Understanding the Role of Alcohol Consumption in Football Cultures (Alcohol FC) (2019-2022)
(Funded by Economic and Social Research Council)
The key objective of this research is to answer the following questions: why do people drink when they watch football; how much harm does it cause; and, what should government do about it? In answering these questions this research will provide evidence of the role alcohol plays and the motivations for consumption for various groups attending and watching football matches on television in order to help prevent excessive/binge consumption and violent or antisocial behaviour. It will also assess the impact that existing regulations designed to restrict the consumption of alcohol at football matches have on the consumption of alcohol for those attending or watching a match.
This research will employ a mix of quantitative and qualitative methods, divided into three work packages (WP) to explore how either attending a match or watching a live broadcast of football on television shapes the alcohol consumption of supporters and attitudes towards the current regulations which govern alcohol and football.
WP1 will start to develop this evidence base by conducting focus groups with football fans to gain in-depth insight into the importance and role of alcohol consumption for those watching or attending a football match. We will also probe the sets of relationships that the sample groups have outside of football, and the roles of alcohol consumption there, eg. with family, friends and in other recreational spaces in order to establish if football is a ‘special space’ for binge drinking or does it reflect/enable heavy drinking that also occurs elsewhere in other social spaces. WP1 will also include an online cross-sectional survey with a larger sample of football fans divided into two parts. Part 1: Drinking behaviour; Part 2: Fan supporting behaviours, and attitudes towards consumption and regulations.
The purpose of WP2 is to gain in-depth insight into the consequences of alcohol consumption for those watching football from the perspective of those who are responsible for match safety and those who will be instrumental in any potential regulatory changes. In-depth interviews with key stakeholders will be conducted. These will include a range of different organisations with different motivations and interests and examine the assumptions they make about the relationship between alcohol consumption and behaviour.
The purpose of WP3 is to observe what part alcohol consumption plays for fans attending a match, the implications of current alcohol restrictions and to explore factors identified in WP1 & WP2 in a naturalistic environment. This WP will involve equipping and training groups of fans to use video recording equipment in order to document attending a football match and in particular, any alcohol consumption which occurs amongst the group. It will consist of a participatory ethnographic element which will identify contexts, forms and experiences of alcohol use which cannot be picked up in other ways. For example, it could help us identify different kinds of consumption happening such as drinking to get drunk, social drinking to keep in with the group, pre-partying and so on which we could then link with potential anti-social behaviour in discussion with fans.
ISM Staff: Richard Purves (PI), Kate Hunt, Ruaraidh Dobson
External: Loughborough, Edinburgh and Nottingham universities
The Impact of Minimum Unit Pricing on Ambulance Callouts in Scotland (IMPAACT) (2019-2021)
(Funded by the Chief Scientist Office)
This study will be the first to determine whether increasing the price of cheap alcohol affects ambulance call-outs and to examine in-depth the impact of alcohol on a public ambulance service.
Ambulance call-outs due to alcohol cost ~£52 million annually in Scotland. Under the Scottish Government’s (SG) world-first ‘Minimum Unit Pricing’ (MUP) policy, the cheapest alcoholic drinks became more expensive from 1st May 2018. Research suggests that this will reduce drinking especially in heavier drinkers from deprived backgrounds, and should reduce ambulance call-outs, but the actual impact of price changes on call-outs has not previously been studied.
Our Objectives are as follows: (1) Using detailed data from the Scottish Ambulance Service (SAS), we will identify alcohol-related ambulance call-outs and examine statistically if MUP had an impact on the number of call-outs, including in different groups (varying by sex/age/wealth); (2) Using in-depth interviews with ambulance staff, we will explore how they experience, identify, handle and record alcohol-related call-outs.
The findings will: inform wider alcohol policy; and support SAS with planning and training staff for future alcohol-related incidents; and help the Scottish Parliament who must decide in 2024 if enough evidence exists of benefits from MUP to continue it beyond that date.
ISM Staff: Niamh Fitzgerald
Stirling Collaborators: Dr David Fitzpatrick, FHSS
External Collaborators: Prof Jim Lewsey, Dr Daniel Mackay, University of Glasgow; Colin Angus, University of Sheffield
Trends and Inequalities in Prescribing for Alcohol Dependence in Scotland (TRIPADS)(Funded by Alcohol Research UK)
More than 15,000 prescriptions are issued every month in Scotland to treat alcohol problems (‘AUDs’). However, high-quality evidence that these drugs are effective is very limited. This study will address this by researching large national databases, without identifying individuals. Clinical trials are well established as the best way to determine whether new treatments work. However, it is also known that people who participate in trials may be different from the general population (e.g. on average, younger and healthier). Our study avoids this problem by covering all patients in Scotland who have been in hospital because of an alcohol problem. We will also involve members of the public with experience of alcohol treatment as advisors to guide the research.
Although there is guidance on what medications to use to help those who are dependent on alcohol to stop drinking initially, it is unclear how to treat people in the longer term to reduce their chances of further problems. In this study, we will research individuals prescribed medications for alcohol treatment after a hospital stay related to alcohol between 2010 and 2017. We will describe the medication they were prescribed and the dose used, and any linked hospital admissions or deaths. We will look at whether these have changed over time and whether they vary in different parts of Scotland or for people of different ages, sex and socio-economic deprivation levels. This research makes innovative use of national linked health records (prescribing, hospital stays, deaths).
ISM Staff: Niamh Fitzgerald (PI at Stirling)
External: Led by Prof Jim Lewsey, University of Glasgow; with Hamish Innes and Dr Andrew McAuley, Glasgow Caledonian University
Exploring Alcohol Sponsorship of Professional Sport in Scotland and the Frequency and Nature of Marketing Exposure in Televised Broadcasts (2018-2019)
(Funded by Alcohol Focus Scotland and Scottish Health Action on Alcohol Problems)
Research suggests that there is a consistent link between exposure to alcohol marketing and consumption, particularly in young people. Sponsorship, in particular, is a powerful communications tool that allows marketers to use attractive associations with sporting events and sports teams to develop salient brand capital, develop positive attitudes and emotional connections with consumers, and foster interactions among peers. Despite this, there is limited evidence concerning the extent of alcohol sponsorship of professional sport in Scotland, how frequently it appears in televised broadcasts, and what different forms sponsorship activity takes. In response, this study aims to:
To explore the use of alcohol sponsorship in professional football and rugby union in Scotland.
To explore the frequency and nature of alcohol marketing in televised broadcasts of professional football and rugby union in Scotland.
The research is divided into three studies. The first study is an open source audit of official sponsorship arrangements for professional football and rugby union teams and competitions in Scotland. The second study is a series of in-depth case studies to explore the nature and use of alcohol sponsorship in professional football and rugby union in Scotland. The third study is a frequency analysis of alcohol marketing references in televised broadcasts of professional football and rugby union matches broadcast in Scotland.
ISM Staff: Richard Purves and Nathan Critchlow
Evaluating Possible Intended and Unintended Consequences of the Implementation of Minimum Unit Pricing (MUP) of Alcohol in Scotland: A Natural Experiment (2017-2020)
The minimum unit pricing (MUP) policy implemented in May 2018 by the Scottish Government aims to reduce the affordability of alcohol. There is evidence that reducing affordability reduces consumption and related harm. However, there has been little evaluation of possible adverse consequences. This study aims to determine the impacts (including whether this differs by age or deprivation) of alcohol minimum unit pricing on selected acute health harms and to monitor what if any, unintended consequences occur. The study has three components. C1 and C2 involve assessments of attendance and use of A&E and sexual health services and are being led by the University of Glasgow. C3 is being undertaken by researchers at the ISM and is collecting qualitative data from young binge drinkers, older heavy drinkers and local stakeholders in three contrasting communities in Scotland. Its primary aim is to explore participants’ expectations, experiences and understanding of the policy and its impacts, including any unintended consequences and challenges with implementation.
ISM Staff: Douglas Eadie, Allison Ford, Martine Stead, Niamh Fitzgerald
External: Alastair Leyland (overall project lead), Shona Hilton, Vittal Katikireddi and Chris Patterson MRC/CSO Social & Public Health Sciences Unit, University of Glasgow
Evaluating the Impact of Minimum Unit Pricing in Scotland: Observational Study of Small Retailers (2017-2019)
(Funded by NHS Health Scotland)
This project is to monitor changes in alcohol pricing and marketing before and after the implementation of Minimum Unit Pricing for alcohol in 2018. Our study will comprise purchase and analysis of price data from small retailer EPOS (electronic point of sale) systems, observations in stores and interviews with retailers. Our methodology builds on previous studies we have conducted for this and other funders to evaluate the implementation and impact of public health policies to regulate the retail environment.
ISM Staff: Martine Stead, Douglas Eadie, Anne Marie MacKintosh, Nathan Critchlow, Niamh Fitzgerald, Jennifer McKell, Richard Purves, Kathryn Angus
Understanding the Impact of Lowering Scotland's Drink-Drive Limit on Driving (2017 - 2018) (Funded by the National Insitute for Health Research)
In December 2014, the ‘drink-drive limit’ was reduced in Scotland from 80mg to 50mg of alcohol in 100ml of blood. Evidence suggests this will reduce road traffic accidents (RTAs) and resultant deaths, at least initially. It could also affect overall levels of drinking and related harms, which are rising in Scotland at least in part due to increased home drinking.
The aim of the study is to explore changes in drinking perceptions, behaviours (including driving), contexts and practices, following the reduction in the drink-drive limit in Scotland, including whether, how and why initial effects were sustained (or not), and implications for overall consumption levels.
ISM will conduct group interviews with the general public and individual interviews with pub/bar owners/managers. Our findings will enable better understanding of how the change may have impacted on overall drinking levels, drinking patterns and related harms in Scotland, and will therefore inform future policies to reduce alcohol-related harm.
ISM Staff: Niamh Fitzgerald and Jennifer McKell
External: Carol Emslie, Glasgow Caledonian University and James Lewsey, University of Glasgow
EXILENS: A Mixed-method, Natural Experiment Evaluation of Public Health Engagement in Alcohol Premises Licensing and Impact on Alcohol-related Harms (2017 - 2020) (Funded by the National Insitute for Health Research)
In Scotland and England, local councils have power over alcohol licensing – that is the system by which certain premises are allowed to sell alcohol. In recent years, professionals who work on ways to improve health across the population (‘Public Health Teams’ or ‘PHT’s) have been trying to influence this licensing system. They do this by getting involved in licensing processes and encouraging licensing authorities and licence-holders to act in ways they hope will ultimately improve the health of the local population.
The aim of the study is to find out what PHTs have been doing and whether their actions have had any impact on these alcohol-related harms.
ISM Staff: Niamh Fitzgerald, Richard Purves, Nathan Critchlow and Linda Bauld
External: Universities of Bristol, Sheffield, Edinburgh, London School of Hygiene and Tropical Medicine, Alcohol Focus Scotland and Alcohol Research UK
Obstetric Research Study - Linking Self Report and Biomarkers of Alcohol Consumption in Early Pregnancy in Glasgow to Pregnancy and Child Health Outcomes: The Obstetric Research Study - Phase 1 (2017 - 2018) (Funded by NHS Greater Glasgow and Clyde)
This study is led by Professor David Tappin of the University of Glasgow.
Alcohol use during pregnancy is the commonest reason for significant development delay in childhood. Currently there is no way to accurately determine the prevalence of significant alcohol use in the pregnant population. This study aims to provide a baseline distribution of chronic alcohol use during pregnancy in Glasgow and Clyde, measured by elevated levels of two alcohol biomarkers.
ISM Staff: Niamh Fitzgerald and Lesley Sinclair
External: Led by David Tappin, University of Glasgow
Loi Evin and Alcohol Marketing (2016 - 2017) (Funded by SHAAP (Scottish Health Action on Alcohol Problems) and IAS (Institute of Alcohol Studies))
Evidence suggests that references to alcohol occur frequently in the broadcasts of international football tournaments, such as the 2014 World Cup and the EURO 2012 Championships. This study reviewed the frequency of visual and verbal alcohol-references in EURO 2016 matches broadcast in the UK, Republic of Ireland and France. By including broadcasts from three countries the study considered whether the tighter restrictions on marketing in France, known as the Loi Evin, are successful in limiting the amount of alcohol references audiences in France are exposed to, compared to the self-regulatory approach in the UK.
ISM Staff: Richard Purves, Martine Stead and Nathan Critchlow
External: Jean Adams, University of Cambridge; Karine Gallopel-Morvan, School of Public Health, France; Patrick Kenny, Dublin Institute of Technology
Publication: Purves RI, Critchlow N, Stead M, Adams J and Brown K (2017). Alcohol marketing during the UEFA EURO 2016 football tournament: A frequency analysis. International Journal of Environmental Research and Public Health, 14(7): 704. doi:10.3390/ijerph14070704
Obesity and Alcohol Use: Is There a Role for Dually Focused Intervention in Young Adults (18-25) to Tackle Unhealthy Eating and Drinking and Effectively Reduce Future Health Inequalities (2016 - 2018) (Funded by the Public Health Research Consortium, Department of Health)
Levels of obesity have risen steadily over the past two decades. Thirty-three percent of regular drinkers in the UK are at risk of related health and other problems.
Alcohol use peaks in early adulthood and can exacerbate weight gain. Liver disease is the third most common cause of premature death in the UK and it is increasingly seen in 15-44 year olds. A high body mass index and heavy drinking are independently associated with liver disease but, in combination, they produce a supra-additive risk of damage. Thus we need to develop interventions focused on both behaviours, especially as they can become closely inter-linked in people’s day-to-day lives.
The aim of the study was to explore the links between unhealthy eating behaviour and risky alcohol use in the social, emotional and cultural lives of young adults (aged 18-25), including perceptions of risks, benefits, costs and consequences of these behaviours in early adulthood, and to work with young adults to co-design a dually focused intervention to help reduce health risk and social inequalities due to excess weight gain and alcohol consumption.
To do this the team carried out: a systematic review, secondary quantitative data analysis of national datasets, in-depth qualitative interviews, and workshops.
ISM Staff: Martine Stead and Niamh Fitzgerald
External: Ashley Adamson (lead), Eileen Kaner, Stephanie Scott and Wendy Wrieden, Newcastle University; and, Chris Power, University College London
Pilot Research Study for the Policy Research Centre for Cancer Prevention, Cancer Research UK: Youth Policy Surveys (YPS) (2016 - 2018) (Funded by Cancer Research UK)
This project supported the Cancer Research UK Policy Research Centre for Cancer Prevention (PRCP) in the development of two new national youth surveys, one on alcohol and the other obesity. Institute for Social Marketing (ISM) staff provided insight and training to the PRCP team in how such studies are carried out, and provided research support, advice, and collaboration on publications. It is intended that data from the surveys will be used to monitor patterns of youth consumption, perceptions of alcohol and obesity and the impact that marketing has on these.
ISM Staff: Martine Stead, Douglas Eadie, Anne Marie MacKintosh, Jennifer McKell and Linda Bauld
Alcohol Screening in Pregnancy Systematic Review (2016 - 2017) (Funded by Glasgow Centre for Population Health)
The study will conduct a systematic review of self-report measures for alcohol consumption in pregnancy.
ISM Staff: Niamh Fitzgerald and Kathryn Angus
Brand Regulation in the UK Alcohol Market: A Pilot Study (2016) (Funded by Cancer Research UK)
Levels of alcohol consumption amongst teenagers remain high. A key reason for this is the ineffective regulation of the industry’s marketing, with rules focusing on media and advertising content that are not working.
This pilot study had two principal objectives:
To explore teenagers relationships with alcohol brands. This added to and updated existing evidence in this area.
To obtain initial feedback from legal experts on the theoretical and practical implications of brand level regulation.
To do this, focus groups were carried out with young people, a rapid scoping review was undertaken and depth interviews were conducted with legal experts.
ISM Staff: Douglas Eadie and Richard Purves
External: Alan Tapp, University of the West of England and Gerard Hastings
Four Nations - How Evidence-based are Alcohol Policies and Programmes Across the UK (2015-2016) (Funded by NESTA)
This report by Niamh Fitzgerald and Colin Angus investigates the extent to which alcohol policies and programmes across the UK are based on evidence.
The divergence of alcohol policy in the four nations of the UK since devolution has allowed us to compare and contrast how evidence is used in alcohol policy and the extent to which current policies across the UK are supported by scientific evidence. In this new report, we discovered substantial differences between the 4 nations in the way that alcohol problems are framed and policies implemented. These differences appear to reflect the level of activity within each country, with alcohol framed as a minority issue affecting only a small group of dependent drinkers at the UK level, while the more active devolved administrations tend to view or portray alcohol problems as a whole population issue.
ISM Staff: Niamh Fitzgerald
External: Colin Angus, University of Sheffield
Publication: Fitzgerald N and Angus C (2015). Four Nations – How Evidence-Based are Alcohol Policies and Programmes across the UK? Alliance for Useful Evidence. Report
Remuneration for Alcohol Brief Interventions in Primary Care: Scoping Study (2015-2016) (Funded by SHAAP (Scottish Health Action on Alcohol Problems))
This study assessed the availability and usefulness of data relating to remuneration and delivery rates for alcohol brief interventions in Scotland, to facilitate a rapid review of such data, inform future remuneration systems, and further study.
ISM Staff: Niamh Fitzgerald and Lisa Scholin (left 2016)
Alcohol in Pregnancy Study (2014-2016) (Funded by Glasgow Centre for Population Health)
Early diagnosis of Foetal Alcohol Syndrome [FAS], a condition resulting from heavy antenatal alcohol consumption, is difficult. This, together with difficulties detecting alcohol use during pregnancy, poses challenges for the evaluation of interventions aimed at reducing antenatal alcohol consumption. The pilot study aimed to determine if a two-stage assay system, measuring Carbohydrate-Deficient Transferrin (CDT) and Ethyl Glucuronide (EtG), could distinguish hazardous alcohol consumption from moderate or no antenatal drinking.
This assay system was then used to determine the baseline prevalence of significant alcohol consumption in the pregnant population by anonymous testing. One hundred and fifty serum samples from women living in the most deprived regions of Glasgow were assayed for the pilot. A further 8000 samples were assayed for the main study.
The aim was to measure the prevalence of significant alcohol consumption in the first trimester of pregnancy in the NHS Greater Glasgow and Clyde Health Board area. By measuring a baseline prevalence, interventions could be developed and assessed to reduce alcohol consumption in women of childbearing age.
ISM supported the development and set-up of sample and data collection and analysis protocols and pathways, analysed data and assisted with write up.
ISM Staff: Linda Bauld, Lesley Sinclair and Niamh Fitzgerald
External: Led by David Tappin, University of Glasgow, Helen Mactier, Roy Sherwood, Janet Brennand
The UPPP Project: Assessing politician’s Understanding, cancer risk Perceptions and Policy Positions on alcohol(2015 - 2016) (Funded by Cancer Research UK)
Cancer Research UK funding has been secured to develop a project that will focus on analysing and monitoring the public statements of key politicians in relation alcohol policy and alcohol-related harm including cancer risk. Such monitoring is an important part of advocacy work, but there is currently no reliable or consensus-based analysis method. The UPPP project seeks to assess the feasibility and value of a bespoke ‘positional analysis’ tool for analysing and monitoring politicians’ understanding of alcohol-related cancer-risks, alcohol problems, and policy positions relating to alcohol. The project will be conducted by a team led by Dr Niamh Fitzgerald at the Institute for Social Marketing, with involvement from the Alcohol Health Alliance, University of Sheffield, University of the West of England and the University of Newcastle.
ISM Staff: Niamh Fitzgerald
The Content and Design of Alcohol Brief Intervention Training for Practitioners (2014-2015) (Funded by Alcohol Research UK)
Research indicates that patients who are drinking alcohol at a risky or harmful level can reduce their drinking if health professionals identify their consumption and engage them in short, structured conversations about it (brief interventions – ‘BI’s). The provision of adequate training for health professionals is considered one important factor in enabling routine delivery of BIs. In research trials, the nature of such training has varied widely.
This project will:
Identify, describe and critically review existing frameworks which may be helpful for describing and analysing training of this kind.
Describe how training for professionals has been reported in BI trials to date.
Source and describe what detailed information on training is available by contacting researchers from these trials.
The outcomes of this work will inform current practice in delivering BI training, and will lay the foundation for future research exploring how training can support BI delivery and effectiveness.
ISM Staff: Niamh Fitzgerald and Kathryn Angus
Overprovision of Licensed Premises in Scotland: A Public Health Perspective (2014) (Funded by NHS Health Scotland)
In Scotland, the number of premises licensed to sell alcohol is controlled through a system of local licensing boards. Legislative changes in recent years have given such boards an objective of ‘protecting and improving public health’. Research has suggested that the controlling the number of licensed premises and therefore the availability of alcohol can reduce alcohol-related harm. This study involves qualitative interviews with individuals across Scotland working mainly in public health or in alcohol and drug partnerships who have worked on licensing issues in recent years. The study aims to identify how these individuals and their organisations have attempted to influence local licensing policies and decisions in Scotland, and in their experience, what factors are important in helping and/or hindering those efforts.
ISM Staff: Niamh Fitzgerald
Publication: Fitzgerald N (2015). Influencing the Implementation of a Public Health Objective in Scottish Alcohol Licensing: A Qualitative Interview Study – Summary Report. Stirling: University of Stirling, Institute for Social Marketing. Report
Women and Alcohol: Towards an Equity Review of the Effectiveness of Population-Based Interventions to Reduce Alcohol Use and Harm by Gender (2014) (Funded by Glasgow Centre for Population Health)
There is good evidence to suggest that a range of population-based interventions such as pricing, control of marketing, and reduction in availability of alcohol can reduce alcohol-related harm. This study will analyse published literature reviews of such interventions to determine the extent to which they report participation by women and any specific effects on women in the original studies underpinning this evidence. The results of the study will inform policy decisions as well as providing a basis for more detailed work considering how these kinds of interventions may have a differential effect by gender.
ISM Staff: Niamh Fitzgerald, Linda Bauld, Kathryn Angus and Martine Stead
UK Centre for Tobacco and Alcohol Studies (UKCTAS) (2013-2018)
The UK Centre for Tobacco and Alcohol Studies is a network of 13 universities (12 in UK, 1 in New Zealand) funded by the UK Clinical Research Collaboration, which builds on the work and success of its predecessor, the UK Centre for Tobacco Control Studies (UKCTCS).
The UKCTAS is now a leading international centre of tobacco and alcohol research and policy excellence with an extensive research programme. We have established a cohort of early career researchers, provide a teaching programme to train and engage the wider research and policy community in tobacco and alcohol research. We facilitate policy development by informing policy makers of the latest scientific research on tobacco and alcohol use, and thus contributing to the nation's public health.
The UKCTAS aims to deliver an international research and policy development portfolio, and build capacity in tobacco and alcohol research. UKCTAS work will include developing strategies for behaviour change in tobacco and alcohol use, assessing risks, identifying measures to reduce harm, monitoring the tobacco and alcohol industries, and developing effective public policies to improve public health and wellbeing.
ISM Staff: Linda Bauld and Gerard Hastings for University of Stirling
Young People, Alcohol Packaging and Digital Media (2013-2014) (Funded by Alcohol Research UK)
Alcohol marketing is a key focus for concern for alcohol and public health researchers because of growing evidence that it is a determinant of uptake and frequency of drinking. To date, research attention has focused on more traditional forms of marketing promotion. However, research needs to keep pace with the fast-changing, multi-platform marketing environment. Two aspects of contemporary alcohol marketing merit particular concern: packaging, and how this relates to online marketing. This research will benefit wider alcohol research and policy by exploring the way in which digital media combines with alcohol labelling and packaging to create a multi-platform marketing environment and to examine to what extent young people interact with this environment.
Research in this new and little understood area needs to use approaches which are reflexive and inductive, and two qualitative methods are proposed - focus groups with young people and netnography of identified social media sites and websites. A total of eight focus groups with 14-17 year-olds (n=48-64) will be used to explore young people’s knowledge, attitudes and behaviour relating to alcohol packaging and labelling. Their levels of awareness and engagement with on-line alcohol marketing through producers’ websites and social media pages, using on-product QR codes, augmented reality packaging and printed web-addresses, will also be explored. The second stage will involve the use of netnography to identify, observe and analyse on-line communications regarding alcohol products on social network pages and websites of certain alcohol brands.
ISM Staff: Richard Purves, Martine Stead and Douglas Eadie
Publication: Purves R, Stead M and Eadie D (2014) 'What are you meant to do when you see it everywhere?': Young people, alcohol packaging and digital media. London: Alcohol Research UK; December.
A Process Evaluation of Alcohol Brief Interventions in Wider Settings (Young People and Social Work) (2012-2014) (Funded by NHS Health Scotland)
The detection of alcohol problems is known to be enhanced by the use of appropriate screening tools, and a considerable body of research evidence now supports the use of Alcohol Brief Interventions (ABIs) in reducing health-related harm due to alcohol consumption. ABIs are time-limited interventions that focus on changing drinking behaviour, and their delivery has become a significant component of the Scottish Government Alcohol Strategy. Although studies have indicated that ABIs can be effective with adults in primary care settings, relatively little is known about their use and value when implemented in settings such as social work and the community, and with young people (under the age of 16).
This study aims to explore the feasibility and acceptability of ABIs delivered to young people and in social work settings through two phases of research; the first mapping and scoping current projects across Scotland, and the second examining delivery in a series of case study projects, and developing proposals for a potential future outcome evaluation. A mixed methods approach is being used involving interviews with project staff and stakeholders and with users of the projects; field visits and observation; and analysis of project documentation and data.
The study is a collaborative project between ISM, Nursing, Midwifery and Health, and the Faculty of Social Sciences.
ISM Staff: Martine Stead, Douglas Eadie and Jennifer McKell, ISM; Dr Tessa Parkes and Avril Nicoll, NWH; Dr Sarah Wilson and Cheryl Burgess, SASS
Publications: Stead S, Parkes T, Nicoll A, Wilson S, Burgess C, Eadie D, Fitzgerald N, McKell J, Reid G, Jepson R, McAteer J and Bauld L (2017). Delivery of alcohol brief interventions in community-based youth work settings: exploring feasibility and acceptability in a qualitative study. BMC Public Health, 17: 357. doi: 10.1186/s12889-017-4256-1
Parkes T, Stead M, Eadie D, Nicoll A, McKell J, Bauld L, Wilson S, Burgess C, Reid G, McAteer J and Jepson R (2013). Alcohol brief interventions in youth and social work settings in Scotland. Addiction Science and Clinical Practice, 8(Suppl 1): A52.
Alcohol Policy Interventions in Scotland and England (APISE) (2012-2015) (Funded by National Prevention Research Initiative (NPRI))
The Alcohol Policy Interventions in Scotland and England study (APISE) was part of a multi-country collaborative project (the International Alcohol Control Policy Evaluation Study) to assess the impact and effectiveness of alcohol control policies. The study design was modelled on the International Tobacco Control study. Longitudinal surveys of drinkers in participating countries, together with the analysis of the policy context, allowed for assessment of change over time within countries and comparison between countries. Funding was secured from the National Prevention Research Initiative (NPRI) to enable collection of baseline data in Scotland and England and a follow-up 12 months later. Three linked stages of research included an audit of alcohol control strategies in each country, exploratory research with adult drinkers and a longitudinal survey.
The baseline survey, conducted 2012/2013, recruited a cohort of 1,749 adult drinkers in England and 1,728 in Scotland. The cohort was followed up 12 months later. The survey was conducted using Computer Assisted Telephone Interviews (CATI) and collected comprehensive consumption data, using a framework that is beverage and location specific, to facilitate identification of impacts of policy change. Policy related measures are measures that are closely linked to a specific policy and therefore expected to be directly affected by the introduction of a particular policy. A range of policy-related measures were included in the study including, for example, affordability which is a key measure in relation to the introduction of Minimum Unit Pricing (MUP). APISE had an international dimension through collaboration with colleagues in New Zealand, Australia, USA, Thailand and South Korea who undertook analogous studies in their countries.
The study was led by researchers at the University of Stirling and was conducted in collaboration with the University of Sheffield, The Open University and the University of Wollongong.
ISM Staff: Gerard Hastings, Anne Marie MacKintosh and Douglas Eadie
Casswell S, Meier P, MacKintosh AM, Brown A, Hastings G, Thamarangsi T, Chaiyasong S, Chun S, Huckle T, Wall M and You RQ (2012). The International Alcohol Control (IAC) Study- Evaluating the impact of alcohol policies. Alcoholism: Clinical and Experimental Research, 36(8): 1462-1467.
Huckle T, Casswell S, MacKintosh AM, Chaiyasong S, Cuong PV, Morojele N, Parry CDH, Meier P, Holmes J, Callinan S, Piazza M, Kazantseva E, Bayandorj T, Gray-Phillip G and Haliday S (2018). The International Alcohol Control Study: Methodology and implementation. Drug and Alcohol Review, 37(S2): S10-S17. https://doi.org/10.1111/dar.12650.
Cuong PV, Casswell S, Parker K, Callinan S, Chaiyasong S, Kazantseva E, Meier P, MacKintosh AM, Piazza M, Gray-Phillip G and Parry CDH (2018). Cross-country comparison of proportion of alcohol consumed in harmful drinking occasions using the International Alcohol Control Study. Drug and Alcohol Review, 37(S2): S45-S52. https://doi.org/10.1111/dar.12665.
Casswell S, Morojele N, Williams PP, Chaiyasong S, Gordon R, Gray-Phillip G, Cuong PV, MacKintosh AM, Halliday S, Railton R, Randerson S and Parry CDH (2018). The Alcohol Environment Protocol: A new tool for alcohol policy. Drug and Alcohol Review, 37(S2): S18-S26. https://doi.org/10.1111/dar.12654.
Gray-Phillip G, Huckle T, Callinan S, Parry CDH, Chaiyasong S, Cuong PV, MacKintosh AM, Meier P, Kazantseva E, Piazza M, Parker K and Casswell S (2018). Availability of alcohol: Location, time and ease of purchase in high- and middle-income countries: Data from the International Alcohol Control study. Drug and Alcohol Review, 37(S2): S36-S44. https://doi.org/10.1111/dar.12693.
Chaiyasong S, Huckle T, Mackintosh AM, Meier P, Parry C, Callinan S, Pham C, Kazantseva E, Gray-Phillip G, Parker K and Casswell S (2018). Drinking patterns vary by gender, age and country-level income: Cross-country analysis of the International Alcohol Control Study. Drug and Alcohol Review, 37(S2): S53-S62. https://doi.org/10.1111/dar.12820.
Huckle T, Romeo JS, Wall M, Callinan S, Holmes J, Meier P, MacKintosh AM, Piazza M, Chaiyasong S, Cuong PV and Casswell S (2018) Socio-economic disadvantage is associated with heavier drinking in high but not middle-income countries participating in the International Alcohol Control Study. Drug and Alcohol Review, 37(S2): S63-S71. https://doi.org/10.1111/dar.12810.
Li J, Lovatt M, Eadie D, Dobbie F, Meier P, Holmes J, Hastings G and MacKintosh AM (2017). Public attitudes towards alcohol control policies in Scotland and England: Results from a mixed-methods study. Social Science and Medicine, 177: 177-189. https://doi.org/10.1016/j.socscimed.2017.01.037.
Research to Develop and Apply a Methodology for Retrospective Adjustment of Alcohol Consumption Trend Data (2012-2013) (Commissioned by the Department of Health, through the Public Health Research Consortium)
Changes over the past couple of decades in glass size and alcohol strength, particularly the trends towards larger measures and higher alcohol content, have made it difficult to obtain a clear picture of alcohol consumption over time, as the underlying assumptions and understanding regarding a standard drink or serving have not been consistent. In order for alcohol policy to be based on accurate consumption data, there is a need to develop and apply a robust methodology for retrospective adjustment of official trend data on alcohol consumption, to take account of changes in glass size and shape and alcohol strength over time. This scoping and feasibility study was commissioned by the Department of Health through the Public Health Research Consortium. Its objectives were to:
Review available research and other evidence to map key changes in alcohol strength, standard measures, glass size and shape over the period 1990-2012;
Interview key stakeholders to establish relevant assumptions and to inform the mapping exercise;
Develop a robust formula / formulae for use in retrospective adjustment of official data;
Apply the formula /formulae to official data on a selective basis;
Report the results and discuss implications for a full-scale study.
The mapping element of the study was conducted by ISM, while the formulae development was conducted by the National Centre for Social Research (NatCen). The mapping element sought to identify and map key changes in glass size, shape and drink strength (percentage of alcohol by volume) since 1990. Two methods were used, desk-based research involving searches of academic and trade periodicals and commercial market research sources, and interviews with key stakeholders. Overall, the findings indicate that the average strength of beer and wine has increased over the period, such that previous survey data on reported consumption of 'standard drinks' have under-estimated the actual amount of alcohol consumed by a considerable degree. Findings from the mapping informed the formula development strand of the work, which proposes conversion factors to make survey data from different years more comparable.
ISM Staff: Martine Stead, Kathryn Angus and Laura Macdonald
Publications: Stead M, Angus K, Macdonald L and Bauld L (2014). Looking into the glass: Glassware as an alcohol marketing tool, and the implications for policy. Alcohol and Alcoholism, online 9th January. doi:10.1093/alcalc/agt178.
Stead M, Bauld L, Angus K, Macdonald L, Munafò M, Attwood A, Ataya A, Fuller E, Pickering K (2013). Scoping and Feasibility Study to Develop and Apply a Methodology for Retrospective Adjustment of Alcohol Consumption Data. Final Report. London: Public Health Research Consortium; October.
Addictions and Lifestyles in Contemporary Europe - Reframing Addictions Project (ALICE RAP) (2011 - 2016) (Funded by the European Commission)
ALICE RAP aims to study and analyse the development and place of well-acknowledged and new addictions as a major societal trend in Europe in relation to governance and public policies and responses. The study involves 67 research institutions from 25 European countries covering the humanities, social sciences and biological and medical sciences. Its scientific objectives are:
To describe the ownership of addictions through a historical study of addiction over the ages, an analysis of public and private stakeholder views and through image analyses, of professional and citizenship views.
To study how addictions are classified and defined, followed by estimates of their health, social and economic impact.
To investigate determinants of addiction through a coordinated and cohesive social, economic and biological analysis of initiation, transition into problem use and transition into and out of dependence.
To analyse the business of addiction through studies of revenues, profits and participants in legal and illegal trade, the impact of suppliers on addictive substance use and behaviours, and analyses of webs of influence on policy responses.
To study addictions governance by describing the views and forces that determine the ways societies steer themselves and by stock-taking of present governance practices to old and emerging addictions.
To analyse youth as customers through considering the impacts of new technologies on promoting and mitigating use, by studying the interrelations of culture and biology, and by determining features that promote resilience and nudge young people to reduce problematic use.
ISM is contributing specifically to Objectives 1 and 4.
ISM Staff: Martine Stead, Kathryn Angus, Richard Purves, Gerard Hastings, Anne Marie MacKintosh and Crawford Moodie
Publications: Stead M, Dobbie F, Angus K, Purves RI, Reith G and Macdonald L (2016). The online bingo boom in the UK: A qualitative examination of its appeal. PLoS ONE, 11(5): e0154763. doi:10.1371/journal.pone.0154763
McLeod J, Gell L, Holmes J, Allamani A, Bjerge B, Bühringer G, Forberger S, Frank V, Lingford-Hughes A, Meier P, Neumann M, Room R, Baumberg B, Eiroa-Orosa FJ, Lees R, Meerkerk G-J, Schmidt L, Stead M, van de Mheen D, and Weirs R (2016). Determinants of risky substance use and risky gambling. Chapter 3 in: Gell L, Bühringer G, McLeod J, Forberger S, Holmes J, Lingford-Hughes A and Meier PS (eds), What Determines Harm from Addictive Substances and Behaviours? Oxford: Oxford University Press, pp35-76. ISBN: 9780198746683. doi:10.1093/acprof:oso/9780198746683.003.0003
Gell L, McLeod J, Holmes J, Allamani A, Baumberg B, Bjerge B, Bühringer G, Eiroa-Orosa J, Forberger S, Frank V, Lingford-Hughes A, Meerkerk G-J, Meier P, Neumann M, Room R, Schmidt L, Stead M, van de Mheen D, Weirs R, and Withington P (2016). Determinants of harmful substance use and gambling. Chapter 4 in: Gell L, Bühringer G, McLeod J, Forberger S, Holmes J, Lingford-Hughes A and Meier PS (eds), What Determines Harm from Addictive Substances and Behaviours? Oxford: Oxford University Press. ISBN: 9780198746683. doi:10.1093/acprof:oso/9780198746683.003.0004
McLeod J, Gell L, Holmes J, Allamani A, Baumberg B, Bjerge B, Bühringer G, Eiroa-Orosa FJ, Forberger S, Frank V, Lingford-Hughes A, Meerkerk GJ, Meier P, Neumann M, Room R, Schmidt L, Stead M, van de Mheen D, Wiers R and Withington P (2016). Determinants of transitions from harmful to low-risk substance use and gambling. Chapter 5 in: Gell L, Bühringer G, McLeod J, Forberger S, Holmes J, Lingford-Hughes A and Meier PS (eds), What Determines Harm from Addictive Substances and Behaviours? Oxford: Oxford University Press. ISBN: 9780198746683. doi:10.1093/acprof:oso/9780198746683.003.0005
Gell L, Bühringer G, Room R, Allamani A, Eiroa-Orosa FJ, Forberger S, Holmes J, Lingford-Hughes A, McLeod J, Meier PS and Stead M (2016). Discussion and Integration of Key Findings. Chapter 6 in: Gell L, Bühringer G, McLeod J, Forberger S, Holmes J, Lingford-Hughes A and Meier PS (eds), What Determines Harm from Addictive Substances and Behaviours? Oxford: Oxford University Press. ISBN: 9780198746683. doi:10.1093/acprof:oso/9780198746683.003.0006
Alcohol and Public Health Strategy (2011-2013) (Funded by Cancer Research UK, British Liver Trust, UKCTCS, Alcohol Focus Scotland, Nottingham University Hospital, Balance North East, Our Life, Alcohol Research UK and Breakthrough Breast Cancer)
This project involved the development of an alcohol and public health strategy independent from government and the alcohol industry. It was developed by a steering group of experts drawn from a range of sectors, chaired by Sir Ian Gilmore of the Alcohol Health Alliance, and supported by researchers from ISM and other Universities. The strategy was informed by reviews of relevant literature and a public opinion element.
An Evaluation to Assess the Implementation of NHS Delivered Alcohol Brief Interventions in Primary Care: Case Study Analysis (2010-2011) (Funded by NHS Health Scotland and carried out in collaboration with Nursing and Midwifery, University of Stirling, and the School of Business, University of Dundee)
Alcohol Brief Interventions (ABIs) are short evidence-based, structured conversations that focus on changing drinking behaviour. In support of the SIGN Guideline 74 that ABIs should be delivered to harmful and hazardous drinkers in Primary Care settings, Accident and Emergency Departments and Antenatal Care settings, the Scottish Government established a new health improvement target for NHS health boards (H4: HEAT target - Health Improvement, Efficiency, Access and Treatment) to deliver 149,449 ABIs between April 2008 and March 2011 in these settings.
Commissioned by NHS Health Scotland, this project evaluated the implementation of ABIs in all three priority settings with a specific emphasis on primary care. Focusing on how screening and ABIs have been implemented, practitioners (n=35) and patients (n=25) were interviewed across eight practices and three health boards, representing a mixture of urban and rural, high and low socio-economic areas and high and low ABI recording rates. These data were supplemented by additional interviews with key informants in each case health board (n=21). Considering processes at both the individual and organisational level, and the level of overall adoption and reach, the findings will support improved delivery of ABIs when embedded into the mainstream delivery of the NHS.
ISM Staff: Douglas Eadie, Susan MacAskill, Stuart Bryce (left 2011) and Oona Brooks (left 2010)
Publication: Parkes T, Eadie D, Petrie D et al (2011). An evaluation to assess the implementation of NHS delivered alcohol brief interventions: Study summary. Drugs and Alcohol Findings. Posted 10th Dec 2012.
The Use of New Media in Alcohol Marketing (2010) (Commissioned by SHAAP (Scottish Health Action on Alcohol Problems))
In analysing the internal marketing documents from both alcoholic beverage producers and their advertising agencies for the Health Select Committee (see below), it was apparent that there has been a rapid growth in the use of new media (ie. digital forms of communication such as the internet, mobile devices, electronic games, blogs and podcasting) to market alcohol in recent years, yet this is an area which presents particular challenges to the current system of self-regulation. This report examines the use of new media to market leading alcohol brands in the UK using a case study approach.
ISM Staff: Oona Brooks (left 2010)
Report: Brooks O (2010). 'Routes to Magic' - The Alcoholic Beverage Industry’s Use of New Media in Alcohol Marketing. Stirling: Institute for Social Marketing.
Health Select Committee Alcohol Document Analysis (2009) (Commissioned by the Health Select Committee and the Alcohol Education and Research Council (AERC))
As part of its 2009 investigation into the conduct of the UK alcohol industry, the House of Commons Health Select Committee obtained access to internal marketing documents from both producers and their advertising agencies. These documents were then analysed by the Institute for Social Marketing.
These revealed major shortcomings in the current self-regulatory codes covering alcohol advertising. Specifically, the codes do not, as they are supposed to, protect young people from alcohol advertising; prevent the promotion of drunkenness and excess; or the linking of alcohol with social and sexual success. Nor do they even attempt to address sponsorship, and the documents show this is being systematically used to undermine rules prohibiting the linking of alcohol with youth culture and sporting prowess. Finally, the codes are extremely weak in their treatment of new media which are rapidly becoming the biggest channel for alcohol promotion. The result is a regulatory system that is impossible to police and vulnerable to exploitation.
ISM Staff:Gerard Hastings, Oona Brooks (left 2010), Kathryn Angus, Martine Stead, Thomas Anker (left) and Tom Farrell (Open University)
Report: Hastings G (2010). Memorandum by Professor Gerard Hastings - 'They'll drink bucket loads of the stuff'. An analysis of internal alcohol industry documents.Available here
Publication: Hastings G, Brooks O, Stead M, Angus K, Anker T and Farrell T (2010). Failure of self-regulation of UK alcohol advertising (Alcohol advertising: The last chance saloon). British Medical Journal, 340: 184-186. Online
Prison Health Needs Assessment for Alcohol Problems(2009-2010) (Commissioned by NHS Health Scotland)
Alcohol problems are a major and growing public health problem in Scotland with the relationship between alcohol and crime, in particular, violent crime, increasingly being recognised. This study was part of a wider Scottish Government funded alcohol research programme in criminal justice settings which also includes a pilot of the delivery of alcohol brief interventions and a scoping study of alcohol interventions in community justice settings. It was anticipated that the study findings would inform broader health service development such as the integration of prison health care into the NHS and the update of core alcohol treatment and support services. These developments were set within a policy and practice context which acknowledges alcohol problems in the population and increasingly so the alcohol problem in offenders, along with the importance of applying a person-centred, recovery orientated approach underpinned by the NHS commitment to quality of services.
The aim of this study was to undertake a needs assessment of alcohol problems experienced by prisoners and provide recommendations for service improvement including a model of care. Key elements included:
a rapid review of the relevant literature on effective interventions
a report on the epidemiology of alcohol problems experienced by prisoners in Scotland
an assessment of alcohol problems among offenders within an individual prison using the AUDIT screening tool
mapping current models of care in the Scottish Prison Service and the interface with community care models
exploration of attitudes towards the delivery and effectiveness of current alcohol interventions through qualitative interviews in a prison case study
a gap analysis between current service provision, best practice, effective interventions and national care standards for substance misuse.
The study involved both quantitative and qualitative information being gathered through primary data collection and document retrieval and analysis.
The final report was launched at the Alcohol and Offenders Event, Edinburgh, 8th February 2011. Tessa Parkes presentation from this event can be found here. Conference presentations and paper submissions are ongoing.
ISM Staff: Susan MacAskill, Douglas Eadie and Oona Brooks (left 2010)
Collaborators: Tessa Parkes (lead), Ruth Jepson, Iain Atherton, Lawrence Doi and Stephen McGhee, Nursing, Midwifery and Health, University of Stirling
A Review of the Evidence for Effective Alcohol Education for the UK(2009-2010) (Commissioned by the Alcohol Education and Research Council (AERC))
The Alcohol and Education Research Council, on behalf of Drinkaware, commissioned ISM to conduct a review of reviews of the international evidence base, with special reference to its applicability and relevance to the UK. ISM was asked to recommend and develop proposals for next steps to strengthen the research agenda and evidence base. ISM developed the design and research objectives for a systematic review of most promising approaches for alcohol education-based interventions, and a longitudinal study of a community and/or family + school-based intervention.
AERC Second Stage: A Systematic Investigation of Critical Elements for Optimum Effectiveness of Promising Approaches and Delivery Methods in School and Family Linked Alcohol Education
Building on the findings of the first stage scooping study, this project systematically reviewed the evidence base on interventions intended to reduce or prevent alcohol misuse amongst young people. The review identified and interrogated the evidence base over a ten year period. Thematic analysis, case study and process and impact evidence collation methods were used. Internal and external elements of intervention programmes most frequently associated with positive behavioural outcomes were reported and strategic implications for future development were identified.
ISM Staff: Georgina Cairns, Martine Stead, Kathryn Angus, Richard Purves, Jennifer McKell and Stuart Bryce (left 2011)
Publications: Cairns G, Purves R, Bryce S, McKell J, Gordon R and Angus K (2011). Investigating the Effectiveness of Education in Relation to Alcohol: A Systematic Investigation of Critical Elements for Optimum Effectiveness of Promising Approaches and Delivery Methods in School and Family Linked Alcohol Education. Stirling: Institute for Social Marketing.
Reducing the Damaging Effects of Alcohol: A Technical Assistance Project for the European Alcohol and Health Forum(2009-2012) (Commissioned by the European Commission (DG SANCO))
In many cultures, alcohol is used to facilitate social interactions and is seen to have many other benefits. However, alcohol consumption is also associated with a broad range of health and social problems with risky drinking patterns becoming progressively more embedded in European cultures. In many member states of the EU such as France , Italy and Spain although alcohol consumption is falling there is increasing evidence of binge drinking and associated harms. In some states such as the UK overall consumption has risen by up to 20% in the last 20 years alongside a change in drinking patterns. In Sweden and the UK, drinking at the weekends in binge sessions has become the dominant alcohol consumption trend. These patterns are becoming more common in Spain whereas previously drinking was traditionally spread out over the week and involved smaller quantities per drinking episode.
Combating the damaging effects of alcohol is a public health priority in many of the Member States and at EU level. Notwithstanding the considerable health consequences of excessive alcohol consumption, there are a number of other associated harms including; lost productivity, violence, hooliganism, crime, family problems, social exclusion, problems at work and drink-driving. A review of the total tangible cost of alcohol to EU society conducted in 2003 estimated this to be €125bn (€79bn-€220bn), which is equivalent to 1.3% GDP. The intangible costs caused by indirect criminal, social and health harms caused by alcohol were estimated to be €270bn in the same review, although other reviews s produced estimates between €150bn and €760bn.
Therefore policy initiatives are required to reduce the damaging effect of alcohol in each of these areas. With its Communication of 24 October 2006 (COM (2006) 625 final), the Commission adopted a European Union strategy to help the Member States reduce the damaging effects of alcohol. Consequently, there is a need to better understand, report and evaluate the impact of policy and strategy designed to minimising the harm associated with alcohol.
ISM provides research-led technical assistance to The European Alcohol and Health Forum. The Forum is a multi-stakeholder collaboration convened and managed by the European Union Directorate-General for Health and Consumer Affairs (DG SANCO). The Forum meets regularly to review evidence for the causes and effects of alcohol misuses and to explore opportunities, policy, activities and their effectiveness in reducing alcohol-related social and health harms.
ISM provides scientific reports and briefings on various topics. During the first 18 months of this four-year project, this has included mapping reports on European social marketing interventions to reduce alcohol-related harms, European alcohol prevention and reduction interventions for young people and European self-regulation of alcohol marketing; a review of the European evidence base for effective alcohol education interventions; building a database of good practice for youth-targeted projects to reduce alcohol misuse.
ISM Staff: Georgina Cairns, Kathryn Angus, Ross Gordon (now based at the University of Wollongong), Laura Macdonald, Douglas Eadie and Richard Purves
Learning About Alcohol: Influences of the Family Context(2008-2010) (Commissioned by the Joseph Rowntree Foundation)
Understanding how drinking habits are learned is central to developing effective means of shifting problematic drinking patterns and cultures. Family settings are increasingly recognised as important initial reference points of individuals' socialisation and exposure to alcohol. Consequently, there is a need to examine the way alcohol is handled in a range of ‘normal' family settings and how this influences children. This study, which is funded by the Joseph Rowntree Foundation, aims to identify influences on how young children aged 7-12 years learn about alcohol and to examine differences by socio-economic status, age, family structure, geographical locality and parental drinking behaviour. The study employs qualitative modes of enquiry, combining two primary data collection methods: focus groups with children and parents to explore of social interaction within the family and beyond, norms and values re. drinking, and response to policy and practice interventions; and family case studies using in-depth interviews with children, parents and significant others to analyse influences within the family network and home context.
Report and summary available from Joseph Rowntree Foundation website
ISM Staff:Douglas Eadie, Susan MacAskill and Oona Brooks (left 2010)