Evidence into action: implementing alcohol screening and brief interventions in the UK Armed Forces

2020 ◽  
Vol 166 (3) ◽  
pp. 187-192 ◽  
Author(s):  
Mark Andrew Dermont ◽  
P Field ◽  
J Shepherd ◽  
R Rushton
Keyword(s):  
Public Health ◽  
Alcohol Use ◽  
Armed Forces ◽  
Alcohol Screening ◽  
Public Health Approach ◽  
Service Personnel ◽  
Increased Risk ◽  
The Uk ◽  
Alcohol Related Harm ◽  
Related Harm

IntroductionAlcohol-related harm continues to represent a major public health problem and previous evidence suggests that alcohol misuse within the UK Armed Forces is higher than in the general population. The aim was to introduce a population-level primary care intervention with an existing evidence base to identify and support Service Personnel whose drinking places them at greater risk of harm.ImplementationFollowing successful piloting, the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) brief screening tool was introduced as part of routine dental inspections by Defence Primary Healthcare (DPHC) dentists. Alcohol brief intervention (ABI) advice and signposting to support services was offered to personnel identified as being at increased risk and recorded in the patient’s electronic health record.Achievements to datePatients attending DPHC Dental Centres are now routinely offered AUDIT-C with 74% (109 459) personnel screened in the first 12 months rising to over 276 000 at 24 months, representing the single largest use of AUDIT-C and ABIs in a military population to date.DiscussionIntroduction of AUDIT-C has seen Defence successfully deliver a whole population alcohol initiative, overcoming implementation barriers to demonstrate the flexibility of a dental workforce to deliver a public health intervention at scale and contributing towards promoting positive attitudes towards alcohol use. The initiative represents a first step towards the goal of a standardised alcohol screening and treatment pathway across DPHC while recognising that the Defence Medical Services are only one aspect of the broader public health approach required to tackle alcohol-related harm in Service Personnel.

scholarly journals Exploring the use of workplaces to recruit “hard-to-reach” male drinkers to a survey on alcohol use and awareness of health messages

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sarah Dance ◽  
Charlotte Dack ◽  
Celia Lasheras ◽  
Cathy McMahon ◽  
Paul Scott ◽  
...  
Keyword(s):  
Public Health ◽  
Alcohol Use ◽  
Financial Incentive ◽  
Health Messages ◽  
Heavy Episodic Drinking ◽  
Future Research ◽  
Recruitment Strategies ◽  
Public Health Messages ◽  
Alcohol Related Harm ◽  
Related Harm

Abstract Background Lower socioeconomic status (SES) groups, particularly lower SES males, are at greater risk of alcohol-related harm than higher SES groups, despite drinking at the same level or less. However, they are rarely recruited for research through typical recruitment strategies. Consequently, limited evidence exists on patterns of alcohol use and effectiveness of public health messages for these groups. Using workplaces to recruit male drinkers from lower SES backgrounds may provide a feasible and accessible approach to research participation and enable improved understanding of alcohol use, drinking motives and acceptance of alcohol-related public health messages in this underrepresented and high-risk group. We investigated workplace-based strategies to recruit male drinkers from lower SES backgrounds. We also investigated their experiences and motivations for alcohol use, and acceptance of alcohol-related public health messages. Methods A feasibility element investigated the effectiveness of workplace-based strategies to recruit male drinkers from lower SES backgrounds in the south west of England. A pilot element investigated this population’s experiences and motivations for alcohol use, and acceptance of alcohol-related public health messages, through a mixed-methods survey. Results Feasibility results indicated that workplace-based recruitment strategies, including recruiting participants in person at their workplace and providing a financial incentive, effectively led to the recruitment of 84 male drinkers (70% recruitment rate), predominately from lower SES backgrounds, to a survey. Pilot results indicated that more than half of participants were at increasing risk of alcohol-related harm, and approximately one fifth engaged in weekly heavy episodic drinking. Participation in campaigns aimed at reducing alcohol use, and knowledge of government alcohol consumption guidelines, were low. Participants reported negative beliefs about alcohol including health effects, dependency and excess use, and financial and occupational effects. Positive beliefs about alcohol included relaxation, socialising, and enjoyment. Conclusions Workplace-based recruitment, using in-person recruitment and a financial incentive, may be a feasible strategy to recruit male drinkers from lower SES backgrounds. Pilot results may direct larger scale research aiming to understand alcohol use in this population and inform targeted public health messages. Workplace-based recruitment may represent a promising avenue for future research aiming to tackle inequalities in participation in alcohol research.

scholarly journals Alcohol use and alcohol-related harm in rural and remote communities: protocol for a scoping review

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e036753
Author(s):  
Erik Loewen Friesen ◽  
Paul Kurdyak
Keyword(s):  
Public Health ◽  
Alcohol Use ◽  
Scoping Review ◽  
Emergency Department Visits ◽  
Health Concern ◽  
Rural And Remote ◽  
Remote Communities ◽  
Scoping Reviews ◽  
Alcohol Related Harm ◽  
Related Harm

IntroductionAlcohol-related harm is a major public health concern and appears to be particularly problematic in rural and remote communities. Evidence from several countries has shown that the prevalence of harmful alcohol use and alcohol-attributable hospitalisations and emergency department visits are higher in rural and remote communities than in urban centres. The extents of this rural–urban disparity in alcohol-related harm as well as the factors that mediate it are poorly understood. The objective of this scoping review is to synthesise the international research on the factors that influence the prevalence or risk of alcohol-related harm in rural and remote communities. This will help to clarify the conceptual landscape of rural and remote alcohol research and identify the gaps in knowledge that need to be addressed.Methods and analysisThis scoping review will access published literature through search strategies developed for Medline, PsycINFO, Embase, CINAHL and Sociological Abstracts. There will be no date, country or language restrictions placed on the search. Title and abstract, followed by full-text screening, will be conducted by two independent reviewers to evaluate all identified articles against a set of prespecified inclusion and exclusion criteria. Data from selected articles will be extracted and compiled into a final manuscript that adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist guidelines.Ethics and disseminationThe results of this review will be helpful in guiding future research on rural and remote alcohol use and alcohol-related harm, which will inform more effective, evidence-based public health strategies to reduce alcohol-related harm in rural and remote communities. The results will be disseminated via field-specific conference presentations and peer-reviewed publication.

scholarly journals House-edge information and a volatility warning reduce gambling initiation and persistence: superior alternatives to return-to-player percentages

2021 ◽  
Author(s):  
Philip Warren Stirling Newall ◽  
Christopher Byrne ◽  
Alex M T Russell ◽  
Matthew Rockloff
Keyword(s):  
Public Health ◽  
Public Health Intervention ◽  
Public Health Approach ◽  
Edge Information ◽  
Average Percentage ◽  
Electronic Gambling Machines ◽  
Long Run ◽  
Electronic Gambling ◽  
The Uk ◽  
Related Harm

Cost-of-play information is one public health intervention recommended to help reduce gambling-related harm. In the UK, this information is given on electronic gambling machines in a format known as the “return-to-player”, e.g., “This game has an average percentage payout of 90%.” However, previous evidence suggests that this information could be improved by equivalently restating it in terms of the “house-edge”, e.g., “This game keeps 10% of all money bet.” A “volatility warning,” stating that this information applies only in the statistical long-run, has also been recommended to help gamblers understand cost-of-play information. However, there is no evidence comparing these information provisions’ effect on gamblers’ behavior. An experiment tested US gamblers’(N=2,433) incentivized behavior in an online slot machine, where this information was manipulated between-participants along with a counter showing the total amount bet. Preregistered analyses showed that participants gambled significantly less when house-edge information or a volatility warning were shown compared to standard return-to-player information, with no effect of the total amount bet counter, and no significant interaction effects. These results suggest that improved cost-of-play information could benefit a public health approach to gambling.

scholarly journals Overt acts of perceived discrimination reported by British working-age adults with and without disability

2019 ◽  
Author(s):  
Eric Emerson ◽  
Allison Milner ◽  
Zoe Aitken ◽  
Lauren Krnjacki ◽  
Cathy Vaughan ◽  
...  
Keyword(s):  
Public Health ◽  
Negative Impact ◽  
Policy Research ◽  
Secondary Analysis ◽  
People With Disabilities ◽  
Public Health Problem ◽  
Health Staff ◽  
Cross Sectional ◽  
Increased Risk ◽  
The Uk

Abstract Background Exposure to discrimination can have a negative impact on health. There is little robust evidence on the prevalence of exposure of people with disabilities to discrimination, the sources and nature of discrimination they face, and the personal and contextual factors associated with increased risk of exposure. Methods Secondary analysis of de-identified cross-sectional data from the three waves of the UK’s ‘Life Opportunities Survey’. Results In the UK (i) adults with disabilities were over three times more likely than their peers to be exposed to discrimination, (ii) the two most common sources of discrimination were strangers in the street and health staff and (iii) discrimination was more likely to be reported by participants who were younger, more highly educated, who were unemployed or economically inactive, who reported financial stress or material hardship and who had impairments associated with hearing, memory/speaking, dexterity, behavioural/mental health, intellectual/learning difficulties and breathing. Conclusions Discrimination faced by people with disabilities is an under-recognised public health problem that is likely to contribute to disability-based health inequities. Public health policy, research and practice needs to concentrate efforts on developing programs that reduce discrimination experienced by people with disabilities.

Reflex syncope in the UK Armed Forces

2021 ◽  
pp. bmjmilitary-2021-001945
Author(s):  
Iain Parsons ◽  
J Ellwood ◽  
M J Stacey ◽  
N Gall ◽  
M Grundy-Bowers ◽  
...  
Keyword(s):  
Medical Information ◽  
Armed Forces ◽  
Well Being ◽  
British Army ◽  
Royal Air Force ◽  
Reflex Syncope ◽  
Increased Risk ◽  
Case Rate ◽  
The Uk ◽  
The Military

IntroductionReflex syncope is the most common subtype of syncope and, despite not being associated with increased mortality, often results in significant morbidity and costly diagnostics. Reflex syncope can be of concern for certain occupational groups and may be exacerbated by some occupations. Reflex syncope in the military is anecdotally common but the extent in the UK Armed Forces (UKAF) is unknown. The aim of this study was to assess the incidence and prevalence of reflex syncope in the UKAF.MethodsA retrospective search of the Defence Medical Information Capability Programme using prespecified read-codes was performed at defence primary healthcare centres over the period of 1 January 2019 to 1 January 2020. Data were obtained on 76 103 service personnel (SP) (53% of the UKAF).ResultsThe overall syncope case rate for the UKAF was 10.5 per 1000 person-years (p-yrs). In comparing services there was a significantly increased risk of syncope in the British Army (10.7 per 1000 p-yrs) compared with the Royal Air Force (8.6 per 1000 p-yrs) (p=0.0365), SP who served overseas (16.7 per 1000 p-yrs) in comparison with UK medical centres (10.3 per 1000 p-yrs) (p<0.0001), and British Army units that regularly took part in State Ceremonial and Public Duties (15.8 per 1000 p-yrs vs 10.2 per 1000 p-yrs) (p=0.0035). Army training units conferred a significantly reduced risk of syncope (p<0.0001).ConclusionsThese data are the first to define the incidence and prevalence of syncope in the UKAF. Orthostasis and heat are probable triggers, although recruits are potentially protected. These data offer opportunities to improve the health and well-being of SP, with economic, logistical and reputational benefits for the UKAF. Further research to identify personnel at risk of future syncopal events may allow for targeted use of countermeasures.

Prevention and Criminal Justice

2020 ◽  
pp. 201-220
Author(s):  
Paul Cairney ◽  
Emily St Denny
Keyword(s):  
Public Health ◽  
Criminal Justice ◽  
Social Policy ◽  
Criminal Justice Policy ◽  
Public Health Approach ◽  
Window Of Opportunity ◽  
Target Populations ◽  
Policy Shift ◽  
The Uk

First, we describe the general issues that governments face when pursuing social and criminal justice policies in a multi-centric environment. Both governments manage the same tensions between relatively punitive and individual versus supportive and population-wide measures to reduce crime, as part of an overall cross-cutting focus on prevention and early intervention. Second, we identify the historic policymaking strategies that UK governments have used to combine social policy and criminal justice policy, often with reference to target populations who—according to several UK ministers—do not pay their fair share to society and do not deserve state help. Third, we show how such trends influence preventive policies in specific areas such as drugs policy, in which the UK still reserves responsibility for drugs classification. Fourth, we use this UK context to identify the extent to which Scottish policy has a greater emphasis of social over criminal justice. To do so, we use the case study of a window of opportunity for a public health approach to serious violence. We focus on Scotland as the relatively innovative government on this issue, to provide context for initial analysis of the UK government’s proposed policy shift.

scholarly journals A qualitative account of young people’s experiences of alcohol screening and brief interventions in schools: SIPS Jr-HIGH trial findings

2019 ◽  
Vol 42 (3) ◽  
pp. e259-e267
Author(s):  
E L Giles ◽  
G J McGeechan ◽  
S J Scott ◽  
R McGovern ◽  
S Boniface ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Young People ◽  
Western Europe ◽  
Controlled Trial ◽  
Alcohol Screening ◽  
Screening And Brief Intervention ◽  
The United Kingdom ◽  
Analysis Process ◽  
Potential Impact ◽  
The Uk

Abstract Background The United Kingdom (UK) has seen a decrease in the number of young people drinking alcohol. However, the UK prevalence of underage drinking still ranks amongst the highest in Western Europe. Whilst there is a wealth of evidence reporting on the effectiveness of both primary, and secondary interventions, there are few reports of the experiences of young people who receive them. Methods The present study reports findings from interviews with 33 young people who were involved in an alcohol screening and brief intervention randomized controlled trial in schools in England. All interviews were analysed using inductive applied thematic analysis. Results Three major themes were identified following the analysis process: 1) drinking identities and awareness of risk; 2) access to support and advice in relation to alcohol use; and 3) appraisal of the intervention and potential impact on alcohol use. Conclusions There appeared to be a reluctance from participants to describe themselves as someone who drinks alcohol. Furthermore, those who did drink alcohol often did so with parental permission. There was variation amongst participants as to how comfortable they felt talking about alcohol issues with school staff. Overall participants felt the intervention was useful, but would be better suited to ‘heavier’ drinkers.

scholarly journals Self-harm and attempted suicide among UK Armed Forces personnel: Results of a cross-sectional survey

2011 ◽  
Vol 58 (4) ◽  
pp. 433-439 ◽  
Author(s):  
Richard J. Pinder ◽  
Amy C. Iversen ◽  
Nav Kapur ◽  
Simon Wessely ◽  
Nicola T. Fear
Keyword(s):  
Attempted Suicide ◽  
Armed Forces ◽  
Psychological Morbidity ◽  
Lifetime Prevalence ◽  
Health Study ◽  
Post Traumatic Stress ◽  
Military Health ◽  
Service Personnel ◽  
Self Harm ◽  
The Uk

Aims: Little has been reported on self-harm among the UK Armed Forces, partly due to the difficulties in recording self-harm, within an often-difficult-to-reach population. This study assesses the lifetime prevalence of attempted suicide and self-harm within currently serving and ex-service personnel of the UK Armed Forces. Methods: Telephone interviews were conducted with 821 personnel who had previously participated in the King’s Centre for Military Health Research military health study. Within the telephone interview, participants were asked about attempted suicide and episodes of self-harm. Results: A lifetime prevalence of 5.6% for intentional self-harm (self-harm or attempted suicide) was reported. Intentional self-harm was associated with psychological morbidity (in particular, post-traumatic stress disorder) and adverse experiences in childhood. Ex-service personnel reported lifetime prevalence more than double that of serving personnel (10.5% vs 4.2%, respectively). Participants reporting intentional self-harm were younger (34.4 years vs 39.8 years). Conclusion: A lifetime prevalence of 5.6% for attempted suicide and self-harm is higher than previous research has suggested. Younger service personnel, those who have experienced adversity in childhood, those with other psychological morbidity, and ex-service personnel are more likely to report self-harm behaviours.

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