The Drink Less smartphone app: the project so far | Claire Garnett

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‘Drink Less’ is a smartphone app for iOS devices that aims to help people reduce their alcohol consumption (drinklessalcohol.com) – you can download it here.

It was developed and evaluated by a team of researchers at University College London using evidence and theory from the field of behavioural science.

Smartphone apps have a wide reach and can be provided to many users at a low cost though few have been evaluated. This means there’s little information on whether and how they work. When the Drink Less app was launched in 2016, many of its users agreed to participate in a study and have their anonymous data used for scientific research to test it.

normative-feedbackThe study tested the five separate app modules (you can read more about the app’s different features in a previous UKCTAS blog post) which each focused on a different behaviour change strategy. Nearly 700 users were recruited to the trial and different groups were randomly given either intensive or minimal versions of each of the app modules. The effectiveness of each was then measured by comparing levels of drinking before using the app and after one-month.

On average, over the month following download, people logged-in 12 times and drank four fewer units of alcohol. People who received a more intensive version of a module did not reduce their alcohol consumption significantly more than people who got a less intensive version of the same module. However, combinations of specific modules led to a greater reduction in alcohol consumption where users had the intensive versions of both modules. This evaluation has recently been published and you can read about it in more detail here.

User testimonials

Drink Less seems to be a popular app amongst users. It has been downloaded over 21,000 times and the app consistently appears amongst the top results for the ‘alcohol’ search term on the Apple App Store and has an average 4-star rating (based on 26 ratings as of 23/3/2018).

In addition to that, the researchers at UCL have received a lot of positive feedback about the app, some of which is shared below (with their permission):

Well researched and brilliantly designed. It’s both easy and thorough to track drinking and how it affects all areas your life. It’s designed so it’s not preaching because mostly you capture and listen to your own advice – very individualised and very powerful. A great tool to help consider past consequence and create better future behaviours around use of alcohol.”

dashboard“Excellent app that is so useful. Would definitely recommend it.”

“Lots of these apps around but this one is easy to use, non-judgemental and backed up by theory. Really like it. I was surprised by my results. Tracker, goal setting and ideas about how my drinking compares with others. I was surprised!”

“I would like to thank the developers who have worked on the app – it’s been a real help for me as I had become a seriously habitual drinker – I have now settled into a good routine, limiting my intake to under 14 units/week and only imbibing on Friday and Saturday evenings. I couldn’t have done it without your help, thank you. I have told many friends about my success with the app…it really has proved to be a game changer.”

“I love your app. In 2 weeks it’s helped me understand my consumption and learn to plan which has helped me cut down. I like the fact it’s contributing to wider research too. I’d tried a number of apps that help you monitor your alcohol consumption, most of them I stopped using after a week or two… but that did change when I started to use the Drink Less app. What I learned was that I needed to think ahead and plan when I was going to drink…

I’m never going to stop drinking, I love a glass of wine, but it has stopped me casually drinking without thinking. I now understand that I must have been passively consuming way way too much. You hear that all the time, but nothing made it as tangible as this app… I work in an industry where alcohol plays a large part of the culture, so gaining this understanding helped me manage those work situations where alcohol was central much better.”

“I’ve been participating with your Drink Less App for the last 14 weeks. During which I’ve made significant changes to my drinking consumption and life style. I feel I’m getting back some control over my drinking which was controlling me…my GP has me down as having average consumption at 27 alcohol units per week. It’s been like that for many years. That’s before I found and started working with your Drink Less app. So getting it down to 13 units / wk is something my wife and I are proud of. Thanks again for your help and please keep up the good work.”

Plans for the future

Drink Less is in a good position to be built upon as an already successful app. Initial findings suggest that it has the potential to help excessive drinkers in the UK reduce their alcohol consumption at a low incremental cost per user.

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Next up for the Drink Less app is to create an optimised version based on user feedback and the findings from the screening trial. This research is part of an 18-month project funded by the NIHR SPHR. And as part of this project, a funding application will be submitted for a confirmatory trial to determine whether the Drink Less app can provide an effective alternative to the help people usually receive for alcohol reduction.

All of the related scientific papers on the Drink Less app are available here.

Acknowledgements

This research was funded by the UK Centre for Tobacco and Alcohol Studies (UKCTAS), the Society for Study of Addiction (SSA), the NIHR School for Public Health Research (NIHR SPHR) and Cancer Research UK (CRUK). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

The Drink Less app was built by Greg Plumby, Edward Warrender and Chris Pritchard (from Portable Pixels) and Hari Karam Singh.

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Stubbing out the public health problem of an era | Blog piece by Tim Coleman | #myresearchlegend

Sir Richard Doll had an illustrious career. Through his efforts, the world learned much about the causes of cancer and the dangers of asbestos, radiation and, of course, smoking. Following his research into smoking and lung cancer during the 1950s, the realisation dawned that tobacco use was the public health problem of the era and not a harmless pastime. We all know what’s happened since. How many other 20th century epidemiologists have had such a transformative impact on peoples’ understanding of the determinants of disease?

myresearchlegendricharddollblog

To what extent do I consider Sir Richard Doll to be a research ‘legend’? I’m not sure I’ve earned the right to bestow that honour, so I’ve taken advice. The Cambridge English Dictionary says a ‘legend’ is “someone very famous and admired, usually because of their ability in a particular area”. Just considering the one area of Doll’s work emphasised above, this is a no-brainer; ‘legend’ threshold is clearly surpassed. Don’t take my word for this, though, Google ‘Richard Doll’ and see if you can find reason to disagree.

Am I hasty in allocating ‘legend’ status? Doll certainly changed the world’s knowledge of many illnesses; shouldn’t an NIHR research legend demonstrate clear NHS impact too? Fortunately Doll’s influence here doesn’t disappoint, even if one again only considers smoking. I am a GP. How would this be different if Sir Richard had never lived? Firstly, I’d probably smoke. A pipe would give me more gravitas than cigarettes and I’d have to either smoke in my consulting room, like some doctors did, or schedule regular ‘pipe breaks’ into my day. I would be blissfully ignorant about harms from smoking and more likely to offer patients cigarettes than help with stopping, even if they developed lung cancer or heart disease.

Smoking Kills

Thankfully, Sir Richard did exist. Although I tried smoking as a teenager, a friend’s mum made me think again and I didn’t ever fully adopt the habit. Immature, teenage me was saved from smoking because Doll had shown how harmful smoking is. Fast forward to my GP work in 2018; again due to Doll, I fully realise that smoking kills my patients and wrecks their lives.

crop.jpgAlso, due to research which was only possible because of his early work, I can offer smokers numerous types of cessation support. It’s even possible to refer on to Stop Smoking Services (SSS) for specialist help, though a major cloud on the horizon is that these vital services are no longer universal; they are endangered.

Through their work at the Statistical research Unit of the MRC, Doll and Hill demonstrated that smoking causes lung cancer; before this smoking was ubiquitous across social classes and many doctors smoked. By 1954, the government accepted the link and the middle classes started quitting in droves. When he died in 2005, Doll would very likely have been delighted that UK smoking rates were falling fast. However, improvements were chiefly amongst the better off, so smoking had become disproportionately concentrated amongst society’s poorest. Given his well-documented non-conformist views, my bet is that he would have been saddened that those with most to gain benefited least from such massive social change. Nevertheless, he might have been heartened by the government’s national and vigorous action against smoking. Back then, although SSS were a very new NHS entity, it was mandatory for Primary Care Trusts to deliver them and SSS were closely performance-managed by the then Department of Health. Any smoker could access services’ evidenced-based support to increase their chances of permanent cessation.

Smoking Prevention

Worldwide, legions of researchers, including me, have followed Doll by trying to find ways of treating or preventing smoking. Few epidemiologists have caused such a seismic shift in the international research agenda. Take a look at the thousands of randomised controlled trials (RCTs) reviewed in the tobacco section of the Cochrane Library. All of these studies test interventions against smoking. This necessary work continues today and NIHR is a leading supporter funding, for example, the largest ever RCTs of Nicotine Replacement Therapy used in pregnancy* or for ‘preloading’.

The NHS is 70. Celebrating research legends is a great idea but it’s important we remember what they did and why they are lauded. It took almost half a century after Doll and Hill’s landmark paper for the NHS to implement national treatment services for smokers, and sadly less than 20 years later these have become an optional extra with patchy coverage across the country. Smoking is less prevalent than in the past but there are still millions of UK citizens who want to stop and can’t manage this alone. Smoking is still a national problem and requires a national NHS response. A crucial component of this response should be to help quitters by giving them the very best support.

Sir Richard’s work has had a great impact, as all research should. The demise of SSS suggests we risk forgetting this when instead we should continue to build on his significant achievements.

*More information on the trial: Double-blind, randomised, placebo-controlled trial of nicotine replacement therapy (NRT) in pregnancy – SNAP is available on the NIHR Journals Library website.

Tim Coleman, Professor of Primary Care, Faculty of Medicine & Health Sciences
University of Nottingham and NIHR Senior Investigator

The NIHR is highlighting seven research legends whose work has shaped the NHS, as part of its celebrations for the NHS’s 70th birthday and the NIHR’s I Am Research campaign.

Original post on NIHR website. – Posted: 04 May 2018

Presentations from the 2017 e-cigarette summit | November 2017

The 5th annual E-Cigarette Summit was held at the Royal Society in London on Friday 17th November 2017. Linda Bauld, Robert West and several other members of the UKCTAS network presented their research at the event to a large audience of other scientists, policy makers, medical and public health professionals and e-cigarette stakeholders. The presentations included the latest evidence on the safety of e-cigarettes for users and bystanders, usage in young people and non-smokers, advertising and marketing, use in public places and the conflicts arising from the tobacco industry’s dual corporate ownership of tobacco harm reduction products and cigarettes.

To view the slides from each presentation and the full list of videos click here.

Robert West (University College London) & Linda Bauld (University of Stirling):

Panel Discussion:

Lion Shahab (University College London) & Jamie Hartmann-Boyce (University of Oxford):

Deborah Arnott (ASH) & Martin Dockrell (Public Health England):

See more information about the event and view each of the lecture slides.

 

Prof Linda Bauld on E-cigarette use during pregnancy at GFN 2017

Global Forum on Nicotine 2017 – ‘Reducing Harm, Saving Lives’

E-cigarette use during pregnancy – What do we know?

At the June Global Forum on Nicotine event Professor Linda Bauld from the University of Stirling and Deputy Director of the UK Centre for Tobacco and Alcohol Studies, presented an update on e-cigarette use during pregnancy. In the presentation Linda highlights the latest research, a brief overview of smoking in pregnancy and why pregnant women who are still smoking should be encouraged to switch to e-cigarettes.

External link for video: E-cigarette use during pregnancy – Professor Linda Bauld

Other links:

Smokefree action’s info-graphic on e-cigarettes in pregnancy

To see other presentations from the conference click here.

Latest press release from UKCTAS:

Vaping may help explain the record fall in UK smoking rates

 

Enough alcohol was sold in Scotland in 2016 for every adult to significantly exceed safe drinking levels each week

New figures published this week reveal that enough alcohol is being sold in England and Wales for every drinker to consume 21 units of alcohol a week – far more than the low-risk level of 14 units per week for both men and women recommended by the UK’s chief medical officers. The figures reveal that the situation is even worse in Scotland, with enough alcohol being sold for every drinker to consume 24 units a week. The data was released by NHS Health Scotland, who also looked at consumption in England and Wales in order to compare patterns across the UK. In 2016 10.5 litres of pure alcohol were sold per adult in Scotland, equivalent to 20.2 units per person per week!

“As a nation we buy enough alcohol for every person in Scotland to exceed the weekly drinking guideline substantially” Lucie Giles (author of the report)

The annual report from NHS Health Scotland brings together data on alcohol retail sales, price and affordability, self-reported consumption and alcohol-related deaths, hospital admissions and social harms. It found that in 2015 an average of 22 people per week died in Scotland due to an alcohol-related cause, a figure 54 per cent higher than that recorded in England and Wales. In the most deprived areas of Scotland alcohol-related death rates were six times higher than in the wealthiest areas. Rates of alcohol-related hospital stays were also nine times higher.

However, the report said there were some signs that Scots were curtailing their drinking habits, with self-reported data showing that the proportion of tee-totallers has also risen.

“This has harmful consequences for individuals, their family and friends as well as wider society and the economy. The harm that alcohol causes to our health is not distributed equally; the harmful effects are felt most by those living in the most disadvantaged areas in Scotland.” Lucie Giles

To tackle high levels of alcohol-related deaths and illness, Scotland is set to introduce a minimum unit price for alcohol; designed to target cheap, high-% alcohol drinks favoured by vulnerable and harmful drinkers.. The Scottish government passed minimum unit pricing over 5 years ago, though implementation of the measure has so far been delayed due to legal challenges from the alcohol industry. Minimum unit pricing formed part of the Westminster government’s alcohol strategy in 2012, though has yet to be implemented in England and Wales. 

“This report shows that, whilst some progress has been made in tackling alcohol misuse, we need to do more. Over the last few years, more than half of alcohol sold in supermarkets and off-licences was sold at less than 50p per unit, and enough alcohol was sold in the off-trade alone to exceed the weekly drinking guideline by a considerable amount. That is why we need minimum unit pricing, which will largely impact on the off-trade and will increase the price of the cheap, high strength alcohol.”  Public Health Minister Aileen Campbell

Responding to the publication of the figures, Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance UK (AHA), said: 

“These figures are shocking and show why minimum unit pricing is needed in Scotland, as well as in the rest of the UK. As a result of the legal challenges from the alcohol industry, lives will undoubtedly have been lost in Scotland. We hope and expect minimum unit pricing to be ruled legal in the final court hearing in this case in July, so that implementation in Scotland can follow.

“If minimum unit pricing is ruled legal in Scotland, a decision by Westminster to delay would be a death sentence for some, including many from the lowest income groups. The evidence is already clear – minimum unit pricing saves lives, prevents illness and lowers hospital admissions.”

The NHS Health Scotland figures are available here.

For more information on Minimum Unit Pricing, check out a report from the University of Sheffield’s Alcohol Research Group.

More posts related to this one:
Alcohol-related Hospital Admissions are at a Record High!
“Government has ‘no sense of direction’ in reducing devastating alcohol harm” Lord Brooke
Experts call for action on HIGH STRENGTH CIDER to protect the homeless and the vulnerable.

 

 

Study finds poorest of us at greater risk of harm from heavy drinking.

Drinking heavily is more harmful to the poorest people in society, who are at greater risk of illness or death because of alcohol consumption, according to a recent medical study. Published in medical journal The Lancet Public Health on Wednesday, it found there is a marked link between socio-economic status and the harm caused by drinking alcohol excessively.

Researchers taking part in the study found increased alcohol consumption was “disproportionately harmful” to the poorest in society. Compared with light drinkers in advantaged areas, excessive drinkers were seven times at risk of an increase in alcohol harm.

This contrasted with excessive drinkers in deprived areas, who were 11 times at risk of an increase. Harmful impacts of alcohol are higher in socio-economically disadvantaged communities. However, until now it was unclear whether those were as a result of
differences in drinking or as a result of other factors.

Lead author Dr Vittal Katikireddi, of the University of Glasgow, said:

“Our study finds that the poorest in society are at greater risk of alcohol’s harmful impacts on health, but this is not because they are drinking more or more often binge drinking.

“Experiencing poverty may impact on health, not only through leading an unhealthy lifestyle but also as a direct consequence of poor material circumstances and psychosocial stresses. Poverty may, therefore, reduce resilience to disease, predisposing people to greater health harms of alcohol.

The authors linked different sets of data to bring together information from Scottish Health Surveys with electronic health records, studying more than 50,000 people.
It suggested that even when other factors are accounted for, including smoking and obesity, living in deprived areas was consistently associated with higher alcohol-related harms. Researchers defined harm from alcohol consumption based on deaths, hospital visits and prescriptions that were attributable to alcohol.

Study co-author Dr Elise Whitley said:

“Heavier drinking is associated with greater alcohol-related harm in all individuals. However, our study suggests that the harm is greater in those living in poorer areas or who have a lower income, fewer qualifications or a manual occupation.

Responding to the study published on Wednesday in The Lancet Public Health which found that drinking heavily is more harmful to the poorest people in society. Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance UK (AHA), said:

“The findings in this study are worrying if not altogether surprising. It is clear that the way alcohol is being sold and promoted in Scotland and elsewhere in the UK is harming some of the most vulnerable people in society. On the other hand, we know what needs to be done, in particular to tackle the scourge of cheap alcohol. In real terms, alcohol is 60% cheaper than it was in 1980 and measures like strength based pricing would disproportionately benefit the poorest groups, in terms of reduced deaths, illness and hospital admissions.

Studies have shown that 82% of the lives saved through minimum unit pricing would come from the lowest income groups. Overall, in the first year alone minimum unit pricing in Scotland is expected to save 60 lives and lead to 1,600 fewer hospital admissions and 3,500 fewer crimes, yet its introduction has been held up for years by alcohol industry legal challenges.

Importantly, minimum unit pricing would leave pub prices untouched, and moderate drinkers would spend only about £2.25 extra per year with a 50p minimum price.”

This is even more evidence of the Alcohol Harm Paradox, which refers to observations that lower socioeconomic status (SES) groups consume less alcohol but experience more alcohol-related problems. However, SES is a complex concept and its observed relationship to social problems often depends on how it is measured and the demographic groups studied. A study published in 2016 hoped to deconstruct this idea and assessed socioeconomic patterns of alcohol consumption and related harm using multiple measures of SES and examined moderation of this patterning by gender and age. You can read the research article here: Deconstructing the Alcohol Harm Paradox: A Population Based Survey of Adults in England



Citation of original research article:

Socioeconomic status as an effect modifier of alcohol consumption and harm: analysis of linked cohort data. 

Dr Srinivasa Vittal Katikireddi, Elise Whitley, Jim Lewsey, Linsay Gray, Prof Alastair H Leyland. Published: 10 May 2017 – Open Access DOI: http://dx.doi.org/10.1016/S2468-2667(17)30078-6


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Over 200,000 children in England are living with Dependent Drinkers!

New figures released today reveal that over 200,000 children in England are living with dependent drinkers who could benefit from receiving specialist alcohol treatment.

The data from Public Health England estimates that there are 600,000 dependent drinkers who would benefit from treatment, yet only just over 100,000 are currently receiving the help they need.

These figures only cover adults who are most seriously dependent on alcohol. It is currently estimated that around 1.5 million adults in England and Wales have some form of alcohol dependence, and that there are 2.5 million children living with an adult drinking at risky levels.

The PHE data is released alongside a report from the Department for Work and Pensions (DWP) focused on improving the life chances and job prospects of the least well-off. The Department has said it will increase access to grant funding and introduce peer mentors for those in alcohol treatment to help them get back into work.

The report comes at a time when politicians are increasingly recognising the harm cheap alcohol is doing to the most vulnerable in society. The March budget included a consultation on the introduction of a new tax band designed to increase the price of strong white cider, a product which is predominantly consumed by children and heavy drinkers.

And earlier today a report published by the House of Lords Licensing Committee following an enquiry into the operation of the 2003 Licensing Act recognised the damage being done by cheap alcohol. The report calls for the introduction of a minimum unit price (MUP) for alcohol across the UK if it is introduced in Scotland and proves to be successful. Its introduction is being stalled by legal action being taken by sections of the alcohol industry. The report also calls for an end to multi-buy deals such as three for the price of two, a measure which has proved to be successful in Scotland.

Alcohol health experts welcomed the measures announced by the DWP today and the focus on the most vulnerable and lowest paid, pointing to studies which have shown that the least well off are around five times more likely to die from alcohol-related causes than those at the top of the income bracket.

Experts also called, however, for a wider, population-level approach to improving life and employment opportunities for dependent drinkers alongside greater support for individuals.

Liver physician Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance UK (AHA), said:

“We welcome the Government’s recognition that cheap alcohol is damaging some of the most vulnerable groups in society. The revelation that 200,000 children in England are living with adults in need of specialist help is deeply worrying. We need to make sure people get the support they need once they have a problem with alcohol, for their own sakes and for the sake of their children. But people don’t set out to become dependent drinkers and we need to stop more people from reaching that stage.

“For the greatest impact, the measures announced today should be combined with
measures like minimum unit pricing of alcohol. Studies have shown that setting a minimum price for alcohol would reduce unemployment and bring substantial numbers of unemployed drinkers back into the workforce.

“The government is already taking steps to tackle alcohol dependence in this broader way, with the recent announcement that it will be consulting on increasing the tax on high- strength ciders, drinks which are known to be drunk by the most vulnerable and do disproportionate harm.

“Studies also indicate that MUP would help address health inequalities, with over 80 per cent of lives saved coming from the lowest income groups. At the same time, the measure would not increase the price of alcohol sold in pubs and clubs.”

The Public Health England figures can be found here.
The DWP report, entitled Improving Lives: helping workless families, is available here.


About the Alcohol Health Alliance UK
The Alcohol Health Alliance UK (AHA) is a group of 50 organisations including the Royal College of Physicians, Royal College of GPs, British Medical Association, Alcohol Concern and the Institute of Alcohol Studies. The AHA works together to:
– Highlight the rising levels of alcohol-related health harm
– Propose evidence-based solutions to reduce this harm
– Influence decision makers to take positive action to address the damage caused by alcohol misuse