‘Hidden habitus’: a qualitative study of socio-ecological influences on drinking practices and social identity in mid-adolescence

This study explored mid-adolescents’ views and experiences of socio-ecological influences on their drinking practices in order to help inform the development of interventions to reduce alcohol-related risk. We conducted 31 in-depth interviews with young people aged 13–17 in North East England. Verbatim interview transcripts and field notes were coded systematically and analysed thematically, following the principles of constant comparison. We adopted Bourdieu’s idea of social game-playing and elements of his conceptual toolkit (particularly habitus, capital and field) during analysis. Analysis yielded three intersecting themes: (1) ‘drinking etiquette’: conveying taste and disgust; (2) ‘playing the drinking game’: demonstrating cultural competency; (3) ‘hidden habitus’—the role of alcohol marketing. Our work demonstrates that there is a nexus of influential factors which come together to help shape and reinforce mid-adolescents’ behaviour, norms and values in relation to alcohol consumption. Drinking practices are not just formed by friendships and family traditions, these are also subject to wider cultural shaping including by the alcohol industry which can encourage brand identification, and gear specific products to add ‘distinction’. However young people are not inactive players and they use aspects of capital and social games to help cement their identity and present themselves in particular ways which in turn are influenced by age, gender and social status. Guided by promising work in the tobacco field, interventions which focus on critical awareness of the framing of alcohol products by key stakeholders, such as policymakers, commercial industry and public health professionals, and by wider society may facilitate behaviour change among young people

Implementing screening and brief alcohol interventions in primary care : views from both sides of the consultation

Excessive drinking is a global health problem which is responsible for a wide range of both chronic and acute illness, and which costs the UK National Health Service (NHS) £1.7 billion annually. Current health policy aims to reduce alcohol-related problems by promoting early identification of risk followed by brief intervention to facilitate positive changes in drinking level or patterns of consumption. However, practical and philosophical barriers concerning screening and brief alcohol intervention have so far impeded its uptake in routine primary care. This qualitative study aimed to simultaneously explore and compare health professionals’ and patients’ views on the acceptability and feasibility of screening and brief alcohol intervention in primary care. Focus groups were held with (a) four primary care teams, (b) two general practitioner (GP) and two nurse groups and (c) six patient groups in the north-east of England. A thematic framework approach was used to analyse audio-taped data via transcripts. Both health professionals and patients reported that raising and discussing alcohol-related risk was acceptable in primary care, when combined with other lifestyle issues or linked to relevant health conditions. Targeted rather than universal screening was the most acceptable method of identifying alcohol-related risk and would fit well with existing practice. However, there was uncertainty among health professionals about the effectiveness of brief alcohol interventions and some disagreement with patients concerning who was best placed to deliver them. Health professionals felt that nurses were best placed for such work whilst patients reported that they would initially raise the subject with GPs. There was broad acceptance of brief intervention approaches but a lack of support and specific incentives for this work impeded its delivery in routine practice

Impact of financial incentives on alcohol intervention delivery in primary care: a mixed-methods study

Background Local and national financial incentives were introduced in England between 2008 and 2015 to encourage screening and brief alcohol intervention delivery in primary care. We used routine Read Code data and interviews with General Practitioners (GPs) to assess their impact. Methods A sequential explanatory mixed-methods study was conducted in 16 general practices representing 106,700 patients and 99 GPs across two areas in Northern England. Data were extracted on screening and brief alcohol intervention delivery for 2010-11 and rates were calculated by practice incentive status. Semi-structured interviews with 14 GPs explored which factors influence intervention delivery and recording in routine consultations. Results Screening and brief alcohol intervention rates were higher in financially incentivised compared to non-incentivised practices. However absolute rates were low across all practices. Rates of short screening test administration ranged from 0.05% (95% CI: 0.03-0.08) in non-incentivised practices to 3.92% (95% CI: 3.70-4.14) in nationally incentivised practices. For the full AUDIT, rates were also highest in nationally incentivised practices (3.68%, 95% CI: 3.47-3.90) and lowest in non-incentivised practices (0.17%, 95% CI: 0.13-0.22). Delivery of alcohol interventions was highest in practices signed up to the national incentive scheme (9.23%, 95% CI: 8.91-9.57) and lowest in non-incentivised practices (4.73%, 95% CI: 4.50-4.96). GP Interviews highlighted a range of influences on alcohol intervention delivery and subsequent recording including: the hierarchy of different financial incentive schemes; mixed belief in the efficacy of alcohol interventions; the difficulty of codifying complex conditions; and GPs’ beliefs about patient-centred practice. Conclusions Financial incentives have had some success in encouraging screening and brief alcohol interventions in England, but levels of recorded activity remain low. To improve performance, future policies must prioritise alcohol prevention work within the quality and outcomes framework, and address the values, attitudes and beliefs that shape how GPs’ provide care

Alcohol screening and brief intervention for adolescents: The how, what and where of reducing alcohol consumption and related harm among young people

Aim: The aim of the study was to explore the evidence base on alcohol screening and brief intervention for adolescents to determine age appropriate screening tools, effective brief interventions and appropriate locations to undertake these activities. Methods: A review of existing reviews (2003-2013) and a systematic review of recent research not included in earlier reviews. Results: The CRAFFT and AUDIT tools are recommended for identification of 'at risk' adolescents. Motivational interventions delivered over one or more sessions and based in health care or educational settings are effective at reducing levels of consumption and alcohol-related harm. Conclusion: Further research to develop age appropriate screening tools needs to be undertaken. Screening and brief intervention activity should be undertaken in settings where young people are likely to present; further assessment at such venues as paediatric emergency departments, sexual health clinics and youth offending teams should be evaluated. The use of electronic (web/smart-phone based) screening and intervention shows promise and should also be the focus of future research. © The Author 2013. Published by Oxford University Press on behalf of the Medical Council on Alcohol

A Qualitative Exploration of Stakeholder Involvement in Decision-Making for Alcohol Treatment and Prevention Services

The concept of providing individuals with a ‘voice’ via stakeholder involvement has been advocated within English health care policy for several decades. Stakeholder involvement encourages people affected by an issue to contribute to planning and decision making regarding treatment and care, inclusive of providers and recipients of care. This paper explores stakeholder involvement in the design and delivery of public health alcohol services. A qualitative case study approach was adopted, including in-depth interviews with 11 alcohol commissioners, 10 alcohol service providers and 6 general practitioners plus three facilitated focus groups with 31 alcohol service users. Findings show that most participants were aware of, and could name, various methods of stakeholder involvement that they had engaged with; however, the extent and impact of stakeholder involvement in decision making are not transparent. It is essential that a deeper understanding is generated of the different roles that stakeholders can play within the entire decision-making process to maximise its utility

Effects of prevention and harm reduction interventions on gambling behaviours and gambling related harm: An umbrella review

Background Harms related to gambling have been found not only to affect problem gamblers, but also to occur amongst low- and moderate-risk gamblers. This has resulted in calls for a public health approach to address a possible ‘prevention paradox’ in gambling related harm. The aim of this study was to evaluate the systematic review evidence base on the effects of prevention and harm reduction interventions on gambling behaviours, and gambling related harm. We also aimed to examine differential effects of interventions across socio-demographic groups. Methods Systematic methods were used to locate and evaluate published systematic reviews of prevention and harm reduction interventions. We designed the review using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) Equity extension Guidelines. Four databases were searched from their start date until May 2018. The quality of the included articles was determined using A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2). Results Ten systematic reviews were identified reporting 55 unique relevant primary studies. Much of the review evidence-base related to pre-commitment and limit setting (24%), self-exclusion (20%), youth prevention programmes (20%), and machine messages/feedback (20%). The effectiveness of harm reduction interventions are limited by the extent to which users adhere to voluntary systems. Less than half of studies examining youth prevention programmes demonstrated positive effects on behaviour. No review extracted data or reported on the differential effects of intervention strategies across sociodemographic groups. The quality of the included reviews (and their primary studies) were generally poor and clear gaps in the evidence base have been highlighted. Conclusions The evidence base is dominated by evaluations of individual-level harm reduction interventions, with a paucity of research on supply reduction interventions. Review conclusions are limited by the quality and robustness of the primary research. Future research should consider the equity effects of intervention strategies