Jan Gill

Providing web-based feedback and social norms information to reduce student alcohol intake: a multisite investigation.

Background Unhealthy alcohol use among university students is cause for concern, yet the level of help seeking behavior for alcohol use is low within the student population. Electronic brief interventions delivered via the Internet present an alternative to traditional treatments and could enable the delivery of interventions on a population basis. Further evidence is needed of the effectiveness of Internet-delivered interventions and of their generalizability across educational institutions. Objective Our objective was to evaluate the effectiveness across 4 UK universities of a Web-based intervention for student alcohol use. Methods In total, 1112 participants took part. Participants were stratified by educational institution, gender, age group, year of study, and self-reported weekly consumption of alcohol and randomly assigned to either the control arm or to the immediate or delayed intervention arms. Intervention participants gained access to the intervention between weeks 1 to 7 or weeks 8 to 15, respectively. The intervention provided electronic personalized feedback and social norms information on drinking behavior accessed by logging on to a website. Participants registered interest by completing a brief screening questionnaire and were then asked to complete 4 further assessments across the 24 weeks of the study. Assessments included a retrospective weekly drinking diary, the Alcohol Use Disorders Identification Test (AUDIT), and a readiness-to-change algorithm. The outcome variable was the number of units of alcohol consumed in the last week. The effect of treatment arm and time on units consumed last week and average units consumed per drinking occasion were investigated using repeated measures multivariate analysis of covariance (MANCOVA). In addition, the data were modeled using a longitudinal regression with time points clustered within students. Results MANCOVA revealed a main effect of time on units of alcohol consumed over the last week. A longitudinal regression model showed an effect of assessment across time predicting that participants who completed at least 2 assessments reduced their drinking. The model predicted an additional effect of being assigned to an intervention arm, an effect that increased across time. Regression analysis predicted that being male or being assigned to an intervention arm increased the odds of not completing all assessments. The number of units of alcohol consumed over the last week at registration, age, university educational institution, and readiness to change were not predictive of completion. Conclusions Delivering an electronic personalized feedback intervention to students via the Internet can be effective in reducing weekly alcohol consumption. The effect does not appear to differ by educational institution. Our model suggested that monitoring alone is likely to reduce weekly consumption over 24 weeks but that consumption could be further reduced by providing access to a Web-based intervention. Further research is needed to understand the apparent therapeutic effect of monitoring and how this can be utilized to enhance the effectiveness of brief Web-based interventions.

The price of a drink: levels of consumption and price paid per unit of alcohol by Edinburgh's ill drinkers with a comparison to wider alcohol sales in Scotland

Aim To compare alcohol purchasing and consumption by ill drinkers in Edinburgh with wider alcohol sales in Scotland. Design Cross-sectional. Setting Two hospitals in Edinburgh in 2008/09. Participants A total of 377 patients with serious alcohol problems; two-thirds were in-patients with medical, surgical or psychiatric problems due to alcohol; one-third were out-patients. Measurements Last weeks or typical weekly consumption of alcohol: type, brand, units (1 UK unit 8 g ethanol), purchase place and price. Findings Patients consumed mean 197.7 UK units/week. The mean price paid per unit was £0.43 (lowest £0.09/unit) (£1 = 1.6 US

UK student alcohol consumption: A cluster analysis of drinking behaviour typologies

or 1.2€), which is below the mean unit price, £0.71 paid in Scotland in 2008. Of units consumed, 70.3% were sold at or below £0.40/unit (mid-range of price models proposed for minimum pricing legislation by the Scottish Government), and 83% at or below £0.50/unit proposed by the Chief Medical Officer of England. The lower the price paid per unit, the more units a patient consumed. A continuous increase in unit price from lower to higher social status, ranked according to the Scottish Index of Multiple Deprivation (based on postcode), was not seen; patients residing in postcodes in the mid-quintile paid the highest price per unit. Cheapness was quoted commonly as a reason for beverage choice; ciders, especially ‘white’ cider, and vodka were, at off-sales, cheapest per unit. Stealing alcohol or drinking alcohol substitutes was only very rarely reported. Conclusions Because patients with serious alcohol problems tend to purchase very cheap alcohol, elimination of the cheapest sales by minimum price or other legislation might reduce their consumption. It is unknown whether proposed price legislation in Scotland will encourage patients with serious alcohol problems to start stealing alcohol or drinking substitutes or will reduce the recruitment of new drinkers with serious alcohol problems and produce predicted longer-term gains in health and social wellbeing.

People seem confused about sensible drinking messages.

Objective: To assess the extent to which university students are following UK Government advice regarding appropriate consumption of alcohol, and to investigate if students can be placed into distinct clusters based on their drinking behaviour. Design: A descriptive questionnaire study. Setting: One hundred and nineteen undergraduate students from Leeds Metropolitan University, UK. Method: An online survey, which included a diary to record daily alcohol consumption over the previous week, was completed during the winter of 2007/08. Cluster analysis was used to classify students into subgroups based on comparable alcohol-drinking characteristics. National recommended sensible drinking behaviour guidelines in terms of total weekly alcohol intake, maximum daily alcohol intake, number of alcohol-free days and estimated blood alcohol levels were used to compare drinking behaviour the previous week by age, sex and cluster group. Results: Consuming weekly alcohol levels considered hazardous was common (58%) with nearly 70% of responders binge drinking at least once over that period; most students (80%) were, however, following the government’s recommendation for two consecutive alcohol-free days per week. No significant differences in drinking behaviour by sex were found, but binge drinkers tended to be younger. Four distinct alcohol-drinking behaviour clusters were identified based on alcohol consumption frequency and quantity. Only students in the non or light drinkers group all remained within national recommended guidelines for weekly intake and alcohol-free days. Conclusion: Students who consume alcohol are commonly drinking daily and weekly alcohol levels in excess of national sensible drinking guidelines; most students, however, abstain from alcohol on at least two consecutive days. The four distinct drinking clusters suggest that students would benefit from targeted interventions. In particular, personalization of interventions to reflect the distinct patterns of drinking behaviour could increase intervention effectiveness.

The total margin of exposure of ethanol and acetaldehyde for heavy drinkers consuming cider or vodka.

EDITOR—Eleven years after publication of guidelines on sensible drinking,1 the social repercussions from the abuse of alcohol remain worrying in the UK. Unit labelling of alcohol drink containers was introduced in 1998 on a voluntary basis. In 2004 the government encouraged manufacturers to add messages on sensible drinking.2 We investigated two interrelated aspects of public health education—recall of sensible drinking messages and awareness of drink labelling—among Scottish supermarket shoppers. The supermarket visited has pre-empted UK drink labelling innovations—since 2003 wine sourced from its own …

Alcohol purchasing by ill heavy drinkers; cheap alcohol is no single commodity

Heavy drinkers in Scotland may consume 1600 g ethanol per week. Due to its low price, cider may be preferred over other beverages. Anecdotal evidence has linked cider to specific health hazards beyond other alcoholic beverages. To examine this hypothesis, nine apple and pear cider samples were chemically analysed for constituents and contaminants. None of the products exceeded regulatory or toxicological thresholds, but the regular occurrence of acetaldehyde in cider was detected. To provide a quantitative risk assessment, two collectives of exclusive drinkers of cider and vodka were compared and the intake of acetaldehyde was estimated using probabilistic Monte-Carlo type analysis. The cider consumers were found to ingest more than 200-times the amount of acetaldehyde consumed by vodka consumers. The margins of exposure (MOE) of acetaldehyde were 224 for the cider and over 220,000 for vodka consumers. However, if the effects of ethanol were considered in a cumulative assessment of the combined MOE, the effect of acetaldehyde was minor and the combined MOE for both groups was 0.3. We suggest that alcohol policy priority should be given on reducing ethanol intake by measures such as minimum pricing, rather than to focus on acetaldehyde.

Heavy drinkers' perspectives on minimum unit pricing for alcohol in Scotland

Objectives Potential strategies to address alcohol misuse remain contentious. We aim to characterise the drink purchases of one population group: heavy drinkers in contact with Scottish health services. We contrast our findings with national sales data and explore the impact of socio-economic status on purchasing behaviour. Study design Cross-sectional study comparing alcohol purchasing and consumption by heavy drinkers in Edinburgh and Glasgow during 2012. Methods 639 patients with serious health problems linked to alcohol (recruited within NHS hospital clinics (in- and out-patient settings) 345 in Glasgow, 294 in Edinburgh) responded to a questionnaire documenting demographic data and last weeks or a ‘typical’ weekly consumption (type, brand, volume, price, place of purchase). Scottish Index of Multiple Deprivation quintile was derived as proxy of sociodemographic status. Results Median consumption was 184.8 (IQR = 162.2) UK units/week paying a mean of 39.7 pence per alcohol unit (£0.397). Off-sales accounted for 95% of purchases with 85% of those <50 pence (£0.5 UK) per alcohol unit. Corresponding figures for the Scottish population are 69% and 60%. The most popular low-priced drinks were white cider, beer and vodka with the most common off-sales outlet being the corner shop, despite supermarkets offering cheaper options. Consumption levels of the cheapest drink (white cider) were similar across all quintiles apart from the least deprived. Conclusions Heavy drinkers from all quintiles purchase the majority of their drinks from off-sale settings seeking the cheapest drinks, often favouring local suppliers. While beer was popular, recent legislation impacting on the sale of multibuys may prevent the heaviest drinkers benefiting from the lower beer prices available in supermarkets. Non-etheless, drinkers were able to offset higher unit prices with cheaper drink types and maintain high levels of consumption. Whilst price is key, heavy drinkers are influenced by other factors and adapt their purchasing as necessary.

The Topic of Alcohol within the Scottish Occupational Therapy Curricula

The irrefutable consequence of Scottish excessive alcohol consumption has prompted implementation and proposal of alcohol policy measures. The purpose of this study is to explore with heavy drinkers their awareness of and identify potential implications of policy introducing alcohol minimum unit pricing (MUP). Face-to-face semi-structured interviews were conducted with drinkers with alcohol-related harm (n = 20; 15 males, five females; aged 34 to 67 years old) in Scotland’s two largest cities (drinkers were participants within a larger quantitative study, through attendance for treatment for alcohol-related harms at National Health Service [NHS] centers). Median weekly consumption among participants was 130.7 units (range: 28-256.3 U.K. units). Views regarding the impact of increased alcohol prices, through MUP, were mixed. While some drinkers indicated potential reduction in intake, thus possibly reducing alcohol harms in the long term, the expected, or even desired, from a public health perspective, effects on consumption and associated harms might not be fully realized in this group. To mitigate possible unintended short-term detrimental effects of MUP on the most vulnerable, careful planning and appropriate resourcing may be required prior to implementation.

The enigma of 'harmful' alcohol consumption: evidence from a mixed methods study involving female drinkers in Scotland

Introduction: Scotland has witnessed a large rise in all types of alcohol-related illnesses, and in alcohol-related deaths. Despite this escalating problem, previous research in Scotland has demonstrated that gaps exist in the knowledge base of graduate occupational therapists. This study therefore aimed to document the content of alcohol in Scottish occupational therapy curricula. Method: This study was conducted during 2010–11. A questionnaire was sent to the programme leader of all the Scottish Higher Education Institutes offering a BSc (Hons) degree in occupational therapy, and to the only Further Education College in Scotland offering a Higher National Certificate in occupational therapy. The response rate was 100%. Findings: There is a lack of cohesive approach to alcohol misuse education within the occupational therapy curricula delivered in Scotland. Key proposals of the Scottish Government targeting alcohol misuse are inadequately addressed. Conclusion: The topic of alcohol and alcohol misuse is taught to varying degrees within the curricula offered in Scotland and further emphasis needs to be placed on understanding alcohol misuse and associated potential interventions, irrespective of practice context.

A teachable moment for the teachable moment? A prospective study to evaluate delivery of a workshop designed to increase knowledge and skills in relation to alcohol brief interventions (ABIs) amongst final year nursing and occupational therapy undergraduates

Background/aims: An appreciation of the drinking patterns of population subgroups may usefully inform tailored interventions. For this purpose, research has highlighted a need to better describe the drinking behaviour of UK women. This study aims to characterise the purchasing and consumption behaviour of female heavy, harmed, drinkers in contact with Scottish health services in two cities and to explore the factors that influence the link to harm. Methods: Mixed methods study involving cross-sectional survey questionnaires and one-to-one interviews (5). The questionnaires documented (1) demographic data (including derived deprivation score), last week’s (or ‘typical’ weekly) consumption (type, brand, volume, price, place of purchase), self-reported illnesses, and (2) Alcohol-Related Problem Questionnaire score. A total of 181 patients with serious health problems linked to alcohol were recruited within National Health Service (NHS) hospital clinics (in- and outpatient settings), in two Scottish cities during 2012. Results: Median consumption was 157.6 UK units for the recorded week, with almost exclusive purchase from ‘off-sale’ retail outlets. Preferred drinks were white cider, vodka and white wine. Increasing problems was positively associated with drinking more in the week, being younger and belonging to Glasgow. Conclusion: For Scottish women, the current definition of ‘harmful’ consumption likely captures a fourfold variation in alcohol intake, with gender differences less apparent. While current alcohol-related harm is positively associated with dose and being younger, there is clear evidence of an influence of the less tangible ‘Glasgow effect’. Future harm concerns are warranted by data relating to pattern, alcohol dose and cigarette use.