Women & Alcohol | Edinburgh and London-Based Seminar Series | 2017

The Institute of Alcohol Studies (IAS) and the Scottish Health Action on Alcohol Problems (SHAAP) are co-hosting a four part seminar series to discuss issues relating to women and alcohol.

Each session will be chaired by an eminent academic, who will invite three guest speakers to present their personal responses to three pre-set questions, which are relevant to the topic.

These events will provide an opportunity for policy makers, academics, activists, and media representatives to critically discuss topics related to women and alcohol use. The intention is to stimulate thinking, challenge some attitudes and perceptions, and to think about future research and policy priorities.

Seminar 1: Friday, 10th March 2017

Women, Alcohol, and Globalisation.
Royal College of Physicians, London, 2 – 4pm

Chair: Dr. Cecile Knai, Associate Professor of Public Health Policy, London School of Hygiene and Tropical Medicine.

  • How does alcohol marketing influence women’s behaviours?
  • How does alcohol marketing influence attitudes towards women?
  • How does alcohol affect women in different social and cultural contexts?

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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.

 

Strong evidence that alcohol causes cancer, but how does the public interpret this information?

“Strong epidemiological evidence concerning the causal role of alcohol consumption in cancer may not fit easily with complex lay understandings of the causes of ill health”

Commentary to: Alcohol consumption as a cause of cancer

Connor [1] argues there is strong epidemiological evidence that alcohol causes cancer but highlights uncertainty about how this message may be understood by the ‘wider public’. We agree that there is public confusion and scepticism about public health advice on drinking, and that alcohol industry actors will seek to exploit this by ‘framing’ the debate in ways which further their commercial interests [2, 3]. However, there is also a pressing need to take into account the wider social context in which any new scientific evidence is introduced [4].

People have multi-factorial understandings of the causes of chronic disease which encompass family history, environmental factors, stress and luck, as well as behavioural factors such as smoking and drinking; these factors are perceived as interconnecting, rather than independent, and may become more or less salient at particular points in the life-course [5, 6]. Davison and colleagues [7, 8] argue that, in an iterative process similar to formal epidemiology, ‘lay’ epidemiologists extract information from mainstream health messages and observe patterns of illness and death among family, friends, acquaintances and those in public life to generate and reformulate hypotheses about ‘candidates’ for particular health problems. Gender, age and socio-economic status are also relevant here [9, 10]. Crucially, uncertainty is a key feature of lay epidemiology; some ‘candidates’ are observed to ‘do all the wrong things’ but live long lives (‘unwarranted survivals’: ‘the fat “Uncle Norman” figure who has survived into a healthy old age, despite extremely heavy smoking and drinking’) ([5], p. 682), while other people lead apparently ‘healthy’ lives but still suffer premature illness or death (‘anomalous deaths’). The ‘anomalous death’ of a relative is particularly important in undermining epidemiological evidence about risk factors for major diseases [11].

There are a number of reasons why the message ‘alcohol causes cancer’ may not fit easily with lay epidemiology. First, candidacy only indicates increased risk—not an inevitable outcome–so a message which emphasizes certainty rather than probability may be disregarded. Research investigating the acceptability of cancer warning messages among Australian drinkers [12] suggests that statements about alcohol leading to an ‘increased risk of cancer’ performed better than those which stated that alcohol ‘can cause cancer’.

Secondly, lay epidemiology encompasses an understanding of the different meaning of risk factors at the population and individual level: ‘most people have notions about what renders a person “a candidate” for a specific disease [incorporating “expert” epidemiological understandings of risk at the population level] whilst simultaneously understanding that life, health and death defy prediction at an individual level’ ([11], p. 445). Thus, simple health messages which focus exclusively upon behavioural risk factors at an individual level draw attention to ‘unwarranted survivals’ and particularly to ‘anomalous deaths’ in people’s social networks. The observation that behavioural change does not guarantee a reduction of risk at an individual level (mirroring epidemiological concerns about the ‘prevention paradox’) [11, 13] may therefore result in public scepticism.

Thirdly, while smokers are currently viewed as ‘candidates’ for cancer, it appears that drinkers are not; lay people struggle to find an explanation for non-smokers who develop cancer and instead emphasize the unpredictability and randomness of the disease [14]. Finally, it is important to explore how terms such ‘drinkers’ and ‘drinking’ might be interpreted by the wider public. While ‘smoking causes cancer’ draws on the commonly understood binary opposition between smokers and non-smokers, ‘drinking causes cancer’ may well be understood as comparing ‘heavy’ drinkers with ‘light’ or ‘moderate’ drinkers, rather than contrasting drinkers with non-drinkers. Qualitative research in the United Kingdom demonstrates that drinking is perceived as a routine activity associated with sociability, pleasure and relaxation and that heavy weekend drinking and drinking to intoxication are normalized; thus, drinking alone or choosing not to drink alcohol are behaviours which require explanation, not excessive drinking in general [13, 15-17]. In addition, people construct themselves as responsible, moderate drinkers and position other groups as the ‘problematic’ drinkers. For example, respondents in mid-life portray themselves as ‘experienced’ drinkers and younger people as irresponsible ‘problem’ drinkers [15], younger adults position older people, especially older women drinking heavily in public, as problematic [18], while younger middle-class women position working class women as vulgar and excessive drinkers [19]. This suggests that ‘drinking causes cancer’ may be interpreted as ‘other people’s excessive drinking causes cancer’.

Connor demonstrates the strength of the evidence for alcohol consumption as a cause of cancer. Further research on how lay people conceptualize drinkers and drinking when assessing candidacy is necessary before this message can be communicated effectively to the public.

Declaration of interests

C.E. is a member of the Alcohol Research UK Grants Advisory Panel and has received research funding from Scottish Health Action on Alcohol Problems. S.M. has no competing interests to declare.

Acknowledgements

Thanks to Kate Hunt, Charlie Davison, Una Macleod and Graham Watt for previous conversations about lay epidemiology, and to Penny Buykx for useful suggestions for literature for this commentary.

Original post with references.

Alcohol consumption as a cause of cancer – Full Study

Reducing Alcohol Consumption: guidelines, local government and smartphone apps

An NIHR School for Public Health Research and UCL Centre for Behaviour Change event.

This event brought together researchers and practitioners in the field of excessive alcohol consumption reduction. Various speakers (from different institutions) discussed the latest research evidence and research evidence gaps. This was followed by a lively debate in the networking reception.

Available now are the presentations from the event and a summary of the social media coverage.

Speakers at the event:

  • Prof. Bernie Hannigan (PHE)
  • Dr John Holmes (ScHARR)
  • Prof. Matt Hickmann (University of Bristol)
  • Dr Jamie Brown (UCL)
  • Dr Gautam Mehta (UCLH)
  • Prof. Eileen Kaner (FUSE)

For more information on the event see the agenda & further information sheet.

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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.”

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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

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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

 

Cheap alcohol: the price we pay and the road to Minimum Unit Pricing!

It has been five years since alcohol partners from across the UK carried out their last comprehensive price survey. A lot has happened in that time. The Coalition Government committed to introduce a minimum unit price (MUP) to tackle the harm caused by the cheapest alcohol. Then, with encouragement from sections of the alcohol industry, they decided to postpone its introduction until the outcome of a legal challenge to minimum unit pricing in Scotland had been resolved. The alcohol duty escalator – which increased duty by 2% above inflation – was scrapped. Wider duty rates were cut. And alcohol harm continued to rise.

Four member organisations of the Alcohol Health Alliance (AHA) – the Institute of Alcohol Studies; Alcohol Focus Scotland; Balance, the North East Alcohol Office; and Healthier Futures – decided to check how those changes had affected the price of alcohol that is available in communities across England and Scotland.

As part of the survey, the partners visited a range of off-sales premises looking for the nation’s cheapest booze. Almost 500 products were examined and the conclusion is clear – alcohol continues to be sold at pocket money prices in supermarkets and off-licences across the UK.

Chairman of the AHA and former president of the Royal College of Physicians, Professor Sir Ian Gilmore, said:

“In spite of a government commitment to tackle cheap, high-strength alcohol, these products are still available at pocket money prices. Harmful drinkers and children are still choosing the cheapest products – predominantly white cider and cheap vodka.

We need to make excessively cheap alcohol less affordable through the tax system, including an increase in cider duty. It’s not right that high strength white cider is taxed at a third of the rate for strong beer. 

In addition, we need minimum unit pricing. This would target the cheap, high strength products drunk by harmful drinkers whilst barely affecting moderate drinkers, and it would leave pub prices untouched.”

Each year, there are almost 23,000 deaths and more than 1 million hospital admissions related to alcohol in England.

More than two-thirds of alcohol sold in the UK is purchased in supermarkets and off-licences.

Headline Findings

  • Alcohol continues to be sold at pocket money prices, with white cider dominating the market for cheap, high-strength drinks.
  • High-strength white cider products, which are predominantly drunk by dependent and underage drinkers, are sold for as little as 16p per unit of alcohol.
  • For the cost of a standard off-peak cinema ticket you can buy seven and a half litres of 7.5% ABV white cider, containing as much alcohol as 53 shots of vodka.
  • Recent cuts in alcohol taxes allow shops and supermarkets to sell alcohol at pocket money prices but have done little to benefit pubs and their customers.
  • High-strength white cider is taxed at the lowest rate of all alcohol products. A can of 7.5% ABV white cider attracts less than one-third of the duty on a can of beer that is the same strength.

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Recommendations

The Government needs to:

  1. Increase duty on high-strength cider
  2. Reinstate the alcohol duty escalator
  3. Upon leaving the EU, tax all alcoholic drinks categories in proportion to strength
  4. Implement a minimum unit price for all alcoholic drinks.

Minimum unit pricing and tax – dispelling the myths

A minimum unit price would only target the highest strength drinks that cause the most harm. There are many myths surrounding minimum unit pricing, which the alcohol industry uses to dissuade people from supporting it. We have included here just a few of those myths and our responses.

Myth: An MUP would affect moderate drinkers too.
Moderate drinkers would experience very little impact from minimum unit pricing, which makes it one of the most effective measures, as it only targets the most harmful drinks of the kind deliberately sought out in this survey. The price of a pint of beer in a pub, for example, would not be affected by minimum unit pricing.
Myth: Taxation would be more effective than an MUP.
Recent research from the University of Sheffield found that, to achieve the same level of impact as an MUP of 50p, a 28% increase in all alcohol duty would be needed, which is outside the realms of possibility when it comes to what the Government will do. Everyone would be affected by these measures, whereas minimum unit pricing only targets the cheapest, strongest drinks.
Myth: Tax and minimum unit pricing cannot be used together.
Increasing duty and introducing an MUP are often presented as alternative solutions, when they can in fact be used to complement each other. Minimum unit pricing is targeted at the cheapest alcohol that is consumed by the most harmful drinkers but there are limits to its impact on wider population alcohol consumption and health, which increases to duty overall would help to tackle.

Tax rises and tougher rules on alcohol promotions work well,
but they will always work better when combined with minimum unit pricing.

Read the full report here.

Unravelling the alcohol harm paradox: a population-based study of social gradients across very heavy drinking thresholds | Research report

 

Who was involved?

Dan Lewer – Imperial College Healthcare NHS Trust, Charing Cross Hospital

Petra Meier – ScHARR, University of Sheffield

Emma Beard – Department of Epidemiology & Public Health and Department of Clinical, Educational and Health Psychology, University College London

Sadie Boniface – National Addications Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London

Eileen Kaner – Institute of Health and Society, Newcastle University

Background to the research:

There is consistent evidence that individuals in higher socioeconomic status groups are more likely to report exceeding recommended drinking limits, but those in lower socioeconomic status groups experience more alcohol-related harm. This has been called the ‘alcohol harm paradox’. Such studies typically use standard cut-offs to define heavy drinking, which are exceeded by a large proportion of adults. Our study pools data from six years (2008–2013) of the population-based Health Survey for England to test whether the socioeconomic distribution of more extreme levels of drinking could help explain the paradox.

Methods used:

The study included 51,498 adults from a representative sample of the adult population of England for a cross-sectional analysis of associations between socioeconomic status and self-reported drinking. Heavy weekly drinking was measured at four thresholds, ranging from 112 g+/168 g + (alcohol for women/men, or 14/21 UK standard units) to 680 g+/880 g + (or 85/110 UK standard units) per week. Heavy episodic drinking was also measured at four thresholds, from 48 g+/64 g + (or 6/8 UK standard units) to 192 g+/256 g + (or 24/32 UK standard units) in one day. Socioeconomic status indicators were equivalised household income, education, occupation and neighbourhood deprivation.

Results of the study:

Lower socioeconomic status was associated with lower likelihoods of exceeding recommended limits for weekly and episodic drinking, and higher likelihoods of exceeding more extreme thresholds. For example, participants in routine or manual occupations had 0.65 (95 % CI 0.57–0.74) times the odds of exceeding the recommended weekly limit compared to those in ‘higher managerial’ occupations, and 2.15 (95 % CI 1.06–4.36) times the odds of exceeding the highest threshold. Similarly, participants in the lowest income quintile had 0.60 (95 % CI 0.52–0.69) times the odds of exceeding the recommended weekly limit when compared to the highest quintile, and 2.30 (95 % CI 1.28–4.13) times the odds of exceeding the highest threshold.

Conclusions

Low socioeconomic status groups are more likely to drink at extreme levels, which may partially explain the alcohol harm paradox. Policies that address alcohol-related health inequalities need to consider extreme drinking levels in some sub-groups that may be associated with multiple markers of deprivation. This will require a more disaggregated understanding of drinking practices.

Read the full report here.