CRESH

Tag: mental health

  • The Uneven Rise of No/Lo Alcohol Drinks in Great Britain: A Look at Local Shops

    New work from the CRESH team has found a significant increase in the availability and sales of no and low alcohol (No/Lo) beverages in convenience stores across Great Britain. At the same time, the growth in availability and sales of these products was disproportionately higher in less deprived neighbourhoods of the country. These findings have some important implications for public health, particularly given the mixed evidence on whether No/Lo beverages act as substitutes for standard alcohol products (potentially reducing harm) or as supplements (potentially increasing overall consumption).

    The Growth of No/Lo Products: a case study in Great Britain

    No/Lo beverages are alcohol-mimicking drinks that contain no or low amounts of alcohol, and their popularity has grown rapidly across high-income countries reflecting changes in consumer preferences and drinking behaviours. Our recent CRESH study, published, with colleagues in Sheffield, in Addiction, examined how the availability and sales of No/Lo products have evolved in local stores across Great Britain between 2018 and 2022. We found that in 2018, only 34% of small retailers sold No/Lo products, rising to 68% by 2022.

    However, the availability and sales of No/Lo beverages differed across neighborhoods with varying levels of deprivation. By 2022, retailers in more affluent neighbourhoods recorded 33% higher sales of No/Lo products and offered more than twice as many products as those in the most deprived areas. Compared with 2018, we identified that these inequalities in availability and sales between the most and least deprived neighbourhoods have widened over time.

    This study draws on data from more than 11 million alcohol transactions from 1,432 retailers operating between 2018 and 2022 across Great Britain. This comprehensive dataset is particularly valuable, as such data are rarely accessible due to high costs and commercial sensitivity. Previous research has largely relied on survey data, which can be affected by recall and social desirability bias and do not capture geographic variation in availability and purchasing patterns. In addition, most existing studies have focused on sales in bars and pubs, whereas this study captures purchasing in retail settings. This is particularly relevant in a context where alcohol consumption at home is increasing, and local shops enable quick and often spontaneous purchases.

    What do these findings mean for public health?

    These findings align with previous research showing that individuals with higher socioeconomic status are more likely to consume No/Lo products, often linked to greater health awareness and lifestyle changes, particularly since COVID-19. These differences in preferences and purchasing power are likely reflected in spatial patterns of availability and sales, with higher uptake in more affluent areas. This can be also explained by the influence of large transnational alcohol companies. Product availability, range, and marketing are shaped by market forces that tend to favour more commercially attractive locations, reinforcing geographic inequalities.

    The public health implications of this uneven distribution remain uncertain. Evidence is mixed on whether No/Lo products reduce overall alcohol consumption (as substitutes) or increase it (as complements). If they do contribute to harm reduction, our findings suggest that these benefits are currently concentrated in more affluent communities—raising concerns about widening inequalities, given that alcohol-related harm is higher in more disadvantaged groups.

    This points to the need to consider equity in how No/Lo products are distributed and promoted. Potential policy responses could include incentives for retailers in more deprived areas to stock No/Lo options, alongside awareness campaigns tailored to different social groups. These approaches could complement existing measures such as alcohol taxation and minimum unit pricing (MUP), which may also make No/Lo products relatively cheaper and therefore more attractive alternatives.

    However, framing No/Lo products as a public health solution requires caution. Increased availability may contribute to the normalisation of alcohol consumption. Major alcohol companies are increasingly promoting No/Lo products, potentially using them to strengthen brand visibility. Such practices may normalise drinking behaviours and indirectly reinforce demand for higher-strength products, thereby undermining anticipated public health benefits. There are also concerns about a possible “gateway” effect, particularly among young people, who can purchase zero-alcohol products and may not clearly distinguish them from alcoholic beverages. This raises questions about the role of No/Lo products in shaping drinking norms from an early age.

    An uneven rise—and what comes next

    The study findings suggest that public health responses to the expansion of No/Lo products should adopt a geographical lens, accounting for regional contexts and inequalities. Any potential benefits or harms are unlikely to be evenly distributed under current market conditions. Further research is needed to better understand whether No/Lo products act as substitutes for or supplements to standard alcohol, particularly by examining: (i) who is being reached; (ii) which populations lack access; and (iii) how retail availability shapes consumption opportunities across different areas. Until stronger evidence is available on harm-reduction effects, consumption patterns, and potential unintended consequences, policies aimed at promoting No/Lo availability should be approached with caution.

    This is particularly relevant in a context where the UK Government has committed to delivering a significant increase in the availability of alcohol-free and low-alcohol drinks.

    Despite this, No/Lo beverages accounted for just 0.25% of total alcohol sales in local shops I 2022 in Great Britain, suggesting that their current impact—whether as substitutes or supplements—is likely to be limited. However, further investigation is warranted.

    This work was funded through the SPECTRUM consortium.

    Roberto Valiente Borox

  • Recession, austerity and health

    We recently developed a project summary for an ESRC-funded study looking at the impact of the financial crisis and subsequent austerity measures on mental health and wellbeing in the UK. The summary for the CRESH project (full title: Recession, austerity and health: changing area socio-economic conditions and their relationship to individual health and wellbeing outcomes in Scotland) includes the key findings, links to papers published, details of some of the dissemination activities, and other useful resources. You can read more in the pdf below:

    Recession, Austerity and Mental Health in ScotlandDownload
  • Mental health problems are common among prisoners in low-income and middle-income countries

    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

  • Hard Times: Mental Health under Austerity event

    Hard Times: Mental Health under Austerity event

    How important for mental health are the changing social, economic and environmental conditions in the places where we live? Our research, funded by ESRC, addresses this question through a new and innovative study of mental health of people living in different parts of Scotland. We are focussing especially on the period since 2007 when economic recession and austerity have impacted to a varying extent across the country. This event will use interactive data visualisations to present our research findings, showing how audience polling techniques allow the participants to select topics of special interest for them, to help determine in ‘real time’ the focus of the results presented. This will be combined with an opportunity for group discussion and exchange of ideas among diverse participants, many of whom will be involved in mental health care and promotion of better mental health. We will be sharing new evidence and discussing the implications for policy and practice in different parts of Scotland. The event is also intended to help shape the future research agenda.

    FREE to attend. Registration via Eventbrite. Refreshments provided.

    LOCATION

    The Melting Pot, 5 Rose Street, Edinburgh, EH2 2PR

    Update 21/12/18

    We had a really productive day on the 7th of November, thanks to the helpful and encouraging input from all the attendees. Please feel free to download and share the Powerpoint slides. We have collated the information gathered using Mentimeter and transcribed the written notes. The report which features a discussion on how these findings relate to the wider project is now available to download.

     

     

  • Being a Scout or Guide protects mental health and narrows inequalities in later life

    By Rich Mitchell and Chris Dibben

    beaver-scouts-plant-trees-for-their-gardener-badge-pic-credit-the-scout-association
    Today, with colleagues from the Longitudinal Studies Centre Scotland at Edinburgh University, we have published a study
    which found that being in the Guides or Scouts as a child seems to protect your mental health long into adulthood. Those who were in the Guides or Scouts were about 18% less likely to have a mood or anxiety disorder at age 50, than those who were not. This protective link seems especially strong for children who grew up in less advantaged households, so much so that the usual ‘gap’ in mental health between those from richer and poorer backgrounds does not exist among those who were Scouts or Guides. (more…)

  • Better woodlands, better health?

    Better woodlands, better health?

    Here, Jennifer Thomson, a PhD student with CRESH, describes her recent research into whether urban communities benefit from local woodland improvements, and places her important findings into policy context.

    (more…)

  • How difficult life events influence risk of mental health problems and moves to deprived neighbourhoods

    We’ve just published a journal article that assesses the links between difficult life events, residential moves and spatial inequalities in mental health in the UK.

    Repossession2We find that people that move following difficult life events, such as relationship breakdown and eviction, have poor mental health and distinctive patterns of mobility.

    Difficult life events appear to both harm mental health and residential opportunities, increasing the likelihood that people with poor mental health will live in socio-economically deprived neighbourhoods. Moves related to difficult life events could reinforce socioeconomic inequalities in health between areas by concentrating people with poor health in disadvantaged areas.

    (more…)

  • Are people in poor health more likely to move to poorer quality physical environments?

    By Helena Tunstall

    Grangemouth Refinery, UK
    Grangemouth Refinery, UK

    It is well known that people living in neighbourhoods with poorer quality physical environments tend to have worse health than those living in better quality environments. For example, those in areas with higher levels of air pollution have greater risk of death from respiratory and cardiovascular disease. However, the vast majority of these studies do not consider the possibility that patterns of residential moves may concentrate people with poorer health in certain types of environments. This is important because it is feasible that the links between the environment and health may, at least partially, be explained by the migration of people with poorer health to poor quality environments. (more…)