Melanie Lovatt

Developing a social practice-based typology of British drinking culture in 2009-2011: Implications for alcohol policy analysis

Abstract Background and aims The concept of national drinking culture is well established in research and policy debate, but rarely features in contemporary alcohol policy analysis. We aim to demonstrate the value of the alternative concept of social practices for quantitatively operationalizing drinking culture. We discuss how a practice perspective addresses limitations in existing analytical approaches to health‐related behaviour before demonstrating its empirical application by constructing a statistical typology of British drinking occasions. Design Cross‐sectional latent class analysis of drinking occasions derived from retrospective 1‐week drinking diaries obtained from quota samples of a market research panel. Occasions are periods of drinking with no more than 2 hours between drinks. Setting Great Britain, 2009–11. Cases A total of 187 878 occasions nested within 60 215 nationally representative adults (aged 18 + years). Measurements Beverage type and quantity per occasion; location, company and gender composition of company; motivation and reason for occasion; day, start‐time and duration of occasion; and age, sex and social grade. Findings Eight occasion types are derived based primarily on parsimony considerations rather than model fit statistics. These are mixed location heavy drinking (10.4% of occasions), heavy drinking at home with a partner (9.4%), going out with friends (11.1%), get‐together at someones house (14.4%), going out for a meal (8.6%), drinking at home alone (13.6%), light drinking at home with family (12.8%) and light drinking at home with a partner (19.6%). Conclusions An empirical model of drinking culture, comprising a typology of drinking practices, reveals the dominance of moderate drinking practices in Great Britain. The model demonstrates the potential for a practice perspective to be used in evaluation of how and why drinking cultures change in response to public health interventions.

Public awareness of the link between alcohol and cancer in England in 2015: a population-based survey

BackgroundPublic knowledge of the association between alcohol and cancer is reported to be low. We aimed to provide up-to-date evidence for England regarding awareness of the link between alcohol and different cancers and to determine whether awareness differs by demographic characteristics, alcohol use, and geographic region.MethodsA representative sample of 2100 adults completed an online survey in July 2015. Respondents were asked to identify which health outcomes, including specific cancers, may be caused by alcohol consumption. Logistic regressions explored whether demographic, alcohol use, and geographic characteristics predicted correctly identifying alcohol-related cancer risk.ResultsUnprompted, 12.9% of respondents identified cancer as a potential health outcome of alcohol consumption. This rose to 47% when prompted (compared to 95% for liver disease and 73% for heart disease). Knowledge of the link between alcohol and specific cancers varied between 18% (breast) and 80% (liver). Respondents identified the following cancers as alcohol-related where no such evidence exists: bladder (54%), brain (32%), ovarian (17%). Significant predictors of awareness of the link between alcohol and cancer were being female, more highly educated, and living in North-East England.ConclusionThere is generally low awareness of the relationship between alcohol consumption and cancer, particularly breast cancer. Greater awareness of the relationship between alcohol and breast cancer in North-East England, where a mass media campaign highlighted this relationship, suggests that population awareness can be influenced by social marketing.

Food provision for older people receiving home care from the perspectives of home-care workers

Malnutrition is a significant cause of morbidity and mortality, particularly among older people. Attention has focused on the inadequacies of food provision in institutions, yet the majority suffering from malnutrition live in the community. The aim of this study was to explore barriers and facilitators to food provision for older people receiving home care. It was a qualitative exploratory study using semi-structured interviews with nine home-care workers in June 2013 employed by independent agencies in a large city in northern England. Data were analysed thematically, based on the principles of grounded theory. Findings showed that significant time pressures limited home-care workers in their ability to socially engage with service users at mealtimes, or provide them with anything other than ready meals. Enabling choice was considered more important than providing a healthy diet, but choice was limited by food availability and reliance on families for shopping. Despite their knowledge of service users and their central role in providing food, home-care workers received little nutritional training and were not involved by healthcare professionals in the management of malnutrition. Despite the rhetoric of individual choice and importance of social engagement and nutrition for health and well-being, nutritional care has been significantly compromised by cuts to social care budgets. The potential role for home-care workers in promoting good nutrition in older people is undervalued and undermined by the lack of recognition, training and time dedicated to food-related care. This has led to a situation whereby good quality food and enjoyable mealtimes are denied to many older people on the basis that they are unaffordable luxuries rather than an integral component of fundamental care.

Development of Trust in an Online Breast Cancer Forum: A Qualitative Study

Background Online health forums provide peer support for a range of medical conditions including life-threatening and terminal illnesses. Trust is an important component of peer-to-peer support, although relatively little is known about how trust forms within online health forums. Objective The aim of this paper is to examine how trust develops and influences sharing among users of an online breast cancer forum. Methods An interpretive qualitative approach was adopted. Data were collected from forum posts from 135 threads on 9 boards on the UK charity, Breast Cancer Care (BCC). Semistructured interviews were conducted with 14 BCC forum users. Both datasets were analyzed thematically using Braun and Clarke’s approach and combined to triangulate analysis. Results Trust operates in 3 dimensions, structural, relational, and temporal, and these intersect with each other and do not operate in isolation. The structural dimension relates to how the affordances and formal rules of the site affected trust. The relational dimension refers to how trust was necessarily experienced in interactions with other forum users: it emerged within relationships and was a social phenomenon. The temporal dimension relates to how trust changed over time and was influenced by the length of time users spent on the forum. Conclusions Trust is a process that changes over time and which is influenced by structural features of the forum, as well as informal but collectively understood relational interactions among forum users. The study provides a better understanding of how the intersecting structural, relational, and temporal aspects that support the development of trust facilitate sharing in online environments. These findings will help organizations developing online health forums.

Public attitudes towards alcohol control policies in Scotland and England: Results from a mixed-methods study

The harmful effects of heavy drinking on health have been widely reported, yet public opinion on governmental responsibility for alcohol control remains divided. This study examines UK public attitudes towards alcohol policies, identifies underlying dimensions that inform these, and relationships with perceived effectiveness. A cross-sectional mixed methods study involving a telephone survey of 3477 adult drinkers aged 16–65 and sixteen focus groups with 89 adult drinkers in Scotland and England was conducted between September 2012 and February 2013. Principal components analysis (PCA) was used to reduce twelve policy statements into underlying dimensions. These dimensions were used in linear regression models examining alcohol policy support by demographics, drinking behaviour and perceptions of UK drinking and government responsibility. Findings were supplemented with a thematic analysis of focus group transcripts. A majority of survey respondents supported all alcohol policies, although the level of support varied by type of policy. Greater enforcement of laws on under-age sales and more police patrolling the streets were strongly supported while support for pricing policies and restricting access to alcohol was more divided. PCA identified four main dimensions underlying support on policies: alcohol availability, provision of health information and treatment services, alcohol pricing, and greater law enforcement. Being female, older, a moderate drinker, and holding a belief that government should do more to reduce alcohol harms were associated with higher support on all policy dimensions. Focus group data revealed findings from the survey may have presented an overly positive level of support on all policies due to differences in perceived policy effectiveness. Perceived effectiveness can help inform underlying patterns of policy support and should be considered in conjunction with standard measures of support in future research on alcohol control policies.

Digital phenotyping and sociological perspectives in a Brave New World

Skinner et al.’s Journal Club paper [1] was prompted by our original publication inAddiction [2]. Thereareareas covered whichdeserve furtherdiscussionand inwriting this,wefind ourselves in two minds. While we agree with Skinner et al. that the development of drinking guidelines and other interventions could benefit from a more contextualized understanding of alcohol use, we feel that some of our key arguments and the problems that we sought to highlight may not have been appreciated fully. Moreover, Skinner’s proposals raise new ethical challenges which merit attention. Here we discuss these points in turn.