Making hospital shops healthier:evaluating the implementation of a mandatory standard for limiting food products and promotions in hospital retail outlets

Background The range of products stocked and their promotions in food retail outlets in healthcare settings can affect food choices by staff, patients and visitors. The innovative Scottish Healthcare Retail Standard (HRS) is a national mandatory scheme requiring all hospital food retail outlets to change the balance of food products stocked and their promotion to comply with nutritional criteria and promotional restrictions. The aim is to facilitate healthier food choices in healthcare settings. This study examined the implementation of HRS and the impact on foods stocked and promoted. Methods The study aimed to examine implementation process and changes to the retail environment in relation to food promotions and choice. A sample of hospital retail outlets (n=17) including shops and trolley services were surveyed using a mixed methods design comprising: (a) structured observational audits of stock, layout and promotions (with a specific focus on chocolate and fruit product lines, and) (b) face-to-face, semi-structured interviews with the shop manager or nominated members of staff (n=32). Data were collected at Wave 1 (2016), at the beginning and during the early stages of HRS implementation; and Wave 2, 12 months later, after the HRS implementation deadline. Results All outlets, both commercial and not-for-profit, in the sample successfully implemented HRS. Implementation was reported to be more challenging by independent shop managers compared to chain store staff. Retail managers identified areas where more implementation guidance and support could have been provided. The number of chocolate product lines and promotions reduced substantially between Waves 1 and 2, but with no substantial increase in fruit product lines and promotions. Despite initial negative expectations of HRS’s impact, managers identified some opportunities in the scheme and positive changes in the supply chain. Conclusions Positive changes in food retail outlets occurred after hospital shops were required to implement HRS. By creating a consistent approach across hospital shops in Scotland, HRS changed the food retail environment for hospital staff, visitors and patients. HRS provides a regulatory template and implementation learning points for influencing retail environments in other jurisdictions and settings

Service failures and challenges in responding to people bereaved through drugs and alcohol: An interprofessional analysis

This article reports findings from the first two stages of a three-stage qualitative study which considered the role of services, including public, private and charitable organisations, in responding to the needs of adults bereaved following the drug and/or alcohol-related death of someone close. The study, the first of its kind to explore the landscape and role of services in substance use deaths, was conducted over two sites: south west England and Scotland. In stage 1 of the research, adopting both convenience and purposive sampling, data were collected via semi-structured interviews on experiences and support needs of bereaved individuals (n = 106). In stage 2, six focus groups were conducted with a purposive sample of practitioners (n = 40), including those working for the police, coroner’s service, procurator fiscal depute (Scotland), health service, funeral service, press, clergy, Public Health England, Drugs Policy Unit, bereavement counselling/support and alcohol and drug treatment services, to investigate how services may better respond to this bereavement. Thematic analysis from both data-sets identified two overarching themes. The first, focusing on practitioner responses, captures how these bereaved people may meet with inadequate, unkind, and discriminatory responses from services. Having to navigate unfamiliar, fragmented, and time-consuming procedures compounds the bereaved’s distress at an already difficult time, illustrated by a ‘mapping’ of relevant services. The second relates to challenges and opportunities for those responding. Service failures reflect practitioners’ poor understanding of both substance use bereavement and the range of other practitioners and services involved. Those bereaved are a poorly understood, neglected and stigmatised group of service users. There is a need for services to respond without judgement or insensitive language, and provide information about, communicate and work closely with, other services despite differences in working practices and cultures. These recommendations could positively affect bereaved peoples’ experiences, alleviating stress and overwhelm at a particularly vulnerable time

Problem drug users' experiences of employment and the benefit system

This report presents the findings of a study commissioned by the Department for Work and Pensions (DWP) to examine the issues surrounding employment and benefit uptake in England by individuals who use illicit drugs, in particular heroin and crack cocaine. In addressing these issues, the study also explores the wider context of education, training, drug use and treatment. This report has two key elements a review of the literature on drug use and benefit uptake, and a qualitative component that included face-to-face interviews with 75 drug users and ten professionals who work with drug users to explore specific issues in detail. The research was carried out by a team from the Centre for Drug Misuse Research at the University of Glasgow and the Centre for the Analysis of Social Policy at the University of Bath

Investigating the effectiveness of education in relation to alcohol: A systematic investigation of critical elements for optimum effectiveness of promising approaches and delivery methods in school and family linked alcohol education

Background: This review examined evidence for school and family linked alcohol education programmes to reduce or prevent the misuse of alcohol by young people. The review aimed to identify critical programme or contextual elements positively associated with evidence of effectiveness. The review paid particular attention to, but was not confined to programmes that included social norms education and/or life skills training and/or the Good Behaviour Game and/or peer-to-peer delivery components. The review was conducted by the Institute for Social Marketing, a joint initiative of the University of Stirling and the Open University. It was commissioned by the Alcohol Education and Research Council (AERC) on behalf of the Drinkaware Trust (DAT) who provided the funding. The original stated purpose of the study was 'to collate evidence that would help to inform how best DAT could approach and be involved in school-based alcohol education across the UK'. Methods: Systematic literature search methods were used, along with a combined quality appraisal and evidence weighting assessment to identify 'promising' interventions. Promising interventions were defined as any intervention where study design was assessed as sound. Weight of evidence for aggregated evaluation results for each intervention was classified as equivocal or convincing. Any intervention reporting adverse effects on substance misuse was excluded. After all relevance and quality screening was completed, the review identified 39 studies collectively reporting on 25 interventions. The results were analysed thematically and with reference to pre-specified research questions. Findings: - The most effective social norms interventions targeted peer alcohol use. Social norm change objectives in both school-based and family components were common and associated with effectiveness. Most of the evidence of effectiveness was derived from mass marketed (not personalised) social norms and did not appear to be informed by dedicated formative research. - Life Skills Training (LST) was also a popular approach, often combined with approaches intended to strengthen protective family factors. Most of the evidence derived from the USA, so cultural transferability remains unclear and requires further piloting. - There was evidence that peer-to-peer delivery is more effective when combined with peer driven planning and other techniques aimed at deeper engagement with target audiences and genuine participatory change. - Reducing environmental availability of alcohol to young people as well as community tolerance of young people's consumption of alcohol appears to enhance the effectiveness of school and family linked alcohol education programmes. - The evidence indicates that a range of education approaches and delivery methods can make a small positive contribution to harm reduction, but there are many examples of interventions which are ineffective or harmful. - Neither knowledge and attitude change, nor acceptability of an intervention is predictive of positive behaviour change. - Involving external specialists can enhance acceptability and effectiveness, but is not critical to effectiveness. - Interventions perceived by target audiences as personally relevant achieve higher retention rates and are more effective than interventions that do not resonate with day to day concerns and circumstances of target audiences. - There is evidence that programme effects, can be sustained up to six years after intervention completion. However, for most interventions positive effects decline fairly rapidly over time and therefore some type(s) of reinforcement intervention are required to maintain positive effects. - Short duration, low-involvement interventions can achieve similar short-term effects to more intensive and longer term interventions. - Most combined family and school‐based interventions appear to lack a holistic perspective or any explanation for how the two components integrated and/or complemented one another within the overall programme design and its aims. Strategic Implications and Recommendations: Combined school and family based alcohol education interventions will be most effective when integrated with broader based environmental interventions. Integration with community interventions can also help to build community ownership and improve intervention acceptability. Explicit linkage of educational interventions with environmental intervention is therefore recommended. Clear conceptual rationale for both the individual content and the integration of school and family components may strengthen efficacy and cost effectiveness. Research in the future on which elements are best delivered via school and which via family programme components would be helpful to future programme design and planning. An overarching strategy grounded in a theoretical model with clear goals and rationale will help guide consistency of messages, priorities and credibility of intervention agents and harm reduction/prevention objectives. This may be especially critical if multiple programmes and target audiences are supported by an intervention organisation. Bottom up/participatory planning and delivery of current practice could be strengthened significantly and the use of specialists in participatory research, development and evaluation are recommended. Consistent, systematic and pre-planned evaluation of future interventions would make a valuable contribution to the scientific evidence base and development of better practice and is therefore recommended. Restricting funding of all future intervention proposals to those which provide a detailed (including dedicated budget) evaluation plan would help to generate reliable and credible practice based evidence. Research into the cost-effectiveness and efficacy of a planned series of short duration, age appropriate interventions would be a useful contribution to the evidence base and development of better practice. Behaviour change must be the definitive measure of effectiveness. It is recommended that scaling up investment should be restricted to approaches and methods that have previously demonstrated measurable (albeit probably small) reductions in alcohol use/misuse, and report comprehensive implementation details

Alcohol Misusers' experiences of employment and the benefit system

This study was commissioned by the Department for Work and Pensions (DWP) to explore the experiences of adults with alcohol misuse problems in the UK in relation to employment, unemployment and benefit uptake. A separate report contains the findings of a study to estimate the number of people who are accessing DWP benefits and who have a problematic relationship with alcohol (Hay et al., 2010)

The Power of Product Innovation: Smokers' Perceptions of Capsule Cigarettes

Introduction  Since being brought to market in 2007, cigarettes with capsules in the filter that can be burst to change the flavor have had remarkable global success, highlighting the importance of product innovation for tobacco companies. Very few studies have explored how these products are perceived by smokers however. This paper sought to address this gap by exploring smokers’ awareness of cigarettes with one or two flavor-changing capsules in the filter and the appeal of these products.  Methods  Twenty focus groups were conducted in Glasgow and Edinburgh in 2015 with current smokers (N= 120), segmented by age (16–17, 18–24, 25–35, 36–50, >50), gender, and social grade.  Results  Awareness, use and appeal of capsule cigarettes was greater among younger adults (16–35 years), who showed most interest in these products. Those who perceived capsules positively mentioned multiple benefits: the ability to burst the capsule, convenience of being able to share cigarettes among menthol and nonmenthol smokers, better taste, fresher breath, reduced smell, and greater discretion. It was suggested that capsule cigarettes, particularly the double capsule cigarette (which had two differently flavored capsules in the filter), would encourage nonsmokers to experiment with smoking and discourage smokers from quitting.  Conclusions  The findings offer some reasons behind the global growth of the capsule cigarette segment.  Implications  Cigarettes with flavor-changing capsules in the filter have been one of the most successful product innovations of the last decade for tobacco companies. They have received very little academic attention however. Employing focus groups with 120 smokers aged 16 and over, we found that capsule cigarettes held most appeal to, and were considered to be targeted at, younger people, with it suggested that these products would encourage initiation and discourage cessation. This study provides some understanding of how these products are viewed by smokers

Process Evaluation of Alcohol Brief Interventions in Wider Settings (Young People and Social Work)

This study aimed to explore the feasibility and acceptability of ABIs delivered to young people and in social work settings. The study did not aim to examine whether individuals who received ABIs changed their drinking behaviour and improved their health but did explore how feasible a future outcome evaluation of ABIs in these settings would be, and the issues and challenges which would be involved in such a study

Novel means of using cigarette packaging and cigarettes to communicate health risk and cessation messages:A qualitative study

Tobacco packaging provides an important means for governments to communicate the health risks associated with smoking. This study explores novel ways in which cigarette packaging, including cigarettes, can be used to communicate health risk and cessation messages. Eight focus groups were conducted with young women smokers (N = 49), aged 16-24years, recruited in Glasgow (Scotland). Each group was shown cigarette packs featuring Quick Response barcodes which link to stop-smoking websites if scanned by a smartphone; cigarette packs with audio messages explaining the risks associated with smoking or providing information on quitting; and cigarettes displaying the warning ‘Smoking kills'. We explored perceptions of each of these designs. Each design received a mixed response but all were perceived to have some value in communicating risk or cessation messages. Many participants were not aware of how Quick Response barcodes worked and only a few actually used them, but they were nevertheless viewed positively, with the link to stop-smoking websites considered appropriate and educational. The packs which played audio messages were viewed as embarrassing and annoying, with this discomfort related to the perceived difficulty in avoiding the warning. The on-cigarette warning was considered a reminder of the health risks and off-putting given the perceived discomfort of smoking a cigarette displaying ‘Smoking kills' in public. This study advances our understanding of how cigarette packaging and cigarettes could potentially be used to communicate with consumers