Adolescents' reflections on school-based alcohol education in the United Kingdom: education as usual compared with a structured harm reduction intervention

Alcohol consumption by adolescents in the United Kingdom (UK) remains high. School-based interventions are expected to play a key role in preventing adolescent alcohol consumption. A series of focus groups were conducted with pupils who received alcohol education as usual and pupils who received a Northern Ireland adaptation of the School Health and Alcohol Harm Reduction Project (SHAHRP), a universal alcohol education program designed to reduce the harms experienced by young drinkers. This study sought to compare and contrast the participants’ engagement with and enjoyment of the different alcohol education that they had received. Focus groups were completed with 129 pupils in 16 schools in Northern Ireland and Scotland. Alcohol education as usual was viewed negatively and was regarded as unstructured, boring, repetitive, and unrealistic. In contrast, the adaptation of SHAHRP was viewed positively and was regarded as enjoyable and worthwhile, and engaging and relevant to the participants’ experiences of alcohol use. These findings suggest that one reason why alcohol education as usual may not be successful in preventing adolescent drinking and protecting adolescents from negative outcomes may be due to its failure to engage participants. Higher acceptability by pupils means that the adaptation of SHAHRP may be one viable alternative

Cause-specific inequalities in mortality in Scotland: two decades of change. A population-based study

<p><b>Background:</b> Socioeconomic inequalities in mortality have increased in recent years in many countries. We examined age-, sex-, and cause-specific mortality rates for social groups in and regions of Scotland to understand the patterning of inequalities and the causes contributing to these inequalities.</p> <p><b>Methods:</b> We used death records for 1980–82, 1991–92 and 2000–02 together with mid-year population estimates for 1981, 1991 and 2001 covering the whole of Scotland to calculate directly standardised mortality rates. Deaths and populations were coded to small areas (postcode sectors and data zones), and deprivation was assessed using area based measures (Carstairs scores and the Scottish Index of Multiple Deprivation). We measured inequalities using rate ratios and the Slope Index of Inequality (SII).</p> <p><b>Results:</b> Substantial overall decreases in mortality rates disguised increases for men aged 15–44 and little change for women at the same ages. The pattern at these ages was mostly attributable to increases in suicides and deaths related to the use of alcohol and drugs. Under 65 a 49% fall in the mortality of men in the least deprived areas contrasted with a fall of just 2% in the most deprived. There were substantial increases in the social gradients for most causes of death. Excess male mortality in the Clydeside region was largely confined to more deprived areas, whilst for women in the region mortality was in line with the Scottish experience. Relative inequalities for men and women were greatest between the ages of 30 and 49.</p> <p><b>Conclusion:</b> General reductions in mortality in the major causes of death (ischaemic heart disease, malignant neoplasms) are encouraging; however, such reductions were socially patterned. Relative inequalities in mortality have increased and are greatest among younger adults where deaths related to unfavourable lifestyles call for direct social policies to address poverty.</p&gt

Research utilisation and knowledge mobilisation in the commissioning and joint planning of public health interventions to reduce alcohol-related harms: a qualitative case design using a cocreation approach

Background: Considerable resources are spent on research to establish what works to improve the nation’s health. If the findings from this research are used, better health outcomes can follow, but we know that these findings are not always used. In public health, evidence of what works may not ‘fit’ everywhere, making it difficult to know what to do locally. Research suggests that evidence use is a social and dynamic process, not a simple application of research findings. It is unclear whether it is easier to get evidence used via a legal contracting process or within unified organisational arrangements with shared responsibilities. Objective: To work in cocreation with research participants to investigate how research is utilised and knowledge mobilised in the commissioning and planning of public health services to reduce alcohol-related harms. Design, setting and participants: Two in-depth, largely qualitative, cross-comparison case studies were undertaken to compare real-time research utilisation in commissioning across a purchaser–provider split (England) and in joint planning under unified organisational arrangements (Scotland) to reduce alcohol-related harms. Using an overarching realist approach and working in cocreation, case study partners (stakeholders in the process) picked the topic and helped to interpret the findings. In Scotland, the topic picked was licensing; in England, it was reducing maternal alcohol consumption. Methods: Sixty-nine interviews, two focus groups, 14 observations of decision-making meetings, two local feedback workshops (n = 23 and n = 15) and one national workshop (n = 10) were undertaken. A questionnaire (n = 73) using a Behaviourally Anchored Rating Scale was issued to test the transferability of the 10 main findings. Given the small numbers, care must be taken in interpreting the findings. Findings: Not all practitioners have the time, skills or interest to work in cocreation, but when there was collaboration, much was learned. Evidence included professional and tacit knowledge, and anecdotes, as well as findings from rigorous research designs. It was difficult to identify evidence in use and decisions were sometimes progressed in informal ways and in places we did not get to see. There are few formal evidence entry points. Evidence (prevalence and trends in public health issues) enters the process and is embedded in strategic documents to set priorities, but local data were collected in both sites to provide actionable messages (sometimes replicating the evidence base). Conclusions: Two mid-range theories explain the findings. If evidence has saliency (relates to ‘here and now’ as opposed to ‘there and then’) and immediacy (short, presented verbally or visually and with emotional appeal) it is more likely to be used in both settings. A second mid-range theory explains how differing tensions pull and compete as feasible and acceptable local solutions are pursued across stakeholders. Answering what works depends on answering for whom and where simultaneously to find workable (if temporary) ‘blends’. Gaining this agreement across stakeholders appeared more difficult across the purchaser–provider split, because opportunities to interact were curtailed; however, more research is needed. Funding: This study was funded by the Health Services and Delivery Research programme of the National Institute for Health Research

Gender and recovery pathways in the UK

Recovery is now the defining feature of UK drug and alcohol policy. Despite this policy emphasis, little attention has been paid to the lived experience of those in recovery. Instead, research has typically concentrated on treatment populations, which are predominantly male. Consequently, we have little insight into recovery experiences in general, and specifically how they might differ for females and males. This article makes an important contribution through offering a unique insight into the addiction/recovery pathways of 342 female and 410 male participants using data gathered via the UK Life in Recovery survey. Participants were recruited via social media and recovery groups. Bivariate analyses were used to explore gender differences in relation to personal characteristics, addiction and recovery (self-defined), well-being, and family life. These data suggest that a greater proportion of females in recovery report having specific needs in relation to mental health and relationships with children or partners whilst a greater proportion of males disclosed having specific needs in relation to physical health. Whilst the findings reflect the importance of ongoing support for everyone in recovery, they also suggest the need to provide gender-responsive recovery support

Higher education, graduate skills and the skills of graduates: the case of graduates as residential sales estate agents

The UK labour market is subject to significant graduatisation. Yet in the context of an over-supply of graduates, little is known about the demand for and deployment of graduate skills in previously non-graduate jobs. Moreover, there is little examination of where these skills are developed, save an assumption in higher education. Using interviews and questionnaire data from a study of British residential sales estate agents, this article explores the demand, deployment and development of graduate skills in an occupation that is becoming graduatised. These data provide no evidence to support the view that the skills demanded and deployed are those solely developed within higher education. Instead what employers require is a wide array of predominantly soft skills developed in many different situs. These findings suggest that, in the case of estate agents, what matters are the ‘skills of graduates’ rather than putative ‘graduate skills’

Older People with Learning Disabilities: Workforce Issues

The life expectancy of people with learning disabilities has increased substantially. Services for older people with learning disabilities are provided by various sectors and practitioners (generic health and social care, or specialist learning disability or old age). The literature suggests that practitioners do not feel well-equipped to support people with learning disabilities as they grow older, and older people's services do not always have the opportunity to share experiences and skills. This paper highlights areas such as dementia support, where the intersection between services is not clear, and explores what might help practitioners to meet the needs of people with learning disabilities as they grow older