Effects of minimum unit pricing for alcohol on different income and socioeconomic groups: a modelling study

Background: Several countries are considering a minimum price policy for alcohol, but concerns exist about the potential effects on drinkers with low incomes. We aimed to assess the effect of a £0·45 minimum unit price (1 unit is 8 g/10 mL ethanol) in England across the income and socioeconomic distributions. Methods: We used the Sheffield Alcohol Policy Model (SAPM) version 2.6, a causal, deterministic, epidemiological model, to assess effects of a minimum unit price policy. SAPM accounts for alcohol purchasing and consumption preferences for population subgroups including income and socioeconomic groups. Purchasing preferences are regarded as the types and volumes of alcohol beverages, prices paid, and the balance between on-trade (eg, bars) and off-trade (eg, shops). We estimated price elasticities from 9 years of survey data and did sensitivity analyses with alternative elasticities. We assessed effects of the policy on moderate, hazardous, and harmful drinkers, split into three socioeconomic groups (living in routine or manual households, intermediate households, and managerial or professional households). We examined policy effects on alcohol consumption, spending, rates of alcohol-related health harm, and opportunity costs associated with that harm. Rates of harm and costs were estimated for a 10 year period after policy implementation. We adjusted baseline rates of mortality and morbidity to account for differential risk between socioeconomic groups. Findings: Overall, a minimum unit price of £0·45 led to an immediate reduction in consumption of 1·6% (−11·7 units per drinker per year) in our model. Moderate drinkers were least affected in terms of consumption (−3·8 units per drinker per year for the lowest income quintile vs 0·8 units increase for the highest income quintile) and spending (increase in spending of £0·04 vs £1·86 per year). The greatest behavioural changes occurred in harmful drinkers (change in consumption of −3·7% or −138·2 units per drinker per year, with a decrease in spending of £4·01), especially in the lowest income quintile (−7·6% or −299·8 units per drinker per year, with a decrease in spending of £34·63) compared with the highest income quintile (−1·0% or −34·3 units, with an increase in spending of £16·35). Estimated health benefits from the policy were also unequally distributed. Individuals in the lowest socioeconomic group (living in routine or manual worker households and comprising 41·7% of the sample population) would accrue 81·8% of reductions in premature deaths and 87·1% of gains in terms of quality-adjusted life-years. Interpretation: Irrespective of income, moderate drinkers were little affected by a minimum unit price of £0·45 in our model, with the greatest effects noted for harmful drinkers. Because harmful drinkers on low incomes purchase more alcohol at less than the minimum unit price threshold compared with other groups, they would be affected most by this policy. Large reductions in consumption in this group would however coincide with substantial health gains in terms of morbidity and mortality related to reduced alcohol consumption. Funding: UK Medical Research Council and Economic and Social Research Council (grant G1000043)

The Case against a Smoker's License

Tobacco continues to kill millions of people around the world each year and its use is increasing in some countries, which makes the need for new, creative, and radical efforts to achieve the tobacco control endgame vitally important. One such effort is discussed in this PLOS Medicine Debate, where Simon Chapman presents his proposal for a "smoker's license" and Jeff Collin argues against. Chapman sets out a case for introducing a smart card license for smokers designed to limit access to tobacco products and encourage cessation. Key elements of the smoker's license include smokers setting daily limits, financial incentives for permanent license surrender, and a test of health risk knowledge for commencing smokers. Collin argues against the proposal, saying that it would shift focus away from the real vector of the epidemic--the tobacco industry--and that by focusing on individuals it would censure victims, increase stigmatization of smokers, and marginalize the poor

Nursing sensitive outcomes in patients with rheumatoid arthritis: A systematic literature review

© 2017 Elsevier Ltd Background Although rheumatology nursing has been shown to be effective in managing patients with rheumatoid arthritis, patient outcomes sensitive to nursing interventions (nursing sensitive outcomes) have not been systematically studied. Objectives The objective of this study was to identify and delineate relevant patient outcomes measured in studies that reported nursing interventions in patients with rheumatoid arthritis. Design A systematic search was conducted from 1990 to 2016. Inclusion criteria were (i) patients with rheumatoid arthritis, (ii) adult population age ≥16 years, (iii) nurse as part of the care team or intervention delivery, (iv) primary research only, (v) English language, and (vi) quantitative studies with nursing sensitive outcomes. Data sources Medline, CINAHL, Ovid nursing, Cochrane library and PsycINFO databases were searched for relevant studies. Review methods Using the predetermined inclusion/exclusion criteria, nine reviewers working in pairs assessed the eligibility of the identified studies based on titles and abstracts. Papers meeting the inclusion criteria were retrieved and full texts were further assessed. Critical Appraisal Skills Programme tools were used to assess the quality of the included studies. Data on nursing sensitive outcomes were extracted independently by two reviewers. The Outcome Measures in Rheumatology comprehensive conceptual framework for health was used to contextualise and present findings. Results Of the 820 articles retrieved, 7 randomised controlled trials and 3 observational studies met the inclusion criteria. Seventeen nursing sensitive outcomes were identified (disease activity, clinical effects, pain, early morning stiffness duration, fatigue, patient safety issues, function, knowledge, patient satisfaction, confidence in care received, mental health status, self-efficacy, patient attitude/perception of ability to control arthritis, quality of life, health utility, health care resources, death). These fitted into 10 health intervention domains in keeping with the pre-specified conceptual framework for health: disease status, effectiveness, safety, function, knowledge, satisfaction, psychological status, quality of life, cost, death. A total of 59 measurement instruments were identified comprising patient reported outcome measures (n = 31), and biologic measures and reports (n = 28). Conclusions This review is notable in that it is the first to have identified, and reported, a set of multidimensional outcome measures that are sensitive to nursing interventions in rheumatology specifically. Further research is required to determine a core set of outcomes to be used in all rheumatology nursing intervention studies

The QuinteT Recruitment Intervention supported five randomized trials to recruit to target: a mixed-methods evaluation

ObjectiveTo evaluate the impact of the Quintet Recruitment Intervention (QRI) on recruitment in challenging randomized controlled trials (RCTs) that have applied the intervention. The QRI aims to understand recruitment difficulties, and then implements ‘QRI-actions’ to address these as recruitment proceeds.Study Design and SettingA mixed-methods study, comprising: a) before-and-after comparisons of recruitment rates and numbers of patients approached, and b) qualitative case studies, including documentary analysis and interviews with RCT investigators.ResultsFive UK-based publicly-funded RCTs were included in the evaluation. All recruited to target. RCT2 and RCT5 both received up-front pre-recruitment training before the intervention was applied. RCT2 did not encounter recruitment issues and recruited above target from its outset. Recruitment difficulties, particularly communication issues, were identified and addressed through QRI-actions in RCTs 1, 3, 4 and 5. Randomization rates significantly improved post-QRI-action in RCTs 1,3, and 4. QRI-actions addressed issues with approaching eligible patients in RCTs 3 and 5, which both saw significant increases in patients approached. Trial investigators reported that the QRI had unearthed issues they had been unaware of, and reportedly changed their practices post QRI-action.ConclusionThere is promising evidence to suggest the QRI can support recruitment to difficult RCTs. This needs to be substantiated with future controlled evaluations

Short-Weighting, Species Authentication, and Labeling Compliance of Prepackaged Frozen Shrimp Sold in Grocery Stores in Southern California

Shrimp is the most-consumed seafood product in the United States; however, there is a lack of research into the extent of short-weighting and mislabeling of shrimp in the commercial marketplace. The objective of this study was to investigate frozen shrimp for Country of Origin Labeling (COOL) compliance, species authentication, acceptable market names, net weights, and percent glaze. A total of 106 frozen shrimp packages were purchased from grocery stores in Southern California. Samples were considered COOL compliant if both the procurement method and country of origin were reported at the point of sale. Species authentication and acceptable market names were determined by comparing the species identification based on DNA barcoding to the acceptable market names on the FDA Seafood List. Net weights and percent glaze were determined by recording the weight of each sample before and after deglazing according to AOAC methods. The measured net weight of each product was compared to the declared net weight to determine if samples had been short-weighted, taking into account the maximum allowable variation (MAV) by the National Institute of Standards and Technology (NIST). Overall, 94% of samples were compliant with COOL. The average percent glaze was 16.6%, with 26% of samples having \u3e20% glaze. Short-weighting was detected in 37% of samples, with the greatest proportion of incidents recorded for the super/extra colossal shrimp category (57.1%). Species labeling errors were observed in 37% of samples due to conflicting market names, species substitution, and/or use of unacceptable market names. The results of this study indicate a high level of COOL compliance but suggest a need for increased scrutiny of species mislabeling and short-weighting of frozen shrimp

Minimum unit pricing for alcohol: policy appraisal modelling of income and socioeconomic group-specific effects on consumption, spending, and health harms

Background UK legislatures are at different stages in the policy process for introducing a minimum price for alcohol. Although there is evidence about the effectiveness of such policies, political and public concern exists about the potential effects on low-income drinkers. We present appraisals of the effects of a £0·45 minimum unit price (MUP; 1 unit=8g/10mL ethanol) policy in England in 2014–15 across the income and socioeconomic distributions. Methods We undertook policy appraisals using the Sheffield Alcohol Policy Model (SAPM version 2.6), a causal, deterministic, epidemiological model. SAPM accounts for differential alcohol purchasing and consumption preferences for population subgroups defined, using self-reported survey data, by age, sex, consumption level, and income or socioeconomic group. We derived volumes purchased and prices paid for ten alcoholic beverage categories (beer, cider, wine, spirits, and ready-to-drink beverages [RTDs], purchased in the on trade [eg, bars] or off trade [eg, shops]) from household-level 2-week spending diaries. A 10 × 10 price elasticity matrix was estimated to describe the relation between price changes and purchasing changes (assumed to represent consumption changes). After a policy change, the elasticity matrix was used to adjust individual-level survey data on self-reported mean weekly and peak daily alcohol consumption. We modelled resulting effects on mortality and disease prevalence using functions relating consumption measures to risk of having 47 chronic or acute disorders wholly or partly attributable to alcohol. Baseline mortality and morbidity rates were those reported for England and Wales in 2005 by the North West Public Health Observatory. These rates are adjusted to account for socioeconomic variability in mortality and morbidity risk with Office for National Statistics socioeconomic group-specific alcohol-related mortality data for 2001–03. Findings On average, moderate drinkers purchase 36 below-MUP units per year whereas harmful drinkers in the lowest and highest income groups purchase 1610 and 712 units, respectively. The policy is estimated to have small effects on moderate drinkers' alcohol consumption (–1·6 units per drinker per year) and spending (£0·78 per year). Bigger behavioural changes are estimated to occur among harmful drinkers and these are largest in the lowest income quintile (–300 units, –£34·63) compared with the highest (–34 units, £16·35). The same pattern of results was noted in sensitivity analyses using (a) alternative elasticity matrices, and (b) population subgroups defined by socioeconomic status rather than income. A list of published sensitivity analyses undertaken with SAPM is provided in the appendix. Health benefits from the policy are also unequally distributed due to differential baseline harm risks and purchasing patterns. Lower socioeconomic groups that make up 41·7% of the population would accrue 81·8% of the reduction in deaths and 87·1% of the reduction in quality-adjusted life-years lost. Interpretation Moderate drinkers, regardless of income, are only marginally affected by the policy because it chiefly targets harmful drinkers. Because they purchase more below-MUP alcohol, low-income harmful drinkers would be affected more than those with higher incomes. Policymakers must balance low-income harmful drinkers' larger consumption reductions against their greater health gains from reduced alcohol-related morbidity and mortality. Limitations of the model include supply-side responses not being considered (eg, retailers increasing prices above the MUP threshold) and the data used for adjusting baseline health risks for socioeconomic groups only relating to mortality and not being condition specific

Effects of minimum unit pricing for alcohol on different income and socioeconomic groups: a modelling study.

Several countries are considering a minimum price policy for alcohol, but concerns exist about the potential effects on drinkers with low incomes. We aimed to assess the effect of a £0·45 minimum unit price (1 unit is 8 g/10 mL ethanol) in England across the income and socioeconomic distributions