Alcohol

(Funded by the World Health Organization)

Cancer Prevention Europe (CPE) is a consortium of research and advocacy organisations established to accelerate progress towards addressing the burden of preventable cancers across Europe. During the first year of CPE’s development, priorities for the consortium were identified and one of these was to systematically collate preventative interventions which have proven evidence of benefit (and proposed interventions lacking benefit) at the population level. An advisory group made up of CPE members was established to guide this work. Following a first meeting of this group and a review of the resources available, it was decided that the scale of this undertaking may be too ambitious to do as a single project and that a ‘proof of concept’ review was needed in the first instance.  This initial review would test methods and approaches and assess the feasibility of a future cross-cutting review, or further reviews by risk factor. Alcohol was selected as an initial risk factor to focus on for the purposes of a pilot review. The aim of the pilot review was to systematically collate review-level evidence on interventions to address alcohol consumption that have proven evidence of benefit at the population level.

ISM Staff: Kathryn Angus

External: Linda Bauld and Kirsty Loudon

(Funded by SHAAP – Scottish Health Action on Alcohol Problems)

Alcohol consumption and related harm are key public health issues in Scotland. In 2016/17, over 24,000 people in Scotland were admitted to a general acute hospital with an alcohol related diagnosis. In this same period, rates of alcohol-specific death and hospital stays were more than eight times higher in the most deprived areas than in the least deprived areas of Scotland. There are a range of specialist alcohol treatment services in Scotland covering a wide variety of interventions depending on the level of need of the individual, but most of these are located in communities, and may be less accessible to people from deprived areas. General practices are thought to be well-placed to deliver interventions to help people with alcohol problems, as they provide continuity of care for patients and build long-term relations and trust with them. However, challenges in managing alcohol problems within this setting exist, and are partly attributed to constraints on resources. Having a specialist alcohol worker located in general practices is one model which has been explored in order to help address some of these challenges.

The ‘Attached Alcohol Nurse’ (AAN) role was piloted in six ‘Deep End’ practices in Glasgow. Deep End practices are a group of general practices serving the most 100 deprived populations in Scotland. Whilst an evaluation of the AAN pilot reported positive outcomes in terms of success in engaging service users, it could not draw any firm conclusions about the effectiveness of having such a model within general practice. The aim of this study was to address some of the gaps in the evidence base by exploring the experiences and perspectives of a range of stakeholders regarding the management of alcohol problems in these Deep End practices.

We used qualitative, semi-structured interviews to obtain the experiences and perspectives of GPs, nurses and service users from four Deep End practices that participated in the AAN project. The academic lead for the GPs at the Deep End group initially contacted these practices on behalf of the research team to ascertain their interest in the study. From each practice, we recruited between four and six stakeholders who had frontline experience with the AAN project. We also recruited strategic staff from the NHS and ADP who had experience in designing, implementing or evaluating the AAN project. Ethical approval was sought from the University of Stirling and the NHS. We were aware of the sensitive nature of the topic, and put the necessary measures in place to mitigate any potential risks to the participants and researchers.

ISM Staff: Andrea Mohan (left), Niamh Fitzgerald, Clare Sharp and Amelie Begley (left)

(Funded by PACTS – Parliamentary Advisory Council for Transport Safety)

Past work examining the reduction in the drink-drive limit in Scotland conducted by members of our team found that the change had no impact on the rate of road traffic accidents (RTAs), with qualitative findings suggesting that the limit may have had little impact on those mostly like to drink and drive. No recent research had been conducted with drink-drivers in the UK, and previous studies had not sought to understand drink-driving from the perspective of drink-drivers who may have had underlying alcohol problems. It was thought that this group may have engaged in more regular drink-driving at higher blood levels as they may have drank alcohol daily in higher quantities, and driving as part of their daily activities. The number of drink-drivers caught in England and Scotland had been on the rise, therefore this research was timely.

The aim of this study was to better understand the experiences and perceptions of repeat drink-drivers in relation to motivations, perceived risks and deterrents. We conducted interviews with a sample of people who had previously been involved in drinking and driving including: 1) current or former drivers with one or more previous convictions for drink-driving, with or without underlying alcohol-related problems; and 2) current or former drivers with current or previous alcohol-related problems (eg. dependence/harmful drinking), who had not previously been convicted for drink-driving but who self-report drinking and driving on multiple occasions in the past. A range of pragmatic recruitment methods were used to achieve the desired number and variety of participants. These included promoting the study through recovery groups, social media, academic contacts, providers of drink-drive rehabilitation services and through the courts/legal representatives. We conducted 30-40 interviews either by telephone of face-to-face, to obtain participants’ perceptions, views and experiences with drink-driving.

This study was part of a larger one led by the Parliamentary Advisory Council for Transport Safety (PACTS) and funded by the Department for Transport. This larger study sought to provide an up-to date insight into the behaviour, mind-set and circumstance of drink drivers by reviewing drink driving trends, practice and interventions in the UK, and interviewing key experts and stakeholders to explore best practice and current policy related to drink-driving in the UK. The findings from this study informed interventions to reduce drink-driving and the harm that this caused in the UK.

ISM Staff: Andrea Mohan (left), Niamh Fitzgerald, Isabelle Uny and Amelie Begley (left)

(Funded by Economic and Social Research Council)

The key objective of this research was to answer the following questions: why do people drink when they watch football; how much harm does it cause; and, what should government do about it? In answering these questions this research provided evidence of the role alcohol plays and the motivations for consumption for various groups attending and watching football matches on television in order to help prevent excessive/binge consumption and violent or antisocial behaviour. It assessed the impact that existing regulations designed to restrict the consumption of alcohol at football matches had on the consumption of alcohol for those attending or watching a match.

This research employed a mix of quantitative and qualitative methods, divided into three work packages (WP) to explore how either attending a match or watching a live broadcast of football on television shaped the alcohol consumption of supporters and attitudes towards the current regulations which govern alcohol and football.

WP1 developed this evidence base by conducting focus groups with football fans to gain in-depth insight into the importance and role of alcohol consumption for those watching or attending a football match. We also probed the sets of relationships that the sample groups had outside of football, and the roles of alcohol consumption there, eg. with family, friends and in other recreational spaces in order to establish if football was a ‘special space’ for binge drinking or did it reflect/enable heavy drinking that also occurred elsewhere in other social spaces. WP1 also included an online cross-sectional survey with a larger sample of football fans divided into two parts. Part 1: Drinking behaviour; Part 2: Fan supporting behaviours, and attitudes towards consumption and regulations.

The purpose of WP2 was to gain an in-depth insight into the consequences of alcohol consumption for those watching football from the perspective of those who were responsible for match safety and those who were instrumental in any potential regulatory changes. In-depth interviews with key stakeholders were conducted. These included a range of different organisations with different motivations and interests and examined the assumptions they made about the relationship between alcohol consumption and behaviour.

The purpose of WP3 was to observe what part alcohol consumption played for fans attending a match, the implications of current alcohol restrictions and explored factors identified in WP1 & WP2 in a naturalistic environment. This WP involved equipping and training groups of fans to use video recording equipment in order to document attending a football match and in particular, any alcohol consumption which occured amongst the group. It consisted of a participatory ethnographic element which identified contexts, forms and experiences of alcohol use which could not be picked up in other ways. For example, it helped identify different kinds of consumption happening such as drinking to get drunk, social drinking to keep in with the group, pre-partying and so on which we then linked with potential anti-social behaviour in discussion with fans.

ISM Staff: Richard Purves (PI), Kate Hunt, Ruaraidh Dobson (left)

External: Loughborough, Edinburgh and Nottingham universities

(Funded by the Chief Scientist Office)

This study was the first to determine whether increasing the price of cheap alcohol affects ambulance call-outs and examined in-depth the impact of alcohol on a public ambulance service. 

Ambulance call-outs due to alcohol cost ~£52 million annually in Scotland. Under the Scottish Government’s (SG) world-first ‘Minimum Unit Pricing’ (MUP) policy, the cheapest alcoholic drinks became more expensive from 1st May 2018.  Research suggests that this will reduce drinking especially in heavier drinkers from deprived backgrounds, and should reduce ambulance call-outs, but the actual impact of price changes on call-outs has not previously been studied.

Our Objectives were as follows: (1) Used detailed data from the Scottish Ambulance Service (SAS) to identify alcohol-related ambulance call-outs and examine statistically if MUP had an impact on the number of call-outs, including in different groups (varying by sex/age/wealth); (2) Used in-depth interviews with ambulance staff to explore how they experienced, identified, handled and recorded alcohol-related call-outs. 

The findings informed wider alcohol policy; and supported SAS with planning and training staff for future alcohol-related incidents; and helped the Scottish Parliament decide in 2024 if enough evidence existed of benefits from MUP to continue it beyond that date.

ISM Staff: Niamh Fitzgerald

Stirling Collaborators: Dr David Fitzpatrick, FHSS

External Collaborators: Prof Jim Lewsey, Dr Daniel Mackay, University of Glasgow; Colin Angus, University of Sheffield

(Funded by Alcohol Research UK)

More than 15,000 prescriptions are issued every month in Scotland to treat alcohol problems (‘AUDs’). However, high-quality evidence that these drugs are effective is very limited. This study addressed this by researching large national databases, without identifying individuals.  Clinical trials are well established as the best way to determine whether new treatments work. However, it is also known that people who participate in trials may be different from the general population (e.g. on average, younger and healthier). Our study avoided this problem by covering all patients in Scotland who had been in hospital because of an alcohol problem. We also involved members of the public with experience of alcohol treatment as advisors to guide the research. 

Although there is guidance on what medications to use to help those who are dependent on alcohol to stop drinking initially, it is unclear how to treat people in the longer term to reduce their chances of further problems.  In this study, we researched individuals prescribed medications for alcohol treatment after a hospital stay related to alcohol between 2010 and 2017. We described the medication they were prescribed and the dose used, and any linked hospital admissions or deaths.  We looked at whether these changed over time and whether they varied in different parts of Scotland or for people of different ages, sex and socio-economic deprivation levels.  This research made innovative use of national linked health records (prescribing, hospital stays, deaths).

ISM Staff: Niamh Fitzgerald (PI at Stirling)

External: Led by Prof Jim Lewsey, University of Glasgow; with Hamish Innes and Dr Andrew McAuley, Glasgow Caledonian University

(Funded by Alcohol Focus Scotland and Scottish Health Action on Alcohol Problems)

Research suggested that there was a consistent link between exposure to alcohol marketing and consumption, particularly in young people. Sponsorship, in particular, was a powerful communications tool that allowed marketers to use attractive associations with sporting events and sports teams to develop salient brand capital, develop positive attitudes and emotional connections with consumers, and foster interactions among peers. Despite this, there was limited evidence concerning the extent of alcohol sponsorship of professional sport in Scotland, how frequently it appeared in televised broadcasts, and what different forms sponsorship activity took. In response, this study aimed:

1. To explore the use of alcohol sponsorship in professional football and rugby union in Scotland.
2. To explore the frequency and nature of alcohol marketing in televised broadcasts of professional football and rugby union in Scotland.

The research was divided into three studies. The first study was an open source audit of official sponsorship arrangements for professional football and rugby union teams and competitions in Scotland. The second study was a series of in-depth case studies exploring the nature and use of alcohol sponsorship in professional football and rugby union in Scotland. The third study was a frequency analysis of alcohol marketing references in televised broadcasts of professional football and rugby union matches broadcast in Scotland.

ISM Staff: Richard Purves and Nathan Critchlow

(Funded by the National Institute for Health Research)

The minimum unit pricing (MUP) policy implemented in May 2018 by the Scottish Government aimed to reduce the affordability of alcohol. There was evidence that reducing affordability reduced consumption and related harm. However, there had been little evaluation of possible adverse consequences. This study aimed to determine the impacts (including whether this differs by age or deprivation) of alcohol minimum unit pricing on selected acute health harms and to monitor what if any, unintended consequences occurred. The study had three components. C1 and C2 involved assessments of attendance and use of A&E and sexual health services and was led by the University of Glasgow. C3 was undertaken by researchers at the ISM and collected qualitative data from young binge drinkers, older heavy drinkers and local stakeholders in three contrasting communities in Scotland. Its primary aim was to explore participants’ expectations, experiences and understanding of the policy and its impacts, including any unintended consequences and challenges with implementation.

ISM Staff: Douglas Eadie (left), Allison Ford, Martine Stead (left), Niamh Fitzgerald

External: Alastair Leyland (overall project lead), Shona Hilton, Vittal Katikireddi and Chris Patterson MRC/CSO Social & Public Health Sciences Unit, University of Glasgow

(Funded by NHS Health Scotland)

This project monitored changes in alcohol pricing and marketing before and after the implementation of Minimum Unit Pricing for alcohol in 2018. Our study comprised purchase and analysis of price data from small retailer EPOS (electronic point of sale) systems, observations in stores and interviews with retailers. Our methodology built on previous studies we had conducted for this and other funders to evaluate the implementation and impact of public health policies to regulate the retail environment. 

ISM Staff: Martine Stead (left), Douglas Eadie (left), Anne Marie MacKintosh, Nathan Critchlow, Niamh Fitzgerald, Jennifer McKell, Richard Purves, Kathryn Angus

(Funded by the National Insitute for Health Research)

In December 2014, the ‘drink-drive limit’ was reduced in Scotland from 80mg to 50mg of alcohol in 100ml of blood. Evidence suggested this would reduce road traffic accidents (RTAs) and resultant deaths, at least initially. It could also affect overall levels of drinking and related harms, which were rising in Scotland at least in part due to increased home drinking.

The aim of the study was to explore changes in drinking perceptions, behaviours (including driving), contexts and practices, following the reduction in the drink-drive limit in Scotland, including whether, how and why initial effects were sustained (or not), and implications for overall consumption levels.

ISM conducted group interviews with the general public and individual interviews with pub/bar owners/managers. Our findings enabled better understanding of how the change may have impacted on overall drinking levels, drinking patterns and related harms in Scotland, and would therefore inform future policies to reduce alcohol-related harm.

ISM Staff: Niamh Fitzgerald and Jennifer McKell

External: Carol Emslie, Glasgow Caledonian University and James Lewsey, University of Glasgow 

(Funded by the National Insitute for Health Research)

In Scotland and England, local councils had power over alcohol licensing – that was the system by which certain premises were allowed to sell alcohol. In recent years, professionals who worked on ways to improve health across the population (‘Public Health Teams’ or ‘PHT’s) had been trying to influence this licensing system. They did this by getting involved in licensing processes and encouraging licensing authorities and licence-holders to act in ways they hoped would ultimately improve the health of the local population.

The aim of the study was to find out what PHTs had been doing and whether their actions had any impact on these alcohol-related harms.

ISM Staff: Niamh Fitzgerald, Richard Purves, Nathan Critchlow and Linda Bauld (left)

External: Universities of Bristol, Sheffield, Edinburgh, London School of Hygiene and Tropical Medicine, Alcohol Focus Scotland and Alcohol Research UK

(Funded by NHS Greater Glasgow and Clyde)

This study was led by Professor David Tappin of the University of Glasgow.

Alcohol use during pregnancy is the commonest reason for significant development delay in childhood. There was no way to accurately determine the prevalence of significant alcohol use in the pregnant population. This study aimed to provide a baseline distribution of chronic alcohol use during pregnancy in Glasgow and Clyde, measured by elevated levels of two alcohol biomarkers.

ISM Staff: Niamh Fitzgerald and Lesley Sinclair (left)

External: Led by David Tappin, University of Glasgow

(Funded by SHAAP (Scottish Health Action on Alcohol Problems) and IAS (Institute of Alcohol Studies)

Evidence suggested that references to alcohol occurred frequently in the broadcasts of international football tournaments, such as the 2014 World Cup and the EURO 2012 Championships. This study reviewed the frequency of visual and verbal alcohol-references in EURO 2016 matches broadcast in the UK, Republic of Ireland and France. By including broadcasts from three countries the study considered whether the tighter restrictions on marketing in France, known as the Loi Evin, are successful in limiting the amount of alcohol references audiences in France are exposed to, compared to the self-regulatory approach in the UK.

ISM Staff: Richard Purves, Martine Stead (left) and Nathan Critchlow

External: Jean Adams, University of Cambridge; Karine Gallopel-Morvan, School of Public Health, France; Patrick Kenny, Dublin Institute of Technology

Publication:
Purves RI, Critchlow N, Stead M, Adams J and Brown K (2017). Alcohol marketing during the UEFA EURO 2016 football tournament: A frequency analysis. International Journal of Environmental Research and Public Health, 14(7): 704. doi:10.3390/ijerph14070704

(Funded by the Public Health Research Consortium, Department of Health)

Levels of obesity had risen steadily over the past two decades. Thirty-three percent of regular drinkers in the UK were at risk of related health and other problems.

Alcohol use peaked in early adulthood and could exacerbate weight gain. Liver disease was the third most common cause of premature death in the UK and it was increasingly seen in 15-44 year olds. A high body mass index and heavy drinking were independently associated with liver disease but, in combination, they produced a supra-additive risk of damage. Thus we needed to develop interventions focused on both behaviours, especially as they could become closely inter-linked in people’s day-to-day lives.

The aim of the study was to explore the links between unhealthy eating behaviour and risky alcohol use in the social, emotional and cultural lives of young adults (aged 18-25), including perceptions of risks, benefits, costs and consequences of these behaviours in early adulthood, and to work with young adults to co-design a dually focused intervention to help reduce health risk and social inequalities due to excess weight gain and alcohol consumption.

To do this the team carried out: a systematic review, secondary quantitative data analysis of national datasets, in-depth qualitative interviews, and workshops.

ISM Staff: Martine Stead (left) and Niamh Fitzgerald

External: Ashley Adamson (lead), Eileen Kaner, Stephanie Scott and Wendy Wrieden, Newcastle University; and, Chris Power, University College London 

(Funded by Cancer Research UK)

This project supported the Cancer Research UK Policy Research Centre for Cancer Prevention (PRCP) in the development of two new national youth surveys, one on alcohol and the other obesity. Institute for Social Marketing (ISM) staff provided insight and training to the PRCP team in how such studies are carried out, and provided research support, advice, and collaboration on publications. It is intended that data from the surveys will be used to monitor patterns of youth consumption, perceptions of alcohol and obesity and the impact that marketing has on these.

ISM Staff: Martine Stead, Douglas Eadie, Anne Marie MacKintosh, Jennifer McKell and Linda Bauld

(Funded by Glasgow Centre for Population Health)

The study conducted a systematic review of self-report measures for alcohol consumption in pregnancy.

ISM Staff: Niamh Fitzgerald and Kathryn Angus

(Funded by Cancer Research UK)

Levels of alcohol consumption amongst teenagers remain high. A key reason for this is the ineffective regulation of the industry’s marketing, with rules focusing on media and advertising content that are not working.

This pilot study had two principal objectives:

• To explore teenagers relationships with alcohol brands. This added to and updated existing evidence in this area.
• To obtain initial feedback from legal experts on the theoretical and practical implications of brand level regulation.

To do this, focus groups were carried out with young people, a rapid scoping review was undertaken and depth interviews were conducted with legal experts.

ISM Staff: Douglas Eadie and Richard Purves

External: Alan Tapp, University of the West of England and Gerard Hastings

(Funded by NESTA)

This report by Niamh Fitzgerald and Colin Angus investigated the extent to which alcohol policies and programmes across the UK were based on evidence.

The divergence of alcohol policy in the four nations of the UK since devolution allowed us to compare and contrast how evidence was used in alcohol policy and the extent to which current policies across the UK were supported by scientific evidence. In this report, we discovered substantial differences between the 4 nations in the way that alcohol problems were framed and policies implemented.  These differences appeared to reflect the level of activity within each country, with alcohol framed as a minority issue affecting only a small group of dependent drinkers at the UK level, while the more active devolved administrations tended to view or portray alcohol problems as a whole population issue. 

ISM Staff: Niamh Fitzgerald

External: Colin Angus, University of Sheffield

Publication:
Fitzgerald N and Angus C (2015). Four Nations – How Evidence-Based are Alcohol Policies and Programmes across the UK? Alliance for Useful Evidence.

(Funded by SHAAP (Scottish Health Action on Alcohol Problems)

This study assessed the availability and usefulness of data relating to remuneration and delivery rates for alcohol brief interventions in Scotland, to facilitate a rapid review of such data, inform future remuneration systems, and further study.

ISM Staff: Niamh Fitzgerald and Lisa Scholin (left 2016) 

(Funded by Glasgow Centre for Population Health)

Early diagnosis of Foetal Alcohol Syndrome [FAS], a condition resulting from heavy antenatal alcohol consumption, is difficult. This, together with difficulties detecting alcohol use during pregnancy, poses challenges for the evaluation of interventions aimed at reducing antenatal alcohol consumption. The pilot study aimed to determine if a two-stage assay system, measuring Carbohydrate-Deficient Transferrin (CDT) and Ethyl Glucuronide (EtG), could distinguish hazardous alcohol consumption from moderate or no antenatal drinking.

This assay system was then used to determine the baseline prevalence of significant alcohol consumption in the pregnant population by anonymous testing. One hundred and fifty serum samples from women living in the most deprived regions of Glasgow were assayed for the pilot. A further 8000 samples were assayed for the main study.

The aim was to measure the prevalence of significant alcohol consumption in the first trimester of pregnancy in the NHS Greater Glasgow and Clyde Health Board area. By measuring a baseline prevalence, interventions could be developed and assessed to reduce alcohol consumption in women of childbearing age.

ISM supported the development and set-up of sample and data collection and analysis protocols and pathways, analysed data and assisted with write up.

ISM Staff: Linda Bauld, Lesley Sinclair and Niamh Fitzgerald

External: Led by David Tappin, University of Glasgow, Helen Mactier, Roy Sherwood,  Janet Brennand 

(Funded by Cancer Research UK)

Cancer Research UK funding was secured to develop a project that would focus on analysing and monitoring the public statements of key politicians in relation alcohol policy and alcohol-related harm including cancer risk. Such monitoring was an important part of advocacy work, but there was no reliable or consensus-based analysis method. The UPPP project sought to assess the feasibility and value of a bespoke ‘positional analysis’ tool for analysing and monitoring politicians’ understanding of alcohol-related cancer-risks, alcohol problems, and policy positions relating to alcohol. The project was conducted by a team led by Dr Niamh Fitzgerald at the Institute for Social Marketing, with involvement from the Alcohol Health Alliance, University of Sheffield, University of the West of England and the University of Newcastle.

ISM Staff: Niamh Fitzgerald

(Funded by Alcohol Research UK)

Research indicated that patients who were drinking alcohol at a risky or harmful level could reduce their drinking if health professionals identified their consumption and engage them in short, structured conversations about it (brief interventions – ‘BI’s).  The provision of adequate training for health professionals was considered one important factor in enabling routine delivery of BIs.  In research trials, the nature of such training varied widely. 

This project:

• Identified, described and critically reviewed existing frameworks which were helpful for describing and analysing training of this kind.
• Described how training for professionals had been reported in BI trials to date.
• Sourced and described what detailed information on training was available by contacting researchers from these trials.

The outcomes of this work informed practice in delivering BI training, and laid the foundation for future research exploring how training could support BI delivery and effectiveness. 

ISM Staff: Niamh Fitzgerald and Kathryn Angus

(Funded by NHS Health Scotland)

In Scotland, the number of premises licensed to sell alcohol is controlled through a system of local licensing boards. Legislative changes gave such boards an objective of ‘protecting and improving public health’. Research suggested that controlling the number of licensed premises and therefore the availability of alcohol could reduce alcohol-related harm. This study involved qualitative interviews with individuals across Scotland working mainly in public health or in alcohol and drug partnerships who worked on licensing issues. The study aimed to identify how these individuals and their organisations attempted to influence local licensing policies and decisions in Scotland, and in their experience, what factors were important in helping and/or hindering those efforts. 

ISM Staff: Niamh Fitzgerald

Publication:
Fitzgerald N (2015). Influencing the Implementation of a Public Health Objective in Scottish Alcohol Licensing: A Qualitative Interview Study – Summary Report. Stirling: University of Stirling, Institute for Social Marketing. Report

(Funded by Glasgow Centre for Population Health)

There was evidence to suggest that a range of population-based interventions such as pricing, control of marketing, and reduction in availability of alcohol could reduce alcohol-related harm. This study analysed published literature reviews of such interventions to determine the extent to which they reported participation by women and any specific effects on women in the original studies underpinning this evidence. The results of the study informed policy decisions as well as providing a basis for more detailed work considering how these kinds of interventions had a differential effect by gender.

ISM Staff: Niamh Fitzgerald, Linda Bauld, Kathryn Angus and Martine Stead

Publication:

Fitzgerald N, Angus K, Emslie C, Shipton D and Bauld L (2016). Gender differences in the impact of population-level alcohol policy interventions: evidence synthesis of systematic reviews. Addiction, 111: 1735-1747. doi:10.1111/add.13452

The UK Centre for Tobacco and Alcohol Studies was a network of 13 universities (12 in UK, 1 in New Zealand) funded by the UK Clinical Research Collaboration, which built on the work and success of its predecessor, the UK Centre for Tobacco Control Studies (UKCTCS).

The UKCTAS was a leading international centre of tobacco and alcohol research and policy excellence with an extensive research programme. It established a cohort of early career researchers, provided a teaching programme to train and engage the wider research and policy community in tobacco and alcohol research. It facilitated policy development by informing policy makers of the latest scientific research on tobacco and alcohol use, and thus contributing to the nation's public health.

The UKCTAS aimed to deliver an international research and policy development portfolio, and built capacity in tobacco and alcohol research. UKCTAS work included developing strategies for behaviour change in tobacco and alcohol use, assessing risks, identifying measures to reduce harm, monitoring the tobacco and alcohol industries, and developing effective public policies to improve public health and wellbeing.

ISM Staff: Linda Bauld and Gerard Hastings for University of Stirling

(Funded by Alcohol Research UK)

Alcohol marketing was a key focus for concern for alcohol and public health researchers because of growing evidence that it was a determinant of uptake and frequency of drinking. To that point in time, research attention focused on more traditional forms of marketing promotion. However, research needed to keep pace with the fast-changing, multi-platform marketing environment. Two aspects of contemporary alcohol marketing merited particular concern: packaging, and how this related to online marketing. This research benefited wider alcohol research and policy by exploring the way in which digital media combined with alcohol labelling and packaging to create a multi-platform marketing environment and examined to what extent young people interacted with this environment.

Research in that area needed to use approaches which were reflexive and inductive, and two qualitative methods were proposed - focus groups with young people and netnography of identified social media sites and websites. A total of eight focus groups with 14-17 year-olds (n=48-64) were used to explore young people’s knowledge, attitudes and behaviour relating to alcohol packaging and labelling. Their levels of awareness and engagement with online alcohol marketing through producers’ websites and social media pages, using on-product QR codes, augmented reality packaging and printed web-addresses, were explored. The second stage involved the use of netnography to identify, observe and analyse online communications regarding alcohol products on social network pages and websites of certain alcohol brands.

ISM Staff: Richard Purves, Martine Stead and Douglas Eadie

Publication:
Purves R, Stead M and Eadie D (2014) 'What are you meant to do when you see it everywhere?': Young people, alcohol packaging and digital media. London: Alcohol Research UK; December.

(Funded by NHS Health Scotland)

The detection of alcohol problems was known to be enhanced by the use of appropriate screening tools, and a considerable body of research evidence supported the use of Alcohol Brief Interventions (ABIs) in reducing health-related harm due to alcohol consumption. ABIs were time-limited interventions that focused on changing drinking behaviour, and their delivery became a significant component of the Scottish Government Alcohol Strategy. Although studies indicated that ABIs could be effective with adults in primary care settings, relatively little was known about their use and value when implemented in settings such as social work and the community, and with young people (under the age of 16).

This study aimed to explore the feasibility and acceptability of ABIs delivered to young people and in social work settings through two phases of research; the first mapping and scoping current projects across Scotland, and the second examining delivery in a series of case study projects, and developed proposals for a potential future outcome evaluation.  A mixed methods approach was used involving interviews with project staff and stakeholders and with users of the projects; field visits and observation; and analysis of project documentation and data. 
 
The study was a collaborative project between ISM, Nursing, Midwifery and Health, and the Faculty of Social Sciences.

ISM Staff: Martine Stead, Douglas Eadie and Jennifer McKell, ISM; Dr Tessa Parkes and Avril Nicoll, NWH; Dr Sarah Wilson and Cheryl Burgess, SASS

Publications:
Stead S, Parkes T, Nicoll A, Wilson S, Burgess C, Eadie D, Fitzgerald N, McKell J, Reid G, Jepson R, McAteer J and Bauld L (2017). Delivery of alcohol brief interventions in community-based youth work settings: exploring feasibility and acceptability in a qualitative study. BMC Public Health, 17: 357. doi: 10.1186/s12889-017-4256-1

Parkes T, Stead M, Eadie D, Nicoll A, McKell J, Bauld L, Wilson S, Burgess C, Reid G, McAteer J and Jepson R (2013). Alcohol brief interventions in youth and social work settings in Scotland. Addiction Science and Clinical Practice, 8(Suppl 1): A52.

(Funded by National Prevention Research Initiative (NPRI)

The Alcohol Policy Interventions in Scotland and England study (APISE) was part of a multi-country collaborative project (the International Alcohol Control Policy Evaluation Study) to assess the impact and effectiveness of alcohol control policies. The study design was modelled on the International Tobacco Control study. Longitudinal surveys of drinkers in participating countries, together with the analysis of the policy context, allowed for assessment of change over time within countries and comparison between countries. Funding was secured from the National Prevention Research Initiative (NPRI) to enable collection of baseline data in Scotland and England and a follow-up 12 months later. Three linked stages of research included an audit of alcohol control strategies in each country, exploratory research with adult drinkers and a longitudinal survey. 

The baseline survey, conducted 2012/2013, recruited a cohort of 1,749 adult drinkers in England and 1,728 in Scotland. The cohort was followed up 12 months later. The survey was conducted using Computer Assisted Telephone Interviews (CATI) and collected comprehensive consumption data, using a framework that is beverage and location specific, to facilitate identification of impacts of policy change. Policy related measures are measures that are closely linked to a specific policy and therefore expected to be directly affected by the introduction of a particular policy. A range of policy-related measures were included in the study including, for example, affordability which is a key measure in relation to the introduction of Minimum Unit Pricing (MUP). APISE had an international dimension through collaboration with colleagues in New Zealand, Australia, USA, Thailand and South Korea who undertook analogous studies in their countries.

The study was led by researchers at the University of Stirling and was conducted in collaboration with the University of Sheffield, The Open University and the University of Wollongong.

ISM Staff: Gerard Hastings, Anne Marie MacKintosh and Douglas Eadie

Publications:

Casswell S, Meier P, MacKintosh AM, Brown A, Hastings G, Thamarangsi T, Chaiyasong S, Chun S, Huckle T, Wall M and You RQ (2012). The International Alcohol Control (IAC) Study- Evaluating the impact of alcohol policies. Alcoholism: Clinical and Experimental Research, 36(8): 1462-1467.

Huckle T, Casswell S, MacKintosh AM, Chaiyasong S, Cuong PV, Morojele N, Parry CDH, Meier P, Holmes J, Callinan S, Piazza M, Kazantseva E, Bayandorj T, Gray-Phillip G and Haliday S (2018). The International Alcohol Control Study: Methodology and implementation. Drug and Alcohol Review, 37(S2): S10-S17. https://doi.org/10.1111/dar.12650.

Cuong PV, Casswell S, Parker K, Callinan S, Chaiyasong S, Kazantseva E, Meier P, MacKintosh AM, Piazza M, Gray-Phillip G and Parry CDH (2018). Cross-country comparison of proportion of alcohol consumed in harmful drinking occasions using the International Alcohol Control Study. Drug and Alcohol Review, 37(S2): S45-S52. https://doi.org/10.1111/dar.12665.

Casswell S, Morojele N, Williams PP, Chaiyasong S, Gordon R, Gray-Phillip G, Cuong PV, MacKintosh AM, Halliday S, Railton R, Randerson S and Parry CDH (2018). The Alcohol Environment Protocol: A new tool for alcohol policy. Drug and Alcohol Review, 37(S2): S18-S26. https://doi.org/10.1111/dar.12654.

Gray-Phillip G, Huckle T, Callinan S, Parry CDH, Chaiyasong S, Cuong PV, MacKintosh AM, Meier P, Kazantseva E, Piazza M, Parker K and Casswell S (2018). Availability of alcohol: Location, time and ease of purchase in high- and middle-income countries: Data from the International Alcohol Control study. Drug and Alcohol Review, 37(S2): S36-S44. https://doi.org/10.1111/dar.12693.

Chaiyasong S, Huckle T, Mackintosh AM, Meier P, Parry C, Callinan S, Pham C, Kazantseva E, Gray-Phillip G, Parker K and Casswell S (2018). Drinking patterns vary by gender, age and country-level income: Cross-country analysis of the International Alcohol Control Study. Drug and Alcohol Review, 37(S2): S53-S62. https://doi.org/10.1111/dar.12820.

Huckle T, Romeo JS, Wall M, Callinan S, Holmes J, Meier P, MacKintosh AM, Piazza M, Chaiyasong S, Cuong PV and Casswell S (2018) Socio-economic disadvantage is associated with heavier drinking in high but not middle-income countries participating in the International Alcohol Control Study. Drug and Alcohol Review, 37(S2): S63-S71. https://doi.org/10.1111/dar.12810.

Li J, Lovatt M, Eadie D, Dobbie F, Meier P, Holmes J, Hastings G and MacKintosh AM (2017). Public attitudes towards alcohol control policies in Scotland and England: Results from a mixed-methods study. Social Science and Medicine, 177: 177-189. https://doi.org/10.1016/j.socscimed.2017.01.037.

Lovatt, M, Eadie D, Meier PS, Li J, Bauld L, Hastings G and Holmes J (2015). Lay epidemiology and the interpretation of low risk drinking guidelines by adults in the United Kingdom. Addiction, 110(12): 1912-1919.

(Commissioned by the Department of Health, through the Public Health Research Consortium)

Changes over the past couple of decades in glass size and alcohol strength, particularly the trends towards larger measures and higher alcohol content, made it difficult to obtain a clear picture of alcohol consumption over time, as the underlying assumptions and understanding regarding a standard drink or serving were not consistent. In order for alcohol policy to be based on accurate consumption data, there was a need to develop and apply a robust methodology for retrospective adjustment of official trend data on alcohol consumption, to take account of changes in glass size and shape and alcohol strength over time. This scoping and feasibility study was commissioned by the Department of Health through the Public Health Research Consortium.  Its objectives were to:

1. Review available research and other evidence to map key changes in alcohol strength, standard measures, glass size and shape over the period 1990-2012;
2. Interview key stakeholders to establish relevant assumptions and to inform the mapping exercise;
3. Develop a robust formula / formulae for use in retrospective adjustment of official data;
4. Apply the formula /formulae to official data on a selective basis;
5. Report the results and discuss implications for a full-scale study.

The mapping element of the study was conducted by ISM, while the formulae development was conducted by the National Centre for Social Research (NatCen). The mapping element sought to identify and map key changes in glass size, shape and drink strength (percentage of alcohol by volume) since 1990. Two methods were used, desk-based research involving searches of academic and trade periodicals and commercial market research sources, and interviews with key stakeholders. Overall, the findings indicate that the average strength of beer and wine has increased over the period, such that previous survey data on reported consumption of 'standard drinks' have under-estimated the actual amount of alcohol consumed by a considerable degree. Findings from the mapping informed the formula development strand of the work, which proposes conversion factors to make survey data from different years more comparable. 

ISM Staff: Martine Stead, Kathryn Angus and Laura Macdonald

Publications:
Stead M, Angus K, Macdonald L and Bauld L (2014). Looking into the glass: Glassware as an alcohol marketing tool, and the implications for policy. Alcohol and Alcoholism, online 9^th January. doi:10.1093/alcalc/agt178.

Stead M, Bauld L, Angus K, Macdonald L, Munafò M, Attwood A, Ataya A, Fuller E, Pickering K (2013). Scoping and Feasibility Study to Develop and Apply a Methodology for Retrospective Adjustment of Alcohol Consumption Data. Final Report. London: Public Health Research Consortium; October.

(Funded by the European Commission)

ALICE RAP aimed to study and analyse the development and place of well-acknowledged and new addictions as a major societal trend in Europe in relation to governance and public policies and responses. The study involved 67 research institutions from 25 European countries covering the humanities, social sciences and biological and medical sciences. Its scientific objectives were:

1. To describe the ownership of addictions through a historical study of addiction over the ages, an analysis of public and private stakeholder views and through image analyses, of professional and citizenship views.
2. To study how addictions are classified and defined, followed by estimates of their health, social and economic impact.
3. To investigate determinants of addiction through a coordinated and cohesive social, economic and biological analysis of initiation, transition into problem use and transition into and out of dependence.
4. To analyse the business of addiction through studies of revenues, profits and participants in legal and illegal trade, the impact of suppliers on addictive substance use and behaviours, and analyses of webs of influence on policy responses.
5. To study addictions governance by describing the views and forces that determine the ways societies steer themselves and by stock-taking of present governance practices to old and emerging addictions.
6. To analyse youth as customers through considering the impacts of new technologies on promoting and mitigating use, by studying the interrelations of culture and biology, and by determining features that promote resilience and nudge young people to reduce problematic use.

ISM contributed specifically to Objectives 1 and 4.

ISM Staff: Martine Stead, Kathryn Angus, Richard Purves, Gerard Hastings, Anne Marie MacKintosh and Crawford Moodie

Publications:
Stead M, Dobbie F, Angus K, Purves RI, Reith G and Macdonald L (2016). The online bingo boom in the UK: A qualitative examination of its appeal. PLoS ONE, 11(5): e0154763. doi:10.1371/journal.pone.0154763

McLeod J, Gell L, Holmes J, Allamani A, Bjerge B, Bühringer G, Forberger S, Frank V, Lingford-Hughes A, Meier P, Neumann M, Room R, Baumberg B, Eiroa-Orosa FJ, Lees R, Meerkerk G-J, Schmidt L, Stead M, van de Mheen D, and Weirs R (2016). Determinants of risky substance use and risky gambling.  Chapter 3 in:  Gell L, Bühringer G, McLeod J, Forberger S, Holmes J, Lingford-Hughes A and Meier PS (eds), What Determines Harm from Addictive Substances and Behaviours? Oxford: Oxford University Press, pp35-76. ISBN: 9780198746683. doi:10.1093/acprof:oso/9780198746683.003.0003

Gell L, McLeod J, Holmes J, Allamani A, Baumberg B, Bjerge B, Bühringer G, Eiroa-Orosa J, Forberger S, Frank V, Lingford-Hughes A, Meerkerk G-J, Meier P, Neumann M, Room R, Schmidt L, Stead M, van de Mheen D, Weirs R, and Withington P (2016).  Determinants of harmful substance use and gambling. Chapter 4 in: Gell L, Bühringer G, McLeod J, Forberger S, Holmes J, Lingford-Hughes A and Meier PS (eds), What Determines Harm from Addictive Substances and Behaviours? Oxford: Oxford University Press. ISBN: 9780198746683. doi:10.1093/acprof:oso/9780198746683.003.0004

McLeod J, Gell L, Holmes J, Allamani A, Baumberg B, Bjerge B, Bühringer G, Eiroa-Orosa FJ, Forberger S, Frank V, Lingford-Hughes A, Meerkerk GJ, Meier P, Neumann M, Room R, Schmidt L, Stead M, van de Mheen D, Wiers R and Withington P (2016). Determinants of transitions from harmful to low-risk substance use and gambling. Chapter 5 in: Gell L, Bühringer G, McLeod J, Forberger S, Holmes J, Lingford-Hughes A and Meier PS (eds), What Determines Harm from Addictive Substances and Behaviours? Oxford: Oxford University Press. ISBN: 9780198746683. doi:10.1093/acprof:oso/9780198746683.003.0005

Gell L, Bühringer G, Room R, Allamani A, Eiroa-Orosa FJ, Forberger S, Holmes J, Lingford-Hughes A, McLeod J, Meier PS and Stead M (2016). Discussion and Integration of Key Findings. Chapter 6 in: Gell L, Bühringer G, McLeod J, Forberger S, Holmes J, Lingford-Hughes A and Meier PS (eds), What Determines Harm from Addictive Substances and Behaviours? Oxford: Oxford University Press. ISBN: 9780198746683. doi:10.1093/acprof:oso/9780198746683.003.0006

(Funded by Cancer Research UK, British Liver Trust, UKCTCS, Alcohol Focus Scotland, Nottingham University Hospital, Balance North East, Our Life, Alcohol Research UK and Breakthrough Breast Cancer)

This project involved the development of an alcohol and public health strategy independent from government and the alcohol industry. It was developed by a steering group of experts drawn from a range of sectors, chaired by Sir Ian Gilmore of the Alcohol Health Alliance, and supported by researchers from ISM and other Universities. The strategy was informed by reviews of relevant literature and a public opinion element.

The report 'Health First: An evidence-based alcohol strategy for the UK', was published on 1st March 2013, and sets out key recommendations, and the evidence to underpin them, to reduce the harm from alcohol in the UK. The report was endorsed by more than 70 organisations from across the UK.

ISM Staff: Gerard Hastings, Linda Bauld, Martine Stead, Anne Marie MacKintosh and Richard Purves

Click here for condensed download version of the report (PDF - 730KB)

(Funded by NHS Health Scotland and carried out in collaboration with Nursing and Midwifery, University of Stirling, and the School of Business, University of Dundee)

Alcohol Brief Interventions (ABIs) are short evidence-based, structured conversations that focus on changing drinking behaviour. In support of the SIGN Guideline 74 that ABIs should be delivered to harmful and hazardous drinkers in Primary Care settings, Accident and Emergency Departments and Antenatal Care settings, the Scottish Government established a new health improvement target for NHS health boards (H4: HEAT target - Health Improvement, Efficiency, Access and Treatment) to deliver 149,449 ABIs between April 2008 and March 2011 in these settings.

Commissioned by NHS Health Scotland, this project evaluated the implementation of ABIs in all three priority settings with a specific emphasis on primary care. Focusing on how screening and ABIs have been implemented, practitioners (n=35) and patients (n=25) were interviewed across eight practices and three health boards, representing a mixture of urban and rural, high and low socio-economic areas and high and low ABI recording rates. These data were supplemented by additional interviews with key informants in each case health board (n=21). Considering processes at both the individual and organisational level, and the level of overall adoption and reach, the findings supported improved delivery of ABIs when embedded into the mainstream delivery of the NHS.

Abstract and Report available from the Health Scotland website.

ISM Staff: Douglas Eadie, Susan MacAskill, Stuart Bryce (left 2011) and Oona Brooks (left 2010)

Publication:
Parkes T, Eadie D, Petrie D et al  (2011). An evaluation to assess the implementation of NHS delivered alcohol brief interventions: Study summary. Drugs and Alcohol Findings. Posted 10th Dec 2012.

(Commissioned by SHAAP (Scottish Health Action on Alcohol Problems))

In analysing the internal marketing documents from both alcoholic beverage producers and their advertising agencies for the Health Select Committee (see below), it was apparent that there has been a rapid growth in the use of new media (ie. digital forms of communication such as the internet, mobile devices, electronic games, blogs and podcasting) to market alcohol in recent years, yet this is an area which presents particular challenges to the current system of self-regulation. This report examined the use of new media to market leading alcohol brands in the UK using a case study approach.

ISM Staff: Oona Brooks (left 2010)

Report: Brooks O (2010). 'Routes to Magic' - The Alcoholic Beverage Industry’s Use of New Media in Alcohol Marketing. Stirling: Institute for Social Marketing.

(Commissioned by the Health Select Committee and the Alcohol Education and Research Council (AERC))

As part of its 2009 investigation into the conduct of the UK alcohol industry, the House of Commons Health Select Committee obtained access to internal marketing documents from both producers and their advertising agencies. These documents were then analysed by the Institute for Social Marketing.

These revealed major shortcomings in the self-regulatory codes covering alcohol advertising. Specifically, the codes did not, as they are supposed to, protect young people from alcohol advertising; prevent the promotion of drunkenness and excess; or the linking of alcohol with social and sexual success. Nor did they even attempt to address sponsorship, and the documents showed this being systematically used to undermine rules prohibiting the linking of alcohol with youth culture and sporting prowess. Finally, the codes were extremely weak in their treatment of new media which were rapidly becoming the biggest channel for alcohol promotion. The result was a regulatory system that was impossible to police and vulnerable to exploitation.

ISM Staff: Gerard Hastings, Oona Brooks (left 2010), Kathryn Angus, Martine Stead, Thomas Anker (left) and Tom Farrell (Open University)

Report: Hastings G (2010). Memorandum by Professor Gerard Hastings - 'They'll drink bucket loads of the stuff'. An analysis of internal alcohol industry documents. Available here

Publication:
Hastings G, Brooks O, Stead M, Angus K, Anker T and Farrell T (2010). Failure of self-regulation of UK alcohol advertising (Alcohol advertising: The last chance saloon). British Medical Journal, 340: 184-186. Online

(Commissioned by NHS Health Scotland)

Alcohol problems were a major and growing public health problem in Scotland with the relationship between alcohol and crime, in particular, violent crime, increasingly being recognised. This study was part of a wider Scottish Government funded alcohol research programme in criminal justice settings which also includes a pilot of the delivery of alcohol brief interventions and a scoping study of alcohol interventions in community justice settings. It was anticipated that the study findings would inform broader health service development such as the integration of prison health care into the NHS and the update of core alcohol treatment and support services. These developments were set within a policy and practice context which acknowledges alcohol problems in the population and increasingly so the alcohol problem in offenders, along with the importance of applying a person-centred, recovery orientated approach underpinned by the NHS commitment to quality of services.

The aim of this study was to undertake a needs assessment of alcohol problems experienced by prisoners and provide recommendations for service improvement including a model of care. Key elements included:

• a rapid review of the relevant literature on effective interventions
• a report on the epidemiology of alcohol problems experienced by prisoners in Scotland
• an assessment of alcohol problems among offenders within an individual prison using the AUDIT screening tool
• mapping current models of care in the Scottish Prison Service and the interface with community care models
• exploration of attitudes towards the delivery and effectiveness of current alcohol interventions through qualitative interviews in a prison case study
• a gap analysis between current service provision, best practice, effective interventions and national care standards for substance misuse.

The study involved both quantitative and qualitative information being gathered through primary data collection and document retrieval and analysis.

The final report was launched at the Alcohol and Offenders Event, Edinburgh, 8th February 2011. Conference presentations and paper submissions are ongoing.

ISM Staff: Susan MacAskill, Douglas Eadie and Oona Brooks (left 2010)

Collaborators: Tessa Parkes (lead), Ruth Jepson, Iain Atherton, Lawrence Doi and Stephen McGhee, Nursing, Midwifery and Health, University of Stirling