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Background: Digital interventions have the potential to reduce alcohol consumption, although evidence on the effectiveness of apps is lacking. Drink Less is a popular, evidence-informed app with good usability, putting it in a strong position to be improved upon prior to conducting a confirmatory evaluation. This paper describes the process of refining Drink Less to improve its usability and likely effectiveness.\ud \ud Methods: The refinement consisted of three phases and involved qualitative and quantitative (mixed) methods: i) identifying changes to app content, based on findings from an initial evaluation of Drink Less, an updated review of digital alcohol interventions and a content analysis of user feedback; ii) designing new app modules with public input and a consultation with app developers and researchers; and iii) improving the app’s usability through user testing.\ud \ud Results: As a result of the updated review of digital alcohol interventions and user feedback analysis in Phase 1, three new modules: ‘Behaviour Substitution’, ‘Information about Antecedents’ and ‘Insights’, were added to the app. One existing module – ‘Identity Change’ – was removed based on the initial evaluation of Drink Less. Phases 2 and 3 resulted in changes to existing features, such as improving the navigational structure and onboarding process, and clarifying how to edit drinks and goals.\ud \ud Conclusions: A mixed methods approach was used to refine the content and design of Drink Less, providing insights into how to improve its usability and likely effectiveness. Drink Less is now ready for a confirmatory evaluation.

Objectives Undertake a scoping review to determine the effectiveness of community-centred interventions designed to improve the mental health and well-being of adults from ethnic minority groups in the UK. Methods We searched six electronic academic databases for studies published between January 1990 and September 2019: Medline, Embase, PsychINFO, Scopus, CINAHL and Cochrane. For intervention description and data extraction we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist and Template for Intervention Description and Replication guide. Quality was assessed using Cochrane risk of bias tools. Grey literature results were deemed beyond the scope of this review due to the large number of interventions and lack of available outcomes data. Results Of 4501 studies, 7 met the eligibility criteria of UK-based community interventions targeting mental health in adults from ethnic minority populations: four randomised controlled trials, one pre/post-pilot study, one cross-sectional study and one ethnographic study. Interventions included therapy-style sessions, peer-support groups, educational materials, gym access and a family services programme. Common components included a focus on tackling social isolation, using lay health workers from within the community, signposting and overcoming structural barriers to access. Four studies reported a statistically significant positive effect on mental health outcomes and six were appraised as having a high risk of bias. Study populations were ethnically heterogeneous and targeted people mainly from South Asia. No studies examined interventions targeting men. Conclusions There is a paucity of high-quality evidence regarding community-centred interventions focused on improving public mental health among ethnic minority groups. Decision makers need scientific evidence to inform effective approaches to mitigating health disparities. Our next steps are to map promising community activities and interventions that are currently being provided to help identify emerging evidence.

Background and Aims\ud \ud Digital interventions are effective for reducing alcohol consumption but evidence is limited regarding smartphone apps. Drink Less is a theory- and evidence-informed app to help people reduce their alcohol consumption that has been refined in terms of its content and design for usability across the sociodemographic spectrum. We aim to evaluate the effectiveness and cost-effectiveness of recommending Drink Less at reducing alcohol consumption compared with usual digital care.\ud \ud Design\ud \ud Two-arm individually randomised controlled trial.\ud \ud Setting\ud \ud Online trial in the United Kingdom (UK).\ud \ud Participants\ud \ud Hazardous or harmful drinkers (Alcohol Use Disorders Identification Test [AUDIT] score ≥8) aged 18+ who want to drink less alcohol (n = 5562). Participants will be recruited from July 2020 to May 2022 using multiple strategies with a focus on remote digital methods.\ud \ud Intervention and comparator\ud \ud Participants will be randomised to receive either an email recommending that they use Drink Less (intervention) or view the National Health Service (NHS) webpage on alcohol advice (comparator).\ud \ud Measurements\ud \ud The primary outcome is change in self-reported weekly alcohol consumption, assessed using the extended AUDIT-Consumption, between baseline and 6-month follow-up. Secondary outcomes include change in self-reported weekly alcohol consumption assessed at 1- and 3-month follow-ups, and the proportion of hazardous drinkers; alcohol-related problems and injury; health-related quality of life; and use of health services assessed at 6-month follow-up. Effectiveness will be examined with adjusted regression models, adjusting for baseline alcohol consumption and using an intention-to-treat approach. A mixed-methods process evaluation will assess engagement, acceptability and mechanism of action. Economic evaluations will be conducted using both a short- and longer-term time horizon.\ud \ud Comments\ud \ud This study will establish the effectiveness and cost-effectiveness of the Drink Less app at reducing alcohol consumption among hazardous and harmful adult drinkers and will be the first randomised controlled trial of an alcohol reduction app for the general population in the United Kingdom. This study will inform the decision on whether it is worth investing resources in large-scale implementation.

Additional file 1. Data extracted about each intervention, if available (list adapted from TiDieR Checklist). This additional file provides information about the type of data that we aimed to extract for each of the interventions identified in this mapping exercise.

Aims: To examine whether daily exposure to tobacco outlets within activity spaces is associated with cigarette smoking and with the number of cigarettes smoked by youth that day. Design: The study used geographic ecological momentary assessment (GEMA) data that combined daily surveys with ecological momentary assessment of global positioning systems (GPS) using geographic information systems (GIS) to allow for real-time data collection of participants' environments and behaviors. Setting: Eight mid-sized California (USA) city areas. Participants: The analytical sample included 1065 days, which were clustered within 100 smoker and non-smoker participants (aged 16–20 years, 60% female). Measurements: Any cigarette smoking and number of cigarettes smoked on a given day, the number of tobacco outlets within 100 m of activity space polylines each day, the number of minutes participants spent within 100 m of tobacco outlets each day and demographic characteristics (age, sex, race/ethnicity and perceived socio-economic status). Findings: Controlling for demographic characteristics, the findings of multi-level mixed effects logistic models were inconclusive, whether or not the number of tobacco outlets within 100 m of youths' activity space polylines or the number of minutes spent within 100 m of tobacco outlets were associated with whether the participant smoked cigarettes on a given day [odds ratio (OR) = 1.05, P = 0.24; OR = 0.99, P = 0.81, respectively]. However, in multi-level zero-inflated negative binomial models, the risk of smoking an additional cigarette on a given day increased with each additional tobacco outlet [incidence rate ratio (IRR) = 1.04, P < 0.05] and each additional minute spent within 100 m of tobacco outlets (IRR = 1.01, P < 0.001) each day. Conclusions: Among young people in urban California, differences in day-to-day exposure to tobacco outlets within activity spaces does not seem to be significantly associated with whether a person smokes a cigarette on a given day, but higher exposure to tobacco outlets appears to be positively associated with the number of cigarettes smoked on that day.

Aim\ud \ud To gain a better understanding of the complex relationships of different measures of social position, educational level and income with alcohol consumption in England.\ud \ud \ud Method\ud \ud Between March 2014 and April 2018 data were collected on n = 57,807 alcohol drinkers in England taking part in the Alcohol Toolkit Study (ATS). Respondents completed the AUDIT-C measure of frequency of alcohol consumption, amount consumed on a typical day and binge drinking frequency. The first two questions were used to derive a secondary measure of quantity: average weekly unit consumption. Socio-economic factors measured were: social-grade (based on occupation), employment status, educational qualifications, home and car ownership and income. Models were constructed using ridge regression to assess the contribution of each predictor taking account of high collinearity. Models were adjusted for age, gender and ethnicity.\ud \ud \ud Results\ud \ud The strongest predictor of frequency of alcohol consumption was social-grade. Those in the two lowest occupational categories of social grade (e.g. semi-skilled and unskilled manual workers, and unemployed, pensioners, casual workers) has fewer drinking occasions than those in professional-managerial occupations (β = -0.29, 95%CI -0.34 to -0.25; β = -0.31, 95%CI -0.33 to -0.29). The strongest predictor of consumed volume and binge drinking frequency was lower educational attainment: those whose highest qualification was an A-level (i.e. college/high school qualification) drank substantially more on a typical day (β = 0.28, 95%CI 0.25 to 0.31) and had a higher weekly unit intake (β = 3.55, 95%CI 3.04 to 4.05) than those with a university qualification. They also reported a higher frequency of binge drinking (β = 0.11, 95%CI 0.09 to 0.14). Housing tenure was a strong predictor of all drinking outcomes, while employment status and car ownership were the weakest predictors of most outcomes.\ud \ud \ud Conclusion\ud \ud Social-grade and educational attainment appear to be the strongest socioeconomic predictors of alcohol consumption indices in England, followed closely by housing tenure. Employment status and car ownership have the lowest predictive power.

Background\ud \ud The Equal North network was developed to take forward the implications of the Due North report of the Independent Inquiry into Health Equity. The aim of this exercise was to identify how to reduce health inequalities in the north of England.\ud \ud Methods\ud \ud Workshops (15 groups) and a Delphi survey (3 rounds, 368 members) were used to consult expert opinion and achieve consensus. Round 1 answered open questions around priorities for action; Round 2 used a 5-point Likert scale to rate items; Round 3 responses were re-rated alongside a median response to each item. In total, 10 workshops were conducted after the Delphi survey to triangulate the data.\ud \ud Results\ud \ud In Round 1, responses from 253 participants generated 39 items used in Round 2 (rated by 144 participants). Results from Round 3 (76 participants) indicate that poverty/implications of austerity (4.87 m, IQR 0) remained the priority issue, with long-term unemployment (4.8 m, IQR 0) and mental health (4.7 m, IQR 1) second and third priorities. Workshop 3 did not diverge from findings in Round 1.\ud \ud Conclusions\ud \ud Practice professionals and academics agreed that reducing health inequalities in the North of England requires prioritizing research that tackles structural determinants concerning poverty, the implications of austerity measures and unemployment.

Aims: There is a clear association between alcohol use and offending behaviour and significant police time is spent on alcohol-related incidents. This study aimed to test the feasibility of a trial of screening and brief intervention in police custody suites to reduce heavy drinking and re-offending behaviour.Short summary: We achieved target recruitment and high brief intervention delivery if this occurred immediately after screening. Low rates of return for counselling and retention at follow-up were challenges for a definitive trial. Conversely, high consent rates for access to police data suggested at least some outcomes could be measured remotely.Methods: A three-armed pilot Cluster Randomised Controlled Trial with an embedded qualitative interview-based process evaluation to explore acceptability issues in six police custody suites (north east and south west of the UK). Interventions included: 1. Screening only (Controls), 2. 10 min Brief Advice 3. Brief Advice plus 20 min of brief Counselling.Results: Of 3330 arrestees approached: 2228 were eligible for screening (67%) and 720 consented (32%); 386 (54%) scored 8+ on AUDIT; and 205 (53%) were enroled (79 controls, 65 brief advice and 61 brief counselling). Follow-up rates at 6 and 12 months were 29% and 26%, respectively. However, routinely collected re-offending data were obtained for 193 (94%) participants. Indices of deprivation data were calculated for 184 (90%) participants; 37.6% of these resided in the 20% most deprived areas of UK. Qualitative data showed that all arrestees reported awareness that participation was voluntary, that the trial was separate from police work, and the majority said trial procedures were acceptable.Conclusion: Despite hitting target recruitment and same-day brief intervention delivery, a future trial of alcohol screening and brief intervention in a police custody setting would only be feasible if routinely collected re-offending and health data were used for outcome measurement.Trial registration: ISRCTN number: 89291046.

Proceedings of the 14th annual conference of INEBRIA