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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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.

 

 

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!

Teenagers who play video games with alcohol & tobacco content are more likely to drink & smoke.

Images and references to alcohol and tobacco in popular video games may be influencing UK teens who play the games and the age restriction system is not working, according to a new study. 

Experts from the UK Centre for Tobacco and Alcohol Studies at The University of Nottingham have carried out the first ever analysis of best-selling video games to find out the extent to which the games include this content and to assess the link between playing the games and drinking and smoking behaviour.

They found that teenagers who play video games featuring alcohol and tobacco references appeared to be directly influenced because they were twice as likely to have tried smoking or drinking themselves.

‘Cut scenes’ on YouTube

The research examined the content of 32 UK best-selling video games of 2012/2013 and carried out a large online survey of adolescents playing games with alcohol and tobacco content. An analysis of ‘cut scenes’ uploaded by gamers to YouTube from the five most popular games was also carried out. All the games studied were from the genres of stealth, action adventure, open world, shooter and survival/horror because they involve avatars that look and act like real people.

The study, published in the journal Cyberpsychology, Behavior and Social Networking, found alcohol and tobacco content in 44% of the most popular video games. They also found this content was not reported by the official regulator, the Pan-European Games Information (PEGI) system which informs the Video Standards Council age ratings that help parents decide whether game content is suitable for their children.

Subliminal messages

The researchers used YouGov survey tools to ask 1,094 UK adolescents aged 11-17 whether they had played any of the most popular video games identified as containing either tobacco or alcohol imagery. They were also asked whether and to what extent they smoked or drank alcohol. The study found that adolescents who had played at least one game with tobacco or alcohol content were twice as likely to have tried smoking or consumed alcohol themselves.

Out of the top five most popular games, Grand Theft Auto V & VI contained the highest level of alcohol and smoking content using fictitious brands only. The other top games containing these references were Call of Duty:Black Ops II, Call of Duty:Modern Warfare 3 and Assassin’s Creed III. There was no electronic cigarette content.

Video and Film
FIG. 1.  Percentage of total coding intervals containing alcohol content by category in the five games.
Video and Film
FIG. 2.  Percentage of total coding intervals containing tobacco content by category in the five games.

 

Psychologist Dr Joanne Cranwell from the UK Centre for Tobacco and Alcohol Studies, said:

”Although around 54% of UK adolescents play video games online, parental concern over exposure to inappropriate content while playing video games seems to be lower than for other media, like movies for example. While 80% of children aged 10-15 play packaged or online video games with an age rating higher than their age, more than half of British parents are unaware of the harmful content this exposes them to.

Video games are clearly attractive to adolescents regardless of age classification. It appears that official PEGI content descriptors are failing to restrict youth access to age inappropriate content. We think that the PEGI system needs to include both alcohol and tobacco in their content descriptors. Also, game developers could be offered incentives to reduce the amount of smoking and drinking in their games or to at least reference smoking and drinking on their packaging and websites.

As a child protection method it is naïve for both the games industry and the Interactive Software Federation of Europe, who regulate the PEGI system, to rely on age ratings alone. Future research should focus on identifying the levels of exposure in terms of dose that youth gamers are exposed to during actual gameplay and the effects of this on long- term alcohol and smoking behaviour.”

A copy of the full paper is online here: Alcohol and tobacco content in UK video games and their association with alcohol and tobacco use among young people.

News Reports:

Teenagers influenced by video games with alcohol, smoking content – ScienceDaily

Nottingham study finds teenagers ‘are influenced’ by smoking and alcohol in video games – NottsTV

GRAND THEFT WARNING – Teenagers who play video games are ‘TWICE as likely to smoke and drink alcohol’ – TheSUN

Teens who play Grand Theft Auto are ‘twice as likely to smoke or drink alcohol’ – AngleNews

Does YOUR teenager play Grand Theft Auto? They are ‘twice as likely to smoke or drink alcohol’ – DailyMail