The range and magnitude of alcohol’s harm to others: a report delivered to the Five Nations Health Improvement Network. A rapid review of cross-sectional surveys

There is a large body of epidemiological literature describing the relationship between alcohol consumption and a range of health conditions including high blood pressure, cancer and liver disease. Reviews have also demonstrated the negative impact alcohol has socially; it is an important factor in crime and disorder, family and marital problems, adverse childhood experiences and reduced workplace productivity through premature death, absenteeism or presenteeism. Increasingly, evidence is demonstrating the detrimental effect of alcohol to people other than the drinker. Considering these ‘harms to others’, or ‘second-hand effects’, can enable a more accurate measurement of the full burden of alcohol on society. Alcohol’s harm to others (AHTO) was identified as an area of interest by the alcohol expert forum of the Five Nations Health Improvement Network (England, Scotland, Wales, the Republic of Ireland [ROI] and Northern Ireland) and is the focus of this rapid review. There have been several reviews that have identified the wide range of harms to people from others drinking. The aim of the review was to describe the range and magnitude of AHTO from cross-sectional surveys. These surveys do not cover all AHTO, for example Foetal Alcohol Syndrome, therefore do not present a complete picture

Alcohol-related harm to others in England: a cross-sectional analysis of national survey data.

ObjectivesTo estimate the prevalence, the frequency and the perpetrators of alcohol-related harm to others (AHTO) and identify factors associated with experiencing harm and aggressive harm.DesignCross-sectional survey.SettingEngland.ParticipantsAdults (general population) aged 16 and over.Outcome measuresPercentage of respondents who experienced harm. Socioeconomic and demographic factors associated with the outcomes. Outcomes were (1) experienced harm/did not experience harm and (2) experienced aggressive harm (physically threatened, physically hurt and forced/pressured into something sexual)/did not experience an aggressive harm (no aggressive harm plus no harm at all).ResultsData to support a response rate calculation were not collected; 96.3% of people surveyed completed the AHTO questions. The weighted sample was 4874; 20.1% (95% CI 18.9 to 21.4, N=980) reported experiencing harm in the previous 12 months and 4.6% (95% CI 4.0 to 5.4, N=225) reported experiencing an aggressive harm. Friends and strangers were the dominant perpetrators. Most harms (74.8%) occurred less than monthly. Factors associated with experiencing harm were: younger age (pConclusionsThis exploratory study, using data collected through the Alcohol Toolkit Survey, shows that AHTO affects 20.1% of the population of England. Even apparently minor harms, like being kept awake, can have a negative impact on health, while aggressive harms are clearly of concern. Using a standard methodology to measure harm across studies would be advantageous. Policies that focus on alcohol must take into consideration the impact of drinking on those other than the drinker

Policies and interventions to reduce harmful gambling: an international Delphi consensus and implementation rating study.

There is increasing public health concern about harmful gambling, but no consensus on effective policies and interventions to reduce risk and prevent harm has been reached. Focusing on policies and interventions (ie, measures), the aim of this study was to determine if expert consensus could be reached on measures perceived to be effective that could be implemented successfully. Our work involved a pre-registered, three-round, independent Delphi panel consensus study and an implementation rating exercise. A starting set of 103 universal and targeted measures, which were sourced from several key resources and inputs from public health stakeholders, were grouped into seven domains: price and taxation; availability; accessibility; marketing, advertising, promotion, and sponsorship; environment and technology; information and education; and treatment and support. Across three rounds, an independent panel of 35 experts individually completed online questionnaires to rank each measure for known or potential effectiveness. A consensus was reached if at least 70% of the panel judged a measure to be either not effective, moderately effective, or highly effective. Then, each measure that reached a consensus for effectiveness was evaluated on four implementation dimensions: practicability, affordability, side-effects, and equity. A summative threshold criterion was used to select a final optimal set of measures for England. The panel reached consensus on 83 (81%) of 103 measures. Two measures were judged as ineffective by the panel. The remaining 81 effective measures were drawn from all domains (14 of 15 measures in the the marketing, advertising, promotion, and sponsorship domain were judged as effective, whereas five of ten measures in the information and education domain were judged as effective). During the evaluation exercise, the 81 measures were assessed for likelihood of implementation success. This assessment considered the practicality, affordability, ability to generate unanticipated side-effects, and ability to decrease differences between advantaged and disadvantaged groups in society of each measure. We identified 40 universal and targeted measures to tackle harmful gambling (three measures from the price and taxation domain; ten from the availability domain; five from the accessibility domain; six from the marketing, advertising, promotion, and sponsorship domain; eight from the environment and technology domain; three from the information and education domain; and five from the treatment and support domain). Implementation of these measures in England could substantially strengthen regulatory controls while providing new resources. The findings of our work offer a blueprint for a public health approach to preventing harms related to gambling

Effect of alcohol label designs with different pictorial representations of alcohol content and health warnings on knowledge and understanding of Low Risk Drinking Guidelines: A randomized controlled trial

Background and aims: The UK Low Risk Drinking Guidelines (LRDG) recommend not regularly drinking more than 14 units of alcohol per week. We tested the effect of different pictorial representations of alcohol content, some with a health warning, on knowledge of the LRDG and understanding of how many drinks it equates to. Design: Parallel randomized controlled trial. Setting: Online, 25 Jan ‐ 1 Feb 2019. Participants: Participants (n = 7,516) were English, over 18 years, and drink alcohol. Interventions: The control group saw existing industry‐standard labels; six intervention groups saw designs based on: food labels (serving or serving & container), pictographs (servings or containers), pie charts (servings), or risk gradients. A total of 500 participants (~70 per condition) saw a health warning under the design. Measurements: Primary outcomes: (i) knowledge: proportion who answered that the LRDG is 14 units; (ii) understanding: how many servings/containers of beverages one can drink before reaching 14 units (10 questions, average distance from correct answer). Findings: In the control group, 21.5% knew the LRDG; proportions were higher in intervention groups (all p < 0.001). The three best‐performing designs had the LRDG in a separate statement, underneath the pictograph container, 51.1% (AOR = 3.74, 95% CI 3.08‐4.54), pictograph serving 48.8% (AOR = 4.11, 95% CI 3.39‐4.99), and pie chart serving, 47.5% (AOR = 3.57, 95% CI 2.93‐4.34). Participants underestimated how many servings they could drink: control M = ‐4.64, SD =3.43; intervention groups were more accurate (all p < 0.001), best performing was pictograph serving (M= ‐0.93, SD = 3.43). Participants overestimated how many containers they could drink: control M = 0.09, SD =1.02; intervention groups overestimated even more (all p< 0.007), worst performing was food label serving (M = 1.10, SD = 1.27). Participants judged the alcohol content of beers more accurately than wine or spirits. The inclusion of a health warning had no statistically significant effect on any measure. Conclusions: Labels with enhanced pictorial representations of alcohol content improved knowledge and understanding of the United Kingdom’s Low Risk Drinking Guidelines (LRDG) compared with industry‐standard labels; health warnings did not improve knowledge or understanding of LRDG. Designs that improved knowledge most had the LRDG in a separate statement located underneath graphics

A rapid evidence review of the effectiveness and cost-effectiveness of alcohol control policies: an English perspective

This paper reviews the evidence for the effectiveness and cost-effectiveness of policies to reduce alcohol-related harm. Policies focus on price, marketing, availability, information and education, the drinking environment, drink-driving, and brief interventions and treatment. Although there is variability in research design and measured outcomes, evidence supports the effectiveness and cost-effectiveness of policies that address affordability and marketing. An adequate reduction in temporal availability, particularly late night on-sale availability, is effective and cost-effective. Individually-directed interventions delivered to at-risk drinkers and enforced legislative measures are also effective. Providing information and education increases awareness, but is not sufficient to produce long-lasting changes in behaviour. At best, interventions enacted in and around the drinking environment lead to small reductions in acute alcohol-related harm. Overall, there is a rich evidence base to support the decisions of policy makers in implementing the most effective and cost-effective policies to reduce alcohol-related harm

Chapter 6C: Fishes

https://nsuworks.nova.edu/occ_facbooks/1114/thumbnail.jp

The Liverpool alcohol-related liver disease algorithm identifies twice as many emergency admissions compared to standard methods when applied to Hospital Episode Statistics for England.

BACKGROUND: Emergency admissions in England for alcohol-related liver disease (ArLD) have increased steadily for decades. Statistics based on administrative data typically focus on the ArLD-specific code as the primary diagnosis and are therefore at risk of excluding ArLD admissions defined by other coding combinations. AIM: To deploy the Liverpool ArLD Algorithm (LAA), which accounts for alternative coding patterns (e.g., ArLD secondary diagnosis with alcohol/liver-related primary diagnosis), to national and local datasets in the context of studying trends in ArLD admissions before and during the COVID-19 pandemic. METHODS: We applied the standard approach and LAA to Hospital Episode Statistics for England (2013-21). The algorithm was also deployed at 28 hospitals to discharge coding for emergency admissions during a common 7-day period in 2019 and 2020, in which eligible patient records were reviewed manually to verify the diagnosis and extract data. RESULTS: Nationally, LAA identified approximately 100% more monthly emergency admissions from 2013 to 2021 than the standard method. The annual number of ArLD-specific admissions increased by 30.4%. Of 39,667 admissions in 2020/21, only 19,949 were identified with standard approach, an estimated admission cost of £70 million in under-recorded cases. Within 28 local hospital datasets, 233 admissions were identified using the standard approach and a further 250 locally verified cases using the LAA (107% uplift). There was an 18% absolute increase in ArLD admissions in the seven-day evaluation period in 2020 versus 2019. There were no differences in disease severity or mortality, or in the proportion of admissions with decompensation of cirrhosis or alcoholic hepatitis. CONCLUSIONS: The LAA can be applied successfully to local and national datasets. It consistently identifies approximately 100% more cases than the standard coding approach. The algorithm has revealed the true extent of ArLD admissions. The pandemic has compounded a long-term rise in ArLD admissions and mortality

Evaluating changes in marine communities that provide ecosystem services through comparative assessments of community indicators

Fisheries provide critical provisioning services, especially given increasing human population. Understanding where marine communities are declining provides an indication of ecosystems of concern and highlights potential conflicts between seafood provisioning from wild fisheries and other ecosystem services. Here we use the nonparametric statistic, Kendall׳s tau, to assess trends in biomass of exploited marine species across a range of ecosystems. The proportion of ‘Non-Declining Exploited Species’ (NDES) is compared among ecosystems and to three community-level indicators that provide a gauge of the ability of a marine ecosystem to function both in provisioning and as a regulating service: survey-based mean trophic level, proportion of predatory fish, and mean life span. In some ecosystems, NDES corresponds to states and temporal trajectories of the community indicators, indicating deteriorating conditions in both the exploited community and in the overall community. However differences illustrate the necessity of using multiple ecological indicators to reflect the state of the ecosystem. For each ecosystem, we discuss patterns in NDES with respect to the community-level indicators and present results in the context of ecosystem-specific drivers. We conclude that using NDES requires context-specific supporting information in order to provide guidance within a management framework