Healthier central England or North–South divide? Analysis of national survey data on smoking and high-risk drinking

In England, around 20% of the population are smokers and 13% drink excessively. These behaviours are leading risk factors for several non-communicable diseases, including cancer, diabetes and chronic respiratory and cardiovascular conditions. It is estimated that around 8000 deaths/year are alcohol-related and 80 000 deaths of adults aged 35 and over are attributed to smoking annually. The prevalence and adverse effects of high-risk drinking and tobacco use are not equally distributed across the country, with large regional variations.

A North–South divide exists for smoking, with higher rates of tobacco use, smoking-related deaths and smoking-related harm in northern regions. 

In contrast, excessive alcohol consumption tends to be lowest in central and eastern regions, while an East versus West divide is seen in the prevalence of alcohol dependency and alcohol sales. These regional variations in consumption do not always map onto experienced harm, a phenomenon known as the Alcohol Harm Paradox. In 2014, alcohol-related death rates were significantly higher among regions in the north of England compared with those in the south.

Objectives: This paper compares patterns of smoking and high-risk alcohol use across regions in England, and assesses the impact on these of adjusting for sociodemographic characteristics.

Design: Population survey of 53 922 adults in England aged 16+ taking part in the Alcohol and Smoking Toolkit Studies.

Measures: Participants answered questions regarding their socioeconomic status (SES), gender, age, ethnicity, Government Office Region, smoking status and completed the Alcohol Use Disorders Identification Test (AUDIT). High-risk drinkers were defined as those with a score of 8 or more (7 or more for women) on the AUDIT.

Results: In unadjusted analyses, relative to the South West, those in the North of England were more likely to smoke, while those from the East of England, South East and London were less likely. After adjustment for sociodemographics, smoking prevalence was no higher in North East (RR 0.97, p>0.05), North West (RR 0.98, p>0.05) or Yorkshire and the Humber (RR 1.03, p>0.05) but was less common in the East and West Midlands (RR 0.86, p<0.001; RR 0.91, p<0.05), East of England (RR 0.86, p<0.001), South East (RR 0.92, p<0.05) and London (RR 0.85, p<0.001). High-risk drinking was more common in the North but was less common in the Midlands, London and East of England. Adjustment for sociodemographics had little effect. There was a higher prevalence in the North East (RR 1.67, p<0.001), North West (RR 1.42, p<0.001) and Yorkshire and the Humber (RR 1.35, p<0.001); lower prevalence in the East Midlands (RR 0.69, p<0.001), West Midlands (RR 0.77, p<0.001), East of England (RR 0.72, p<0.001) and London (RR 0.71, p<0.001); and a similar prevalence in the South East (RR 1.10, p>0.05)

Figure 2Figure 2: Association between Government Office Region and high-risk drinking: (A) unadjusted;
(B) adjusted for gender, age, ethnicity and socioeconomic status (reference region: South West). Note: this shows the relative risk difference for each region relative to the South West (dotted reference region). Increasing red tones reflect increasingly higher significant risk and increasing blue tones reflect increasingly lower significant risk. Regions shaded white have a similar risk to the South West. Online supplementary figure S9 labels the Government Office Regions in England.
Expand Image – More diagrams in the main report

Conclusions: In adjusted analyses, smoking and high-risk drinking appear less common in ‘central England’ than in the rest of the country. Regional differences in smoking, but not those in high-risk drinking, appear to be explained to some extent by sociodemographic disparities.

Strengths and limitations of this study

  • Used a representative survey about smoking and drinking conducted on a large sample of the adult population in England.

  • Based on the most up-to-date information in England on regional differences in smoking and high-risk drinking accounting for disparities in gender, socioeconomic status (SES), ethnicity and age.

  • Respondents may have underestimated or failed to report their drinking and smoking.

  • Patterns of smoking and alcohol use were only available at the Government Office Region level, whereas important variation may occur at a more micro-geographical level.

bmj

Copyright information:
Published by the BMJ Publishing Group Limited.

 

Read the full report here!

Kettil Bruun Society 43rd Annual Alcohol Symposium | Sheffield 5-9th June, 2017

The 43rd annual symposium of the Kettil Bruun Society is hosted by the School of Health and Related Research (ScHARR) at the University of Sheffield. The symposium will be held in the Inox Dine area of the Student’s Union building.

For information about the Kettil Bruun Society, the Symposium, and to register, submit abstracts and book social tours, please click here.

To go straight to registration, please click here.

The conference is generously supported by the Insitute for Alcohol Studies, Alcohol Research UK, and the Society for the Study of Addiction.

The Kettil Bruun Society (KBS):

The principal aims of the Kettil Bruun Society (KBS) are to investigate social, epidemiological and cross-cultural research on alcohol use, to promote the exchange of scientific knowledge and experiences among researchers from various disciplines and to encourage international collaboration. The comparison of social and epidemiological developments found in different countries makes it possible to disentangle major trends from underlying patterns of alcohol use. This is particularly useful for the development of effective strategies to regulate alcohol use – an aspect which is of great interest to many countries.

The Symposium:

The primary purpose of the symposium is to provide a forum for researchers involved in studies on alcohol to exchange ideas about their ongoing research. The scope of the symposium includes studies of determinants and consequences of drinking, drinking culture and drinking patterns, social and institutional responses to drinking related harms, prevention and care. Empirical research, theoretical papers and reviews of the literature are welcome. Social and epidemiological studies have to be interpreted in a broad context as they include research in a variety of disciplines, such as psychology, sociology, criminology, economics, history and other sciences. Papers on other forms of substance use such as tobacco and drugs are also accepted, particularly papers considering the way they relate to alcohol use.

The symposium focuses on the discussion of papers that are pre-circulated electronically on this website. The author introduces the paper in a 10-minute segment, followed by prepared comments from a discussant and general audience participation. Any person submitting a paper may be asked to be a discussant or chair of a session.

Abstracts:

Please submit an abstract by 20 January 2017. The word limit for the abstract is 250 words and you should also include a conflict of interest statement and a maximum of three keywords (these are not included in the word count). For reports of empirical research, the abstract should be structured into sections: introduction, methods, results and conclusion.

All abstracts must include a conflict of interest statement. This should identify any author who has a relationship (financial or otherwise) which could be viewed as presenting a potential conflict of interest and give a full disclosure of this relationship.  If there are no conflicts of interest to report, please write ‘None’.

If you know in advance that you will only be able to attend the conference on certain days then please use the option in the submission form to indicate this and we will try to accommodate you when scheduling sessions.

 

UKCTAS welcome today’s ruling to introduce a minimum unit price in Scotland!

Plans to set a minimum price for alcohol in Scotland have been backed by the Scottish courts.

The Court of Session in Edinburgh ruled against a challenge by the Scotch whisky industry, who claimed the plans were a breach of European Law. The ruling now paves the way for the Scottish government to implement its policy, passed by MSPs in 2012.

Under the plans, a price of 50p per unit of alcohol would be set, taking a bottle of spirits to at least £14. The Scottish government, health professionals, police, alcohol charities and some members of the drinks industry believe minimum pricing would help address Scotland’s “unhealthy relationship with drink”.

Sir Ian Gilmore responding to the ruling made today in the Scottish courts in relation to minimum unit pricing in Scotland:

“We welcome this court ruling, and hope to see minimum unit pricing speedily implemented in Scotland. Now is the time to act, even if the global alcohol producers, prioritising commercial interests over Scotland’s health, try to delay further by another appeal.

Now is also the time for England and Wales to follow suit and introduce MUP. The UK government committed to introducing MUP in 2012, and the public support the measure. Government-commissioned research estimates that in the first year following the implementation of MUP in England, there would be nearly 140 fewer crimes per day.

MUP leaves pub prices untouched, and targets the cheap alcohol which is preferentially consumed by children and dependent drinkers. Recent AHA research has found that alcohol is being sold for as little as 16p per unit, with 3 litre bottles of white cider, which contain the same amount of alcohol as 22 shots of vodka, available for just £3.49.

MUP would also be of greatest benefit to those on low income, with 8 out of 10 lives saved coming from the lowest income groups, and greater harm reductions felt by these groups. The government has spoken of its commitment to even out life chances, and MUP would go a long way in furthering this agenda.”

Dr John Holmes from the University of Sheffield said:

“The policy would mainly affect harmful drinkers, and it is the low income harmful drinkers—who purchase more alcohol below the minimum unit price threshold than any other group—who would be most affected. Policy makers need to balance larger reductions in consumption by harmful drinkers on a low income against the large health gains that could be experienced in this group from reductions in alcohol-related illness and death.”

Screen Shot 2016-10-21 at 12.04.04.png
Modelling by the University of Sheffield estimates that a 50p MUP in Scotland would have the following effects after one year:

· 60 fewer deaths

· 1,300 fewer hospital admissions

· 3,500 fewer crimes

According to the modelling, the health gains will continue to increase over 20 years. At this time, in Scotland there would be an estimated:

· 120 fewer deaths due to alcohol each year

· 2,000 fewer hospital admissions due to alcohol each year

Work commissioned by the Government from the University of Sheffield revealed that 1 year after introducing an MUP in England there would be:

· 50,700 fewer crimes

· 376,600 fewer days absent from work

· 192 fewer deaths

screen-shot-2016-10-21-at-12-03-42

Professor Petra Meier, Director of the Sheffield Alcohol Research Group, and another author of the study, added:

“Our study finds no evidence to support the concerns highlighted by Government and the alcohol industry that minimum unit pricing would penalise responsible drinkers on low incomes. Instead, minimum unit pricing is a policy that is targeted at those who consume large quantities of cheap alcohol.

“By significantly lowering rates of ill health and premature deaths in this group, it is likely to contribute to the reduction of health inequalities.”

Minimum pricing for alcohol effectively targets high risk drinkers, with negligible effects on moderate drinkers with low incomes – Research report from the University of Sheffield.

Press summary of the Opinion of the Court in the reclaiming motion by the Scotch Whisky Association and others against the Lord Advocate and the Advocate General for Scotland

 

Are recent attempts to quit smoking associated with reduced drinking in England? | Research report

 

This study sought to address the following research questions:

  • What is the association among smokers in England between a recent attempt to quit smoking and alcohol consumption?
  • What is the association among smokers with higher risk alcohol consumption in England between a recent attempt to stop smoking and a current attempt to cut down on their drinking?

The researchers looked at the association among smokers in England between a recent attempt to quit smoking and alcohol consumption. They identified smokers as light or heavy drinkers (light was indicated with an Audit-C score below 5 and heavy was indicated with an Audit-C score greater than 5) and analysed their recent attempt to stop smoking (identified by those who had attempted to quit in the last week with those who had not) and a current attempt to cut down on their drinking.

This was an observational study which means that it cannot demonstrate cause and effect. It may be that smokers choose to restrict their alcohol consumption when attempting to quit smoking to reduce the chance of relapse. Alternatively, it could be that people who drink less are more likely to quit smoking. If this is the case, smokers with higher alcohol consumption may need further encouragement to quit smoking.

Jamie Brown said “We can’t yet determine the direction of causality. Further research is needed to disentangle whether attempts to quit smoking precede attempts to restrict alcohol consumption or vice versa. We’d also need to rule out other factors which make both more likely. Such as the diagnosis of a health problem causing attempts to cut down on both drinking and smoking.”

This study is part of an ongoing Smoking Toolkit Study and Alcohol Toolkit Study, designed to provide tracking information about smoking, alcohol consumption and related behaviors in England. Each month a new sample of approximately 1700 adults aged 16 and over complete a face-to-face computer assisted survey. The Smoking Toolkit Study and the Alcohol Toolkit Study are primarily funded by Cancer Research UK and the NIHR School for Public Health Research respectively.

Background

Alcohol consumption during attempts at smoking cessation can provoke relapse and so smokers are often advised to restrict their alcohol consumption during this time. This study assessed at a population-level whether smokers having recently initiated an attempt to stop smoking are more likely than other smokers to report i) lower alcohol consumption and ii) trying to reduce their alcohol consumption.

Method

Cross-sectional household surveys of 6287 last-year smokers who also completed the Alcohol Use Disorders Identification Test consumption questionnaire (AUDIT-C). Respondents who reported attempting to quit smoking in the last week were compared with those who did not. Those with AUDIT-C≥5 were also asked if they were currently trying to reduce the amount of alcohol they consume.

Results

After adjustment for socio-demographic characteristics and current smoking status, smokers who reported a quit attempt within the last week had lower AUDIT-C scores compared with those who did not report an attempt in the last week (βadj = −0.56, 95 % CI = −1.08 to −0.04) and were less likely to be classified as higher risk (AUDIT-C≥5: ORadj  = 0.57, 95 % CI = 0.38 to 0.85). The lower AUDIT-C scores appeared to be a result of lower scores on the frequency of ‘binge’ drinking item (βadj  = −0.25, 95 % CI = −0.43 to −0.07), with those who reported a quit attempt within the last week compared with those who did not being less likely to binge drink at least weekly (ORadj = 0.54, 95 % CI = 0.29 to 0.999) and more likely to not binge drink at all (ORadj  = 1.70, 95 % CI = 1.16 to 2.49). Among smokers with higher risk consumption (AUDIT-C≥5), those who reported an attempt to stop smoking within the last week compared with those who did not were more likely to report trying to reduce their alcohol consumption (ORadj = 2.98, 95 % CI = 1.48 to 6.01).

Conclusion

Smokers who report starting a quit attempt in the last week also report lower alcohol consumption, including less frequent binge drinking, and appear more likely to report currently attempting to reduce their alcohol consumption compared with smokers who do not report a quit attempt in the last week.

Lead author Jamie Brown, from University College London, England, said:

“These results go against the commonly held view that people who stop smoking tend to drink more to compensate. It’s possible that they are heeding advice to try to avoid alcohol because of its link to relapse.”

   Who was involved?

Jamie Brown, Robert West, Emma Beard, Alan Brennan, Colin Drummond, Duncan Gillespie, Matthew Hickman, John Holmes, Eileen Kaner, Susan Michie.

BMC Public Health, 2016; 16 (1) DOI: 10.1186/s12889-016-3223-6

Read the full report on BMC here!

 

 

Minimum unit pricing and strength-based taxation have larger impacts on health inequalities than increasing current alcohol taxes.

Introducing minimum unit pricing or alcohol-content-taxation would reduce inequalities in health more than increasing alcohol duty under the current tax system or increasing VAT on alcohol, a new report has shown.

Research from the University of Sheffield’s Alcohol Research Group (SARG) compared four policy strategies for regulating alcohol prices to estimate how changes in alcohol price would affect individual levels of alcohol consumption and the subsequent impact on illness and deaths associated with 43 alcohol-attributable conditions in England.

The study, which is the first of its kind, showed that strategies which strongly link alcohol content with the price of drinks were more suited to tackling health inequalities compared to the current duty system where wine and cider are taxed by total beverage volume regardless of strength, and duty rates per unit of alcohol vary widely between different types of drink.

There are substantial mup-graphhealth inequalities in England, with people in the lowest socioeconomic group dying on average six years earlier than those in the highest. Reducing inequalities in health is a key priority across the globe and tackling alcohol-related harm plays a major role in reducing the gap.          

The research, published today (23 February 2016) in the leading medical journal Plos Medicine, revealed a tax based on alcohol strength and minimum unit pricing would both have large impacts on harmful drinking across all socioeconomic groups, whilst having minimal effects on those drinking in moderation.

The four pricing strategies were chosen at a level estimated to prevent exactly the same number of alcohol-related deaths in the population so that the researchers could compare effects in different groups of the population.

The strategies were:

1) A 13.4 per cent increase in duty for all products under the current UK system.

2) A four per cent tax based on product price.

3) A strength-based tax of 22p per UK alcohol unit.

4) Minimum price of 50p per unit, below which alcohol cannot be sold.

“Alcohol is now 54 per cent more affordable in the UK than it was in 1980 and harmful alcohol consumption is a major public health issue accounting for an estimated 2.7 million deaths globally.

Our findings suggest that minimum unit pricing and taxing alcohol by strength are a well-targeted interventions which would lead to greater reductions in health inequalities compared to the current UK duty system or taxes levied on sales price – a tax system prevalent in many developing countries.

Our results also suggest that a substantial 13.4 per cent increase in current duty would be required to achieve the same overall harm reductions as a 50p minimum unit price.

EU countries have limited options however, as EU law prohibits taxation by strength for wine and cider. The implementation of minimum unit pricing in Scotland is still held up in a court case brought against the Scottish Government by the alcohol industry, where the Government needs to demonstrate that minimum unit pricing would have important public health benefits that cannot be achieved as effectively through existing taxation powers.

Similar plans in Wales, Northern Ireland and the Republic of Ireland are resting on the outcome of this court case. Although set in England, our study makes a major contribution to the evidence in this respect.”

Professor Petra Meier

Director of SARG at the School of Health and Related Research (ScHARR)  

“Alcohol taxes are the most common intervention internationally, although minimum unit pricing has recently started to attract much international interest. Until now there was little evidence to support policy makers wishing to compare the health impacts of different taxation. 

Minimum unit pricing and strength-based taxation are better-targeted than the current UK tax system for reducing alcohol-related harm as they have larger effects on heavy drinkers and smaller effects on moderate drinkers.”

Dr John Holmes, Senior Research Fellow at SARG