Category Archives: Alcohol

New ESRC funded study on Tobacco and Alcohol

We are delighted to announce that we have been awarded funding from the ESRC for a project exploring tobacco and alcohol environments in Scotland. The project ‘Change in alcohol and tobacco availability, population health and the lived experience’ will be funded for 3 years, beginning December 2019 for a total of £761, 470. The project will be led by Professor Niamh Shortt with co-investigators from the University of Edinburgh (Professor Jamie Pearceand Dr Tom Clemens), Glasgow Caledonian University (Professor Carol Emslie) and the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow (Professor Richard Mitchell).

This research will measure change in the availability of alcohol and tobacco in Scottish neighbourhoods over time and explore how this change relates to health outcomes and how residents experience the availability of alcohol and tobacco in their neighbourhoods. The findings will be important because smoking and alcohol consumption are leading causes of illness and death. In Scotland smoking causes one in every 5 deaths and one in 20 deaths is related to alcohol. This harm is not equally shared; those on the lowest incomes suffer the greatest harm. These illnesses and deaths are preventable. The World Health Organisation recommends that nations prioritise interventions that reduce the supply of alcohol and tobacco.

Why might neighbourhood supply of alcohol and tobacco matter? Research suggests that when there are a lot of outlets in a neighbourhood this impacts upon consumption in three ways. 1. The outlets may be more competitive and drive prices down to attract customers. 2. Oversupply may normalise the products when they are sold alongside everyday commodities, such as bread and milk. 3. Tobacco and alcohol may simply be easier to buy in areas where there are more outlets.

In order to explore the relationship between supply, behaviour and harm we need data on the location of every outlet in Scotland selling tobacco and/or alcohol. Ideally, to be able to say something about whether the relationship may be causal, we need this data over time. We have already collected data on the specific location of every outlet selling tobacco and licensed to sell alcohol over multiple time periods (2012 and 2016 (nationwide alcohol and tobacco – see paper here) and 2008 (alcohol in four cities – see paper here)). As part of this project we will collect updated data for 2019/20. This will allow us to measure this change over time. Using an approach called trajectory modelling we will group neighbourhoods that have had a similar degree of change; some neighbourhoods may have lost, or gained, local shops or pubs, whereas some may not have changed at all. We will then identify features of these neighbourhoods that may be driving this change, for example the age profile of the population or poverty levels. This will help policy makers understand the drivers of change in our neighbourhoods.

To measure the relationship between changing supply and harm we will link these trajectories, and our measures of availability at each time point, to alcohol and tobacco health outcomes (behaviour, illness and death). We will use statistical models to see whether areas experiencing an increase or decrease in outlets have seen a corresponding increase or decrease in these outcomes. This will allow us to get a better understanding of whether an over supply of alcohol and tobacco is related to smoking and alcohol consumption and harm. These findings will provide important evidence related to the provision of such commodities in our neighbourhoods.

Although these statistics are important to report we also need to understand why an oversupply of alcohol and tobacco may influence behaviour and harm. Whilst the literature suggests the pathways listed above, we know little about the experiences of individuals living in neighbourhoods with contrasting availability. We don’t understand the individual experience of any of these pathways. Professor Carol Emslie will lead a qualitative work package and researchrs will meet with groups of individuals, in neighbourhoods of contrasting trajectories, to talk to them about the supply of alcohol and tobacco. We will explore their experiences of neighbourhood and assess how their perceived notions of their neighbourhood availability contrast with our statistical measures. Finally, we will meet with residents, retailers and policy stake-holders to explore potential interventions related to supply. Policies at this level require public, retailer and political support. We will discuss the priorities held by various groups, present our quantitative results and gauge attitudes towards potential interventions.

Throughout the project will be committed to knowledge exchange, public events and speaking with non academic partners. If you wish to know more about this research, or would like one of the researchers to come to your organisation to provide you initial findings (once the project is under way) then contact the Principal Investigator here: niamh.shortt@ed.ac.uk

Mental health problems are common among prisoners in low-income and middle-income countries

In a major international review, we found very high rates of psychiatric and substance use disorders among prisoners in low-income and middle-income countries. The results from the systematic review and meta-analysis published in Lancet Global Health showed that the prevalence of psychosis, depression, and drug and alcohol use disorders is much higher in this marginalised population in comparison to the community, pointing to unmet needs and calling for action in research and policy.

Mental health and substance use problems are common among individuals involved in the criminal justice system. Incarcerated men and women often come from disadvantaged socioeconomic and family background, and frequently have a life history of victimisation and substance use, making them more vulnerable to mental health problems. While in prison, they often remain undiagnosed and untreated. Prisoners with unmet mental health needs have higher mortality, especially by suicide, and greater risk of recidivism and reoffending after release in the community, leading to multiple imprisonments.

Although 70% of the worldwide prison population are residing in low-income and middle-income countries (LMIC), almost all scientific evidence is coming from studies conducted in high-income countries. It is an important limitation as recommendations from a mostly Western context might not be applicable or generalizable to poorly resourced settings. Prison conditions in LMICs are usually very harsh, characterised by overcrowding, poor nutrition, and sanitation, and limited or complete lack of access to basic health care. To provide evidence for future research and policy making, we conducted a systematic review and meta-analysis on prison prevalence studies in LMICs.

After screening 6000 titles and abstracts from 17 electronic global databases, we identified 23 relevant publications based on 14,527 prisoners from 13 different LMICs. Considering a one year time interval, approximately 6.2% of the prisoners had psychosis, 16.0% major depression, 3.8% alcohol use disorders, and 5.1% drug use disorders. To illustrate the immense burden of mental health problems, we quantified the difference between the prevalence among prisoners in each sample and in the sex-matched general populations of the respective countries. Prevalence rates among prisoners were 16 times higher for psychosis, 6 times higher for major depression and illicit drug use disorder prevalence, and twice as high for alcohol use disorders, indicating a significant public health concern and large unmet health care needs in this marginalised group. Moreover, rates in prison populations of LMICs might be even higher than in high-income countries.

Based on our findings, we presented several implications and recommendations for research and policy.

  1. While a review from 2012 on prison mental health in high-income countries identified over 100 samples, we were able to find only 23 studies from a much larger and diverse group of countries. There is a need further evidence from LMICs to adequately plan interventions for prisoners with mental disorders, especially from regions underrepresented in research such as Central and East Asia, and Central America.
  2. Because correctional facilities in LMICs often lack basic health care, the implementation of cost-effective interventions and scalable treatments for individuals with mental health problems is crucial.
  3. Imprisonment could present an opportunity to treat people with mental health and substance use problems who otherwise would be difficult to reach for health services. National governments in LMICs should move the responsibility for prison health care from prison administrations to the national health services.
  4. Since human right violations, and physical and psychological abuse are more common in resource-poor correctional settings, increasing mental health literacy among staff and protecting the rights and health of people with mental illnesses should be a priority for penal justice policies.

The invited comment on our paper gives a valuable and very practical recommendation on how to improve mental health services in correctional facilities. Training prison health workers by mental health professionals using the WHO’s Intervention Guide for mental disorders (mhGAP-IG), could be a cost-effective and valuable programme for addressing the treatment gap among prisoners in LMICs and coming closer to the Sustainable Development Goals declared by the United Nations.

By Gergo Baranyi, PhD Student in Human Geography and Marie Sklodowska-Curie Early Stage Researcher, The University of Edinburgh

Does place matter during recovery from alcohol dependence?

In a new paper, published in Health and Place, Niamh Shortt, Sarah Rhynas and Aisha Holloway ask ‘Can the environment play a role in recovery?’ Here they discuss the findings from the paper.

Place matters for health. We know that features of the natural, built, and social environment can be either health promoting or health damaging.  From previous research we know that the environment is likely to be significant in shaping health-related behaviours, including alcohol consumption (here and here) and smoking patterns (here and here). In a new paper we have explored individuals’ experience and perceptions of the role of place in recovery from alcohol dependence. We wanted to gain a better understanding of the influence of the environment on the everyday experiences of those in recovery.

In order to do this we worked alongside a group of individuals who attend a recovery café in Central Scotland.  We used photovoice, a participatory research method that enabled the participants to capture images of their recovery. Individuals at various stages of recovery, but all at least one year sober, were able to document features of the environment that enable and/or hinder their journey.  Nine participants captured a total of 468 photographs. During focus group discussions participants identified features of the environment that were therapeutic and risky.

Therapeutic environments

Almost all of the participants made references to natural, wide-open spaces, such as hills, the sea, green spaces, in which they found calm and healing.  Participants associated such spaces with escape, meditation, clearing a busy mind, calm and support (Figure 1).

Figure 1: ‘I’ve took a, a picture at the top of the Braids. Eh, one that looks onto Arthur’s seat. Really green Arthur’s seat. And to the right a bit looks as far doon, I think you can see Bass Rock. Eh, and all that beauty and scenery and it’s on our doorstep. And I use it for a bit of my meditation and clearing my mind and that’.

therapeutic

Aside from vast open spaces, participants also found support in more everyday spaces, including the recovery café itself or in their homes. The café provides a space where the participants could see that they are ‘not the only one’, other café users understand their behaviour and the café itself was seen as a place of refuge following difficult moments.

Risky environments

All of the participants highlighted places of risk within their everyday environments, for most the single biggest element of risk was the retail environment, including both the sale and marketing of alcohol. For one participant the constant presence of alcohol was summed up with a photograph of the view from his window that included the local shop (Figure 2).

Figure 2: ‘it’s just there right on my doorstep and the first sign is beers and ciders’.

risky

The same participant noted that, before recovery, he was able to navigate the city to buy alcohol 24 hours a day, the challenge for him now is to try to avoid it in an environment where it is so readily available.  Participants spoke of the difficulty of avoiding such triggers in the everyday.

Further themes discussed in this paper include the transitory nature of place (places moving from supportive to risky and vice versa) and shame and stigma. This paper demonstrates that the journey of recovery from alcohol dependence is embedded in place, with place both supporting and hindering recovery.  The findings confirm that people in recovery experience a particular set of challenges on a day-to-day basis. Of particular note here was the ubiquitous sale of alcohol and presence of alcohol marketing and promotions.  By viewing recovery as a journey we can begin to frame alcohol dependence as a process of change; change in both the individual and in the way in which the individual sees and interacts with the environment. According to Banonis ‘recovering from addiction is a daily choice’ (Banonis 1989, p.37), however such choices are not made in a vacuum. This paper extends previous work by the CRESH team that argues that such health-related choices can be made more or less difficult by the environment in which one lives.

 

Scotland’s poorest neighbourhoods have the most shops selling alcohol and tobacco

By Niamh K Shortt

New research published this week in BMC Public Health by the CRESH team, and colleagues in Global Public Health, has found that Scotland’s most deprived neighbourhoods have the highest availability of both tobacco and alcohol outlets.  The average density of tobacco outlets rises from 50 per 10,000 population in the least income deprived areas to 100 per 10,000 in the most deprived areas.  For alcohol outlets licensed to sell alcohol for consumption off the premises the figures were 25 per 10,000 in the least income deprived areas rising to 53 per 10,000 in the most income deprived areas.

CIgarettes and Alcohol. By CharlesFred, Flickr. Creative Commons Licence.
Source: CharlesFred, Flickr. Creative Commons Licence.

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Scottish MSPs – why vote for a national register of alcohol premises?

By Niamh Shortt

The Air Weapons and Licensing (Scotland) Bill stage 3 will be debated today in the Scottish Parliament. Amendments to the bill include a clause, proposed by Dr Richard Simpson (MSP Labour, Mid-Scotland and Fife), to establish a National Register of Alcohol Premise Licenses and Personal Licences.  CRESH support this amendment and called for such a register in evidence given by Niamh Shortt to the Local Government and Regeneration Committee.

edinburgh_outlets_map
Alcohol outlets (red dots) in Edinburgh. Base map data are © Crown Copyright and Database Right 25 June 2015. Ordnance Survey (Digimap Licence).

Continue reading Scottish MSPs – why vote for a national register of alcohol premises?

Empowering communities: An interactive tobacco and alcohol outlet density webmap for Scotland

Today we are launching an interactive webmap that allows users to map tobacco and alcohol outlet density, and related health outcomes, for neighbourhoods (‘datazones‘) across Scotland.  The underlying data we have collected and assembled can also be freely downloaded for use.  Our research from Scotland shows that outlet density matters for health:

  • areas with the highest alcohol outlet density have double the death rate of those with the lowest densities (see our blog postreport and infographic)
  • adolescents living in areas with the highest tobacco outlet density are almost 50% more likely to smoke than those with the lowest (see our blog post, paper and infographic).

ALCOHOL OUTLET DATA UPDATED 25 JUNE 2015:  Previous to this date the alcohol outlet density data had used an alternate measure of density than outlets per km2, resulting in values that were typically 30-40% lower than the actual value.  Whilst the figures have changed the general picture has not: an area of high density remains an area of high density.  The rest of the data are unaffected.

webmap

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Alcohol and Health in Scotland: Key Stats

As MSPs meet in the Scottish Parliament today to debate progress made against Scotland’s Alcohol Strategy, we’re launching a timely infographic to highlight the very real dangers of the oversupply of alcohol in our society, and the knock-on implications for health and inequality. Final Infographic

Continue reading Alcohol and Health in Scotland: Key Stats