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It is becoming increasingly common for frontline clinicians to see children and teenagers struggle with their mental health. Since mental health issues have increased over the past ten years in the UK, they are now the leading cause of disability and cost the British economy £105 billion annually. The review discusses the evidence base underpinning the effect of yoga on children's mental health and summarises the results of 21 research papers. The Cumulative Index to Nursing and Allied Health Literature, PsycINFO, ERIC, Web of Science, PubMed, Medline and Cochrane Library were searched through Ovid from January 2008 until May 2022. The keywords 'yoga OR mindfulness – AND school AND children OR child OR youth OR adolescent' were used. The search was limited to studies in the English language. The quality of each study was rated against Version 2 of the Cochrane risk-of-bias tool for randomised control trials and a set of inclusion and exclusion criteria. The evidence for yoga therapies in children is encouraging, although studies include methodological flaws such as small sample sizes and sparse information on interventions. This review has highlighted that yoga interventions may be implemented in schools as a preventative and therapeutic measure for mental health issues. [ABSTRACT FROM AUTHOR]

Background: This study examined changes in population-level co-use of cannabis and alcohol before and 12 months after nonmedical cannabis legalization in Canada, relative to the United States that had previously legalized and not legalized (US legal and illegal states, respectively). Methods: Data are from waves 1 and 2 of the International Cannabis Policy Study, collected in 2018 (before) and 2019 (12 months after legalization in Canada). Respondents aged 16–65 years from Canada (n = 25,313) and US legal (n = 25,189) and US illegal (n = 19,626) states completed an online survey. Changes in co-use between 2018 and 2019 in US legal and illegal states compared to those in Canada were assessed using multinomial logistic regression. Results: Descriptive analyses show increases in cannabis use and monthly or more frequent (MMF) co-use between 2018 and 2019 in all jurisdictions. Compared to no MMF use of cannabis or alcohol, there was no evidence suggesting differences in changes in MMF co-use in US legal or illegal states relative to Canada. However, respondents in US legal states had 33% higher odds of MMF alcohol-only use (OR = 1.33, 99% CI: 1.12, 1.57) compared to no MMF use relative to Canada. Conclusions: Increases in co-use were observed between 2018 and 2019 in all jurisdictions regardless of the legal status of cannabis. These shifts were largely due to increases in cannabis use across the population, including those that use alcohol, and may indicate changing societal norms toward cannabis generally. As the cannabis legalization transition in Canada matures, evaluation over the longer term will improve understanding of the influence of cannabis liberalization on co-use. [ABSTRACT FROM AUTHOR]

This commentary about alcohol marketing regulation in the UK draws on a conference held by the Institute of Alcohol Studies, highlighting a need for policy interventions to prevent harm and improve public health. Hazardous and harmful alcohol use is associated with many health conditions, wider social consequences, and harms to others. Following no improvement in alcohol mortality rates in the past decade, 2020 saw alcohol-specific deaths rise to record levels in the UK. Bans or comprehensive restrictions on alcohol advertising across multiple types of media are listed by the World Health Organization (WHO) as one of the 'best buy' policies to reduce alcohol harm. The UK's current complaints-led self-regulatory approach fails to protect consumers and vulnerable groups from being exposed to influential alcohol marketing. There are few meaningful sanctions to deter brands and companies from violating existing codes, processes are retrospective, reactive and slow, and the codes fail in their stated aim of protecting young people. Other important impacts on heavier drinkers and those in recovery, as well as on gender and health equity, are also inadequately addressed. Innovation is also urgently needed to effectively regulate ever-evolving digital alcohol marketing. Addressing these issues through a combination of comprehensive restrictions, content controls, labelling, and replacing self-regulation with an independent body will benefit public health as well as protecting the vulnerable, including heavier drinkers, people in recovery, and children and young people. [ABSTRACT FROM AUTHOR]

Background There is growing evidence that common strategies are used across unhealthy commodity industries (UCIs) to influence policy decisions in line with their commercial interests. To date, there have been relatively few studies comparing corporate political activity (CPA) across UCIs, especially comparing the alcohol and gambling industries. Methods A comparative and inductive thematic analysis of alcohol and gambling industry submissions to two House of Lords (HoL) inquiries in the UK was conducted. Themes in the framing, arguments and strategies used by the alcohol and gambling industries in CPA were compared. Results Alcohol and gambling industry responses largely used the same framings, both in terms of the problems and solutions. This included arguing that harms are only experienced by a 'minority' of people, emphasising individual responsibility and shifting blame for harms to other industry actors. They promoted targeted or localised solutions to these harms, in place of more effective population level solutions, and emphasised the perceived harms of introducing regulation not in the industries' interests. Conclusions These findings are consistent with previous literature suggesting that UCIs use the same framing and arguments to shape the narrative around their harms and solutions to those harms. This study also identified novel strategies such as shifting blame of harms to other industry actors. Policy makers should be aware of these strategies to avoid undue industry influence on policy decisions and understanding commonalities in strategies may help to inform more effective public health responses across all UCIs. [ABSTRACT FROM AUTHOR]

Background and aims: Alcohol use increases throughout adolescence. Emergency department (ED) attendance is an opportunity for alcohol screening and brief intervention (ASBI), which is effective for adults. This trial evaluated the effectiveness and cost‐effectiveness of ASBI compared with screening alone (SA) in high‐risk adolescents. Design, Setting and Participants: Multi‐centre, three‐group, single‐blind, individually randomized trial with follow‐ups after 6 and 12 months in 10 ED settings in England. From October 2014 to May 2015 we screened 3327 adolescents aged 14 to 18 years, of whom 756 (22.7%) scored at least 3 on the Alcohol Use Disorders Identification Test: consumption (AUDIT‐C) and consented to participate in this trial. Mean age was 16.1 years; 50.2% were female and 84.9% were white. Interventions: Interventions were personalized feedback and brief advice (PFBA), personalized feedback plus electronic brief intervention (eBI) and SA. Measures: The primary outcome was the weekly alcohol consumed in standard UK units (8 g ethanol) at 12 months post‐randomization, derived from extended AUDIT‐C. Economic outcomes included quality of life and service use, from perspectives of both the National Health Service and personal social services (NHS&PSS) and society. Findings: At 12 months, mean weekly consumption was 2.99 [95% confidence interval (CI) = 2.38–3.70] standard units for the SA group, 3.56 (95% CI = 2.90, 4.32) for PFBA and 3.18 (95% CI = 2.50, 3.97) for eBI, showing no significant differences. The PFBA group consumed mean 0.57 (−0.36, 1.70) units more than SA; and eBIs consumed 0.19 (−0.71, 1.30) more. Bayes factors suggested lack of effectiveness explained non‐significance. From the NHS&PSS perspective, economic analysis showed that PFBA and eBI were not cost‐effective compared with SA: PFBA yielded incremental cost‐effectiveness ratio of £6213 (−£736 843, £812 884), with the intervention having 54% probability of being cost‐effective compared with SA at the £20 000 WTP threshold. Conclusions: In emergency departments in England, neither personalized feedback and brief advice nor personalized feedback plus electronic brief intervention showed evidence of being effective or cost‐effective when compared with screening alone in reducing alcohol consumption among adolescents. [ABSTRACT FROM AUTHOR]

Aims Adolescents in the UK are among the heaviest drinkers in Europe. The World Health Organization recommends alcohol product labelling to inform consumers about product information and health risks associated with alcohol use. This study investigates support for product information and health messaging on alcohol packaging among UK adolescents. Methods The 2019 UK Youth Alcohol Policy Survey was an online cross-sectional survey among 3388 adolescents aged 11–19. Participants indicated their support for seven forms of messaging on packaging (e.g. number of alcohol units, links to health conditions). Logistic regression models investigated associations between support for each of the seven forms and alcohol use, perceived risks of alcohol use, and previous exposure to messaging. Results Between 60 and 79% of adolescents were supportive of different aspects of product labelling. Compared to lower-risk drinkers, higher-risk drinkers (AUDIT-C 5+) had higher odds of supporting including the number of alcohol units (OR: 1.82, 95% CI: 1.31–2.54), calories (OR: 1.52, 95% CI: 1.04–1.68), and strength of the product (OR: 1.73, 95% CI: 1.19–2.52) but lower odds of supporting including information on alcohol-related health conditions (OR: 0.68, 95% CI: 0.53–0.87). Adolescents who perceived risks of alcohol use more strongly were more likely to support all forms of product information and messaging. Conclusions The majority of adolescents supported improved alcohol labelling. Higher-risk drinkers were supportive of improved product information but less supportive of health-related messaging. Adolescents who believe alcohol carries health risks were more likely to support messaging. [ABSTRACT FROM AUTHOR]

The article presents the discussion on Chief Medical Officer for England recommending that young people remaining alcohol free until 18 years of age. Topics include highest levels of drinking among adolescents and the North East England being one of the highest levels of adolescent alcohol consumption in the UK; and exploring the relationship between alcohol use during adolescence and negative consequences in adulthood.

In the UK, harm caused by alcohol has worsened since 2020. A recent report from the Institute of Alcohol Studies projecting future rates of major alcohol-related diseases highlights what this means for health and healthcare. The authors argue that this additional burden is not inevitable if effective policies are introduced. [ABSTRACT FROM AUTHOR]

AbstractBackgroundAimsMethodsResultsConclusionOlder people commonly take prescribed medications, some of which are contra-indicated with alcohol. Few population-based studies have assessed the relationship between taking these medicines, different levels of alcohol use, and potential harm.To investigate the prevalence of taking alcohol-interactive (AI) medication and alcohol consumption among older adults and to compare the ten-year mortality risk among different categories of drinkers.Data were obtained from 6220 participants (mean age 70, 71% male) within the UK Whitehall II cohort study of civil servants from phase 11 (2012–2013) who were followed up for mortality over ten years. Alcohol use was based on volume of consumption in self-reported drinks per week, and hazardous pattern of consumption was assessed with the Alcohol Use Disorders Identification Test – Consumption (AUDIT-C). AI medications were coded from self-reported medication use. Deaths were obtained from the NHS central registry (2012–2022).55% of participants took AI medication and of these, 73% also consumed alcohol, and 43% drank hazardously. These participants were more likely to be male, older, and belong to lower socioeconomic groups. Among those taking AI medication, there was a significantly higher mortality hazard for ex-drinkers (HR =1.43 CI 1.14, 1.80) and nondrinkers (HR= 2.09 CI 1.33, 3.27) compared to moderate drinkers but no significant difference for higher risk/hazardous drinkers after adjusting for confounding factors.In these older adults, there was a high prevalence of taking alcohol-interactive medication and drinking alcohol. Whilst there was no increased mortality risk other non-fatal outcomes should be considered. [ABSTRACT FROM AUTHOR]

Introduction: To gain a better understanding of the complex and independent associations between different measures of socioeconomic position (SEP) and smoking in England.Aims and Methods: Between March 2013 and January 2019 data were collected from 120 496 adults aged 16+ in England taking part in the Smoking Toolkit Study. Of these, 18.04% (n = 21 720) were current smokers. Six indicators of SEP were measured: social grade, employment status, educational qualifications, home and car ownership and income. Models were constructed using ridge regression to assess the contribution of each measure of SEP, taking account of high collinearity.Results: The strongest predictor of smoking status was housing tenure. Those who did not own their own home had twice the odds of smoking compared with homeowners (odds ratio [OR] = 2.01). Social grade, educational qualification, and income were also good predictors. Those in social grades C1 (OR = 1.04), C2 (OR = 1.29), D (OR = 1.39), and E (OR = 1.78) had higher odds of smoking than those in social grade AB. Similarly, those with A-level/equivalent (OR = 1.15), GCSE/vocational (OR = 1.48), other/still studying (OR = 1.12), and no post-16 qualifications (OR = 1.48) had higher odds of smoking than those with university qualifications, as did those who earned in the lowest (OR = 1.23), third (OR = 1.18), and second quartiles (OR = 1.06) compared with those earning in the highest. Associations between smoking and employment (OR = 1.03) and car ownership (OR = 1.05) were much smaller.Conclusions: Of a variety of socioeconomic measures, housing tenure appears to be the strongest independent predictor of smoking in England, followed by social grade, educational qualifications, and income. Employment status and car ownership have the lowest predictive power.Implications: This study used ridge regression, a technique which takes into account high collinearity between variables, to gain a better understanding of the independent associations between different measures of SEP and smoking in England. The findings provide guidance as to which SEP measures one could use when trying to identifying individuals most at risk from smoking, with housing tenure identified as the strongest independent predictor. [ABSTRACT FROM AUTHOR]

Background: Whether alcohol and cannabis complement or substitute each other has been studied for over two decades. In the changing cannabis policy landscape, debates are moving rapidly and spill-over effects on other substances are of interest.Aims: update and extend a previous systematic review, by: (a) identifying new human behavioural studies reporting on substitution and/or complementarity of alcohol and cannabis, and (b) additionally including animal studies.Methods: We replicated the search strategy of an earlier systematic review, supplemented with a new search for animal studies. Search results were crossed checked against the earlier review and reference lists were hand searched. Findings were synthesised using a narrative synthesis.Results: Sixty-five articles were included (64 in humans, one in animals). We synthesised findings into categories: patterns of use, substitution practices, economic relationship, substance use disorders, policy evaluation, others and animal studies. Overall, 30 studies found evidence for substitution, 17 for complementarity, 14 did not find evidence for either, and four found evidence for both.Conclusions: Overall, the evidence regarding complementarity and substitution of cannabis and alcohol is mixed. We identified stronger support for substitution than complementarity, though evidence indicates different effects in different populations and to some extent across different study designs. The quality of studies varied and few were designed specifically to address this question. Dedicated high-quality research is warranted. [ABSTRACT FROM AUTHOR]

Aim: To examine patterns of hazardous, harmful and dependent drinking across different socio-economic groups, and how this relationship may be explained by common mental disorder. Methods and findings: Between 2011–2013, 1,052 participants (age range 17–91, 53% female) were interviewed for Phase 2 of the South East London Community Health study. Latent class analysis was used to define six groups based on multiple indicators of socio-economic status in three domains. Alcohol use (low risk, hazardous, harmful/dependent) was measured using the Alcohol Use Disorders Identification Test and the presence of common mental disorder was measured using the revised Clinical Interview Schedule. Multinomial regression was used to explore associations with hazardous, harmful and dependent alcohol use, including after adjustment for common mental disorder. Harmful and dependent drinking was more common among people in Class 2 'economically inactive renters' (relative risk ratio (RRR) 3.05, 95% confidence interval (CI) 1.07–8.71), Class 3 'economically inactive homeowners' (RRR 4.11, 95% CI 1.19–14.20) and Class 6 'professional renters' (RRR 3.51, 95% CI 1.14–10.78) than in Class 1 'professional homeowners'. Prevalent common mental disorder explained some of the increased risk of harmful or dependent drinking in Class 2, but not Class 3 or 6. Conclusions: Across distinct socio-economic groups in a large inner-city sample, we found important differences in harmful and dependent drinking, only some of which were explained by common mental disorder. The increased risk of harmful or dependent drinking across classes which are very distinct from each other suggests differing underlying drivers of drinking across these groups. A nuanced understanding of alcohol use and problems is necessary to understand the inequalities in alcohol harms. [ABSTRACT FROM AUTHOR]

Aims: To explore adolescents’ experiences of consenting to, and participating in, alcohol intervention trials when attending for emergency care. Methods: In-depth semi-structured interviews with 27 adolescents (16 males; aged 14–17 years (Mage = 15.7)) who had taken part in one of two linked brief alcohol intervention trials based in 10 accident and emergency departments in England. Interviews were transcribed verbatim and subject to thematic analysis. Results: Research and intervention methods were generally found to be acceptable though confidentiality was important and parental presence could hinder truthful disclosures regarding alcohol use. Participants discussed the importance of being involved in research that was relevant to them and recognised alcohol consumption as a normative part of adolescence, highlighting the importance of having access to appropriate health information. Beyond this, they recognised the benefits and risks of trial participation for themselves and others with the majority showing a degree of altruism in considering longer term implications for others as well as themselves. Conclusions: Alcohol screening and intervention in emergency care is both acceptable and relevant to adolescents but acceptability is reliant on confidentiality being assured and may be inhibited by parental presence. Trial registration: [ABSTRACT FROM AUTHOR]

Aims To review the evidence on the effect of brief interventions (BIs) for alcohol among adults with risky alcohol consumption and comorbid mental health conditions. Methods A systematic review of randomized controlled trials (RCTs) published before May 2016 was undertaken and reported according to PRISMA guidelines. The findings were combined in a narrative synthesis. The risk of bias was assessed for included trials. Results Seventeen RCTs were included in the review and narrative synthesis: 11 in common mental health problems, and 6 in severe mental illness. There was considerable heterogeneity in study populations, BI delivery mode and intensity, outcome measures and risk of bias. Where BI was compared with a minimally active control, BI was associated with a significant reduction in alcohol consumption in four out of nine RCTs in common mental disorders and two out of five RCTs in severe mental illness. Where BI was compared with active comparator groups (such as motivational interviewing or cognitive behavioural therapy), findings were also mixed. Differences in the findings may be partly due to differences in study design, such as the intensity of BI and possibly the risk of bias. Conclusions Overall, the evidence is mixed regarding the effects of alcohol BI in participants with comorbid mental health conditions. Future well-designed research is required to answer this question more definitively. [ABSTRACT FROM AUTHOR]

Aims: To review the evidence on the effect of brief interventions (BIs) for alcohol among adults with risky alcohol consumption and comorbid mental health conditions. Methods: A systematic review of randomized controlled trials (RCTs) published before May 2016 was undertaken and reported according to PRISMA guidelines. The findings were combined in a narrative synthesis. The risk of bias was assessed for included trials. Results: Seventeen RCTs were included in the review and narrative synthesis: 11 in common mental health problems, and 6 in severe mental illness. There was considerable heterogeneity in study populations, BI delivery mode and intensity, outcome measures and risk of bias. Where BI was compared with a minimally active control, BI was associated with a significant reduction in alcohol consumption in four out of nine RCTs in common mental disorders and two out of five RCTs in severe mental illness. Where BI was compared with active comparator groups (such as motivational interviewing or cognitive behavioural therapy), findings were also mixed. Differences in the findings may be partly due to differences in study design, such as the intensity of BI and possibly the risk of bias. Conclusions: Overall, the evidence is mixed regarding the effects of alcohol BI in participants with comorbid mental health conditions. Future well-designed research is required to answer this question more definitively. [ABSTRACT FROM AUTHOR]

Purpose: The Warwick-Edinburgh Mental Well-being Scale (WEMWBS), 14 positively worded statements, is a validated instrument to measure mental wellbeing on a population level. Less is known about the population distribution of the shorter seven-item version (SWEMWBS) or its performance as an instrument to measure wellbeing.Methods: Using the Health Survey for England 2010-2013 (n = 27,169 adults aged 16+, nationally representative of the population), age- and sex-specific norms were estimated using means and percentiles. Criterion validity was examined using: (1) Spearman correlations (ρ) for SWEMWBS with General Health Questionnaire (GHQ-12), happiness index, EQ-VAS (2) a multinomial logit model with SWEMWBS (low, medium and high wellbeing) as the outcome and demographic, social and health behaviours as explanatory variables. Relative validity was examined by comparing SWEMWBS with WEMWBS using: (1) Spearman correlations (continuous data), and (2) the weighted kappa statistic (categorical), within population subgroups.Results: Mean (median) SWEMWBS was 23.7 (23.2) for men and 23.2 (23.2) for women (p = 0.100). Spearman correlations were moderately sized for the happiness index (ρ = 0.53, P < 0.001), GHQ-12 (ρ = -0.52, p < 0.001) and EQ-VAS (ρ = 0.40, p < 0.001). Participants consuming <1 portion of fruit and vegetables a day versus ≥5 (odds ratio = 1.43 95% Confidence Interval = (1.22-1.66)) and current smokers versus non-smokers (1.28 (1.15-1.41)) were more likely to have low vs medium wellbeing. Participants who binge drank versus non-drinkers were less likely to have high versus medium wellbeing (0.81 (0.71-0.92)). Spearman correlations between SWEMWBS and WEMWBS were above 0.95; weighted kappa statistics showed almost perfect agreement (0.79-0.85).Conclusion: SWEMWBS distinguishes mental wellbeing between subgroups, similarly to WEMWBS, but is less sensitive to gender differences. [ABSTRACT FROM AUTHOR]

Background: Adolescence is a critical developmental stage when young people make lifestyle choices that have the potential to impact on their current and future health and social wellbeing. The relationship between substance use and criminal activity is complex but there is clear evidence that the prevalence of problematic substance use is far higher among adolescent offenders than the general adolescent population. Adolescent offenders are a marginalized and vulnerable population who are significantly more likely to experience health and social inequalities in later life than their non-offending peers. There is a paucity of evidence on effective interventions to address substance use and risk-taking behaviours in adolescent offender populations but it is clear that preventative or abstinence orientated interventions are not effective. RISKIT-CJS is an intervention developed in collaboration with young people taking account of the current best evidence. Feasibility and pilot studies have found the intervention addresses the needs of adolescents, is acceptable and has demonstrated potential in reducing substance use and risk-taking behavior.Methods: The study is a mixed method, two-armed, prospective, pragmatic randomized controlled trial with individual randomisation to either treatment as usual alone or the RISKIT-CJS intervention in addition to treatment as usual. Adolescents, aged 13 to 17 years inclusive, engaged with the criminal justice system who are identified as having problematic substance use are eligible to participate. The study will be conducted across three geographical areas; South and South East England, London and North East England between March 2017 and February 2019.Discussion: The study represents an ambitious programme of work to address an area of need for a marginalized and vulnerable population.Trial Registration: ISRCTN77037777 registered 15/09/2016. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown heavier drinkers are less likely to respond to surveys and require extended efforts to recruit. This study applies the continuum of resistance model to explore how survey estimates of alcohol consumption may be affected by non-response bias in three consecutive years of a general population survey in England. Methods: Using the Health Survey for England (HSE) survey years 2011–13, number of contact attempts (1–6 and 7+) were explored by socio-demographic and drinking characteristics. The odds of drinking more than various thresholds were modelled using logistic regression. Assuming that non-participants were similar to those who were difficult to contact (the continuum of resistance model), the effect of non-response on measures of drinking was investigated. Results: In the fully-adjusted regression model, women who required 7+ calls were significantly more likely to drink more than the UK Government’s recommended daily limit (OR 1.19, 95% CI 1.06–1.33, P = 0.003) and to engage in heavy episodic drinking (OR 1.23, 95% CI 1.07–1.42, P = 0.004), however this was not significant in men in the fully-adjusted model. When the continuum of resistance model was applied, there was an increase in average weekly alcohol consumption of 1.8 units among men (a 12.6% relative increase), and an increase of 1.5 units among women (a 20.5% relative increase). There was also an increase in the prevalence of heavy episodic drinking of 2.5% among men (an 12.0% relative increase) and of 2.0% among women (a 15.8% relative increase), although other measures of drinking were less affected. Conclusion: Overall alcohol consumption and the prevalence of heavy episodic drinking were higher among HSE participants who required more extended efforts to contact. The continuum of resistance model suggests non-response bias does affect survey estimates of alcohol consumption. [ABSTRACT FROM AUTHOR]

Introduction: Drinking has adverse impacts on health, well-being, education and social outcomes for adolescents. Adolescents in England are among the heaviest drinkers in Europe. Recently, the proportion of adolescents who drink alcohol has fallen, although consumption among those who do drink has actually increased. This trial seeks to investigate how effective and efficient an alcohol brief intervention is with 11-15 years olds to encourage lower alcohol consumption. Methods and analysis: This is an individually randomised two-armed trial incorporating a control arm of usual school-based practice and a leaflet on a healthy lifestyle (excl. alcohol), and an intervention arm that combines usual practice with a 30 min brief intervention delivered by school learning mentors and a leaflet on alcohol. At least 30 schools will be recruited from four regions in England (North East, North West, London, Kent and Medway) to follow-up 235 per arm. The primary outcome is total alcohol consumed in the last 28 days, using the 28 day Timeline Follow Back questionnaire measured at the 12-month follow-up. The analysis of the intervention will consider effectiveness and cost-effectiveness. A qualitative study will explore, via 1:1 in-depth interviews with (n=80) parents, young people and school staff, intervention experience, intervention fidelity and acceptability issues, using thematic narrative synthesis to report qualitative data. Ethics and dissemination: Ethical approval was granted by Teesside University. Dissemination plans include academic publications, conference presentations, disseminating to local and national education departments and the wider public health community, including via Fuse, and engaging with school staff and young people to comment on whether and how the project can be improved. [ABSTRACT FROM AUTHOR]

Background: There is consistent evidence that individuals in higher socioeconomic status groups are more likely to report exceeding recommended drinking limits, but those in lower socioeconomic status groups experience more alcohol-related harm. This has been called the 'alcohol harm paradox'. Such studies typically use standard cut-offs to define heavy drinking, which are exceeded by a large proportion of adults. Our study pools data from six years (2008-2013) of the population-based Health Survey for England to test whether the socioeconomic distribution of more extreme levels of drinking could help explain the paradox.Methods: The study included 51,498 adults from a representative sample of the adult population of England for a cross-sectional analysis of associations between socioeconomic status and self-reported drinking. Heavy weekly drinking was measured at four thresholds, ranging from 112 g+/168 g + (alcohol for women/men, or 14/21 UK standard units) to 680 g+/880 g + (or 85/110 UK standard units) per week. Heavy episodic drinking was also measured at four thresholds, from 48 g+/64 g + (or 6/8 UK standard units) to 192 g+/256 g + (or 24/32 UK standard units) in one day. Socioeconomic status indicators were equivalised household income, education, occupation and neighbourhood deprivation.Results: Lower socioeconomic status was associated with lower likelihoods of exceeding recommended limits for weekly and episodic drinking, and higher likelihoods of exceeding more extreme thresholds. For example, participants in routine or manual occupations had 0.65 (95 % CI 0.57-0.74) times the odds of exceeding the recommended weekly limit compared to those in 'higher managerial' occupations, and 2.15 (95 % CI 1.06-4.36) times the odds of exceeding the highest threshold. Similarly, participants in the lowest income quintile had 0.60 (95 % CI 0.52-0.69) times the odds of exceeding the recommended weekly limit when compared to the highest quintile, and 2.30 (95 % CI 1.28-4.13) times the odds of exceeding the highest threshold.Conclusions: Low socioeconomic status groups are more likely to drink at extreme levels, which may partially explain the alcohol harm paradox. Policies that address alcohol-related health inequalities need to consider extreme drinking levels in some sub-groups that may be associated with multiple markers of deprivation. This will require a more disaggregated understanding of drinking practices. [ABSTRACT FROM AUTHOR]

Background Under-reporting of alcohol consumption is widespread; surveys typically capture 40-60% of alcohol sales. However the population distribution of under-reporting is not well understood. Methods Mixed-methods study to identify factors associated with under-reporting, using the nationally-representative Health Survey for England (HSE) 2011 (overall response rate 66%). Comparison of retrospective computer-assisted personal interview and seven-day drinking diary (n = 3,774 adults 18+, 50% women, diary response rate 69%) to identify factors associated with diary responses exceeding those of the interview using multivariable linear regression for three outcomes: drinking days in the week recorded, volume consumed on heaviest drinking day in the week recorded, and weekly alcohol consumption. Qualitative semi-structured interviews (n = 10) explored reasons for under-reporting in further detail. Results Number of drinking days was slightly greater in the diary than the interview (P < 0.001). Reported consumption was higher in the diary than in the interview for heaviest drinking day in the week recorded (0.7 units greater among men, 1.2 units among women, P < 0.001), and weekly alcohol consumption in women only (1.1 units among women, P = 0.003). Participants who drank more frequently, more heavily, and had a more varied drinking pattern with respect to the types of drink consumed or choice of drinking venues had a larger difference between their diary week and their interview week. The qualitative interviews identified having a non-routine drinking pattern, self-perception as a non-frequent drinker, and usually tracking drinking using experiential approaches as linked to more drinking being reported in the diary than the retrospective interview. Conclusions Heavy drinking and non-routine drinking patterns may be associated with greater underreporting of alcohol consumption. Estimates of drinking above recommended levels are likely to be disproportionately under-estimated. [ABSTRACT FROM AUTHOR]

Bhattacharya and colleagues show that the alcohol industry is hugely reliant upon people drinking above guideline levels for revenue, highlighting the fundamental conflict of interest in allowing industry to self-regulate or be involved in health policy making. [ABSTRACT FROM AUTHOR]