These are publications in academic journals relating to the Alcohol Toolkit Study. 

Publications

Association between smoking and alcohol-related behaviours: A time-series analysis of population trends in England

published May 2017 in Addiction (Abingdon, England)
PMID: 28556467 Beard E1,2, West R1, Michie S3, Brown J2,3.

AIMS:

This paper estimates how far monthly changes in prevalence of cigarette smoking, motivation to quit and attempts to stop smoking have been associated with changes in prevalence of high-risk drinking, and motivation and attempts to reduce alcohol consumption in England.

DESIGN:

Data were used from the Alcohol and Smoking Toolkit Studies between April 2014 and June 2016. These involve monthly household face-to-face surveys of representative samples of ~1700 adults in England.

MEASUREMENTS:

ARIMAX modelling was used to assess the association over time between monthly prevalence of a) smoking and high-risk drinking; b) high motivation to quit smoking and high motivation to reduce alcohol consumption; and c) attempts to quit smoking and attempts to reduce alcohol consumption.

FINDINGS:

Mean smoking prevalence over the study period was 18.6% and high-risk drinking prevalence was 13.0%. A decrease of 1% of the series mean smoking prevalence was associated with a reduction of 0.19% of the mean prevalence of high-risk drinking (95%CI 0.03 to 0.34, p = 0.017. A statistically significant association was not found between prevalence of high motivation to quit smoking and high motivation to reduce alcohol consumption (β 0.324 95%CI -0.371 to 1.019, p = 0.360) or prevalence of attempts to quit smoking and attempts to reduce alcohol consumption (β -0.026 95%CI -1.348 to 1.296, p = 0.969).

CONCLUSION:

Between 2014 and 2016, monthly changes in prevalence of smoking in England were positively associated with prevalence of high-risk drinking. There was no significant association between motivation to stop and motivation to reduce alcohol consumption, or attempts to quit smoking and attempts to reduce alcohol consumption.

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Predictors of and reasons for attempts to reduce alcohol intake: A population survey of adults in England

published March 2017 in PloS one [12(3):e0173458]
PMID: 28278218 Beard E1,2, Brown J1,2, Kaner E3, West R2, Michie S1.

OBJECTIVE:

This study aimed to assess the predictors among high-risk drinkers in England of attempts to reduce alcohol consumption, the reasons given for these attempts and the association between the various reasons and alcohol consumption.

METHOD:

Data came from 2,800 high-risk drinkers taking part in the Alcohol Toolkit Study (ATS) between March 2014 and November 2016 who were attempting to reduce their alcohol consumption. Participants completed the Alcohol Use Disorders Identification Test (AUDIT) and were asked questions regarding their socio-demographic characteristics, attempts to cut down and reasons for doing so.

RESULTS:

Those cutting down were significantly older (OR 1.01, p<0.001), were more likely to be female (OR 1.32, p<0.05), had higher AUDIT-C scores (OR 1.12, p<0. 001), were less likely to be of white ethnicity (OR 0.64, p<0. 001), and were more likely to reside in the South of England (OR 1.34, p<0. 001). They were also more likely to be of higher occupationally-based social-grades (p<0. 001). The main reported reasons for reducing consumption were: fitness (22.5%), weight loss (20.4%), future health (20.4%), advice from a health-care professional (7.9%) and cost (7.6%). Those reporting the followings reasons for cutting down had higher AUDIT-C scores than those who did not report these reasons: a concern about further health problems (β 0.20, p<0.05), advice from a doctor/health worker (β 0.38, p<0.05), that drinking was too expensive (β 0.42, p<0.01) and detoxification (β 0.42, p<0.01). Lower AUDIT-C scores were noted among those who reported that they knew someone who was cutting down (β -0.67, p<0.05), that there was no reason (β -0.36, p<0.05), or they didn't know why they were cutting down (β -0.25, p<0.05).

CONCLUSIONS:

Around a fifth of high-risk drinkers in England report trying to reduce their drinking, particularly older, high-socioeconomic female drinkers from the south of England. Attempts to cut down appear to be driven by a desire to improve health, advice from others and cutting down on the cost of drinking.

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Healthier central England or North-South divide? Analysis of national survey data on smoking and high-risk drinking

published March 2017 in BMJ open [7(3):e014210]
PMID: 28249851 Beard E1,2, Brown J1,2, West R2, Angus C3, Kaner E4, Michie S1.

OBJECTIVES:

This paper compares patterns of smoking and high-risk alcohol use across regions in England, and assesses the impact on these of adjusting for sociodemographic characteristics.

DESIGN:

Population survey of 53 922 adults in England aged 16+ taking part in the Alcohol and Smoking Toolkit Studies.

MEASURES:

Participants answered questions regarding their socioeconomic status (SES), gender, age, ethnicity, Government Office Region, smoking status and completed the Alcohol Use Disorders Identification Test (AUDIT). High-risk drinkers were defined as those with a score of 8 or more (7 or more for women) on the AUDIT.

RESULTS:

In unadjusted analyses, relative to the South West, those in the North of England were more likely to smoke, while those from the East of England, South East and London were less likely. After adjustment for sociodemographics, smoking prevalence was no higher in North East (RR 0.97, p>0.05), North West (RR 0.98, p>0.05) or Yorkshire and the Humber (RR 1.03, p>0.05) but was less common in the East and West Midlands (RR 0.86, p<0.001; RR 0.91, p<0.05), East of England (RR 0.86, p<0.001), South East (RR 0.92, p<0.05) and London (RR 0.85, p<0.001). High-risk drinking was more common in the North but was less common in the Midlands, London and East of England. Adjustment for sociodemographics had little effect. There was a higher prevalence in the North East (RR 1.67, p<0.001), North West (RR 1.42, p<0.001) and Yorkshire and the Humber (RR 1.35, p<0.001); lower prevalence in the East Midlands (RR 0.69, p<0.001), West Midlands (RR 0.77, p<0.001), East of England (RR 0.72, p<0.001) and London (RR 0.71, p<0.001); and a similar prevalence in the South East (RR 1.10, p>0.05) CONCLUSIONS: In adjusted analyses, smoking and high-risk drinking appear less common in 'central England' than in the rest of the country. Regional differences in smoking, but not those in high-risk drinking, appear to be explained to some extent by sociodemographic disparities.

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Short-term effects of announcing revised lower risk national drinking guidelines on related awareness and knowledge: a trend analysis of monthly survey data in England

published December 2016 in BMJ open [6(12):e013804]
PMID: 27909041 Holmes J1,2, Brown J2,3,4, Meier P1,2, Beard E2,3,4, Michie S2,3, Buykx P1,2.

OBJECTIVES:

To evaluate short-term effects of publishing revised lower risk national drinking guidelines on related awareness and knowledge. To examine where drinkers heard about guidelines over the same period.

DESIGN:

Trend analysis of the Alcohol Toolkit Study, a monthly repeat cross-sectional national survey.

SETTING:

England, November 2015 to May 2016.

PARTICIPANTS:

A total of 11 845 adults (18+) living in private households in England.

INTERVENTION:

Publication of revised national drinking guidelines in January 2016 which reduced the male guideline by approximately one-third to 14 units per week.

MEASUREMENTS:

Whether drinkers (1) had heard of drinking guidelines (awareness), (2) stated the guideline was above, exactly or below 14 units (knowledge) and (3) reported seeing the stated guideline number of units in the last month in each of 11 locations (exposure). Sociodemographics: sex, age (18-34, 35-64, 65+), social grade (AB, C1C2, DE). Alcohol consumption derived from graduated frequency questions: low risk (<14 units/week), increasing/high risk (14+ units/week).

RESULTS:

Following publication of the guidelines, the proportion of drinkers aware of guidelines did not increase from its baseline level of 85.1% (CI 82.7% to 87.1%). However, the proportion of male drinkers saying the guideline was 14 units or less increased from 22.6% (CI 18.9% to 26.7%) in December to 43.3% (CI 38.9% to 47.8%) in January and was at 35.6% (CI 31.6% to 39.9%) in May. Last month exposure to the guidelines was below 25% in all locations except television/radio where exposure increased from 33% (CI 28.8% to 36.2%) in December to 65% (CI 61.2% to 68.3%) in January. Awareness and knowledge of guidelines was lowest in social grade DE and this gap remained after publication.

CONCLUSIONS:

Publication of new or revised lower risk drinking guidelines can improve drinkers' knowledge of these guidelines within all sociodemographic groups; however, in the absence of sustained promotional activity, positive effects may not be maintained and social inequalities in awareness and knowledge of guidelines are likely to persist.

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Use of aids for smoking cessation and alcohol reduction: A population survey of adults in England

published December 2016 in BMC public health [16(1):1237]
PMID: 27931202 Beard E1,2, Brown J3,4, Michie S3, Kaner E5, Meier P6, West R4.

BACKGROUND:

It is important for policy planning to chart the methods smokers and high-risk drinkers use to help them change their behaviour. This study assessed prevalence of use, and characteristics of users, of support for smoking cessation and alcohol reduction in England.

METHODS:

Data were used from the Smoking and Alcohol Toolkit Studies, which involve monthly face-to-face computer-assisted interviews of adults aged 16+ in England. We included data collected between June 2014 and July 2015 on 1600 smokers who had made at least one quit attempt and 911 high-risk drinkers (defined as scores >8+ on the full AUDIT or 5+ on questions 1-3 of the AUDIT-C) who had made an attempt to cut down in the past 12 months. Participants provided information on their socio-demographic characteristics and use of aids during their most recent quit attempt including pharmacotherapy, face-to-face counselling, telephone support, self-help materials (digital and printed), and complementary medicine.

RESULTS:

A total of 60.3% of smokers used aids in the past year, compared with just 14.9% of high-risk drinkers. Use of pharmacotherapy was high among smokers and very low among drinkers (56.0%versus1.2%). Use of other aids was low for both behaviours: face-to-face counselling (2.6%versus4.8%), self-help materials (1.4%versus4.1%) and complementary medicine (1.0%versus0.5%). Use of aids was more common among smokers aged 25-54 compared with 16-24 year olds (25-34,ORadj1.49,p = 0.012; 35-44,ORadj1.93,p < 0.001; 35-44,ORadj1.93,p < 0.001; 45-54,ORadj1.66,p = 0.008), with cigarette consumption >10 relative to <1 (10-20,ORadj2.47,p = 0.011; >20,ORadj4.23,p = 0.001), and less common among ethnic minorities (ORadj0.69,p = 0.026). For alcohol reduction, use of aids was higher among ethnic minority groups (ORadj2.41;p = 0.015), and those of social-grade D/E relative to AB (ORadj2.29,p = 0.012&ORadj3.13,p < 0.001).

CONCLUSION:

In England, the use of pharmacotherapy is prevalent for smoking cessation but not alcohol reduction. Other aids are used at a low rate, with face-to-face counselling being more common for alcohol reduction than smoking cessation.

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Deconstructing the Alcohol Harm Paradox: A Population Based Survey of Adults in England

published September 2016 in PloS one [11(9):e0160666]
PMID: 27682619 Beard E1,2, Brown J1,2, West R2, Angus C3, Brennan A3, Holmes J3, Kaner E4, Meier P3, Michie S1.

BACKGROUND:

The Alcohol Harm Paradox refers to observations that lower socioeconomic status (SES) groups consume less alcohol but experience more alcohol-related problems. However, SES is a complex concept and its observed relationship to social problems often depends on how it is measured and the demographic groups studied. Thus this study assessed socioeconomic patterning of alcohol consumption and related harm using multiple measures of SES and examined moderation of this patterning by gender and age.

METHOD:

Data were used from the Alcohol Toolkit Study between March and September 2015 on 31,878 adults (16+) living in England. Participants completed the AUDIT which includes alcohol consumption, harm and dependence modules. SES was measured via qualifications, employment, home and car ownership, income and social-grade, plus a composite of these measures. The composite score was coded such that higher scores reflected greater social-disadvantage.

RESULTS:

We observed the Alcohol Harm Paradox for the composite SES measure, with a linear negative relationship between SES and AUDIT-Consumption scores (β = -0.036, p<0.001) and a positive relationship between lower SES and AUDIT-Harm (β = 0.022, p<0.001) and AUDIT-Dependence (β = 0.024, p<0.001) scores. Individual measures of SES displayed different, and non-linear, relationships with AUDIT modules. For example, social-grade and income had a u-shaped relationship with AUDIT-Consumption scores while education had an inverse u-shaped relationship. Almost all measures displayed an exponential relationship with AUDIT-Dependence and AUDIT-Harm scores. We identified moderating effects from age and gender, with AUDIT-Dependence scores increasing more steeply with lower SES in men and both AUDIT-Harm and AUDIT-Dependence scores increasing more steeply with lower SES in younger age groups.

CONCLUSION:

Different SES measures appear to influence whether the Alcohol Harm Paradox is observed as a linear trend across SES groups or a phenomenon associated particularly with the most disadvantaged. The paradox also appears more concentrated in men and younger age groups.

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Temporal patterns of alcohol consumption and attempts to reduce alcohol intake in England

published September 2016 in BMC public health [16:917]
PMID: 27585991 de Vocht F1,2, Brown J3,4, Beard E3,4, Angus C3,5, Brennan A3,5, Michie S3,4, Campbell R3,6, Hickman M3,6.

BACKGROUND:

The Alcohol Toolkit Study (ATS) is a monthly survey of approximately 1700 adults per month aged 16 years of age or more in England. We aimed to explore patterns of alcohol consumption and motivation to reduce alcohol use in England throughout the year.

METHODS:

Data from 38,372 participants who answered questions about alcohol consumption (March 2014 to January 2016) were analysed using weighted regression using the R survey package. Questions assessed alcohol consumption (AUDIT-C) and attempts to reduce consumption.

RESULTS:

Sixty-seven percent of participants reported using alcohol, with a small negative trend of about 2 % reduction over 12 months in the studied period (P < 0.01). These include ~25 % higher risk drinkers and ~10 % regular binge drinkers. About 20 % of higher risk drinkers indicated they were attempting to reduce their alcohol consumption. Attempts were lowest in December (-20 %; 95 % CI 0-35 %), but increases significantly in January (+41 %; 95 % CI 16-73 %) compared with other months (P < 0.001), indicating a small net gain; at least in attempts to reduce. However, there was no evidence that the increased motivation in January was accompanied by a reported decrease in consumption or binge drinking events. This could be an artefact of the use of AUDIT questions, but could also reflect a disconnect between attempting to reduce alcohol consumption and subsequent change; maybe as a result of lack of continuing support.

CONCLUSIONS:

January is associated with moderate increased attempts to reduce alcohol consumption. However, we find little evidence of a change in alcohol consumption. In part, this may be due to temporal insensitivity of the AUDIT questions.

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Are recent attempts to quit smoking associated with reduced drinking in England? A cross-sectional population survey

published July 2016 in BMC public health [16:535]
PMID: 27443348 Brown J1,2,3, West R4,5,6, Beard E7,4, Brennan A5,8, Drummond C9, Gillespie D5,8, Hickman M10, Holmes J5,8, Kaner E11, Michie S7,5,6.

BACKGROUND:

Alcohol consumption during attempts at smoking cessation can provoke relapse and so smokers are often advised to restrict their alcohol consumption during this time. This study assessed at a population-level whether smokers having recently initiated an attempt to stop smoking are more likely than other smokers to report i) lower alcohol consumption and ii) trying to reduce their alcohol consumption.

METHOD:

Cross-sectional household surveys of 6287 last-year smokers who also completed the Alcohol Use Disorders Identification Test consumption questionnaire (AUDIT-C). Respondents who reported attempting to quit smoking in the last week were compared with those who did not. Those with AUDIT-C≥5 were also asked if they were currently trying to reduce the amount of alcohol they consume.

RESULTS:

After adjustment for socio-demographic characteristics and current smoking status, smokers who reported a quit attempt within the last week had lower AUDIT-C scores compared with those who did not report an attempt in the last week (βadj = -0.56, 95 % CI = -1.08 to -0.04) and were less likely to be classified as higher risk (AUDIT-C≥5: ORadj = 0.57, 95 % CI = 0.38 to 0.85). The lower AUDIT-C scores appeared to be a result of lower scores on the frequency of 'binge' drinking item (βadj = -0.25, 95 % CI = -0.43 to -0.07), with those who reported a quit attempt within the last week compared with those who did not being less likely to binge drink at least weekly (ORadj = 0.54, 95 % CI = 0.29 to 0.999) and more likely to not binge drink at all (ORadj = 1.70, 95 % CI = 1.16 to 2.49). Among smokers with higher risk consumption (AUDIT-C≥5), those who reported an attempt to stop smoking within the last week compared with those who did not were more likely to report trying to reduce their alcohol consumption (ORadj = 2.98, 95 % CI = 1.48 to 6.01).

CONCLUSION:

Smokers who report starting a quit attempt in the last week also report lower alcohol consumption, including less frequent binge drinking, and appear more likely to report currently attempting to reduce their alcohol consumption compared with smokers who do not report a quit attempt in the last week.

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Comparison of brief interventions in primary care on smoking and excessive alcohol consumption: a population survey in England

published January 2016 in The British journal of general practice : the journal of the Royal College of General Practitioners [66(642):e1-9]
PMID: 26719481 Brown J1, West R1, Angus C2, Beard E3, Brennan A2, Drummond C4, Hickman M5, Holmes J2, Kaner E6, Michie S3.

BACKGROUND:

Brief interventions have a modest but meaningful effect on promoting smoking cessation and reducing excessive alcohol consumption. Guidelines recommend offering such advice opportunistically and regularly but incentives vary between the two behaviours.

AIM:

To use representative data from the perspective of patients to compare the prevalence and characteristics of people who smoke or drink excessively and who receive a brief intervention.

DESIGN AND SETTING:

Data was from a representative sample of 15 252 adults from household surveys in England.

METHOD:

Recall of brief interventions on smoking and alcohol use, sociodemographic information, and smoking and alcohol consumption patterns were assessed among smokers and those who drink excessively (AUDIT score of ≥8), who visited their GP surgery in the previous year.

RESULTS:

Of 1775 smokers, 50.4% recalled receiving brief advice on smoking in the previous year. Smokers receiving advice compared with those who did not were more likely to be older (odds ratio [OR] 17-year increments 1.19, 95% confidence interval [CI] =1.06 to 1.34), female (OR 1.35, 95% CI =1.10 to 1.65), have a disability (OR 1.44, 95% CI = 1.11 to 1.88), have made more quit attempts in the previous year (compared with no attempts: one attempt, OR 1.65, 95% CI = 1.32 to 2.08; ≥2 attempts, OR 2.02, 95% CI =1.49 to 2.74), and have greater nicotine dependence (OR 1.17, 95% CI =1.05 to 1.31) but were less likely to have no post-16 qualifications (OR 0.81, 95% CI = 0.66 to 1.00). Of 1110 people drinking excessively, 6.5% recalled receiving advice in their GP surgery on their alcohol consumption in the previous year. Those receiving advice compared with those who did not had higher AUDIT scores (OR 1.17, 95% CI =1.12 to 1.23) and were less likely to be female (OR 0.44, 95% CI = 0.23 to 0.87).

CONCLUSION:

Whereas approximately half of smokers in England visiting their GP in the past year report having received advice on cessation, <10% of those who drink excessively report having received advice on their alcohol consumption.

© British Journal of General Practice 2016.

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Protocol for a national monthly survey of alcohol use in England with 6-month follow-up: 'The Alcohol Toolkit Study'

published March 2015 in BMC public health [15:230]
PMID: 25884652 Beard E1,2, Brown J3,4, West R5, Acton C6, Brennan A7, Drummond C8, Hickman M9, Holmes J10, Kaner E11, Lock K12, Walmsley M13, Michie S14.

BACKGROUND:

Timely tracking of national patterns of alcohol consumption is needed to inform and evaluate strategies and policies aimed at reducing alcohol-related harm. Between 2014 until at least 2017, the Alcohol Toolkit Study (ATS) will provide such tracking data and link these with policy changes and campaigns. By virtue of its connection with the 'Smoking Toolkit Study' (STS), links will also be examined between alcohol and smoking-related behaviour.

METHODS/DESIGN:

The ATS consists of cross-sectional household, computer-assisted interviews of representative samples of adults in England aged 16+. Each month a new sample of approximately 1800 adults complete the survey (~n = 21,600 per year). All respondents who consent to be followed-up are asked to complete a telephone survey 6 months later. The ATS has been funded to collect at least 36 waves of baseline and 6-month follow-up data across a period of 3 years. Questions cover alcohol consumption and related harm (AUDIT), socio-demographic characteristics, attempts to reduce or cease consumption and factors associated with this, and exposure to health professional advice on alcohol. The ATS complements the STS, which has been tracking key performance indicators relating to smoking since 2006. As both the ATS and STS involve the same respondents, it is possible to assess interactions between changes in alcohol and tobacco use. Data analysis will involve: 1) Descriptive and exploratory analyses undertaken according to a pre-defined set of principles while allowing scope for pursuing lines of enquiry that arise from prior analyses; 2) Hypothesis testing according to pre-specified, published analysis plans. Descriptive data on important trends will be published monthly on a dedicated website: www.alcoholinengland.info .

DISCUSSION:

The Alcohol Toolkit Study will improve understanding of population level factors influencing alcohol consumption and be an important resource for policy evaluation and planning.

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