Industry use of evidence to influence alcohol policy: a case study of submissions to the 2008 Scottish government consultation.

Jim McCambridge and colleagues analyze industry submissions to a Scottish Government consultation on whole-population approaches to alcohol policy

The Impact of asking about interest in free nicotine patches on smoker's stated intent to change: real effect or artefact of question ordering?

INTRODUCTION Stage of change questions are often included on general population surveys to assess the proportion of current smokers intending to quit. The current study reported on a methodological experiment to establish whether participant's self-reported stage of change can be influenced by asking about interest in free nicotine patches immediately prior to asking about intent to change. METHODS As part of an ongoing random digit dialing survey, a randomized half of participants were asked if they would be interested in receiving nicotine patches to help them quit smoking prior to being asked whether they intended to quit smoking in the next 6 months and 30 days. RESULTS Participants who were first asked about interest in free nicotine patches were more likely to rate themselves as in preparation for change (asked first = 33%; not asked first = 19%), and less likely to rate themselves as in the precontemplation stage of change (asked first = 34%; not asked first = 47%), compared with participants who were not asked about their interest in free nicotine patches prior to being asked about their stage of change (P < .001). CONCLUSIONS There are several possible explanations of the results. It is possible that offers of free nicotine patches increases smokers intentions to quit, at least temporarily. Alternatively, smokers being asked about interest in free nicotine patches may expect that the researchers would like to hear about people intending to quit, and respond accordingly.This research is funded by the Canadian Institutes of Health Research (CIHR) grant #: MOP 111209

Exploratory randomized controlled trial evaluating the impact of a waiting list control design

BACKGROUND Employing waiting list control designs in psychological and behavioral intervention research may artificially inflate intervention effect estimates. This exploratory randomized controlled trial tested this proposition in a study employing a brief intervention for problem drinkers, one domain of research in which waiting list control designs are used. METHODS All participants (N = 185) were provided with brief personalized feedback intervention materials after being randomly allocated either to be told that they were in the intervention condition and that this was the intervention or to be told that they were in the waiting list control condition and that they would receive access to the intervention in four weeks with this information provided in the meantime. RESULTS A total of 157 participants (85%) were followed-up after 4 weeks. Between-group differences were found in one of four outcomes (proportion within safe drinking guidelines). An interaction was identified between experimental manipulation and stage of change at study entry such that participant change was arrested among those more ready to change and told they were on the waiting list. CONCLUSIONS Trials with waiting list control conditions may overestimate treatment effects, though the extent of any such bias appears likely to vary between study populations. Arguably they should only be used where this threat to valid inference has been carefully assessed.During the conduct of this research, John Cunningham was supported as the Canada Research Chair on Brief Interventions for Addictive Behaviours. Kypros Kypri is supported by a National Health & Medical Research Council Senior Research Fellowship (APP1041867) and a Senior Brawn Fellowship from the University of Newcastle Jim McCambridge is supported by a Wellcome Trust Research Career Development fellowship in Basic Biomedical Science (WT086516MA)

Industry actors, think tanks, and alcohol policy in the United kingdom.

Corporate actors seek to influence alcohol policies through various means, including attempts to shape the evidential content of policy debates. In this case study, we examined how SABMiller engaged the think tank Demos to produce reports on binge drinking, which were heavily promoted among policymakers at crucial stages in the development of the UK government's 2012 alcohol strategy. One key report coincided with other SABMiller-funded publications, advocating measures to enhance parenting as an alternative to minimum unit pricing. In this instance, the perceived independence of an influential think tank was used to promote industry interests in tactics similar to those of transnational tobacco corporations. This approach is in keeping with other alcohol industry efforts to marginalize the peer-reviewed literature

Has industry funding biased studies of the protective effects of alcohol on cardiovascular disease? A preliminary investigation of prospective cohort studies.

INTRODUCTION AND AIMS: There have been no previous quantitative analyses of the possible effects of industry funding on alcohol and health research. This study examines whether findings of alcohol's protective effects on cardiovascular disease may be biased by industry funding. DESIGN AND METHODS: Findings from a recent systematic review of prospective cohort studies were combined with public domain data on alcohol industry funding. The six outcomes evaluated were alcohol's effects on cardiovascular disease mortality, incident coronary heart disease, coronary heart disease mortality, incident stroke, stroke mortality and mortality from all causes. RESULTS: We find no evidence of possible funding effects for outcomes other than stroke. Whether studies find alcohol to be a risk factor or protective against incident stroke depends on whether or not there is possible industry funding [risk ratio (RR) 1.07 (0.97-1.17) for those without concern about industry funding compared with RR 0.88 (0.81-0.94)]. For stroke mortality, a similar difference is not statistically significant, most likely because there are too few studies. DISCUSSION AND CONCLUSIONS: Dedicated high-quality studies of possible alcohol industry funding effects should be undertaken, and these should be broad in scope. They also need to investigate specific areas of concern, such as stroke, in greater depth

'Tied up in a legal mess' : The alcohol industry's use of litigation to oppose minimum alcohol pricing in Scotland

This article examines the alcohol industry's legal challenges to minimum unit pricing (MUP) in Scotland through the stages heuristic of the policy process. It builds on previous studies of alcohol pricing policy in Scotland and across the UK, and of the use of legal challenges by health harming industries to oppose health policy globally. Having failed to prevent MUP passing into law, industry actors sought to frustrate the implementation of the legislation via challenges in the Scottish, European and UK courts. However, the relevance of legal challenges is not limited to the post-legislative stage of the policy process but was foreshadowed in all earlier stages of the policy process. The potential for a legal challenge to MUP, and the alcohol industry's clearly articulated intention to pursue such action, was used by industry actors to seek to prevent the adoption of MUP in the agenda setting, policy formulation and legislative stages and created significant 'regulatory chill' in other areas of Scottish and UK alcohol policy. Litigation, and the prospect of it, was thus part of a coherent and integrated long-term strategy which adapted to changes in the political climate and to different stages in the policy process. While both the rhetoric and reality of litigation failed to prevent policy implementation, it succeeded in causing a delay of six years, imposing significant costs on the Scottish government and creating policy inertia in Scottish alcohol policy subsequently. Moreover, the inclusion of a 'sunset clause' in the legislation, requiring ongoing evaluation of the policy's effects, presents additional opportunities for the industry to reverse MUP. Thus, industry strategies to undermine MUP and delay further alcohol policy developments require ongoing attention by policy actors and scholars

Policy windows and multiple streams : An analysis of alcohol pricing policy in England

This article adopts a multiple streams approach to examine the failure to implement minimum unit pricing (MUP) for alcohol in England. It demonstrates that the multiple streams model provides a valuable conceptual tool for explaining how and why policies are, and are not, enacted. However, it finds that while problem streams and policy streams are useful heuristic devices, in practice they may overlap and be mutually constitutive. The case of MUP also highlights the potential for policy spillover between jurisdictions and different policy contexts, showing both limits to, and the complex nature of, these processes. It shows the need for high level political commitment in order to implement controversial policies, even when they are backed by strong supporting evidence. Furthermore, it highlights the importance of civil society actors not just in bringing policy issues onto the agenda, but in supporting governments in adopting measures to address them

Authors’ reply to Rao

Rao’s account of innovations to reduce alcohol related harm among older people is a welcome reminder that much can be done in clinical practice to support people to make changes that benefit their health.1 2 It also shows the gap between this important work and NHS policy agendas. We agree that identifying and replicating examples of good practice is an important step forward and that this should be supported by investment in rigorous evaluation. We urgently need to develop an evidence base to support development and implementation of new approaches in health services, but the scale of the challenge should not be underestimated