New study finds no clear evidence that nicotine “preloading” helps smokers to quit | University of Oxford

There is insufficient evidence to show that using nicotine patches for four weeks before a quit attempt (known as “preloading”) improves long-term smoking abstinence, finds a trial published by The BMJ this week.

The researchers found that nicotine preloading reduces craving intensity and seems to make quitting easier, but that this beneficial effect may have been masked by a concurrent reduction in the use of varenicline in the period after quit day. As varenicline is the most effective smoking cessation drug, this may have undermined the benefit of preloading.

Nicotine patch

If it were possible to overcome this unintended consequence, nicotine preloading “could lead to a worthwhile increase in long term smoking abstinence,” they say.

The research was funded by the National Institute for Health Research.

Although there have been several new drugs for tobacco cessation since the 1970s, treatment has remained largely the same, with behavioural support to motivate and strengthen a person’s resolve to remain abstinent and drugs to reduce the strength of urges to smoke after quit day.

Some studies have suggested that using nicotine replacement therapy before a quit attempt is more effective than when used in the conventional way to support abstinence, while other studies suggest preloading has no effect.

A research team from the UK Centre for Tobacco and Alcohol Studies, led by Professor Paul Aveyard at the University of Oxford, set out to examine the effectiveness of a nicotine patch worn for four weeks before a quit attempt. Continue reading

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Serving smaller alcoholic drinks could reduce the UK’s alcohol consumption | Research Report | University of Liverpool

New research published in Addiction, conducted by researchers from the Universities of Liverpool and Sheffield, highlights the potential benefits of reducing the standard serving size of alcoholic beverages.

It is well known that alcohol consumption contributes to premature death and ill health, and alcohol-related harm places a substantial burden on society. Many drinkers find it hard to cut down and attempts to cut down often do not lead to actual reductions in alcohol consumption. Therefore, changes to the environment that make it easier for people to drink less could have a substantial impact on public health.

One potential environmental influence on alcohol consumption is serving size. Nutrition research consistently shows that portion sizes affect how much a person eats. People eat more if they are given a relatively large portion of food compared to smaller portions, but they do not compensate for this by eating less later on. However, the effect that serving size has on alcohol consumption has not been examined until now. The present research aimed to investigate if reducing the serving size of alcoholic beverages would reduce alcohol consumption.

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Standard vs Reduced serving sizes:

The researchers, led by Dr Inge Kersbergen from the University of Liverpool, tested the effects of reducing the serving size of alcohol on how much alcohol participants drank in two studies.

In the first study, participants were randomized to consume alcohol from standard or reduced serving sizes whilst watching a one-hour TV programme in a laboratory that looks like a living room. Standard serving sizes contained 2.07 units per serving (equivalent to a pint of weak lager) and reduced serving sizes contained 25% less than the standard serving.

In the second study, participants were invited to one of four pub quiz nights in a local bar which only sold standard vs. reduced serving sizes. Standard servings were pints and 175ml of wine (‘typically served as a medium glass in pubs’) and reduced servings were 2/3 pints and 125ml of wine (‘small glass’). Drink prices were adjusted to make sure that the standard and reduced serving sizes were the same value for money. Researchers observed how much alcohol each participant drank.

In both experiments, participants could order as many drinks as they wanted for the duration of the experiment. This means that participants drinking from reduced servings could compensate for the smaller serving size by ordering more drinks if they wanted to.

The researchers found that participants who were served relatively smaller servings drank less alcohol in a single drinking session than participants who were served standard servings. In the first study, reduced serving sizes led to a 20.7% – 22.3% decrease in alcohol consumption over a one-hour drinking period in the ‘living room’ lab. In the second study, reduced serving sizes led to a 32.4% – 39.6% decrease alcohol consumption over a longer drinking period (up to three hours) during the real-life pub quiz.

Based on the results the researchers used the Sheffield Alcohol Policy Model to estimate that reducing the standard serving size of beer, wine and cider in bars and restaurants by a quarter would lead to 1,400 fewer deaths and 73,000 fewer hospital admissions every year.

Public health intervention:

Dr Kersbergen, said: “These studies are the first to demonstrate that reducing the serving size of alcoholic beverages prompts reductions in alcohol consumption.

The typical serving size of beer in the UK of a pint is larger than many other countries and the size of wine servings in UK bars and restaurants has increased in recent decades, so there is room for serving sizes to be reduced without making them unrealistically small. Reducing the standard serving size of alcohol in bars and restaurants may be an effective way to reduce alcohol consumption at the population level and improve public health.”

Professor Matt Field, who leads the Addiction research group within the Department of Psychological Sciences at the University of Liverpool, added: “Reducing the standard serving size of alcoholic drinks could automatically prompt people to drink less, even if they are not motivated to cut down. But at the same time, the total amount that people consume would remain completely their own choice”.

Dr Eric Robinson, a University of Liverpool researcher who was also involved in the study, said: “Our research showed that people do not seem to compensate for the smaller servings by ordering more drinks on a single night and it seems unlikely that any further compensation would happen, but future research is needed to find out if people may compensate in other ways, such as drinking more often or getting stronger drinks.”

The full study, entitled ‘Reducing the standard serving size of alcoholic beverages prompts reductions in alcohol consumption’, can be found here and was funded in part by an MRC research grant awarded to Dr Eric Robinson.

Original post 14/05/2018: University of Liverpool News

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.

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?

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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

Alcohol Policy in Practice | Continuing Professional Development Course | 11th-13th September 2018

Following the successful Alcohol CPD courses held in 2014-2017; we are delighted to announce the line-up for our 2018 course, featuring some exciting new inputs!

This year’s course will feature inputs from Prof. Anna Gilmore and colleagues from the University of Bath, Dr Carol Emslie from Glasgow Caledonian University, Dr James Nicholls from Alcohol Research UK, and Professor Karine Gallopel-Morvan from the EHESP School of Public Health, France. We also welcome the return of highly-rated inputs from leading experts such as Katherine Brown from the Institute of Alcohol Studies and Colin Shevills of Balance North East.

What previous participants said:

“Great range of content and world-class speakers. Organisers did an amazing job including looking after us all while we were here. The mix of lectures / Q & As / panel discussions was great. Really worth taking time away from work/home to attend this.”
“Extremely informative course and relevant to current alcohol policy challenges. Good venue, convenient location and lovely setting. Module well organised and brilliant range of speakers.”
“Thank you very much. It was a great privilege to listen and attend this course. Lectures and lecturers were outstanding.”
“Very informative useful training, well worth my time and travel.”
“Wonderful networking opportunity.”
“Thank you for such a brilliant training event – the content was spot on, all the presentations and sessions were really, really good and I came away feeling that I had learned masses: a rich diet of fact and opinion. I can honestly say that I have rarely – if ever – enjoyed such an event quite as much as this one.”

Anyone wishing to gain an in-depth understanding and up to date insight into evidence and innovative practice in alcohol policy in the UK and internationally.
Previous participants have included people working in public health, local and national alcohol policy, or alcohol research; from Iceland to New Zealand.
Places are filling up fast and the early-bird rate applies until Friday 15th June 2018! 

Apply Here!

New Publication from the Sheffield Alcohol Research Group: Model-based appraisal of the comparative impact of Minimum Unit Pricing and taxation policies in Wales

Three quarters of all alcohol consumed in Wales is drunk by less than a quarter of the adult population who are hazardous or harmful drinkers and spend up to £2,882 per year on booze, research has revealed.

A report looking into the potential impact of minimum unit pricing and taxation policies in Wales was published Thursday 22nd February by the Sheffield Alcohol Research Group at the University of Sheffield.

The publication, which found that the 3% of the population who are harmful drinkers, account for 27% of all alcohol consumed, comes after the Welsh Government announced a new Bill that, if agreed by the National Assembly, will introduce a minimum price for the sale of alcohol.

The Bill, which is designed to reduce hazardous and harmful drinking would make it an offence for alcohol to be supplied below that price.

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Health Secretary, Vaughan Gething said: “People who drink alcohol at hazardous and harmful levels drink 75% of the alcohol consumed in Wales.

“The introduction of a minimum unit price would be effective in reducing alcohol consumption among these groups, as well as reducing the number of alcohol-related deaths and hospitalisations.”

The availability of cheap, strong alcohol is estimated to lead to 50,000 alcohol-related hospital admissions a year, costing the Welsh NHS £120 million annually and, in 2015, there were 463 alcohol-related deaths in Wales.

The report reveals the population of Wales buys 50% of its alcohol for less than 55p per unit, 37% for less than 50p per unit and 27% for less than 45p per unit, with heavier drinkers being more likely to buy alcohol sold below these thresholds.

Mr Gething said: “The report shows the greatest impact of a minimum unit price would be on the most deprived harmful drinkers, while moderate drinkers would experience only small impacts on their alcohol consumption and spending.

“This is because moderate drinkers tend to buy alcohol which would be subject to little or no increase in price under the policy.

“If passed, this law will potentially save lives.”

The research also shows harmful drinkers spend an average £2,882 a year on alcohol, or around £7.80 per day, compared to £1,209 for hazardous drinkers and £276 for moderate drinkers.

The Sheffield Alcohol Research Group, commissioned by the Welsh Government in June 2017 to update a 2014 appraisal of the likely impact of a range of minimum unit pricing policies, concluded a minimum unit price set at between 35p and 70p would be effective in reducing alcohol consumption among hazardous and, particularly, harmful drinkers.

Research highlights:

  • Moderate drinkers drink an average of 211 units of alcohol per year compared to 1,236 for hazardous drinkers and 3,924 for harmful drinkers.
  • Harmful drinkers spend an average £2,882 a year on alcohol compared to £1,209 for hazardous drinkers and £276 for moderate drinkers.
  • Alcohol-attributable deaths and hospital admissions are concentrated in hazardous and particularly harmful drinkers who are more deprived.

External news coverage:

75% of alcohol in Wales is drunk by just over a fifth of the population according to new report – ITV News

Minimum alcohol price help call for ‘hazardous’ drinkers – BBC News

75% of alcohol drunk in Wales consumed by 22% of the population, report says – Guernsey Press