The effect of alcohol marketing on people with, or at risk of, an alcohol problem: A rapid literature review

There is a comprehensive evidence base demonstrating the relationship between alcohol marketing and underage drinking. Far less is known about the impact of alcohol marketing on other potentially vulnerable populations, such as people with, or at risk of, an alcohol problem. For the purposes of this review, this includes people with an alcohol use disorder, in recovery from an alcohol use disorder, and hazardous and harmful drinkers. This report presents findings from a rapid review that aimed to answer the following research questions: • What is the effect of alcohol marketing on drinking behaviour in adults with, or at risk of, an alcohol problem? • What are the psychological and neurological effects of alcohol marketing in adults with, or at risk of, an alcohol problem? A rapid review of primary studies was conducted with the aim of exploring the effect or potential effect of alcohol marketing on people with, or at risk of an alcohol problem, as defined above. Studies were eligible for inclusion in this review if their populations were defined within the paper as being with, or at risk of an alcohol problem, taking into account the possibility of different definitions in different settings. Studies were only included if results or outcomes were presented separately for at least one of the populations of interest. Binge drinkers were not included as a population of interest in this review. Studies covering different aspects of the ‘marketing mix’ (the four Ps of promotion, place, product, and price) were included, with the exception of alcohol outlet density, labelling and non-branded alcohol cues. Children and adolescents were excluded from the review. Quantitative and qualitative study designs were eligible for inclusion. Outcomes related to alcohol use were included, as well as psychological indicators such as awareness of or noticing marketing, appeal or perception of alcohol advertisements, alcohol craving, intentions to consume alcohol, symptoms of alcohol dependence and alcohol-related emotions and cognitions. Searches for relevant literature were conducted through three peer-reviewed electronic literature databases (from inception to November 2021), reference list scanning and citation tracking of included studies, grey literature searching of relevant websites, and enquiries through expert networks. We undertook a narrative synthesis of included papers, grouping studies together by population (participants with harmful or hazardous consumption levels of alcohol and those recovering from an alcohol use disorder) and by type of study (quantitative; qualitative). The review included 11 studies, which focused on participants recovering from an alcohol use disorder (AUD, 6 studies) and those with hazardous or harmful consumption levels of alcohol (5 studies). Seven studies used a quantitative design and four used a qualitative design. Of the quantitative studies, three were crosssectional studies and four were experimental studies. A limited number of studies have investigated the effect of alcohol advertising in harmful/hazardous drinkers. In experimental studies, one included study found no effect of adverts on actual alcohol consumption, but found that alcohol advertising could influence positive alcohol-related emotions and cognitions among heavy drinkers. Another found that individuals who exhibit greater risky alcohol use are more likely to express intentions to consume alcohol upon exposure to beer than water ads. Finally, one study found shorter reaction times in problem drinkers relative to non-problem drinkers when exposed to non-branded alcohol images in a study where participants were instructed to respond as quickly as possible to ‘go’ stimuli whilst refraining from responding to ‘no-go’ stimuli with branded and unbranded alcohol pictures as stimuli. Two cross-sectional studies highlighted the potential risks of alcohol advertising for heavy drinkers: one found that drinkers reporting symptoms of alcohol problems were more likely to notice alcohol brands in magazines and newspapers, while another found that among students, heavy drinkers perceived alcohol adverts as more appealing; however, due to the observational designs used, neither of these studies were able to make causal inferences about the effect of alcohol advertising. Similarly, a small number of quantitative studies have investigated the effects of advertising on drinkers in recovery. Only two studies were found, both of which suggest a relatively small effect of alcohol advertising in this population. One crosssectional study reported that more than three quarters of participants (77%) recalled seeing alcohol marketing in the last six months, with 24% reporting that alcohol marketing was influential. The most influential factors affecting the purchase of a specific alcohol product included price, accessibility, the brand and alcohol percent. Using an experimental design, a further study reported increased craving after exposure to alcohol advertisements and this measure showed a positive association with the number of alcohol-dependence symptoms. In absolute terms, however, craving was relatively low. In three interview studies, respondents indicated that alcohol advertisements triggered a desire to drink, particularly those which contained the participants’ preferred drink and even where the advertisements were perceived negatively. Some reported that they viewed advertisements as being responsible for their relapse. Television was cited as being a particularly powerful medium, with feelings that television intruded into their own home. One study further reported that music and party scenes were particularly troubling in terms of creating an association with good times. Participants in both studies reported negative emotions associated with viewing alcohol advertisements, including loss, lack of belonging, anger, sadness, guilt and exclusion from the norm. Participants in these studies reported needing to use strategies to avoid alcohol advertising, either through turning off and avoiding adverts or recalling the negative aspects of alcohol use. The retail environment was also identified in one further qualitative study as being challenging for drinkers in recovery. High visibility of alcohol, especially in small shops where it is harder to avoid alcohol products, and in-store advertising were identified as risks to recovery. • Taken together, the findings of the studies included in this review suggest that an effect of alcohol marketing in people with, or at risk of, an alcohol problem is likely. • Several studies report effects of alcohol marketing such as influences on positive alcohol-related emotions and cognitions and alcohol craving, which may translate into effects on alcohol consumption. There is also evidence that alcohol marketing is perceived to act as a trigger by people in recovery from alcohol problems and pose a risk to recovery. • This review demonstrates that the impact of alcohol marketing on people with or at risk of an alcohol problem should be a concern for marketing regulators and a focus for future research. • Future research should include longitudinal and experimental studies to determine whether alcohol advertisement has a causal effect on alcohol use in people with or at risk of an alcohol problems, including the differential effects between these groups and of different types of marketing

Comparing the performance of the novel FAMCAT algorithms and established case-finding criteria for familial hypercholesterolaemia in primary care

OBJECTIVE: Familial hypercholesterolaemia (FH) is a common inherited disorder causing premature coronary heart disease (CHD) and death. We have developed the novel Familial Hypercholesterolaemia Case Ascertainment Tool (FAMCAT 1) case-finding algorithm for application in primary care, to improve detection of FH. The performance of this algorithm was further improved by including personal history of premature CHD (FAMCAT 2 algorithm). This study has evaluated their performance, at 95% specificity, to detect genetically confirmed FH in the general population. We also compared these algorithms to established clinical case-finding criteria. METHODS: Prospective validation study, in 14 general practices, recruiting participants from the general adult population with cholesterol documented. For 260 participants with available health records, we determined possible FH cases based on FAMCAT thresholds, Dutch Lipid Clinic Network (DLCN) score, Simon-Broome criteria and recommended cholesterol thresholds (total cholesterol >9.0 mmol/L if ≥30 years or >7.5 mmol/L if <30 years), using clinical data from electronic and manual extraction of patient records and family history questionnaires. The reference standard was genetic testing. We examined detection rate (DR), sensitivity and specificity for each case-finding criteria. RESULTS: At 95% specificity, FAMCAT 1 had a DR of 27.8% (95% CI 12.5% to 50.9%) with sensitivity of 31.2% (95% CI 11.0% to 58.7%); while FAMCAT 2 had a DR of 45.8% (95% CI 27.9% to 64.9%) with sensitivity of 68.8% (95% CI 41.3% to 89.0%). DLCN score ≥6 points yielded a DR of 35.3% (95% CI 17.3% to 58.7%) and sensitivity of 37.5% (95% CI 15.2% to 64.6%). Using recommended cholesterol thresholds resulted in DR of 28.0% (95% CI 14.3% to 47.6%) with sensitivity of 43.8% (95% CI 19.8% to 70.1%). Simon-Broome criteria had lower DR 11.3% (95% CI 6.0% to 20.0%) and specificity 70.9% (95% CI 64.8% to 76.5%) but higher sensitivity of 56.3% (95% CI 29.9% to 80.2%). CONCLUSIONS: In primary care, in patients with cholesterol documented, FAMCAT 2 performs better than other case-finding criteria for detecting genetically confirmed FH, with no prior clinical review required for case finding. TRIAL REGISTRATION NUMBER: NCT03934320

Individual patient data meta-analysis of randomized controlled trials of community occupational therapy for stroke patients

&lt;p&gt;&lt;b&gt;Background and Purpose:&lt;/b&gt; Trials of occupational therapy for stroke patients living in the community have varied in their findings. It is unclear why these discrepancies have occurred.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Methods:&lt;/b&gt; Trials were identified from searches of the Cochrane Library and other sources. The primary outcome measure was the Nottingham Extended Activities of Daily Living (NEADL) score at the end of intervention. Secondary outcome measures included the Barthel Index or the Rivermead ADL (Personal ADL), General Health Questionnaire (GHQ), Nottingham Leisure Questionnaire (NLQ), and death. Data were analyzed using linear or logistic regression with a random effect for trial and adjustment for age, gender, baseline dependency, and method of follow-up. Subgroup analyses compared any occupational therapy intervention with control.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Results:&lt;/b&gt; We included 8 single-blind randomized controlled trials incorporating 1143 patients. Occupational therapy was associated with higher NEADL scores at the end of intervention (weighted mean difference [WMD], 1.30 points, 95% confidence intervals [CI], 0.47 to 2.13) and higher leisure scores at the end of intervention (WMD, 1.51 points; 95% CI, 0.24 to 2.79). Occupational therapy emphasizing activities of daily living (ADL) was associated with improved end of intervention NEADL (WMD, 1.61 points; 95% CI, 0.72 to 2.49) and personal activities of daily living (odds ratio [OR], 0.65; 95% CI, 0.46 to 0.91), but not NLQ. Leisure-based occupational therapy improved end of intervention NLQ (WMD, 1.96 points; 95% CI, 0.27 to 3.66) but not NEADL or PADL.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Conclusions:&lt;/b&gt; Community occupational therapy significantly improved personal and extended activities of daily living and leisure activity in patients with stroke. Better outcomes were found with targeted interventions.&lt;/p&gt

Factors associated with smoking cessation in early and late pregnancy in the smoking, nicotine, and pregnancy trial: a trial of nicotine replacement therapy

Introduction: Previous studies have found partners’ smoking status, multiparity, and nicotine dependence to be associated with smoking cessation in pregnancy. However, no studies have investigated influences on cessation among women using nicotine replacement therapy (NRT). We analyzed data from a trial of NRT in pregnancy to determine factors associated with shorter- and longer-term cessation. Methods: Data were collected at baseline, 1 month, and delivery from 1,050 pregnant women. Two multivariable logistic models for validated cessation at 1 month and delivery were created with a systematic strategy for selection of included factors. Results: All findings are from multivariable analyses. At 1 month, odds of cessation were greater among those who completed full time education at >16 years of age (odds ratio [OR] = 1.82, 95% confidence interval CI = 1.24–2.67, p = .002) but they were lower in women with higher baseline cotinine levels (OR = 0.93, 95% CI = 0.90–0.95, p 16 years of age (OR = 1.89, 95% CI = 1.16–3.07, p = 0.010) but were inversely associated with higher baseline cotinine levels (OR = 0.96, 95% CI = 0.92–0.99, p = .010). Conclusions: Women who are better educated and have lower pretreatment cotinine concentrations had higher odds of stopping smoking and factors associated with shorter and longer term cessation were similar

Interventions for preventing non-melanoma skin cancers in high-risk groups

Background Some groups of people have a greater risk of developing common non‐melanoma skin cancers (NMSC). Objectives To evaluate interventions for preventing NMSC in people at high risk of developing NMSC. Search methods We searched the Cochrane Skin Group Specialised Register (March 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2007, MEDLINE (from 2003 to March 2007), EMBASE (from 2005 to March 2007), the metaRegister of Controlled Trials (February 2007). References from trials and reviews were also searched. Pharmaceutical companies were contacted for unpublished trials. Selection criteria Randomised controlled trials of adults and children at high risk of developing NMSC. Data collection and analysis Two review authors independently selected studies and assessed their methodological quality. Main results We identified 10 trials (7,229 participants) that assessed a variety of interventions. One trial found T4N5 liposome lotion significantly reduced the rate of appearance of new BCCs in people with xeroderma pigmentosum. One of three trials of renal transplant recipients showed a significantly reduced risk of new NMSCs when acitretin was compared to placebo (relative risk (RR) 0.22 95% confidence interval (CI) 0.06 to 0.90) and no significant difference in risk of adverse events in two trials (RR 1.80, 95% CI 0.70 to 4.61). In three trials conducted in people with a history of NMSC, the evidence was inconclusive for the development of BCCs for retinol or isoretinoin. However the risk of a new SCC in one trial (HR 1.79, 95% CI 1.16 to 2.76) and adverse events in another trial (RR 1.76, 95% CI 1.57 to 1.97) were significantly increased in the isotretinoin group compared with placebo. In one trial selenium showed a reduced risk of other types of cancer compared with placebo (RR 0.65, 95% CI 0.50 to 0.85) but also a significantly elevated risk of a new NMSC (HR 1.17, 95% CI 1.02 to 1.34). The evidence for one trial of beta‐carotene was inconclusive; and there was a trend towards fewer new NMSC in a trial of a reduced fat diet (RR 0.16, 95% CI 0.02 to 1.31), p = 0.09. Authors' conclusions Some preventative treatments may benefit people at high risk of developing NMSC, but the ability to draw firm conclusions is limited by small numbers of trials, often with one trial per intervention or with inconsistent results between studies

Incidence of fatal food anaphylaxis in people with food allergy: a systematic review and meta-analysis

BACKGROUND: Food allergy is a common cause of anaphylaxis, but the incidence of fatal food anaphylaxis is not known. The aim of this study was to estimate the incidence of fatal food anaphylaxis for people with food allergy and relate this to other mortality risks in the general population. METHODS: We undertook a systematic review and meta-analysis, using the generic inverse variance method. Two authors selected studies by consensus, independently extracted data and assessed the quality of included studies using the Newcastle-Ottawa assessment scale. We searched Medline, Embase, PsychInfo, CINAHL, Web of Science, LILACS or AMED, between January 1946 and September 2012, and recent conference abstracts. We included registries, databases or cohort studies which described the number of fatal food anaphylaxis cases in a defined population and time period and applied an assumed population prevalence rate of food allergy. RESULTS: We included data from 13 studies describing 240 fatal food anaphylaxis episodes over an estimated 165 million food-allergic person-years. Study quality was mixed, and there was high heterogeneity between study results, possibly due to variation in food allergy prevalence and data collection methods. In food-allergic people, fatal food anaphylaxis has an incidence rate of 1.81 per million person-years (95%CI 0.94, 3.45; range 0.63, 6.68). In sensitivity analysis with different estimated food allergy prevalence, the incidence varied from 1.35 to 2.71 per million person-years. At age 0–19, the incidence rate is 3.25 (1.73, 6.10; range 0.94, 15.75; sensitivity analysis 1.18–6.13). The incidence of fatal food anaphylaxis in food-allergic people is lower than accidental death in the general European population. CONCLUSION: Fatal food anaphylaxis for a food-allergic person is rarer than accidental death in the general population

Factors associated with the effectiveness and reach of NHS Stop Smoking Services for pregnant women in England

Background The UK National Health Service provides Stop Smoking Services for pregnant women (SSSP) but there is a lack of evidence concerning how these are best organised. This study investigates influences on services’ effectiveness and also on their propensity to engage pregnant smokers with support in stopping smoking. Methods Survey data collected from 121/141 (86%) of SSSP were augmented with data from Hospital Episode Statistics and the 2011 UK National Census. ‘Reach’ or propensity to engage smokers with support was defined as the percentage of pregnant smokers setting a quit date with SSSP support, and ‘Effectiveness’ as the percentage of women who set a quit date who also reported abstinence at four weeks later. A bivariate (i.e. two outcome variable) response Markov Chain Monte Carlo model was used to identify service-level factors associated with the Reach and Effectiveness of SSSP. Results Beta coefficients represent a percentage change in Reach and Effectiveness by the covariate. Providing the majority of one-to-one contacts in a clinic rather than at home increased both Reach (%) (β: 6.97, 95% CI: 3.34, 10.60) and Effectiveness (%) (β: 7.37, 95% CI: 3.03, 11.70). Reach of SSSP was also increased when the population served was more deprived (β for increase in Reach with a one unit increase in IMD score: 0.55, 95% CI: 0.25, 0.85), had a lower proportion of people with dependent children (β: -2.52, 95% CI: -3.82, −1.22), and a lower proportion of people in managerial or professional occupations (β: -0.31, 95% CI: -0.59, −0.03). The Effectiveness of SSSP was decreased in those areas that had a greater percentage of people >16 years with no educational qualifications (β: -0.51, 95% CI: -0.95, −0.07). Conclusions To engage pregnant smokers and to encourage them to quit, it may be more efficient for SSSP support to be focussed around clinics, rather than women’s homes. Reach of SSSP is inversely associated with disadvantage and efforts should be made to contact these women as they are less likely to achieve abstinence in the short and longer term