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Alcohol Toolkit Study (ATS)

 

ATS Logo
Principal InvestigatorProfessor Susan Michie (UCL),
Professor Jamie Brown (UCL)
Co-Investigator Professor Robert West (UCL),
Dr Lion Shahab (UCL),
Professor Matthew Hickman (University of Bristol),
Dr Frank de Vocht (University of Bristol),
Dr John Holmes (University of Sheffield),
Mr Colin Angus (University of Sheffield),
Dr Penny Buykx (University of Sheffield),
Dr Duncan Gillespie (University of Sheffield),
Professor Alan Brennan (University of Sheffield),
Professor Eileen Kaner (University of Newcastle),
Dr Amy O’Donnell (University of Newcastle),
Dr Ruth McGovern (University of Newcastle)
Additional UCL team membersDr Emma Beard
Project start and end dates May 2017 - October 2018
FunderNIHR School for Public Health Research 
Project websitehttp://www.alcoholinengland.info/

Project aims

The overarching objective was to advance understanding of the population-level context of alcohol use and policy. We achieved this objective by extending the ATS to collect data on a variety of contextual variables for a further 18 months including beverage type and expenditure, exposure to brief intervention, attempts and motivation to reduce consumption, and use of aids and motives.

 

Project details

BACKGROUND
A detailed monthly national survey is needed to understand population-wide influences on alcohol use, and to inform and evaluate policies aimed at reducing alcohol-related harm. The Alcohol Toolkit Study (ATS), established by funding from the school in 2014, is a monthly household survey of the adult population in England. It collected comprehensive information across 36 consecutive months from over 60,000 people on alcohol consumption and harm (AUDIT), which was contextualised by data on a range of alcohol-related behaviour and social background. The project was a collaborative effort between four SPHR members involving 26 contributors from the SPHR collaboration, Public Health England (PHE), Department of Health and other collaborating institutions. See www.alcoholinengland.info. Our original project funded by the school produced successes (e.g., engagement with PHE, impactful publications and symposia, and further funding from NIHR). On this basis, we obtained a substantial investment from CRUK to fund the most expensive feature of the survey – detailed questions about alcohol consumption - for a further five years until 2022. To build our understanding of the population context of alcohol use, we sought an additional 18-months of school investment to continue the collection and analysis of all the other measures.

RESULTS
We found that:

  1. The way health professionals currently provide brief advice on smoking and drinking in primary care in England may be helping to reduce socioeconomic inequalities in health (1)
  2. Education and a measure of ‘social grade’ based on jobs appear to be the best socioeconomic predictors of alcohol consumption indices in England, followed closely by housing tenure. Employment status and car ownership are the least helpful (2)
  3. Between 2014 and 2016, changes in the percentage of people smoking in England followed similar changes in the percentage of people who are at high-risk from their drinking (4)
  4. Higher-risk drinkers in England who report greater motivation to reduce their consumption are more likely to report making an attempt to reduce in the next 6 months but this may not be associated with a reduction in alcohol consumption (5)
  5. Adults in England with probable alcohol dependence report more motivation to quit drinking and greater use of specialist treatment and self-help support than other drinkers. However, the majority still do not access treatment resources to support their attempts (6)
  6. Most adults in England agree that health care providers should routinely ask about alcohol consumption. However, older adults and those in lower socio-economic groups are less supportive. Drinking status appears to have limited impact on whether people believe that alcohol is a personal matter and not something health care providers should ask about (7)
  7. Following the publication of revised drinking guideline in January 2016, there was a brief increase in the proportion of drinkers who reporting seeing the guidelines but self-reported capabilities and opportunities to drink within the guidelines appeared to reduce (8).

CONCLUSIONS & IMPLICATIONS
The wide variety of questions on alcohol use and key-related behaviours has resulted in several important findings which have implications for policy and identify ways in which high-risk alcohol consumption may be reduced. In the future, a large investment from the new UK Prevention Research Partnership has funded the expansion of the ATS to Scotland and Wales and will allow us to evaluate natural experiments created by differences in policies and approaches across devolved nations.

 

Next steps

In the future, a large investment from the new UK Prevention Research Partnership has funded the expansion of the ATS to Scotland and Wales and will allow us to evaluate natural experiments created by differences in policies and approaches across devolved nations.

 

Publications

1. Angus C, Brown J, Beard E, Gillespie D, Buykx P, Kaner E, Michie S, Meier P (2019) Brief interventions as a tool for addressing health inequalities: Socioeconomic variations in delivery of brief interventions for smoking and drinking in primary care in England. BMJ Open, 9, e023448. doi: 10.1136/bmjopen-2018-023448

2. Beard, E. V., Brown, J., West, R., Kaner, E., Meier, P., & Michie, S. (2019). Associations between socio-economic factors and alcohol consumption: a population survey of adults in England. PLOS ONE, 4;14(2):e0209442. doi: 10.1371/journal.pone.0209442

3. Beard E, Marsden J, Brown J, Tombor I, Stapleton J, Michie S, West R (2019) Understanding and using time series analyses in addiction research. Addiction, https://doi.org/10.1111/add.14643.
 
4. Beard, E., West, R., Michie, S., and Brown, J. (2017) Association between smoking and alcohol-related behaviours: a time–series analysis of population trends in England. Addiction, 112: 1832–1841. doi: 10.1111/add.13887.

5. De vocht et al (2018). Association of motivation to reduce alcohol consumption with self-reported attempts to reduce alcohol consumption and change in alcohol consumption in high-risk drinkers: a prospective population survey. Addiction, 113: 817– 827. doi: 10.1111/add.14132.
 
6. Dunne, J., Kimergård, A., Brown, J., Beard, E., Buykx, P., Michie, S., & Drummond, C. (2018). Attempts to reduce alcohol intake and treatment needs among people with probable alcohol dependence in England: a general population survey. Addiction, 113: 1430– 1438. https://doi.org/10.1111/add.14221.
 
7. O'Donnell, A., Abidi, L., Brown, J., Karlsson, N., Nilsen, P., Roback, K., Skagerström J, & Thomas, K. (2018). Beliefs and attitudes about addressing alcohol consumption in health care: a population survey in England. BMC public health, 18 (1), 391. doi:10.1186/s12889-018-5275-2

8. Stevely A, Buykx P, Brown J, Beard E, Michie S, Meier P, Holmes J (2018) Exposure to revised drinking guidelines and 'COM-B' determinants of behaviour change: Descriptive analysis of a monthly cross-sectional survey in England. BMC Public Health, 18, 1-9. doi:10.1186/s12889-018-5129-y.