Does coding method matter? An examination of propensity score methods when the treatment group is larger than the comparison group

In educational contexts, students often self-select into specific interventions (e.g., courses, majors, extracurricular programming). When students self-select into an intervention, systematic group differences may impact the validity of inferences made regarding the effect of the intervention. Propensity score methods are commonly used to reduce selection bias in estimates of treatment effects. In educational contexts, often a larger number of students receive a treatment than not. However, recommendations regarding the application of propensity score methods when the treatment group is larger than the comparison group have not been empirically examined. The current study examined the recommendation to recode the treatment and comparison groups (i.e., two types of treatment effect coding; Ho et al., 2007). A simulation study was conducted to examine the performance of three propensity score methods (nearest neighbor matching, nearest neighbor matching with a 0.20 SD caliper, and generalized boosted modeling), using two coding methods (ATT and ATC) when the treatment group was larger than the comparison group. Additionally, three treatment sample sizes (200, 600, 1,000), three treatment to comparison group ratios (2:1, 4:3, 1:4), and four true treatment effects (Cohen’s d of 0, 0.20, 0.50, 0.80) were simulated. For nearest neighbor matching with a 0.20 SD caliper, adequate group covariate balance and low bias in the estimated treatment effect were observed across both coding methods regardless of which group was larger. In contrast, for generalized boosted modeling and nearest neighbor matching, group covariate balance and bias in the estimated treatment effect differed across coding method. When the treatment group was larger than the comparison group, ATC coding resulted in better group covariate balance and lower bias than ATT coding. However, ideal balance was not obtained on all covariates, and bias in the estimated treatment effect was high for generalized boosted modeling and nearest neighbor matching. In sum, when the treatment group was larger than the comparison group, coding method did not matter for nearest neighbor matching with a 0.20 SD caliper. Conversely, for generalized boosted modeling, ATC coding performed better than ATT coding. Nearest neighbor matching did not perform well regardless of coding method

Integrating tasks, technology, and the Common Core Standards in the Algebra II classroom

The Common Core State Standards for Mathematics were released in June of 2010. The standards were developed by a team of over 75 teachers and specialist in response to improve math education in the United States through more focused, coherent, rigorous standards to help our students be competitive in the 21st century. As of June 2012, 45 states had adopted the new standards which better coordinate what students at individual grade level should know and be able to do to in order to be college and career ready by grade twelve. With new computer based assessments being developed and set to be given to students as early as 2014 to assess understanding of these standards, it is necessary for teachers to begin implementing instructional shifts in the classroom that prepare students for both the Standards for Mathematical Content and the Standards for Mathematical Practice. The concept of dual intensity emphasizes that both procedural and conceptual skills are of equal importance in the classroom and changes should be made to provide opportunities for students to experience both in an atmosphere that is both rigorous and intense. Providing students opportunities to demonstrate The Standards for Mathematical Practice will involve the most change in the classroom. It will involve a change in the classroom environment involving the roles of both the teacher and the student. This thesis discusses how the use of tasks and technology were used in the Algebra II classroom to implement the Common Core Standards and describes student misconceptions and lesson revisions for future use that include connections to calculus. The process of formative assessment was used to provide information to both the teacher and the student intended to improve teaching and learning in the classroom. Information gained from the formative assessment reinforced the need to provide more opportunities for students to connect the Standards for Mathematical Content and the Standards for Mathematical Practice using tasks and technology

TB201: Comparison of the Efficacy of Sodium Acid Sulfate and Citric Acid Treatments in Reducing Acrylamide Formation in French Fries

Two acidulant food additives, sodium acid sulfate (SAS) and citric acid, were investigated for their effectiveness in reducing acrylamide formation in french fries. Acrylamide concentration was determined by gas chromatography-mass spectrometry (GC-MS) after cleanup of french fry extracts by passage through a C-18 column and derivitization by bromination. At a frying temperature of 180°C, both acidulants appeared ineffective, possibly due to the rapid rate of acrylamide formation, which surpassed the capacity of the acidulants to protonate acrylamide intermediates. At the lowest frying temperature tested (160°C), 3% SAS and 3% citric acid significantly (P \u3c 0.05) inhibited acrylamide formation as compared to the control. However, 3% SAS appeared to inhibit acrylamide formation more effectively than citric acid at 160°C, as well as at frying temperatures of 170 and 180°C. Our results indicate that acrylamide formation during frying can be reduced by treatment of potatoes with 3% SAS or citric acid, but SAS, a stronger acid with a lower pKa, is the more effective acidulant.https://digitalcommons.library.umaine.edu/aes_techbulletin/1006/thumbnail.jp

People living with or affected by HIV/AIDS, Greensboro and High Point, Guilford County: an action-oriented community diagnosis: findings and next steps of action

Background As of 2006, Guilford County has the third-highest Human Immunodeficiency Virus (HIV) prevalence in North Carolina, and the number of HIV-positive people in the county is expected to grow as effective treatments help HIV-positive people to live longer and potentially more productive lives. The result is an increasing burden on the AIDS service organizations working to provide quality medical care as well as access to housing, employment, and psychosocial support in the Greensboro/High Point area. Given this situation, where should limited human and financial resources be targeted to best meet the needs of people living with HIV/AIDS? In order to answer this question, a community assessment of people in Greensboro/High Point, NC living with or affected by HIV/AIDS was conducted from October 2007 to April 2008. The assessment was conducted by a team of five graduate students from the Department of Health Behavior and Health Education at the UNC-Chapel Hill School of Public Health, working under the guidance of two community preceptors, Ms. Debra Massey-Richardson and Mr. James McNair, of the Guilford Community AIDS Partnership. The assessment was carried out based on the Action-Oriented Community Diagnosis (AOCD) model of community assessment and engagement, which focuses on a wide variety of factors contributing to the health of a community, as well as the social environment which influence the perception of strengths and needs within a community. The goal of AOCD is to generate community ownership through a process of identifying priority issues and planning action steps for positive change. Methodology The focus of this AOCD was people infected with or affected by HIV/AIDS (PLWHA) in Greensboro and High Point. These two metropolitan areas of Guilford County were chosen as the focal points of this process because they share comparatively high levels of infection, a common network of service providers, and the potential for receiving common resources at the county level.3 The following report describes the process of conducting the AOCD, which began with gathering secondary data to provide a contextual background on life in the community and on the local epidemiology of HIV/AIDS. Team members gained entrée into the community through guided “windshield tours” of Greensboro and High Point and by participating in numerous community events, including church services, AIDS fundraising events, support group meetings, and social events held at a local day center for PLWHA. Team members also made contact with 21 service providers and 36 PLWHA living and working in Greensboro and High Point through focus groups and individual interviews which focused on community strengths and priority needs, available community resources, and barriers to change. The results of this data collection were analyzed to identify overarching themes, which were then prioritized with the assistance of a planning committee comprised of local service providers and community members. Five highest-priority themes were presented at a community forum held at the Macedonia Family Resource Center in High Point on April 14, 2008. The primary goals of the forum were to celebrate the strengths of the PLWHA community, transition the student team out Greensboro and High Point, and transfer ownership of the process to the local community. Forum participants discussed the priority themes identified through the AOCD, and generated specific action steps to address each theme. Themes and action steps are listed below. Priority Themes Theme One: PLWHA have many basic, unmet needs, including food, housing and unemployment, which overshadow HIV/AIDS as a priority. Action Steps: Talk with all major known service providers in addition to clients to determine what local resources are available to help meet basic needs such as food and housing. Based on the results of this investigation, compile a comprehensive resource manual to serve as a guide for both PLWHA and service providers. Theme Two: Mental health and substance abuse issues complicate living with HIV/AIDS by making it difficult to seek treatment for HIV/AIDS, follow medical regimes, and locate adequate support and care. Action Steps: Contact local organizations to assess the available mental health and substance abuse services in both Greensboro and High Point. After a comprehensive list is generated, compile the information into a pamphlet that can be distributed to community members in a variety of venues such as churches, grocery stores, social services and the Department of Motor Vehicles. Decrease the stigma associated with mental illness and addiction in addition to improving outreach efforts. Theme Three: The diversity of PLWHA, stigma surrounding the disease, and a lack of trust and dialogue between PLWHA all contribute to the absence of a cohesive community to provide support and engage in advocacy. Action Steps: Discuss community strengthening and other needs with residents of Williams Delashment Crossing, a housing community for PLWHA. Schedule a follow-up meeting on the topic of community strengthening, which may be held in the Williams Delashment Crossing housing community. Hold a regular meeting of High Point service providers to combat the tendency of some service agencies to become isolated from the larger community. Theme Four: There is an uneven distribution between services available for people living with HIV/AIDS in Greensboro and High Point. Action Steps: Contact churches to assist in meeting basic needs such as food and transportation. Educate people about existing services by involving the local libraries. Create a collaboration or directory of services useful to people living with HIV/AIDS, which would create unity among service providers and assist them in making referrals for clients who do not meet eligibility requirements for their services. Contact service agencies such as clinics and hospitals about the costs to expand available care. Theme Five: Misconceptions about HIV/AIDS in the community at large, a lack of people living with HIV and AIDS who are open about their status, and a strong emphasis on conservative values contribute to intense social stigma against people living with HIV and AIDS. Action Steps: Convene further meetings about HIV/AIDS-related stigma. Each member of the group will invite one friend or colleague to the first follow-up meeting. Create programs to reach youth at churches, YMCAs and Boys and Girls Clubs. Distribute condoms. Attend existing community events and pass out educational information and condoms. Encourage PLWHA to be proactive in sharing their experiences with the wider community. Team Recommendations The student team presents the following recommendations for improving the health and quality of life of people living with or affected by HIV/AIDS in Greensboro and High Point: Create a comprehensive and up-to-date directory of services for PLWHA. Create a Higher Ground-style community center for PLWHA in High Point. Where possible, centralize fringe medical services. Increase cooperation with local governments. Find venues to educate youth about HIV other than in schools. Increase awareness among service providers, funders, and political leaders of the importance of HIV, mental health, and substance abuse issues. Involve faith-based communities in awareness and education efforts. Include more of a focus on community building activities. Increase resources available for basic needs. The recommendations presented above are not comprehensive, and this document is intended as a starting point rather than a final report. Following sections include a detailed discussion of background data on HIV/AIDS in Guilford County, an in-depth examination of prioritized themes and action steps generated through the AOCD, a description of the community forum, and an explanation of the methodology used to carry out the assessment. Materials used to conduct the assessment, as well as a resource guide and a discussion of non-prioritized themes identified through the assessment can all be found in the appendices following the end of the report. It is the hope of the AOCD team members that the community of services providers and PLWHA in Greensboro and High Point will find the information useful as a foundation for moving forward and taking positive action to continue improving the lives of those living with or affected by HIV/AIDS.Master of Public Healt

Breaking beta: deconstructing the parasite transmission function

Transmission is a fundamental step in the life cycle of every parasite but it is also one of the most challenging processes to model and quantify. In most host–parasite models, the transmission process is encapsulated by a single parameterβ. Many different biological processes and interactions, acting on both hosts and infectious organisms, are subsumed in this single term. There are, however, at least two undesirable consequences of this high level of abstraction. First, nonlinearities and heterogeneities that can be critical to the dynamic behaviour of infections are poorly represented; second, estimating the transmission coefficientβfrom field data is often very difficult. In this paper, we present a conceptual model, which breaks the transmission process into its component parts. This deconstruction enables us to identify circumstances that generate nonlinearities in transmission, with potential implications for emergent transmission behaviour at individual and population scales. Such behaviour cannot be explained by the traditional linear transmission frameworks. The deconstruction also provides a clearer link to the empirical estimation of key components of transmission and enables the construction of flexible models that produce a unified understanding of the spread of both micro- and macro-parasite infectious disease agents

CD8+ T lymphocyte responses target functionally important regions of Protease and Integrase in HIV-1 infected subjects

BACKGROUND: CD8+ T cell responses are known to be important to the control of HIV-1 infection. While responses to reverse transcriptase and most structural and accessory proteins have been extensively studied, CD8 T cell responses specifically directed to the HIV-1 enzymes Protease and Integrase have not been well characterized, and few epitopes have been described in detail. METHODS: We assessed comprehensively the CD8 T cell responses to synthetic peptides spanning Protease and Integrase in 56 HIV-1 infected subjects with acute, chronic, or controlled infection using IFN-γ-Elispot assays and intracellular cytokine staining. Fine-characterization of novel CTL epitopes was performed on peptide-specific CTL lines in Elispot and (51)Chromium-release assays. RESULTS: Thirteen (23%) and 38 (68%) of the 56 subjects had detectable responses to Protease and Integrase, respectively, and together these targeted most regions within both proteins. Sequence variability analysis confirmed that responses cluster largely around conserved regions of Integrase, but responses against a large, highly conserved region of the N-terminal DNA-binding domain of Integrase were not readily detected. CD8 T cell responses targeted regions of Protease that contain known Protease inhibitor mutation residues, but strong Protease-specific CD8 T cell responses were rare. Fine-mapping of targeted epitopes allowed the identification of three novel, HLA class I-restricted, frequently-targeted optimal epitopes. There were no significant correlations between CD8 T cell responses to Protease and Integrase and clinical disease category in the study subjects, nor was there a correlation with viral load. CONCLUSIONS: These findings confirm that CD8 T cell responses directed against HIV-1 include potentially important functional regions of Protease and Integrase, and that pharmacologic targeting of these enzymes will place them under both drug and immune selection pressure

Understanding Substance Use and the Wider Support Needs of Scotland’s Prison Population

Introduction: The Scottish Government has committed to undertaking a comprehensive, national assessment of the health and social care needs of Scotland’s prison population. The last prison health needs assessment was conducted in 2007 and a great deal has changed in the policy and service delivery landscape since then. This needs assessment is one of four commissioned studies1 and focuses on an assessment of the needs of the prison population relating to alcohol, drugs, and tobacco use. Background Substance use has long been a concern for the health and wellbeing of people living in Scotland’s prisons and remains one of the most prominent challenges to Scotland’s prison system. People who live in prison are disproportionately more likely to use alcohol, drugs, and tobacco than those individuals who do not enter prison (Toomey et al., 2022). Crime and substance use are known to be closely associated2. Problemetic substance use often contributes to the factors involved in why someone is in prison and often continues (or for some begins) whilst living in prison (Carnie and Boderick, 2019). Many people living in prison have substance use needs that pre-date their imprisonment and can stem from multiple factors, such as experiencing trauma and social and economic inequality (Devries et al., 2014; Najavits, 2015). Within custody, people experience limited access to family and community supports, bullying, and feelings of hopelessness which risks perpetuating and escalating substance use. The prevalence of substance use within prisons is a serious threat to the health of people living there and to general public health. It threatens the safety of prison officers and healthcare staff and creates challenges in terms of maintaining good order and discipline (O’Hagan, 2017). With the recent rates in drug-related deaths continuing to soar across Scotland, there is increasing pressure to take more urgent action to address substances and the harms that they present (NRS, 2021). The exact picture of substance use in Scottish prisons is unclear. There is a lack of available data, which will be highlighted later in this report. Estimating the prevalence of substance use in Scottish prisons is therefore highly challenging, particularly in relation to drug use (Toomey et al., 2022). What is apparent though is that levels of drug deaths across Scotland are very high. In 2019, in reponse to the high levels of drug deaths in Scotland, the Drug Deaths Taskforce [DDTF] was established.3 This group is made up of volunteer members who have been proactive about pushing for the implementation of the MAT [Medical Assisted Treatment] Standards.4 1 The other three studies are: (1) physical and general health, including major clinical and long-term conditions, infectious disease, non-communicable disease, sexual health; (2) mental health; and (3) social care and support needs. 2 The Scottish Parliament - Healthcare in Prisons 3 Drug Deaths Task Force 4 MAT Standards, introduced by the Scottish Government in 2021, are an evidence-based set of standards to enable the consistent delivery of safe, accessible, high-quality drug treatment across Scotland. 2 Current substance use data often relies on self-reporting5 or upon incident reports which do not present the full picture of substance use. In the most recent Scottish Prison Service [SPS] Prisoner Survey (Carnie and Boderick, 2019), 41% self reported that they engaged in problematic drug use prior to imprisonment; 45% had been under the influence of drugs, and 40% reported being drunk at the time of their offence. This is indicative of a high level of need. People living in prison experience substantially poorer health than the general population, in part because of the high prevalence of smoking amongst those living in prison (Spaulding, 2018). High rates of smoking in prisons had been consistently reported in the SPS Prisoner Survey prior to the introduction of a smoke free prison environment (2018). The 2013 survey reported that 74% of people living in prison smoked which contrasts with a prevalence rate of around 20% in Scotland as a whole. Whilst the prison system continues to be the host for many of those who are found to have committed substance related crimes, there have been increasing conversations about whether this is in fact the right place for them (Scottish Parliament, 2022). It has long been acknowledged that the opportunities and provisions for rehabilitation within a prison setting are limited (ibid.)6. So too there is a real sense that the revolving door of prisons can exacerbate and encourage substance use: ‘We do not rehabilitate prisoners well, we do not prepare them for release well and we do not support them on release well, because our system is chock-a-block with people who should not be in it.’ (Professor Fergus McNeill, evidence provided to Scottish Parliament, 2022, pg. 11) Alcohol and Drugs Each prison in Scotland has developed its own policies and procedures to manage drug and alcohol use. In part this can be traced back to the NHS takeover of addictions work in Scottish prisons from Phoenix Futures (2011). In the absence of universal guidance, each NHS Board that had a prison in its catchment area decided what approach to take (NHS, 2016). One requirement, however, was that services should be available on an equitable basis to community-based services. Whilst there are different approaches across prisons, there are a number of policies and documents that offer guidance to all prisons. One of these is the National Naloxone Programme which has been active in Scottish Prisons since 2011. This has provided all those leaving prison with Naloxone in an attempt to address opioid related overdoses upon release (Bird et al. 2014). As data collection for this study progressed, some respondents informed us that naloxone provision had continued to be developed. For example, intranasal naloxone is now offered, making it a needle-less product. Online service, training and learning opportunities have been expanded, and there has also been a move to educate and organise peer naloxone 5 Self-reporting results in limited findings as, particularly in relation to substance use, it is uncommon for people to be completely honest in their self-disclosures and so results in data consisting of what people are willing to self-disclose. 6 It should be acknowledged here that rehabilitation opportunities do vary across prisons and prisoner categories. 3 distributors and trainers, something which has enjoyed much success (DDTF, 2021). Across Scotland, the SPS’ Management of Offender at Risk Due to Any Substance [MORS] policy was introduced in December 2014. This guidance instructs prison staff on how to respond if they identify someone as being at risk from a substance and how healthcare staff should engage with the incident. Rights, Respect and Recovery, Scotland’s strategy for reducing drug and alcohol related harms and deaths, was published in 2018 (Scottish Government, 2018). The strategy provided a specific focus on prisons as one of the key organisations that should be involved in delivering on national substance use goals. In January 2021, the strategic approach was further enhanced through the announcement by the First Minister of a new ‘National Mission’ to reduce drug-related deaths and harms, supported by an additional £50 million funding per year (for the next five years). 7 In response to the Covid-19 pandemic, the Scottish Government allocated £1.9 million to support people to switch to Buvidal as an OST treatment option (MacNeill, 2021). Buvidal is a longer-acting form of OST that means people can switch from a daily medication regime to only needing to take their presciption on a weekly or monthly basis. Intial small-scale feedback on Buvidal has highlighted its potential to support people to make positive changes to their lives and demonstrated it may improve outcomes for prison leavers, such avoiding relapses in the community or helping them look employment (MacNeill, 2020). Increasing the number of people being prescribed Buvidal in Scotland’s prisons may also go some way towards alleviating the current burden placed on prison operations and healthcare by the daily administration of methadone. Tobacco SPS and partners have successfully delivered smoke free environments since November 2018. This change was introduced as part of a wider Scottish Government focus on changing smoking habits for future generations. In the lead up to, and in the aftermath of the introduction of a smoke free policy, smoking in prison has transformed from an under-researched and poorly understood policy area, to one which is underpinned by a rich literature base which engenders ongoing policy and practice conversations. In January 2022 the final report for the Tobacco in Prisons Study [TiPS] was published (Hunt et al., 2022). The study documents the impact of smoke free prisons in Scotland. It indicates that smoke free prisons policy have quickly become the ‘new normal’. Second hand smoking has been reduced by 90% and e-cigarette use has became commonplace. TiPS was the first study internationally to explore this topic and did so extensively. As such it has not been appropriate nor useful for this needs assessment to 7 National mission - Alcohol and drugs 4 replicate or duplicate evidence gathering with regard to current policy and programmes around Tobacco. Therefore, the team has focused on alcohol and drug use as a priority for the data collection for this project whilst considering the place of tobacco use alongside other substance use. Study Aim and Objectives The aim of this needs assessment study was to help the Scottish Government and its partners better understand what the healthcare needs of people with substance use problems living in Scotland’s prisons are. The specific objectives of the needs assessment were to: 1. Conduct a rapid review of the research literature from the UK and (if there is a strong rationale for it) comparable jurisdictions on the nature and extent of substance use needs and support within prison populations. 2. Synthesise available national and local-level data and research to report on the epidemiology of substance use experienced by Scotland’s prison population, including newer trends such as New Psychoactive Substances [NPS] usage, compared to others in the criminal justice system (e.g. people serving community sentences) and the general population. 3. Map current models of substance use care/interventions within Scotland’s prisons, how they interface with other healthcare interventions within prisons, and how they interface with community care models and services, including assessing aspects of treatment continuity, finding examples of best practice, and throughcare pathways during transition from custody to the community. 4. Assess the scope for the improved collection of routine data that can be made available to analysts, managers, and service providers for continued monitoring and analysis of support needs relating to substance use. 5. Offer insights for future data linkage and data collection priorities. 6. Include the perspectives of people with lived experience of prison and substance use to incorporate their views and insights. Methodology Study methods The core elements of the study focused on qualitative approaches (comprising of: (1) semi-structured interviews with a broad range of professional stakeholder groups; (2) a short-life working group with a diverse range of professional stakeholders from key partners in SPS, NHS, and the Third Sector; and (3) interviews with those who have lived and/or living experience). These approaches were supplemented with a rapid literature review, a review of existing (published) data, and a mapping exercise (see Table 1 below). Although the original study design included a desk-based review and synthesis of all available (published) datasets, and that this would be expected to be seen within a Health Needs Assessment report, it is not included in the usual way in this report. 5 From our early review of available Scottish health datasets, it became evident that published healthcare data regarding substance use for Scotland’s prisons was deficient and would not provide meaningful, real-time insights. We have included (see Table 2 in Chapter 5) an overview of the available datasets (including comments upon their individual strengths and limitations), but have focused our approach on a qualitative high-level strategic review of how healthcare data is gathered and used in order to identify the areas where substance use data collection, analysis and linkaging needs to improve (see Chapter 5). The context of the Covid-19 pandemic necessitated a flexible approach, with all working group sessions and semi-structured interviews conducted remotely or on the phone. Full details of study methods and our approach to analysis is provided in Appendix A. Recruitment, sampling, and activity completed A summary of study methods, recruitment, sampling and activity completed is presented in the table below. Fieldwork activities took place between October 2021 and February 2022

Exploring differential item functioning in the SF-36 by demographic, clinical, psychological and social factors in an osteoarthritis population

The SF-36 is a very commonly used generic measure of health outcome in osteoarthritis (OA). An important, but frequently overlooked, aspect of validating health outcome measures is to establish if items work in the same way across subgroup of a population. That is, if respondents have the same 'true' level of outcome, does the item give the same score in different subgroups or is it biased towards one subgroup or another. Differential item functioning (DIF) can identify items that may be biased for one group or another and has been applied to measuring patient reported outcomes. Items may show DIF for different conditions and between cultures, however the SF-36 has not been specifically examined in an osteoarthritis population nor in a UK population. Hence, the aim of the study was to apply the DIF method to the SF-36 for a UK OA population. The sample comprised a community sample of 763 people with OA who participated in the Somerset and Avon Survey of Health. The SF-36 was explored for DIF with respect to demographic, social, clinical and psychological factors. Well developed ordinal regression models were used to identify DIF items. Results: DIF items were found by age (6 items), employment status (6 items), social class (2 items), mood (2 items), hip v knee (2 items), social deprivation (1 item) and body mass index (1 item). Although the impact of the DIF items rarely had a significant effect on the conclusions of group comparisons, in most cases there was a significant change in effect size. Overall, the SF-36 performed well with only a small number of DIF items identified, a reassuring finding in view of the frequent use of the SF-36 in OA. Nevertheless, where DIF items were identified it would be advisable to analyse data taking account of DIF items, especially when age effects are the focus of interest

Assessing the Experiences and Impact of Minimum Pricing for Alcohol on Service Users and Service Providers: Interim Findings

1. Introduction 1.1 In May 2018, Welsh Government issued a specification for an evaluation that would assess the process and impact of the introduction of a Minimum Price for Alcohol [MPA] in Wales. The contract was split into four ‘lots’: (1) a contribution analysis, (2) work with retailers, (3) qualitative work with services and service users, and (4) an assessment of impact on the wider population of drinkers. 1.2 Three of the contracts (Lots 1, 3 and 4) were awarded to a consortium of researchers based at Glyndŵr University (Wrexham), Figure 8 Consultancy Services Ltd (Dundee), and University of South Wales1. Lot 2 was awarded to the National Centre for Social Research2. 1.3 The explicit aim of this component of the research is to assess both the experience and impact of MPA on service users (harmful, hazardous, and dependent drinkers) and services across Wales (including exploring the extent to which switching between substances may have been a consequence of the legislation and the impacts of minimum pricing on household budgets). 1.4 The original plan was to assess the impact of MPA at 18 months and 42 months post-implementation. As a result of the ongoing impact of the COVID-19 pandemic, the 18-month follow-up was postponed for six months. This report therefore presents findings from data collected 24 months post-implementation of the legislation. The second follow-up study will still be conducted at 42 months post-implementation, at which point a final evaluation report will be completed and submitted to Welsh Government. 1.5 At this early stage of the evaluation process it is not possible to detail with certainty the full impact of the policy on service users and services without conflating the impact of MPA with the impact of COVID-19 and the current cost of living crisis. We are, however, able to frame early evidence around the ‘early effects’ of the policy, rather than purporting any actual impact(s) of the policy. 1.6 Therefore, this report, which is based on research conducted two years post-implementation of the legislation, provides an important interim assessment of the experience and early effects of MPA on those drinkers who are: (1) directly targeted 1 Lot 1 is led by Glyndŵr University, Lot 3 is led by Figure 8 Consultancy Services Ltd, and Lot 4 is led by University of South Wales. 2 National Centre for Social Research 5 by the legislation (i.e. harmful and hazardous drinkers); and (2) the most vulnerable population group that are directly impacted, but not directly targeted, by the legislation (i.e. low income dependent drinkers). 1.7 The research gathered the views and opinions of both service users and service providers using a combination of qualitative interviews and online survey questionnaires (see sections 1.11-1.13 ‘Language’ and Chapter 3 for further detail on the use of these labels/descriptors). 1.8 In relation to service users, the key objectives of the study were to explore: • how they prepared for the change in the legislation; • their perceptions of the legislation; • what changes they made, if any, to their use of alcohol after the introduction of a minimum unit price for alcohol; • what changes, if any, they made to their use of alternative substances after the change in legislation; • their perceptions of changes (including substance switching) that other people made after the introduction of the legislation; and • the impact of the new legislation on their household expenditure and other aspects of their lives (e.g. relationships, employment, health). 1.9 In relation to service providers, the key objectives of the study were to explore: • the approaches they used to help people prepare for the introduction of a minimum price for alcohol; • their perceptions of changes in substance use (including substance switching) that service users made after the introduction of minimum unit pricing for alcohol; • the impact of the new legislation on the lives of service users (e.g. household expenditure, health, relationships, employment, etc); and • how useful the support materials or guidance that were provided were, as well as any additional materials that may be required. Structure of the report 1.10 The report is divided into three key parts: • The first (Chapters 2-4) provides contextual information, an overview of the research methods, as well as the characteristics of the interview and survey samples. 6 • The second (Chapters 5-6) presents the results of the study and is structured into two core chapters which present the analysed views of the two key stakeholder groups (service users and service providers). • The third (Chapters 7-8) summarises the results, provides a comparative discussion of the views of service users and service providers, and includes a set of ‘next steps’ for consideration by the Welsh Government. Language (labels and descriptors) 1.11 For clarity, the research team have chosen to adopt two labels/descriptors: ‘service users’ (drinkers) and ‘service providers’. Detailed characteristics of these groups, for both survey and interview samples, are provided in Chapter 4. 1.12 Within the report, additional and nuanced terms are used to reflect the specifics of delineated sub-populations within these overall groups. 1.13 In relation to the term ‘service users’, the report acknowledges that survey and interviewing sampling focused on those individuals whose level of drinking is categorised3 as either hazardous, harmful, or dependent4