already drunk to high risk levels, and 10.1% by those who had already drunk to very high risk levels. Greater proportions of the alcohol consumed by women and younger people was consumed beyond these levels, but the proportion did not change substantially from 2009 to 2017. CONCLUSIONS: Depending on the consumption threshold used, potentially intoxicated drinkers consume between 10% and 43% of pure alcohol drunk in on-trade venues in Great Britain, suggesting that overservice is commonplace.