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Violent injury varies widely across England and Wales as does the price of alcohol. While the links between alcohol consumption and violence are well established in the medical and epidemiological literature, a causal link is questionable. This paper cuts through the causative argument by reporting a link between the general price of alcohol and violence-related injury across the economic regions of England and Wales. It examines the influence of the real price of alcohol and identifies an 'April effect' that coincides with the annual uprating of alcohol prices for excise duties, on violence-related injuries recorded at Emergency Department attendance. The data are monthly frequency of violent injury rates covering the period 2005-2014 across the economic regions. The principal finding is that a one-way relationship between the real price of alcohol and violent injury is established, and tax policy can be used to reduce the incidence of violent injury and the associated health costs., (© 2023. The Author(s).)

This paper explores the genesis of D.L. Davie's 1962 paper on 'Normal drinking in recovered alcohol addicts' in terms of the background and training of its author and the institutional context within which he worked. Davies was born in 1911 and died in 1982. Alter a brilliant undergraduate medical career and war service in command of a military hospital, Davies joined the staff of the Maudsley Hospital in 1946 and was exposed to the intellectual influence of Aubrey Lewis. The research tradition to which he was introduced emphasised case description. The 1962 paper radically challenged perceived wisdom by purporting to describe 7 'alcohol addicts' who had achieved sustained, controlled drinking over a 7-11 year period. A subsequent follow-up of these cases suggested that Davies had been substantially mislead, and the paradox exists that a widely influential paper which did much to stimulate new thinking was based on faulty data. Some possible explanations for the occurrence of such a scientific accident are considered and the relevance of this story for the present day.

This study details trends in direct alcohol biomarker concentrations from civil cases within the United Kingdom (UK). Our subject cohort in this study related to family law litigation, where an individual was subject to an alcohol monitoring order by the court. This monitoring was conducted by quantification of alcohol biomarkers Phosphatidlyethanol (PEth) in dried blood spots (DBS) and Ethyl Glucuronide (EtG) and Ethyl Palmitate (EtPa) from hair segments. In total 298 PEth cases predominantly from the South East of England during the period July 2022 to August 2023 were analysed for alcohol biomarkers in DBS and hair. Subjects alcohol intake was classified as abstinence/low alcohol consumption, moderate or excessive alcohol consumption, based on a combination of Society for Hair Testing and PEth Net guidelines. Our results indicate that 33 % of PEth concentrations were consistent with excessive alcohol use (>200 ng/mL DBS), with 36 % consistent with social or moderate alcohol use (20-200 ng/mL DBS). In relation to EtG and EtPa 23 % and 31 % of subjects were classified as excessive alcohol users respectively. This study indicates that DBS sampling of PEth is a more sensitive predictor of alcohol use, in particular, at differentiating between moderate and excessive alcohol use compared to EtG and EtPa testing in hair. The authors suggest that increased frequency in the sampling of PEth in DBS (multiple occasions per month) may provide a more accurate assessment and simplification of the interpretation criteria of alcohol patterns rather than the combined hair testing and DBS sampling that are typically requested by UK courts., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: The current paper examines the proportion of drinking occasions and total alcohol consumed that takes place at off-premise locations. Comparisons are made between high-income countries: Australia, New Zealand, England and Scotland, and across drinker-types: high-risk and lower-risk., Methods: Data were taken from the International Alcohol Control study in Australia (N = 1789), New Zealand (N = 1979), England (N = 2844) and Scotland (N = 1864). The cross-national survey measures location and beverage-specific alcohol consumption. The number of drinking occasions and mean consumption across on- and off-premise locations and the proportion of drinking occasions that high- and lower-risk drinkers had at on- and off-premise locations was estimated for each country., Results: The majority of drinking occasions among high-risk drinkers occurred at off-premise locations across all four countries; Australia 80.1%, New Zealand 72.0%, England 61.7% and Scotland 60.7%. High-risk drinkers in Australia had significantly larger proportions of drinking occasions occurring at off-premise locations compared to England and Scotland. Across all countries, high-risk drinkers and lower-risk drinkers consumed significantly larger quantities of alcohol per occasion at off-premise locations compared to on-premises locations. Finally, the majority of total alcohol consumed occurred at off-premise locations across all countries for high- and lower-risk drinkers., Discussion and Conclusions: As the accessibility to alcohol outside of licensed premises continues to increase, particularly with the expansion of home delivery services, it is important to be mindful of the high proportion of heavy drinking occasions that occur off-premise., (© 2024 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

In this paper we explore the importance of relationality and care for understanding women's alcohol use, using a theoretical framework comprising concepts from feminist ethics of care, the sociology of personal life, and feminist approaches to governmentality. A key focus is how care giving responsibilities and expectations in families appear to be particularly significant for creating or constraining possibilities for drinking practices. We draw on findings from a qualitative study about alcohol use and stress with 26 women, aged 24-67 years, in the North East of England, UK. We consider how care practices in families feature in the accounts of alcohol use by women with and without children, and how the symbolic and material aspects of social class interact with care to alter the drinking practices women engage in. The interpretation extends scholarship on women's drinking, by adopting a relational approach to identity and linking private care practices and alcohol use to social and political structures. Public health approaches for preventing or reducing heavy drinking practices are predominantly situated within biomedical or psychological paradigms. Intervention approaches to reduce women's drinking that draw on our theoretical framework could offer potential for reducing harmful alcohol use in a more meaningful way. [ABSTRACT FROM AUTHOR]

Background: Youth alcohol consumption has fallen markedly over the last twenty years in England. This paper explores the drivers of the decline from the perspectives of young people. Methods: The study used two methods in a convergent triangulation design. We undertook 38 individual or group qualitative interviews with 96 participants in various educational contexts in England. An online survey of 547 young people in England, was also conducted. Participants were aged between 12–19 years. For both data sources, participants were asked why they thought youth alcohol drinking might be in decline. Analysis of interview data was both deductive and inductive, guided by a thematic approach. Content analysis of survey responses further refined these themes and indicated their prevalence within a larger sample. Results: The research identified eight key themes that young people used to explain the decline in youth drinking: The potential for alcohol-related harm; Contemporary youth cultures and places of socialisation; The affordability of alcohol; Displacement of alcohol by other substances; Access and the regulatory environment; Disputing the decline; Future Orientations; and Parenting and the home environment. Heterogeneity in the experiences and perspectives of different groups of young people was evident, particularly in relation to age, gender, and socio-economic position. Conclusions: Young people's explanations for the decline in youth drinking in England aligned well with those generated by researchers and commentators in prior literature. Our findings suggest that changing practices of socialisation, decreased alcohol affordability and changed attitudes toward risk and self-governance may be key explanations. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to offer a viewpoint on the impact that the COVID-19 pandemic has had on people's engagement with an online alcohol service in the UK. This paper examines whether self-reported mental health concerns increased during the pandemic compared to pre-pandemic times. Design/methodology/approach: A comparison was made between service data captured in one contract area – West Sussex, England – pre-pandemic (April 2019 to March 2020) and during pandemic (April 2020 to March 2021). Findings: Self-reported mental health treatment needs increased during the pandemic period (71.2% of presentations compared to 50% pre-pandemic) via the online coaching service. Male referrals increased by 74% during the pandemic period compared to the previous year. Female referrals decreased by 4% in the same time period. Feelings of shame and guilt as well as loss of a confidential space to engage in online interventions were common concerns reported by service users. Research limitations/implications: Research limitations include the relatively small sample size, the sample comprised of self-referred treatment seeking clients, and there was no control group. All data collected is self-report therefore subjective and not necessarily meeting diagnostic criteria. Practical implications: Of note was the impact of the pandemic on women and their reduced access to the online service during the pandemic. Commissioners and services must adapt their service design and delivery alongside the new "normal" way of living and working. Routine screening of mental health and alcohol use are recommended. Originality/value: This paper offers insight from an established online/digital service and the impact of the pandemic on people's engagement with the service. [ABSTRACT FROM AUTHOR]

How did cultural consumption change during the Covid-19 pandemic? Whilst the impact of the pandemic on cultural production has been given significant attention, work on consumption has seen less attention. This paper addresses this gap in the literature by presenting a comparative analysis of two, nationally representative, surveys of cultural activity in England. The analysis demonstrates that, when cultural consumption moved online and to digital modes of delivery and engagement as a result of the pandemic, there was no discernible transformation in the stratification of cultural participation in England. The majority of the population, characterised by the absence of participation in formal, and often state-funded, cultural forms, saw no change to their patterns of engagement. Where cultural consumption did increase, this was among the small minority of people who were already highly engaged. This minority maps closely onto pre-existing inequalities identified by existing research on cultural consumption, in England and beyond. For cultural consumption and the stratification of taste, it seems that the 'new normal' of pandemic life was much like the 'old normal' of an art and cultural audience characterised by significant inequality. [ABSTRACT FROM AUTHOR]

Developing a deep and contextualised understanding of risk is important for public health responses to young people's alcohol consumption, which is frequently positioned as an outcome of risky behaviour. This paper expands conceptualisations of risk to encompass its wider social and cultural context through a social practice exploration of young people's controlled and managed intoxicated alcohol consumption practice. We report data from a fourteen-month qualitative study of the alcohol consumption practices of 23 young people in England, drawing on group interviews and social media interactions. Our findings provide a nuanced understanding of risk-taking, demonstrating that risk is an important aspect of the ongoing participation and performance in alcohol consumption practice and that health information and advice can be and was frequently incorporated into drinking practice without contributing to fundamental change. This raises new questions about the effectiveness of health interventions that focus on the individual, discussed in the final section of the paper. [ABSTRACT FROM AUTHOR]

Background: There are likely to be differences in alcohol consumption levels and patterns across local areas within a country, yet survey data is often collected at the national or sub-national/regional level and is not representative for small geographic areas. Methods: This paper presents a method for reweighting national survey data—the Health Survey for England—by combining survey and routine data to produce simulated locally representative survey data and provide statistics of alcohol consumption for each Local Authority in England. Results: We find a 2-fold difference in estimated mean alcohol consumption between the lightest and heaviest drinking Local Authorities, a 4.5-fold difference in abstention rates, and a 3.5-fold difference in harmful drinking. The method compares well to direct estimates from the data at regional level. Conclusions: The results have important policy implications in itself, but the reweighted data can also be used to model local policy effects. This method can also be used for other public health small area estimation where locally representative data are not available. [ABSTRACT FROM AUTHOR]

Introduction: The UK low‐risk drinking guidelines were revised in 2016. Drinkers were primarily informed about the guidelines via news media, but little is known about this coverage. This study investigated the scale and content of print and online textual news media coverage of drinking guidelines in England from February 2014 to October 2017. Methods: We searched the Nexis database and two leading broadcasters' websites (BBC and Sky) for articles mentioning the guidelines. We randomly selected 500 articles to code for reporting date, accuracy, tone, context and purpose of mentioning the guidelines, and among these, thematically analysed 200 randomly selected articles. Results: Articles mentioned the guidelines regularly. Reporting peaked when the guidelines revision was announced (7.4% of articles). The most common type of mention was within health‐ or alcohol‐related articles and neutral in tone (70.8%). The second most common was in articles discussing the guidelines' strengths and weaknesses, which were typically negative (14.8%). Critics discredited the guidelines' scientific basis by highlighting conflicting evidence and arguing that guideline developers acted politically. They also questioned the ethics of limiting personal autonomy to improve public health. Criticisms were partially facilitated by announcing the guidelines alongside a 'no safe level of drinking' message, and wider discourse misrepresenting the guidelines as rules, and highlighting apparent inconsistencies with standalone scientific papers and international guidelines. Discussion and Conclusions: News media generally covered drinking guidelines in a neutral and accurate manner, but in‐depth coverage was often negative and sought to discredit the guidelines using scientific and ethical arguments. [ABSTRACT FROM AUTHOR]

New students arrive at university with pre-determined perceptions around how alcohol can be used as a tool to overcome anxieties and secure new friendships, which in turn influences students' drinking behaviors. From a health promotion perspective, the transition to university may present a unique yet understudied opportunity to challenge and reframe situated drinking norms. This paper explores prospective university students' perceptions of the role that alcohol plays at university and the influence that these perceptions have on behavior. Focus groups with 46 prospective university students (aged 16-20 years) recruited from colleges and sixth forms in the North West of England. Through various sources of information, new students arrive at university with pre-conceived perceptions of a heavy student drinking culture and knowledge around how alcohol can be used to aid successful integration with new peers. Alcohol was viewed by new students as a social lubricant which is key to accruing social capital. Cultural presentations of the student drinker identity led prospective students to formulate negative connotations of those students who transgress from the norms of drinking. The findings provide new insights into how young people conceptualize alcohol at university and the impact that these perceptions have on shaping ideology and influencing drinking behavior. Breaking down these norms presents real challenges for those trying to address excessive drinking in universities, therefore, early intervention which challenges, re-frames and modifies perceptions before students arrive on campus may help to reduce the pressure and expectations to drink in social situations. [ABSTRACT FROM AUTHOR]

Posttraumatic Stress Disorder (PTSD) may be a common issue in primary care in the UK, but there have been no studies of all-cause PTSD in general samples of attenders in this country. The current paper thus explores the extent and distribution of probable PTSD among patients attending general practices in England. Cross-sectional survey data from adult patients (n = 1058) attending 11 general practices in southwest England were analysed. Patients were recruited from waiting rooms and completed anonymous questionnaires, including measures of depression, anxiety and risky alcohol use. Current probable PTSD was measured using the 4-item Primary Care PTSD Scale (PC-PTSD). Results indicated 15.1% of patients that exhibited probable PTSD (PC-PTSD ≥ 3), with higher levels observed in practices from deprived areas. There were 53.8% of patients with probable PTSD that expressed the desire for help with these issues. The analyses suggested that rates were lowest among older adults, and highest among patients who were not in cohabitating relationships or were unemployed. Measures of anxiety and depression were associated with 10-fold and 16-fold increases in risk of probable PTSD, respectively, although there were no discernible associations with risky drinking. Such preliminary findings highlight the need for vigilance for PTSD in routine general practice in the UK, and signal a strong need for additional research and attention in this context. [ABSTRACT FROM AUTHOR]

Background: In January 2016, the UK announced and began implementing revised guidelines for low-risk drinking of 14 units (112 g) per week for men and women. This was a reduction from the previous guidelines for men of 3-4 units (24-32 g) per day. There was no large-scale promotion of the revised guidelines beyond the initial media announcement. This paper evaluates the effect of announcing the revised guidelines on alcohol consumption among adults in England., Methods: Data come from a monthly repeat cross-sectional survey of approximately 1700 adults living in private households in England collected between March 2014 and October 2017. The primary outcomes are change in level and time trend of participants' Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) scores., Results: In December 2015, the modelled average AUDIT-C score was 2.719 out of 12 and was decreasing by 0.003 each month. After January 2016, AUDIT-C scores increased immediately but non-significantly to 2.720 (β=0.001, CI -0.079 to 0.099) and the trend changed significantly such that scores subsequently increased by 0.005 each month (β=0.008, CI 0.001 to 0.015), equivalent to 0.5% of the population increasing their AUDIT-C score by 1 point each month. Secondary analyses indicated the change in trend began 7 months before the guideline announcement and that AUDIT-C scores reduced significantly but temporarily for 4 months after the announcement (β=-0.087, CI -0.167 to 0.007)., Conclusions: Announcing new UK drinking guidelines did not lead to a substantial or sustained reduction in drinking or a downturn in the long-term trend in alcohol consumption, but there was evidence of a temporary reduction in consumption., Competing Interests: Competing interests: JH and PM were members of and then advisors to the UK Chief Medical Officer’s Guideline Development Group, which recommended the new drinking guidelines. JH, PM, AB and PFB also received funding for contract research from Public Health England to provide epidemiological modelling that informed the Guideline Development Group’s work. EB, JB, SM, AKS and LW declare no interests., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Objectives: Brief interventions (BI) for smoking and risky drinking are effective and cost-effective policy approaches to reducing alcohol harm currently used in primary care in England; however, little is known about their contribution to health inequalities. This paper aims to investigate whether self-reported receipt of BI is associated with socioeconomic position (SEP) and whether this differs for smoking or alcohol., Design: Population survey of 8978 smokers or risky drinkers in England aged 16+ taking part in the Alcohol and Smoking Toolkit Studies., Measures: Survey participants answered questions regarding whether they had received advice and support to cut down their drinking or smoking from a primary healthcare professional in the past 12 months as well as their SEP, demographic details, whether they smoke and their motivation to cut down their smoking and/or drinking. Respondents also completed the Alcohol Use Disorders Identification Test (AUDIT). Smokers were defined as those reporting any smoking in the past year. Risky drinkers were defined as those scoring eight or more on the AUDIT., Results: After adjusting for demographic factors and patterns in smoking and drinking, BI delivery was highest in lower socioeconomic groups. Smokers in the lowest social grade had 30% (95% CI 5% to 61%) greater odds of reporting receipt of a BI than those in the highest grade. The relationship for risky drinking appeared stronger, with those in the lowest social grade having 111% (95% CI 27% to 252%) greater odds of reporting BI receipt than the highest grade. Rates of BI delivery were eight times greater among smokers than risky drinkers (48.3% vs 6.1%)., Conclusions: Current delivery of BI for smoking and drinking in primary care in England may be contributing to a reduction in socioeconomic inequalities in health. This effect could be increased if intervention rates, particularly for drinking, were raised., Competing Interests: Competing interests: CA, EB and PB’s salaries are funded or part-funded by the National Institute for Health Research (NIHR)’s School for Public Health Research (SPHR) and all have received funding from Cancer Research UK (CRUK); EFSK is a senior investigator in SPHR. JB is funded by CRUK and the Society for the Study of Addiction; SM is funded by CRUK. CA has received funding related to commissioned research from Systembolaget, the Swedish government-owned alcohol retail monopoly. CA and PM have received funding related to commissioned research from Alko, the Finnish government-owned alcohol retail monopoly. JB and EB have both received unrestricted research funding from Pfizer relating to smoking cessation studies., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Aims: Recent years have seen a rise in new and innovative policies to reduce alcohol consumption and related harm in England, which can be implemented by local, as opposed to national, policy-makers. The aim of this paper is to explore the processes that underpin the adoption of these alcohol policies within local authorities. In particular, it aims to assess whether the concept of policy transfer (i.e. a process through which knowledge about policies in one place is used in the development of policies in another time or place) provides a useful model for understanding local alcohol policy-making., Methods: Qualitative data generated through in-depth interviews and focus groups from five case study sites across England were used to explore stakeholder experiences of alcohol policy transfer between local authorities. The purposive sample of policy actors included representatives from the police, trading standards, public health, licensing, and commissioning. Thematic analysis was used inductively to identify key features in the data., Results: Themes from the policy transfer literature identified in the data were: policy copying, emulating, hybridization, and inspiration. Participants described a multitude of ways in which learning was shared between places, ranging from formal academic evaluation to opportunistic conversations in informal settings. Participants also described facilitators and constraints to policy transfer, such as the historical policy context and the local cultural, economic, and bureaucratic context, which influenced whether or not a policy that was perceived to work in one place might be transferred successfully to another context., Conclusions: Theories of policy transfer provide a promising framework for characterising processes of local alcohol policy-making in England, extending beyond debates regarding evidence-informed policy to account for a much wider range of considerations. Applying a policy transfer lens enables us to move beyond simple (but still important) questions of what is supported by 'robust' research evidence by paying greater attention to how policy making is carried out in practice and the multiple methods by which policies diffuse across jurisdictions., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background and Aims: Youth alcohol consumption has declined significantly during the past 15 years in many high‐income countries, which may have significant public health benefits. However, if the reductions in drinking occur mainly among lighter drinkers who are at lower risk, then rates of alcohol‐related harm among young people today and adults in future may not fall in line with consumption. There is conflicting evidence from Swedish school studies, with some suggesting that all young people are drinking less, while others suggest that alcohol consumption among heavier drinkers may be stable or rising while average consumption declines. This paper extends the geographical focus of previous research and examines whether the decline in youth drinking is consistent across the consumption distribution in England. Design Quantile regression of 15 waves of repeat cross‐sectional survey data. Setting: England, 2001–16. Participants: A total of 31 882 schoolchildren (50.7% male) aged 11–15 who responded to the Smoking Drinking and Drug Use among Young People surveys. Measurements Past‐week alcohol consumption in UK units at each fifth percentile of the consumption distribution. Findings Reductions in alcohol consumption occurred at all percentiles of the consumption distribution analysed between 2001 and 2016, but the magnitude of the decline differed across percentiles. The decline in consumption at the 90th percentile [β = −0.21, confidence interval (CI) = −0.24, −0.18] was significantly larger than among either lighter drinkers at the 50th percentile (β = −0.02, CI = −0.02, −0.01) or heavier drinkers at the 95th percentile (β = −0.16, CI = −0.18, −0.13). Conclusions: Alcohol consumption among young people in England appears to be declining across the consumption distribution, and peaks among heavy drinkers. The magnitude of this decline differs significantly between percentiles of the consumption distribution, with consumption falling proportionally less among the lightest, moderate and very heaviest youth drinkers. [ABSTRACT FROM AUTHOR]

This paper explores the faith that different agencies, state and social, placed in police data detailing drunkenness, how that data was extracted, and, as a consequence, those who would make claims based on the data. Statistical rankings both reflected and reinforced a nineteenth-century geography of drunkenness, which revealed Liverpool to be the drink capital of England; this paper reveals how that geography was propped on problematic figures, which were reworked in contemporary discourses of drink and crime, and argues for a spatial contextualization of drinking and drunkenness. [ABSTRACT FROM AUTHOR]

Background: In the last thirty years there has been a rise in harmful alcohol use amongst White British women. Approaches to alcohol harm reduction typically position drinking as an individual behaviour, with an emphasis on people to make changes to and by themselves. Moving away from an individual approach, this paper works with a relational framework to develop understanding of non-dependent women's drinking in the context of their everyday lives. It draws on Feminist Ethics of Care theory, to consider the importance of care in women's lives and alcohol as an element of their 'practices of care' in different relationships., Methods: The study adopted an interpretive approach and drew on feminist principles of practice. Qualitative one-to-one face-to-face interviews were undertaken with twenty-six White women living in the North East of England. Participants were aged between 24 and 67 years. Thematic analysis of the data was carried out., Results: Participants' relationships came through the analysis as central to understanding the way alcohol did and not feature in care practices. In couple relationships drinking offered a way of doing 'care' together, yet when it was used too often it no longer became appropriate as a form of care. In non-family relationships alcohol enabled care giving and receiving, while disguising that care was being received. In relationships with mothers the use of alcohol was relatively absent in the care practices described. Participants' relationship to alcohol as a form of care of self, particularly when drinking alone, was closely related to their roles and responsibilities to others., Conclusions: Overall the data suggests that interventions targeting women's drinking should start from a position that women are relational. Moreover that when care by others is lacking or unavailable, alcohol can increasingly be introduced into care practices, and the reproduction of these practices may be leading to an increase in heavy drinking. By seeing alcohol use in the context of wider familial and non-familial relationships, this work has important implications for future interventions.

Background and aims: During the past three decades an expansive literature has emerged that is dedicated to analysing the processes of policy transfer. One neglected pathway involves subnational agents emulating crime control innovations that have emerged in subnational jurisdictions of other nations. This paper presents the case of the London Mayor's Office for Policing and Crime's (MOPAC) Alcohol Abstinence Monitoring Requirement (AAMR) Pilot to examine the multi‐level factors that facilitate and/or constrain international–subnational crime and justice policy transfer. Methods: A qualitative case study design reconstructed the (in)formal events that led to components of the South Dakota 24/7 Sobriety Project (USA) being either abandoned or integrated into MOPAC's AAMR Pilot. Evidence is drawn from elite interviews and documentary materials. Results: A series of inter/transnational‐, macro‐domestic‐, meso‐ and micro‐level factors enabled and/or obstructed processes of complete international–subnational policy transfer. Exclusion of domestic violence perpetrators from the London Pilot was fuelled by interest‐group hostility and mobilization. Use of alcohol tags rather than breathalysers to monitor compliance was a result of political–economic constraints, concern surrounding intrusion, technological innovation and policy‐orientated learning. The decision to omit an 'offender pays' funding mechanism was a consequence of legal incompatibility and civil service reluctance, while 'flash incarceration' for breach was not implemented due to European policy harmonization. Conclusions: The London Alcohol Abstinence Monitoring Requirement Pilot was a policy 'synthesis' that combined ideas, goals, vocabulary, principles, technology and practices from the South Dakota model with the existing English and Welsh criminal justice framework. Structural factors and the actions of particular agents limited the extent to which policy transfer occurred. [ABSTRACT FROM AUTHOR]

We evaluate the impact of a price floor for alcohol introduced in Scotland in 2018, using a difference-in-differences strategy with England as a control group. We show that the policy led to the largest reductions in alcohol units purchased among the heaviest drinkers—the group who, at the margin, are likely to create the largest externalities from drinking. The price floor is well targeted at heavy drinkers because they buy a much greater fraction of their units from cheap products and switched away from these products strongly, with only limited substitution towards more expensive products. We show that if the marginal external cost of drinking is at least moderately higher for heavy than lighter drinkers, then a price floor outperforms an ethanol tax. However, more flexible tax systems can achieve similar reductions in externalities to the price floor, but avoid the large transfers from public funds to the alcohol industry that arise under the floor. [ABSTRACT FROM AUTHOR]

Objectives: This paper compares patterns of smoking and high-risk alcohol use across regions in England, and assesses the impact on these of adjusting for sociodemographic characteristics., Design: Population survey of 53 922 adults in England aged 16+ taking part in the Alcohol and Smoking Toolkit Studies., Measures: Participants answered questions regarding their socioeconomic status (SES), gender, age, ethnicity, Government Office Region, smoking status and completed the Alcohol Use Disorders Identification Test (AUDIT). High-risk drinkers were defined as those with a score of 8 or more (7 or more for women) on the AUDIT., Results: In unadjusted analyses, relative to the South West, those in the North of England were more likely to smoke, while those from the East of England, South East and London were less likely. After adjustment for sociodemographics, smoking prevalence was no higher in North East (RR 0.97, p>0.05), North West (RR 0.98, p>0.05) or Yorkshire and the Humber (RR 1.03, p>0.05) but was less common in the East and West Midlands (RR 0.86, p<0.001; RR 0.91, p<0.05), East of England (RR 0.86, p<0.001), South East (RR 0.92, p<0.05) and London (RR 0.85, p<0.001). High-risk drinking was more common in the North but was less common in the Midlands, London and East of England. Adjustment for sociodemographics had little effect. There was a higher prevalence in the North East (RR 1.67, p<0.001), North West (RR 1.42, p<0.001) and Yorkshire and the Humber (RR 1.35, p<0.001); lower prevalence in the East Midlands (RR 0.69, p<0.001), West Midlands (RR 0.77, p<0.001), East of England (RR 0.72, p<0.001) and London (RR 0.71, p<0.001); and a similar prevalence in the South East (RR 1.10, p>0.05) CONCLUSIONS: In adjusted analyses, smoking and high-risk drinking appear less common in 'central England' than in the rest of the country. Regional differences in smoking, but not those in high-risk drinking, appear to be explained to some extent by sociodemographic disparities., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

In this paper, we test path models that study the interrelations between primary health care provider attitudes towards working with drinkers, their screening and brief advice activity, and their receipt of training and support and financial reimbursement. Study participants were 756 primary health care providers from 120 primary health care units (PHCUs) in different locations throughout Catalonia, England, The Netherlands, Poland, and Sweden. Our interventions were training and support and financial reimbursement to providers. Our design was a randomized factorial trial with baseline measurement period, 12-week implementation period, and 9-month follow-up measurement period. Our outcome measures were: attitudes of individual providers in working with drinkers as measured by the Short Alcohol and Alcohol Problems Perception Questionnaire; and the proportion of consulting adult patients (age 18+ years) who screened positive and were given advice to reduce their alcohol consumption (intervention activity). We found that more positive attitudes were associated with higher intervention activity, and higher intervention activity was then associated with more positive attitudes. Training and support was associated with both positive changes in attitudes and higher intervention activity. Financial reimbursement was associated with more positive attitudes through its impact on higher intervention activity. We conclude that improving primary health care providers' screening and brief advice activity for heavy drinking requires a combination of training and support and on-the-job experience of actually delivering screening and brief advice activity.

Within a social justice ethical framework, the use of 'enforcement' measures to prevent people from engaging in 'street activities', such as begging and street drinking, can only be morally justified if such initiatives can be shown to benefit the welfare of the vulnerable 'street users' affected. It may be hypothesized that this is unlikely, and such measures are bound to be regressive in their effects, but in fact evidence from an evaluation conducted in five locations across England suggests otherwise. Drawing on a normative framework which engages with both moral and political philosophy, this paper argues that the motivations and impacts associated with enforcement are more ethically complex, and less punitive, than they may at first appear. It demonstrates that the use of enforcement measures, when accompanied by appropriate support, can in fact lead to beneficial outcomes for some individuals involved in begging or street drinking in some situations. The outcomes for other members of the street population can, however, be very negative, and are highly unpredictable, such that the use of enforcement is always a high-risk strategy, even if ethically justifiable in certain circumstances. [ABSTRACT FROM AUTHOR]

The Licensing Act (2003) was enacted in England and Wales against the backdrop of media concern about ‘binge Britain’ and violent town centres avoided by ‘social drinkers’. This paper responds to these concerns by asking how to create more inclusive urban centres at night. Findings from focus groups found it was not alcohol consumption or a reluctance to partake in urban life that was detracting residents. Using the notion of ‘comfort’, the paper instead reveals a strong desire for varied late-night experiences ranging from quiet local venues, to active streets and live venues. [ABSTRACT FROM AUTHOR]

With the publication of the Alcohol Harm Reduction Strategy for England in 2004,(1) it is timely to reflect on the social and political contexts that have influenced alcohol policy. This paper provides an overview of trends in the development of alcohol policy in England since 1950 with a focus on treatment policy. In particular, it traces factors that have prompted change and resulted in the "treatment" response of the 1960s becoming a small part of a larger, complex approach to the "management" of alcohol-related harm. The publication of the Alcohol Harm Reduction Strategy for England(1) and the Interim Analytical Report,(2) which provided the evidence and framework for the strategy, has resulted in fierce debate on the political processes underlying the emergence of the strategy, the extent to which the strategy is "evidence-based," its strategic aims, and the mechanisms for implementation. This paper argues that responses to policy statements-like the policies themselves-have to be examined within the political, economic, and cultural contexts of their time. [ABSTRACT FROM AUTHOR]

Aims This paper estimates how far monthly changes in prevalence of cigarette smoking, motivation to quit and attempts to stop smoking have been associated with changes in prevalence of high-risk drinking, and motivation and attempts to reduce alcohol consumption in England. Design Data were used from the Alcohol and Smoking Toolkit Studies between April 2014 and June 2016. These involve monthly household face-to-face surveys of representative samples of ~1700 adults in England. Measurements Autoregressive Integrated Moving Average with Exogeneous Input (ARIMAX) modelling was used to assess the association over time between monthly prevalence of (a) smoking and high-risk drinking; (b) high motivation to quit smoking and high motivation to reduce alcohol consumption; and (c) attempts to quit smoking and attempts to reduce alcohol consumption. Findings Mean smoking prevalence over the study period was 18.6% and high-risk drinking prevalence was 13.0%. A decrease of 1% of the series mean smoking prevalence was associated with a reduction of 0.185% of the mean prevalence of high-risk drinking 2 months later [95% confidence interval (CI) = 0.033 to 0.337, P = 0.017]. A statistically significant association was not found between prevalence of high motivation to quit smoking and high motivation to reduce alcohol consumption (β = 0.324, 95% CI = -0.371 to 1.019, P = 0.360) or prevalence of attempts to quit smoking and attempts to reduce alcohol consumption (β = −0.026, 95% CI = -1.348 to 1.296, P = 0.969). Conclusion Between 2014 and 2016, monthly changes in prevalence of smoking in England were associated positively with prevalence of high-risk drinking. There was no significant association between motivation to stop and motivation to reduce alcohol consumption, or attempts to quit smoking and attempts to reduce alcohol consumption. [ABSTRACT FROM AUTHOR]

This paper aims to analyze the characteristics of national health surveys conducted in Brazil and England by their respective Statistics institutes. For Brazil, the National Health Survey (PNS) was considered, and the Health Survey for England (HSE) for England. To this end, we show a preliminary overview of the different population profiles of the two countries. Then, a brief historical background is presented, including the common themes that are addressed in the PNS and HSE that favor comparative analyses. Finally, we compared, for example, the inequalities in access to and use of Brazilian and English health services. The results show several possibilities for comparative analysis on topics such as health perception, tobacco use, alcohol consumption, diabetes, and hypertension. However, the need to consider the specificities of the population profile of each country and the methodological characteristics of the surveys is emphasized. [ABSTRACT FROM AUTHOR]

Background: Looked after children and care leavers have an increased risk of drug and alcohol use compared to their non-LAC peers. Despite high prevalence rates within this population, looked after children are reported to show low levels of engagement in services resulting in unmet needs emerging from substance use. This paper reports on the initial formative phase of a pilot feasibility randomised controlled trial; SOLID (Supporting Looked After Children and Care Leavers In Decreasing Drugs, and Alcohol) that aimed to adapt two evidence-based psychosocial interventions, Motivational Enhancement Therapy and Social Behaviour and Network Therapy, which will aim to reduce substance misuse by looked after children.Methods: We conducted qualitative semi-structured interviews and focus groups with 19 looked after children aged 12 to 20 years old, 16 carers and 14 professionals across four local authorities in the North East of England. The data gathered were analysed and then presented within co-production workshops inclusive of 13 young people and 14 professionals (drug and alcohol practitioners and social workers). Findings were used to adapt and refine the interventions prior to the trial.Results: Overall findings suggested that whilst original components of both interventions were feasible to deliver and acceptable, specific process areas were highlighted including: increased emphasis upon therapeutic relationships, the benefits of using creative non-traditional methods of engagement and identification of treatment goals wider than those narrowly focused on substance misuse.Conclusion: This paper provides an example of methods used to collect multiple perspectives to refine and co-develop interventions to reduce drug and alcohol use in the specific population of looked after children.Trial Registration: ISRCTN80786829 (first registered 06.06.2016- prospectively registered). [ABSTRACT FROM AUTHOR]

Purpose: Harmful alcohol consumption among the ageing population is an important public health issue. Very few studies ask drinkers why they change their consumption in later life. The aim of this paper was to determine whether a group of people aged over 60 years increased or decreased their alcohol consumption over the past decade and to determine the reasons for their change. We also examined whether the responses varied by age, sex and socio-economic position (SEP)., Subjects and Methods: Data were taken from 6,011 participants (4,310 men, 1,701 women, age range 61 to 85 years) who completed questionnaires at phase 11 (2012-2013) of the Whitehall II Cohort Study., Results: Over half the study members reported a change in alcohol consumption over the past decade (40% decreased, 11% increased). The most common reasons given for decreases were as a health precaution and fewer social occasions. Common reasons for increases were more social occasions and fewer responsibilities. The lowest SEP group was less likely to increase consumption compared to high SEP (RR 0.57, 95% CI 0.40 to 0.81). Women were more likely to increase consumption in response to stress/depression than men (RR1.53, 95% CI 1.04 to 2.25). Compared to high SEP, the lowest SEP group was less likely to reduce as a health precaution (RR 0.61, 95% CI 0.38 to 0.76)., Conclusions: Alcohol consumption in late life is not fixed. Reasons for change vary by age, sex and SEP. Such information could be used to tailor intervention strategies to reduce harmful consumption.

Background: Although most people are aware of government guidelines for alcohol consumption, few have accurate knowledge of these and fewer still use these guidelines to monitor their drinking. Most people also lack accurate knowledge of the alcohol content of the drinks they consume. The aim of the study reported here was to examine whether or not personalized feedback on alcohol consumption based on performance in a drink-pouring task and self-reported alcohol intake would improve university students' knowledge of alcohol consumption guidelines and reduce their alcohol intake., Methods: A quasi-randomized control trial with a 2-month follow-up was conducted with 200 students aged 18 to 37 in the south of England. Participants were allocated to a "pour + feedback" group that completed a drink-pouring task and received personalized feedback, a "pour only" group that completed the drink-pouring task but did not receive feedback, and a control group., Results: At follow-up, participants in the "pour + feedback" group had significantly better knowledge of government guidelines, and significantly lower weekly alcohol intake when compared to the "control" and "pour only" groups., Conclusions: Further refinement of the drink-pouring intervention and feedback is reported in this paper, and assessment of their impact in various populations may lead to better understanding of which elements of personalized feedback have the greatest influence on young people's alcohol use., (Copyright © 2015 by the Research Society on Alcoholism.)

Previous research has established that young people tend to operate with a sense of invulnerability when it comes to risk-taking behaviour. This paper initially investigates the possibility that this might be a product of their relative lack of exposure to situations or events which involve death or serious threats to health. It then considers the thesis that exposure to such ‘serious health-related incidents’ will act as ‘critical incidents’ affecting the health-related behaviour of young people. Findings are based on the ESRC-funded research project Critical Incidents and Risk-Taking Behaviour Among Schoolchildren (R000 22 1802) which has investigated perceptions of risk and the consumption of alcohol and tobacco by 15- to 16-year-olds in a central region of England. The research reveals a high level of exposure to ‘serious health-related incidents’ and the findings provide some modest support for this thesis that these act as ‘critical incidents’ shaping the willingness of the young people to take risks with their health. However, the findings also indicate significant limitations to the thesis. These limitations are discussed and it is concluded that they stem from the use of ‘expert opinion’ and ‘medical models’ of health as the bases for identifying critical incidents. [ABSTRACT FROM AUTHOR]

Background Previous studies have demonstrated positive outcomes from a range of pharmacy public health services, but barriers to delivery remain. This paper explores the processes of delivering an alcohol screening and intervention service, with a view to improving service delivery. Methods A mixed-methods, multi-perspective approach was used, comprising in-pharmacy observations and recording of service provision, follow-up interviews with service users and interactive feedback sessions with service providers. Results Observations and recordings indicate that staff missed opportunities to offer the service and that both availability and delivery of the service were inconsistent, partly owing to unavailability of trained staff and service restrictions. Most service users gave positive accounts of the service and considered pharmacies to be appropriate places for this service. Respondents also described positive impacts, ranging from thinking more about alcohol consumption generally to substantial reductions in consumption. Key facilitators to service provision included building staff confidence and service champions. Barriers included commissioning issues and staff perception of alcohol as a sensitive topic. Conclusions Findings support expansion of pharmacies' role in delivering public health services and highlight benefits of providing feedback to pharmacy staff on their service provision as a possible avenue for service improvement. [ABSTRACT FROM AUTHOR]

Background: The Public Health Responsibility Deal (RD) in England is a public-private partnership involving voluntary pledges between government, industry, and other organisations to improve public health by addressing alcohol, food, health at work, and physical activity. This paper analyses the RD physical activity (PA) pledges in terms of the evidence of their potential effectiveness, and the likelihood that they have motivated actions among organisations that would not otherwise have taken place. Methods: We systematically reviewed evidence of the effectiveness of interventions proposed in four PA pledges of the RD, namely, those on physical activity in the community; physical activity guidelines; active travel; and physical activity in the workplace. We then analysed publically available data on RD signatory organisations' plans and progress towards achieving the physical activity pledges, and assessed the extent to which activities among organisations could be attributed to the RD. Results: Where combined with environmental approaches, interventions such as mass media campaigns to communicate the benefits of physical activity, active travel in children and adults, and workplace-related interventions could in principle be effective, if fully implemented. However, most activities proposed by each PA pledge involved providing information or enabling choice, which has limited effectiveness. Moreover, it was difficult to establish the extent of implementation of pledges within organisations, given that progress reports were mostly unavailable, and, where provided, it was difficult to ascertain their relevance to the RD pledges. Finally, 15 % of interventions listed in organisations' delivery plans were judged to be the result of participation in the RD, meaning that most actions taken by organisations were likely already under way, regardless of the RD. Conclusions: Irrespective of the nature of a public health policy to encourage physical activity, targets need to be evidence-based, well-defined, measurable and encourage organisations to go beyond business as usual. RD physical activity targets do not adequately fulfill these criteria. [ABSTRACT FROM AUTHOR]

Background Although most people are aware of government guidelines for alcohol consumption, few have accurate knowledge of these and fewer still use these guidelines to monitor their drinking. Most people also lack accurate knowledge of the alcohol content of the drinks they consume. The aim of the study reported here was to examine whether or not personalized feedback on alcohol consumption based on performance in a drink-pouring task and self-reported alcohol intake would improve university students' knowledge of alcohol consumption guidelines and reduce their alcohol intake. Methods A quasi-randomized control trial with a 2-month follow-up was conducted with 200 students aged 18 to 37 in the south of England. Participants were allocated to a 'pour + feedback' group that completed a drink-pouring task and received personalized feedback, a 'pour only' group that completed the drink-pouring task but did not receive feedback, and a control group. Results At follow-up, participants in the 'pour + feedback' group had significantly better knowledge of government guidelines, and significantly lower weekly alcohol intake when compared to the 'control' and 'pour only' groups. Conclusions Further refinement of the drink-pouring intervention and feedback is reported in this paper, and assessment of their impact in various populations may lead to better understanding of which elements of personalized feedback have the greatest influence on young people's alcohol use. [ABSTRACT FROM AUTHOR]

We analysed the relationship between drug use and wellbeing using data from the Crime Survey for England and Wales. We focused on cannabis use, the most commonly used drug, but also controlled for use of other drugs, alcohol consumption and a range of potential confounds. Measuring life satisfaction on a 0–10 scale, linear models found that people who had never used cannabis had significantly higher scores than current users (0.54). Never having used other types of drugs was also associated with 0.37 extra life satisfaction points. Moderate alcohol use (1–2 days per week) was associated with higher life satisfaction than abstainers or more regular drinkers. Following the "life satisfaction approach", we estimated the extra income that would be needed to compensate for the wellbeing loss associated with cannabis use. Accounting for income endogeneity, our results suggested that being a current cannabis user may cost an individual over £5600 per year, in terms of lost wellbeing, while being a current user of other drugs may cost approximately £4000 per year. While acknowledging possible reverse causality, we estimated the annual population cost of drug use may be as high as £10.7bn in terms of lost wellbeing. [ABSTRACT FROM AUTHOR]

This final report of the Lancet Commission into liver disease in the UK stresses the continuing increase in burden of liver disease from excess alcohol consumption and obesity, with high levels of hospital admissions which are worsening in deprived areas. Only with comprehensive food and alcohol strategies based on fiscal and regulatory measures (including a minimum unit price for alcohol, the alcohol duty escalator, and an extension of the sugar levy on food content) can the disease burden be curtailed. Following introduction of minimum unit pricing in Scotland, alcohol sales fell by 3%, with the greatest effect on heavy drinkers of low-cost alcohol products. We also discuss the major contribution of obesity and alcohol to the ten most common cancers as well as measures outlined by the departing Chief Medical Officer to combat rising levels of obesity-the highest of any country in the west. Mortality of severely ill patients with liver disease in district general hospitals is unacceptably high, indicating the need to develop a masterplan for improving hospital care. We propose a plan based around specialist hospital centres that are linked to district general hospitals by operational delivery networks. This plan has received strong backing from the British Association for Study of the Liver and British Society of Gastroenterology, but is held up at NHS England. The value of so-called day-case care bundles to reduce high hospital readmission rates with greater care in the community is described, along with examples of locally derived schemes for the early detection of disease and, in particular, schemes to allow general practitioners to refer patients directly for elastography assessment. New funding arrangements for general practitioners will be required if these proposals are to be taken up more widely around the country. Understanding of the harm to health from lifestyle causes among the general population is low, with a poor knowledge of alcohol consumption and dietary guidelines. The Lancet Commission has serious doubts about whether the initiatives described in the Prevention Green Paper, with the onus placed on the individual based on the use of information technology and the latest in behavioural science, will be effective. We call for greater coordination between official and non-official bodies that have highlighted the unacceptable disease burden from liver disease in England in order to present a single, strong voice to the higher echelons of government. [ABSTRACT FROM AUTHOR]

Excessive alcohol consumption among young people in England regularly features in national media and has been a focus of recent academic research and government policy. Though the majority of young people do not regularly drink excessively, heavy sessional drinking - 'binge' drinking - is associated with negative health and social consequences for those who do. Alcohol-related health problems in young people are not spread consistently across England, however, and while there are significant intra-regional differences, northern regions fare worse overall than those in the south. This paper draws on an 18-month project which explored differences in the physical, social and regulatory environments (highlighted by previous research as influential) in two locations with contrasting alcohol harm profiles. The paper focuses on the lives of 15-16 year olds and examines potential differences that influence behaviour at this crucial age; and in particular issues that might presage risky and/or harmful drinking in young adulthood. The study examines evidence from young people themselves (activity diaries and interviews); stakeholder interviews; and observation analysis. The study finds social practices in the two areas to be largely similar; moreover, the collectivised and social nature of alcohol consumption suggests sources of influence from a wider context, beyond immediate family and friendship groups. However these social practices were acted out in locations with very different physical characteristics, in particular these related to the availability of non-alcohol focused leisure activities and the spatial arrangement/visibility of adult drinking culture., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Aim:   This paper provides a historical overview of licensing law in Scotland. It seeks to put important contemporary policy developments into their historical context and to draw attention to key themes in licensing policy debates across the United Kingdom., Design:   Based on a survey of statutes, commissions of enquiry and consumption and retail data, this paper draws together historical evidence to present a synopsis of Scottish licensing history., Settings:   The article focuses on Scotland, but also discusses UK-wide licensing policy over a 250-year period., Findings:   Scottish licensing has diverged from licensing in England and Wales and has addressed some historical licensing weaknesses, including problems of accountability, overprovision and systemic oversight regarding off-sales. Distinctive features of current Scottish legislation include public health protection as a statutory licensing objective; local Licensing Forums and Licensing Standards Officers; a requirement for explicit policies on the 'overprovision' of licensed premises; mandatory restrictions on price promotions in the on- and off-trades; and limitations on opening hours for off-licences., Conclusion:   Scotland has developed alcohol policies several times addressing long-standing licensing weaknesses throughout the United Kingdom. Some Scottish alcohol policies have later become the norm in England and Wales., (© 2012 The Author, Addiction © 2012 Society for the Study of Addiction.)

Background: A large-scale survey was conducted in 2008 in north west England, a region with high levels of alcohol-related harm, during a regional 'Big Drink Debate' campaign. The aim of this paper is to explore perceptions of how alcohol consumption would change if alcohol prices were to increase or decrease., Methods: A convenience survey of residents (≥ 18 years) of north west England measured demographics, income, alcohol consumption in previous week, and opinions on drinking behaviour under two pricing conditions: low prices and discounts and increased alcohol prices (either 'decrease', 'no change' or 'increase'). Multinomial logistic regression used three outcomes: 'completely elastic' (consider that lower prices increase drinking and higher prices decrease drinking); 'lower price elastic' (lower prices increase drinking, higher prices have no effect); and 'price inelastic' (no change for either)., Results: Of 22,780 drinkers surveyed, 80.3% considered lower alcohol prices and discounts would increase alcohol consumption, while 22.1% thought raising prices would decrease consumption, making lower price elasticity only (i.e. lower prices increase drinking, higher prices have no effect) the most common outcome (62%). Compared to a high income/high drinking category, the lightest drinkers with a low income (adjusted odds ratio AOR = 1.78, 95% confidence intervals CI 1.38-2.30) or medium income (AOR = 1.88, CI 1.47-2.41) were most likely to be lower price elastic. Females were more likely than males to be lower price elastic (65% vs 57%) while the reverse was true for complete elasticity (20% vs 26%, P < 0.001)., Conclusions: Lower pricing increases alcohol consumption, and the alcohol industry's continued focus on discounting sales encourages higher drinking levels. International evidence suggests increasing the price of alcohol reduces consumption, and one in five of the surveyed population agreed; more work is required to increase this agreement to achieve public support for policy change. Such policy should also recognise that alcohol is an addictive drug, and the population may be prepared to pay more to drink the amount they now feel they need.

This paper describes the development of the first set of national guidance focused on the prevention of alcohol problems in England. These guidelines were produced by the National Institute for Health and Clinical Excellence (NICE) working with a multidisciplinary program development group of scientists, practitioners and lay members. In this work, screening and brief alcohol interventions represent a key element of a comprehensive public health strategy to prevent alcohol-related risk and harm across the population. The first controlled trials of brief alcohol intervention were published in the mid to late 1980's and there are now around 60 published trials in this field. After 25 years of accumulated evidence in this field, brief alcohol interventions have yet to make a significant impact on routine clinical practice. While it is imperative to have good science to make the case for brief intervention delivery, this work is in vain if practitioners are unwilling or unable to use these interventions with their patients. Evidence from the alcohol field and other clinical areas indicates that national prioritisation of brief alcohol intervention activity, by a body, such as NICE, is likely to be a key driver of implementation by practitioners. This paper summarises a suite of complementary system-level and practice recommendations, which were published by NICE in June 2010, and considers their likely impact on screening and brief alcohol in England.[Kaner E. NICE work if you can get it: Development of national guidance incorporating screening and brief intervention to prevent hazardous and harmful drinking in England., (© 2010 Australasian Professional Society on Alcohol and other Drugs.)

Abstinence from alcohol is a way of life for many American evangelicals, with rates of abstention running at over 70% among some Pentecostal denominations. This paper examines the religious beliefs that, historically, have supported teetotalism. The most notable of these is Christian perfection, a doctrine that originated in 18th-century England, that was then radicalized in America in the early 19th century. Abstinence from alcohol is highest among denominations that make Christian perfection the cornerstone of their teachings, and lowest among those that discount human agency. The paper also argues that 19th-century American evangelicals were by no means committed uniformly to temperance as a way of life, and that this was especially true of the various Methodist churches.

Aim: The goals of this paper are to evaluate whether drinking practices among peers mediates the relationship between a low level of response (LR) to alcohol and a person's heavier drinking and alcohol-related problems in 12-14-year-olds., Design: Correlations and structural equation models (SEM) were used to test a hypothesized model of the relationships among key variables in adolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC), a longitudinal birth cohort study in Bristol, England., Participants: These included 688 boys (40.4%) and girls who were offspring of the pregnant women who had been selected as ALSPAC participants in 1991 and 1992. The offspring were interviewed at about age 13 years, and those who had ever consumed a full drink completed the Self-Report of the Effects of Alcohol (SRE) questionnaire indicating the number of drinks required for up to four effects early in their drinking histories. A higher number of drinks required for effects indicated a low LR per drink consumed., Findings: The SEM explained 58% of the variance of the alcohol pattern, and had good fit characteristics. A low LR was related to heavier drinking and more alcohol problems both directly and as mediated partially by drinking in peers. The model performed well across the narrow age range, and applied equally well in boys and girls., Conclusions: The perceived drinking practices of peers is a potentially important mediator of how a low LR to alcohol relates to drinking practices during early adolescence. The findings may be useful in developing approaches to prevent heavier drinking in this young group.

Aims: This paper describes prevalences, time-trends and characteristics of self-reported never-drinkers, during the period 1994-2003, focussing particularly on white adults aged 18-54., Methods: Data on 122,809 adults (18 + ) were obtained from the Health Survey for England (HSfE). Logistic regressions were used to estimate time trends in self-reported never-drinking, and associations between never-drinking and living alone, and educational qualification. Analyses were stratified by gender, age group and period., Results: The overall proportion of white, female never-drinkers was 5.5%, rising monotonically with age. Proportions among men were much lower, with the lowest proportion (1.1%) in the 30-54 age group. Odds of never-drinking increased by 3% per year in those aged 30-54, a trend not explained by any covariates. Smaller increases were seen among those aged 18-29. Never-drinking was strongly associated with living with another adult and with lower qualification. The association with qualification increased over time among young women, and the association with living with another adult increased among men aged 30-54., Conclusions: Never-drinkers are a significant minority in England, whose prevalence rose, between 1994 and 2003, among adults aged under 55 years. The prevalence varies considerably by age, sex, and social characteristics, and the social discrepancies in never-drinking appear to be widening.

This paper investigates alcohol outcomes and heavy drinking among 418 drug misusers from the National Treatment Outcome Research Study who completed followup interviews at 1, 2, and 4-5 years. About a quarter of the sample were drinking heavily at intake. Alcohol consumption at followup was predicted by drinking prior to intake, and about a quarter of those who were classified as alcohol abstainers, medium-level drinkers, or heavy drinkers at intake, remained in the same drinking category at all assessment points. Drinking outcomes were not related to opioid use. Heavy drinkers at followup were more likely to be using non-opioid drugs. The poor drinking outcomes are a matter for concern. Drug misusers with concurrent alcohol problems may require special treatment provision. The extent of heavy drinking among drug misusers both before and after treatment indicates a need to develop and strengthen programs and interventions to tackle alcohol-related problems in this patient group.

Popular narratives have variously depicted Liverpool as a city of decline, protest, revival and hedonism. From being the 'Detroit of England' to the 'alcohol capital of England', Liverpool is seen to spatially and discursively embody a 'place of chronicity'. In this paper, we explore the way in which place matters to health in order to critically interrogate why it is that Liverpool has consistently recorded the highest level of alcohol-related hospital admissions in England. To this end, we draw on qualitative interviews with health and social care practitioners working with people with complex alcohol needs. The interviews provide an important insight into the practical and policy realities of alcohol misuse in Liverpool. We further suggest that local responses to alcohol consumption and addiction are explicitly tied to both an imperative to overturn the city's negative reputation and self-image and a commitment to improving the health and well-being of high impact users. [ABSTRACT FROM AUTHOR]

A recent paper in Social Science and Medicine (Twigg et al. 50 (2000) 1109) outlined an approach to the estimation of prevalences of small-area health-related behaviour using multilevel models. This paper compares results from the application of the multilevel approach with those derived using the more traditional strategy of the local 'lifestyle' survey. Estimations of smoking prevalence and high alcohol consumption are examined and critical assessments made of both estimation approaches. It is concluded that the alternative method is more suited towards the prediction of smoking rates as opposed to unsafe alcohol consumption.

SummaryIntroduction1Definitions of ethnic groups and demographics of minority ethnic groups in the UK○ 1.1 Definitions of 'ethnic groups' and 'ethnicity'○ 1.2 Demographics and characteristics of minority ethnic groups in the UK– Countries of origin– Age/sex distribution and life expectancy– Geographical distribution and size of household– Religious beliefs– Education and employment patternsKey points2Overview of the health profile and dietary habits of minority ethnic groups in the UK○ 2.1 Available surveys○ 2.2 Overview of the health profiles among adults from minority ethnic groups– Overall health– Cardiovascular disease (CVD)– Coronary heart disease (CHD)– Stroke– Type 2 diabetes– Obesity○ 2.3 Possible causes of increased disease risk among minority ethnic groups○ 2.4 Smoking, drinking and physical activity habits○ 2.5 Dietary habits and nutritional status○ 2.6 Overview of the health profiles and dietary and health behaviour patterns of children from minority ethnic groups– Overall health– Diet and health behaviour patterns○ 2.7 Gaps in data availabilityKey points3Factors affecting food choice– Income and socio‐economic status– Food availability and access– Awareness of healthy eating– Religious beliefs– Food beliefs– Time and cooking skills– Generation and genderKey points4Traditional diets of minority ethnic groups○ 4.1 Overview of traditional diets of minority ethic groups– South Asians– African‐Caribbeans– Chinese○ 4.2 Dietary acculturation○ 4.3 Nutritional composition of ethnic‐style cuisineKey points5Nutritional interventions and health promotion among minority ethnic groups○ 5.1 Effective nutritional interventions○ 5.2 Health promotion interventions to prevent problems associated with fasting○ 5.3 Priorities for nutritional interventions and health promotion○ 5.4 Using behaviour change models○ 5.5 Current community initiatives○ 5.6 Catering for institutionalised individuals○ 5.7 Recommendations for future research, policy and practiceKey points6Conclusion• Acknowledgements• References Summary: According to the latest census, non‐white minority ethnic groups made up 7.9% of the UK's population in 2001. The largest of these groups were South Asians, Black African‐Caribbeans and Chinese. Studies have shown that some minority ethnic groups are more likely to experience poorer health outcomes compared with the mainstream population. These include higher rates of cardiovascular disease (CVD), type 2 diabetes and obesity. The differences in health outcomes may reflect interactions between diet and other health behaviours, genetic predisposition and developmental programming, all of which vary across different groups. As is the case for the rest of the population, the dietary habits of minority ethnic groups are affected by a wide variety of factors, but acquiring a better understanding of these can help health professionals and educationalists to recognise the needs of these groups and help them to make healthier food choices. Unfortunately, to date, there have been few tailored, well‐designed and evaluated nutritional interventions in the UK targeting minority ethnic population groups. Further needs assessment and better evaluation of nutritional interventions have been recommended to enhance the understanding of the effectiveness of different approaches amongst minority ethnic groups. This briefing paper will provide an overview of the health profile, dietary habits and other health behaviours of the three largest non‐white minority ethnic groups in the UK, explore the factors affecting their food choices, provide a summary of their traditional diets and review the evidence base to identify the factors that support successful nutrition interventions in these groups. [ABSTRACT FROM AUTHOR]

Ecstasy, the street name for 3,4-meththylenedioxymethamphetamine, has been associated with a range of psychiatric symptoms and impaired psychological health in both problem and recreational users. The purpose of the present paper is to determine how these impairments are related to the history of polydrug use, and the conditions under which individuals ingest ecstasy. Associations between the variables of interest were investigated utilizing negative binomial regression. Liverpool and Preston in the North West of England. A convenience sample of 159 recreational ecstasy/polydrug users (80 males, 79 females). The sample was composed primarily of undergraduates. The dependent variable was the number of reported ecstasy-related adverse effects. Independent variables included quantitative aspects of ecstasy and other drug use, and the various beliefs and behaviours associated with ecstasy use. The number of adverse effects was associated positively with life-time exposure to ecstasy and negatively with period of abstinence from the drug. Adverse effects were more common among those who consumed ecstasy and alcohol concurrently, but were unrelated to other aspects of polydrug use. They were unaffected by whether the user took precautions when using the drug, and only weakly related to prior beliefs concerning the effects of ecstasy. Greater life-time exposure to ecstasy and consuming the drug concurrently with alcohol increase the likelihood of experiencing adverse effects, including paranoia, poor general health, irritability, confusion and moodiness. Adverse effects decrease with the period of abstinence from the drug. [ABSTRACT FROM AUTHOR]

This paper provides a methodological review of a piece of qualitative policy research formulating recommendations for the commissioning and delivery of offender alcohol interventions, for application both within the English region for which it was commissioned, and more widely. It begins by providing some background information on why and how the research was initiated. It then provides a detailed summary of the methods utilised. These were characterised by sustained engagement with diverse stakeholders and the iterative identification of both findings and recommendations. The authors will conclude with a discussion of the validity and possible application of the method adopted to policy research and service development in the field of dual diagnosis and complex needs, particularly in circumstances where impasse at the levels of policy and local strategy is matched with unmet need within a target population. [ABSTRACT FROM AUTHOR]