[Show abstract][Hide abstract] ABSTRACT: Background There is evidence of an association between alcohol use and offending behaviour and around a quarter of police time is spent on alcohol-related incidents. Police custody, therefore, provides an important opportunity to intervene. This pilot trial aims to investigate whether a definitive evaluation of screening and brief interventions aimed at reducing risky drinking in arrestees is acceptable and feasible in the custody suite setting. Methods Screening will be carried out by trained detention officers or drug and alcohol workers in four police forces across two geographical areas (North East and South West England). Detention officers (or drug and alcohol workers) will be cluster randomised to one of three conditions: screening only (control group), screening followed immediately by 10 min of manualised brief structured advice delivered by the individual responsible for screening (intervention 1) or screening followed by 10 min of manualised brief structured advice delivered by the individual responsible for screening plus the offer of a subsequent 20-min session of behaviour change counselling delivered by a trained alcohol health worker (intervention 2). Participants will be arrestees aged 18+ who screen positive on the Alcohol Use Disorders Identification Test. Participants will be followed up at 6 and 12 months post-intervention. An embedded qualitative process evaluation will explore acceptability of alcohol screening and brief intervention to staff and arrestees as well as facilitators and barriers to the delivery of such approaches in this setting. Results Recruitment is currently underway and due to end May 2015. Conclusion Results from this pilot trial will determine if a definitive evaluation is possible in the future and will provide stakeholder input to its design. Trial registration Reference number: ISRCTN89291046.
[Show abstract][Hide abstract] ABSTRACT: Timely tracking of national patterns of alcohol consumption is needed to inform and evaluate strategies and policies aimed at reducing alcohol-related harm. Between 2014 until at least 2017, the Alcohol Toolkit Study (ATS) will provide such tracking data and link these with policy changes and campaigns. By virtue of its connection with the 'Smoking Toolkit Study' (STS), links will also be examined between alcohol and smoking-related behaviour.
The ATS consists of cross-sectional household, computer-assisted interviews of representative samples of adults in England aged 16+. Each month a new sample of approximately 1800 adults complete the survey (~n = 21,600 per year). All respondents who consent to be followed-up are asked to complete a telephone survey 6 months later. The ATS has been funded to collect at least 36 waves of baseline and 6-month follow-up data across a period of 3 years. Questions cover alcohol consumption and related harm (AUDIT), socio-demographic characteristics, attempts to reduce or cease consumption and factors associated with this, and exposure to health professional advice on alcohol. The ATS complements the STS, which has been tracking key performance indicators relating to smoking since 2006. As both the ATS and STS involve the same respondents, it is possible to assess interactions between changes in alcohol and tobacco use. Data analysis will involve: 1) Descriptive and exploratory analyses undertaken according to a pre-defined set of principles while allowing scope for pursuing lines of enquiry that arise from prior analyses; 2) Hypothesis testing according to pre-specified, published analysis plans. Descriptive data on important trends will be published monthly on a dedicated website: www.alcoholinengland.info .
The Alcohol Toolkit Study will improve understanding of population level factors influencing alcohol consumption and be an important resource for policy evaluation and planning.
BMC Public Health 12/2015; 15(1):1542. DOI:10.1186/s12889-015-1542-7 · 2.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Screening and brief interventions (SBI) delivered in primary health care (PHC) are cost-effective in decreasing alcohol consumption; however, they are underused. This study aims to identify implementation strategies that focus on SBI uptake and measure impact on: 1) heavy drinking; and 2) delivery of SBI in PHC. Meta-analysis was conducted of controlled trials of SBI implementation strategies in PHC to reduce heavy drinking. Key outcomes included alcohol consumption, screening, brief interventions and costs in PHC. Predictor measures concerned single versus multiple strategies, type of strategy, duration and physician-only input versus that including mid-level professionals. Standardised mean differences (SMD) were calculated to indicate the impact of implementation strategies on key outcomes. Effect sizes were aggregated using meta-regression models. The 29 included studies were of moderate methodological quality. Strategies had no overall impact on patients' reported alcohol consumption (SMD 0.07;95%-CI −0.02–0.16), despite improving screening (SMD 0.53;95%-CI 0.28–0.78) and brief intervention delivery (SMD 0.64;95%-CI 0.27–1.02). Multifaceted strategies, i.e. professional and/or organisational and/or patient oriented strategies, seemed to have strongest effects on patients' alcohol consumption (p<0.05, compared with professional oriented strategies alone). Regarding SBI delivery, combining professional with patient oriented implementation strategies had the highest impact (p<0.05). Involving other staff besides physicians was beneficial for screening (p<0.05). To increase delivery of alcohol screening and brief interventions and decrease patients' alcohol consumption, implementation strategies should include a combination of patient, professional and organisational oriented approaches and involve mid-level health professionals as well as physicians. This article is protected by copyright. All rights reserved.
[Show abstract][Hide abstract] ABSTRACT: Purpose - The purpose of this paper is to examine the prevalence of alcohol use disorders (AUDs) amongst young people in the criminal justice system (CJS) in the North East of England and to compare the ability of the Alcohol Use Disorders Identification Test (AUDIT) to the Youth Justice Board ASSET tool in identifying alcohol-related need in Youth Offending Team (YOT) clients. Design/methodology/approach - A validated screening tool (AUDIT) was used to identify alcohol-related health risk or harm. Findings from AUDIT were compared with those of the standard criminogenic risk screening tool used in CJS (ASSET). An anonymous cross-sectional questionnaire was administered during a one-month period in 2008. The questionnaires were completed by 11-17-year-old offenders who were in contact with three YOTs, one Youth Offending Institution and one Secure Training Estate. Findings - In total, 429 questionnaires were completed out of a possible 639 (67 per cent). The majority (81 per cent) of the young offenders were identified as experiencing alcohol-related health risk or harm and 77 per cent scored within a possibly alcohol-dependent range. In total, 77 (30 per cent) of young people completing both assessments were identified as having an AUD by AUDIT but not identified as needing alcohol-related treatment using ASSET. Research limitations/implications - This research was confined to one geographical area of England, however, the results show that even in this area of high drinking by young people the levels of AUDs amongst young people in the CJS are very high. Social implications - There are major social implications to this research. It is imperative for changes to be made to the care pathways in place in the UK for young people coming through the CJS with alcohol-related issues. Originality/value - This paper adds to the evidence base by using well-validated tools to measure alcohol use amongst young people in the CJS in the UK.
International Journal of Prisoner Health 06/2015; 11(2):75-86. DOI:10.1108/IJPH-08-2013-0041
[Show abstract][Hide abstract] ABSTRACT: Background: Alcohol is a major global threat to public health. Although the main burden of chronic alcohol-related disease is in adults, its foundations often lie in adolescence. Alcohol consumption and related harm increase steeply from the age of 12 until 20 years. Several trials focusing upon young people have reported significant positive effects of brief interventions on a range of alcohol consumption outcomes. A recent review of reviews also suggests that electronic brief interventions (eBIs) using internet and smartphone technologies may markedly reduce alcohol consumption compared with minimal or no intervention controls. Interventions that target non-drinking youth are known to delay the onset of drinking behaviours. Web based alcohol interventions for adolescents also demonstrate significantly greater reductions in consumption and harm among 'high-risk' drinkers; however changes in risk status at follow-up for non-drinkers or low-risk drinkers have not been assessed in controlled trials of brief alcohol interventions. Design and methods: The study design comprises two linked randomised controlled trials to evaluate the effectiveness and cost-effectiveness of two intervention strategies compared with screening alone. One trial will focus on high-risk adolescent drinkers attending Emergency Departments (Eds) and the other will focus on those identified as low-risk drinkers or abstinent from alcohol but attending the same ED. Our primary (null) hypothesis is similar for both trials: Personalised Feedback and Brief Advice (PFBA) and Personalised Feedback plus electronic Brief Intervention (eBI) are no more effective than screening alone in alcohol consumed at 12 months after randomisation as measured by the Time-Line Follow-Back 28-day version. Our secondary (null) hypothesis relating to economics states that PFBA and eBI are no more cost-effective than screening alone. In total 1,500 participants will be recruited into the trials, 750 high-risk drinkers and 750 low-risk drinkers or abstainers. Participants will be randomised with equal probability, stratified by centre, to either a screening only control group or one of the two interventions: single session of PFBA or eBI. All participants will be eligible to receive treatment as usual in addition to any trial intervention. Individual participants will be followed up at 6 and 12 months after randomisation.
BMC Public Health 04/2015; 15(345). DOI:10.1186/s12889-015-1679-4 · 2.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Title: A pilot feasibility trial cluster randomised controlled trial of screening and brief alcohol intervention to prevent hazardous drinking in young people aged 14-15 in a high school setting (SIPS JR-HIGH)
Authors: Dorothy Newbury-Birch, Stephanie O’Neil, Amy O’Donnell, Simon Coulton, Denise Howel, Elaine McColl, Elaine Stamp, Erin Graybill, Eilish Gilvarry, Kirsty Laing, Ruth McGovern, Paolo Deluca, Colin Drummond, Christine Harle, Paul McArdle, Les Tate, Eileen Kaner.
Correspondence to: firstname.lastname@example.org
Background: Approximately 33% of 15-16 year olds in England report alcohol intoxication in the past month. This present work builds on the evidence base by focusing on ASBI to reduce hazardous drinking in younger adolescents.
Setting: Seven schools across one geographical area in North-East of England.
Methods: Feasibility of trial processes, recruitment and retention and a qualitative evaluation examined facilitators and barriers to the use of ASBI approaches in the school setting in this age group. A three arm pilot cRCT (with randomisation at the school level) with qualitative evaluation to assess the feasibility of a future definitive cRCT of the effectiveness and cost-effectiveness of ASBI in a school setting with an integrated qualitative component. The trial ran in parallel with a repeated cross sectional survey which facilitated screening for the trial.
Participants: Year 10 school pupils (aged 14-15).
Interventions: Young people who screened positive on a single alcohol screening question and consented to take part were randomised to either feedback that they may be risky drinking and provision of an advice leaflet (control condition, n=two schools); a 30-minute brief interactive session which combined structured advice and motivational interviewing techniques delivered by the school learning mentor (Intervention 1, n=two schools); a 60-minute session involving family members delivered by the school learning mentor (Intervention 2, n=three schools). Young people were followed-up at 12-months.
Objectives: To explore the feasibility and acceptability of a future definitive cRCT of ASBI in a school setting to staff, young people and parents; To explore the fidelity of the interventions as delivered by school learning mentors; To estimate the parameters for the design of a definitive cRCT of brief alcohol intervention, including rates of eligibility, consent, participation and retention at 12-months; To pilot the collection of cost and resource use data to inform the cost-effectiveness/utility analysis in a definitive trial.
Main outcome measures: Feasibility and acceptability
Randomisation: Randomisation was carried out at the school level. Randomisation achieved balance on two school-level variables (numbers of pupils in school year and proportion receiving free school meals).
Blinding: School staff, young people and researchers were not blind to the intervention allocated.
Results: 229 young people were eligible for the trial. 182 (82%) were randomised (control n=53; Intervention 1 n=54; Intervention 2 n=75). Of the 75 randomised to Intervention 2, 67 received Intervention 1 (89%). Eight received both Intervention 1 and Intervention 2 (11%). 160/182 were successfully followed up at 12 months (88%). Interviews were carried out with six school lead liaisons; 13 learning mentors; 27 young people and seven parents (n=53). Analysis shows that the school setting is a feasible and acceptable place to carry out ASBI with learning mentors seen as suitable people to do this. Intervention 2 was not seen as feasible or acceptable by school staff, parents or young people.
Outcomes/conclusions: It is feasible and acceptable to carry out a trial of the effectiveness and cost-effectiveness of single session ASBI with young people in the school setting with learning mentors delivering the intervention. A definitive study should not include a parental arm
Trial registration: The trial is registered on the ISRCTN register as ISRCTN07073105
Source of funding: The SIPS JR-HIGH pilot feasibility study was funded under the NIHR Public Health Research Programme commissioned call 10/3002 Alcohol and Young People: Interventions to prevent hazardous drinking of alcohol by school aged children and young people.
[Show abstract][Hide abstract] ABSTRACT: Screening and brief interventions (BI) have been shown to be effective in the management of alcohol consumption for non-treatment-seeking
heavy drinkers, who are at physical and social risk, but not yet dependent. The robust evidence base for the effectiveness
of BI in primary health care suggests an implementation in other settings could be beneficial. Given the association between
alcohol and social problems, social work has a long history of working with persons with alcohol-use disorders, and social
workers are often the first service provider to come into contact with heavy-drinking individuals. This critical commentary
summarises the existing literature on BI effectiveness in social services and criminal justice settings, and discusses to
which extent the social work field might be a promising area for BI delivery.
British Journal of Social Work 09/2014; 45(3). DOI:10.1093/bjsw/bcu100 · 1.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aims: To document the attitudes of general practitioners (GPs) from eight European countries to alcohol and alcohol problems and how these attitudes are associated with self-reported activity in managing patients with alcohol and alcohol problems.
Methods: A total of 2345 GPs were surveyed. The questionnaire included questions on the GP's demographics, reported education and training on alcohol, attitudes towards managing alcohol problems and self-reported estimates of numbers of patients managed for alcohol and alcohol problems during the previous year.
Results: The estimated mean number of patients managed for alcohol and alcohol problems during the previous year ranged from 5 to 21 across the eight countries. GPs who reported higher levels of education for alcohol problems and GPs who felt more secure in managing patients with such problems reported managing a higher number of patients. GPs who reported that doctors tended to have a disease model of alcohol problems and those who felt that drinking was a personal rather than a medical responsibility reported managing a lower number of patients.
Conclusion: The extent of alcohol education and GPs' attitudes towards alcohol were associated with the reported number of patients managed. Thus, it is worth exploring the extent to which improved education, using pharmacotherapy in primary health care and a shift to personalized health care in which individual patients are facilitated to undertake their own assessment and management (individual responsibility) might increase the number of heavy drinkers who receive feedback on their drinking and support to reduce their drinking.
Alcohol and Alcoholism 09/2014; 49(5):531-9. DOI:10.1093/alcalc/agu043 · 2.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Robust evidence supports the effectiveness of screening and brief alcohol interventions in primary healthcare. However lack of understanding about their ‘active ingredients’ and concerns over the extent to which current approaches remain faithful to their original theoretical roots, has led some to demand a cautious approach to future roll-out pending further research. Against this background, this paper provides a timely overview of the development of the brief alcohol intervention evidence base in order to assess the extent to which it has achieved the four key levels of intervention research: efficacy; effectiveness; implementation; and demonstration. Methods: Narrative overview based on:(1) results of a review of systematic reviews and meta-analyses of the effectiveness of brief alcohol intervention in primary healthcare;(2) synthesis of the findings of key additional primary studies on the improvement and evaluation of brief alcohol intervention implementation in routine primary healthcare. Results: The brief intervention field seems to constitute an almost perfect example of the evaluation of a complex intervention. Early evaluations of screening and brief intervention approaches included more tightly controlled efficacy trials and have been followed by more pragmatic trials of effectiveness in routine clinical practice. Most recently, attention has shifted to dissemination, implementation and wider-scale roll-out. However, delivery in routine primary health remains inconsistent, with an identified knowledge gap around how to successfully embed brief alcohol intervention approaches in mainstream care, and as yet unanswered questions concerning what specific intervention component prompt the positive changes in alcohol consumption. Conclusion: Both the efficacy and effectiveness of brief alcohol interventions have been comprehensively demonstrated, and intervention effects seem replicable and stable over time, and across different study contexts.
Frontiers in Psychiatry 08/2014; 5(113). DOI:10.3389/fpsyt.2014.00113
[Show abstract][Hide abstract] ABSTRACT: Aim: To evaluate the effectiveness of different brief intervention strategies at reducing hazardous or harmful drinking in the probation setting. Offender managers were randomized to three interventions, each of which built on the previous one: feedback on screening outcome and a client information leaflet control group, 5 min of structured brief advice and 20 min of brief lifestyle counselling. Methods: A pragmatic multicentre factorial cluster randomized controlled trial. The primary outcome was self-reported hazardous or harmful drinking status measured by Alcohol Use Disorders Identification Test (AUDIT) at 6 months (negative status was a score of <8). Secondary outcomes were AUDIT status at 12 months, experience of alcohol-related problems, health utility, service util-ization, readiness to change and reduction in conviction rates. Results: Follow-up rates were 68% at 6 months and 60% at 12 months. At both time points, there was no significant advantage of more intensive interventions compared with the control group in terms of AUDIT status. Those in the brief advice and brief lifestyle counselling intervention groups were statistically significantly less likely to reoffend (36 and 38%, respectively) than those in the client information leaflet group (50%) in the year following intervention. Conclusion: Brief advice or brief lifestyle counselling provided no additional benefit in reducing hazardous or harmful drinking compared with feedback on screening outcome and a client information leaflet. The impact of more intensive brief intervention on reoffending warrants further research.
Alcohol and Alcoholism 07/2014; 49(5). DOI:10.1093/alcalc/agu046 · 2.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Alcohol misuse is common in people attending emergency departments (EDs) and there is some evidence of efficacy of alcohol screening and brief interventions (SBI). This study investigated the effectiveness of SBI approaches of different intensities delivered by ED staff in nine typical EDs in England: the SIPS ED trial.
Methods and Findings
Pragmatic multicentre cluster randomized controlled trial of SBI for hazardous and harmful drinkers presenting to ED. Nine EDs were randomized to three conditions: a patient information leaflet (PIL), 5 minutes of brief advice (BA), and referral to an alcohol health worker who provided 20 minutes of brief lifestyle counseling (BLC). The primary outcome measure was the Alcohol Use Disorders Identification Test (AUDIT) status at 6 months. Of 5899 patients aged 18 or more presenting to EDs, 3737 (63·3%) were eligible to participate and 1497 (40·1%) screened positive for hazardous or harmful drinking, of whom 1204 (80·4%) gave consent to participate in the trial. Follow up rates were 72% (n = 863) at six, and 67% (n = 810) at 12 months. There was no evidence of any differences between intervention conditions for AUDIT status or any other outcome measures at months 6 or 12 in an intention to treat analysis. At month 6, compared to the PIL group, the odds ratio of being AUDIT negative for brief advice was 1·103 (95% CI 0·328 to 3·715). The odds ratio comparing BLC to PIL was 1·247 (95% CI 0·315 to 4·939). A per protocol analysis confirmed these findings.
SBI is difficult to implement in typical EDs. The results do not support widespread implementation of alcohol SBI in ED beyond screening followed by simple clinical feedback and alcohol information, which is likely to be easier and less expensive to implement than more complex interventions.
Current Controlled Trials ISRCTN 93681536
PLoS ONE 06/2014; 9(6):e99463. DOI:10.1371/journal.pone.0099463 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: AimTo identify shared patterns of views in young people relating to the influence of industry-driven alcohol marketing (price, promotion, product and place of purchase/consumption) on their reported drinking behaviour. DesignQ methodology harnessed qualitative and quantitative data to generate distinct clusters of opinions as follows: 39 opinion statements were derived from earlier in-depth qualitative interviews with 31 young people; by-person factor analysis was carried out on 28 participants' (six previous interviewees and 22 new recruits) rank orderings of these statements (most-to-least agreement); interpretation of the factor arrays was aided by 10-15-minute debriefing interviews held immediately following each Q-sort. SettingNortheast England ParticipantsYoung people aged 14-17years purposively recruited from high schools, higher education colleges, youth centres and youth offending teams. FindingsCentroid factor extraction and varimax rotation of factors generated three distinct accounts: factor one (autonomous, sophisticated consumers') illustrated a self-defined sense of individuality and autonomy in alcohol choices; factor two (price-driven consumers') appeared price-led, choosing to drink what was most accessible or cheapest; and factor three (context-focused consumers') described drinking practices where products were chosen to serve specific functions such as being easy to carry while dancing. Conclusions
Considering young people's views on alcohol marketing, different perspectives can be identified. These include perceived imperviousness to maketing, responsiveness to price and affordability and responsiveness to marketing focusing on youth lifestyles.
[Show abstract][Hide abstract] ABSTRACT: New clinical research findings may require clinicians to change their behaviour to provide high-quality care to people with type 2 diabetes, likely requiring them to change multiple different clinical behaviours. The present study builds on findings from a UK-wide study of theory-based behavioural and organisational factors associated with prescribing, advising, and examining consistent with high-quality diabetes care.Aim: To develop and evaluate the effectiveness and cost of an intervention to improve multiple behaviours in clinicians involved in delivering high-quality care for type 2 diabetes.Design/methods: We will conduct a two-armed cluster randomised controlled trial in 44 general practices in the North East of England to evaluate a theory-based behaviour change intervention. We will target improvement in six underperformed clinical behaviours highlighted in quality standards for type 2 diabetes: prescribing for hypertension; prescribing for glycaemic control; providing physical activity advice; providing nutrition advice; providing on-going education; and ensuring that feet have been examined. The primary outcome will be the proportion of patients appropriately prescribed (using anonymised computer records), advised, and examined (using anonymous patient surveys) at 12 months. We will use behaviour change techniques targeting motivational, volitional, and impulsive factors that we have previously demonstrated to be predictive of multiple health professional behaviours involved in high-quality type 2 diabetes care. We will also investigate whether the intervention was delivered as designed (fidelity) by coding audiotaped workshops and interventionist delivery reports, and operated as hypothesised (process evaluation) by analysing responses to theory-based postal questionnaires. In addition, we will conduct post-trial qualitative interviews with practice teams to further inform the process evaluation, and a post-trial economic analysis to estimate the costs of the intervention and cost of service use.
[Show abstract][Hide abstract] ABSTRACT: Objective: This article reviewed the literature and critically analysed the concept of preparation for parenthood. The analysis is mainly of a discursive nature with some theoretical underpinnings. Background: Preparation for parenthood is a concept that is generally used within psychology, sociology and health professional practice especially midwifery, in terms of preparation for birth and parenthood sessions. However, parents often report feeling unprepared during this period. In order to ensure appropriate delivery of support and education during this time it is important to fully understand what preparation for parenthood really means by unravelling its component elements and understanding its contemporary relevance. Methods: A number of sources were searched using the keywords ‘preparation’ and ‘parenthood’. The concept analysis framework put forward by Walker and Avant was used to develop appropriate cases to further illustrate and explore meaning. Results: The literature search confirmed limited evidence with regards to an in-depth exploration of the concept and the separate elements that are related to each other. This investigation is the first of its kind considering the full range of meanings with regards to the concept and the contemporary evidence available. Law, gender, culture and spirituality all influence the concept and thus antecedents and consequences cannot always be applied to contexts which are fundamentally different. Conclusion: Preparation for parenthood is multi-faceted and changing, thus further research with regards to this concept is warranted. This analysis provides the groundwork for the development of measures that may be used within clinical practice.
Journal of Reproductive and Infant Psychology 03/2014; 32(2). DOI:10.1080/02646838.2013.869578 · 0.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 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.
A review of existing reviews (2003-2013) and a systematic review of recent research not included in earlier reviews.
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.
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.
Alcohol and Alcoholism 11/2013; 49(2). DOI:10.1093/alcalc/agt165 · 2.09 Impact Factor