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July 2020

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Editorial – July 2020

In this edition:

  • Super Saturday night’s alright for drinking – UK Government declares pubs open for business again while research uncovers worrying levels of home drinking since March

  • Local spending cuts a potential driver of alcohol-related hospital admissions

  • On-screen alcohol leaves lasting impression – study of Britain’s most popular homegrown TV soaps find alcohol playing a starring role 🎵 Podcast feature 🎵

  • A review of the first Early Career Alcohol Research Symposium conference from Ines Henriques-Cadby

  • Government promises addiction strategy – which will include alcohol

  • Alcohol calorie labelling in Obesity Strategy – Department of Health and Social Care promise a consultation over the display of ‘liquid calories’ on beverages by the year’s end

  • Licensing laws relaxed in Northern Ireland – Stormont Assembly agrees to abolish Easter opening hours restrictions – but consultation on minimum unit pricing appears on the horizon

We hope you enjoy our roundup of stories below: please feel free to share. Thank you.

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Super Saturday night’s alright for drinking

Billed as ‘Super Saturday’, 04 July 2020 marked the official day in which hospitality sector providers reopened their doors for business. For those eager to resume their usual socialising habits from the pre-pandemic days, this meant a return to licensed venues, especially pubs. Industry-funded regulator Portman Group warned people to drink responsibly (Night Time Industries Association, 03 Jul), anticipating the increasing opportunities for people to socialise and meet up in larger groups. However, despite a situation still far from ‘business as usual’, several areas were full with crowds of people by Saturday midnight.

With greater numbers of people socialising under the influence of alcohol during the course of the evening, it became obvious that government-enforced social distancing rules were not being followed. Chair of the Police Federation in England and Wales, John Apter, tweeted after his late night shift in Southampton at 2:07am:

The government also came under fire for initial plans to allow bars and pubs to sell alcohol off-premises: Speaking to The Telegraph (14 Jul), former Home Secretary Lord Blunkett said that whilst he was ‘totally in favour of kick-starting elements of the economy that have been so badly damaged by the lockdown’, giving permission for licensed premises to sell takeaway alcohol would ‘fuel the already worrying concerns about activity late at night, particularly in the major cities’.

And as lockdown eases further, the damaging effects of combining social distancing with alcohol-fuelled socialising have become clear. For example, after the weekend, several pubs, including The Ravensdale in Mansfield, were forced to close due to ‘irresponsible behaviour’, potentially caused by the large gatherings of drinkers in and around the pub itself (Nottingham Post, 04 Jul).

Moreover, as the government announced the following Monday that British tourists would be able to visit certain European countries without a compulsory fortnight’s quarantine upon returning, concerns arose over the drunken antics of British tourists at Magaluf, a popular holiday destination in Mallorca, Spain, just a few days later. Local residents reported ‘chaos’ to social media channels, some posting videos of tourists with ‘no face masks on, jumping on top of cars, drunk, drinking alcohol in the street’ (VICE UK, 14 Jul). Some local authorities reported experiencing similar problems even before the government eased lockdown measures: the day before the hospitality sector was due to reopen, Hackney Council announced a temporary ban on alcohol at London Fields due to ‘weeks of unacceptably high levels of litter, public urination and defecation and disturbance to local people’ (Hackney Gazette, 03 Jul). Meanwhile, polling data suggested that the government’s decision to permit the reopening of pubs and bars was not driven by public demand. A YouGov poll surveying 2,879 British adults on the same Monday after reopening found that just 5% had visited a pub the weekend of ‘Super Saturday’. The pollsters also found that most people were prepared to wait until later this year to revisit their local drinking establishment: 42% of 1,618 adults predicted that they would do so compared with just 3% who were planned on doing so on the day of its official reopening. Nonetheless, the government has pressed on with extending alcohol licensing provisions in the Business and Planning Act 2020 so pubs can purchase a pavement licence for eating and drinking on the public highway (Harpers, 22 Jul). Licences will last until September 2021.

The effects of lockdown drinking reverberate

Meanwhile, the lockdown has led to an ‘unprecedented surge’ in alcohol problems according to a One Poll survey commissioned by Help4Addiction, with four in ten British households, 53% of women and 71% of those made redundant admitting to drinking more than before (Daily Mail, 19 Jul). Experts believe that parents’ drinking to cope with the stresses of childcare and home-schooling since March are amongst the reasons for this. Nick Conn of Help4Addiction said of the ‘unprecedented surge’ in calls to their helpline:

I have never seen anything like this. Anyone that was in early recovery we seemed to find was relapsing and anyone that was in addiction was getting worse. We are expecting another surge of calls when people go back to work because at that point they’ll realise they have a problem. They may not be aware of the consequences at this stage. They’ll want to stop but can’t.

New Public Health England (PHE) data suggests a similar outlook: Since lockdown began, the estimated number of drinkers consuming more than 50 units of alcohol a week in England (harmful levels) has ‘soared’ by a third (to 5% of adults), and of the 500,000 drinkers who increased their intake to this extent, women and those in their 30s and 40s are most affected (Daily Mail, 26 Jul). Furthermore, the notion that the lockdown has been a stress-induced experience that people use alcohol to navigate it is supported by an Alcohol Change UK-commissioned Opinium survey (03 Jul), which found that:

  • More than a quarter of people think they have drunk more during lockdown
  • Heavier drinkers were more likely to drink more in lockdown: 38% of those who typically drank heavily on pre-lockdown drinking days (seven plus units) said they drank more during lockdown
  • One in five has drunk as a response to stress or anxiety.
  • Parents of under 18s were more likely to say that they had done so (30%) than non-parents (17%) and parents of adult children (11%). Of those who drank more heavily during lockdown (nine plus units on each drinking day), 40% had drunk as a response to stress or anxiety.

These findings add to a growing body of research about a unique period in the nation’s history, much of which has been documented in our briefing, Alcohol consumption during the COVID-19 lockdown in the UK, which has so far found that survey data points to roughly equal proportions of people cutting down and increasing their alcohol intake. But for heavy drinkers likely to do the latter, public health experts urge the government to support alcohol treatment services in order to reverse the potential tide of harm. Consultant psychiatrist and addictions specialist at King’s College London Dr Tony Rao, who analysed the PHE data for the Daily Mail, warned of the major impact that the surge in drinking will have on the health of the nation for years to come. He said: ‘Covid-19 has shone a light on the burning deck of the growing burden of alcohol problems in our society. We have been waiting for a proper alcohol strategy since 2012. This is today’s problem – not tomorrow’s.’ Institute of Alcohol Studies Chief Executive Dr Katherine Severi, also stressed the importance of making sure that preventing alcohol harm is a priority for the national COVID-19 recovery plan, ‘to ease the burden on our health and social care services and improve the health of the nation’.

 

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On-screen alcohol leaves lasting impression (and other research)

🎵 Podcast feature 🎵

Some of the nation’s most popular soap operas (such as EastEnders, Coronation Street and Emmerdale) constitute a potential driver for alcohol consumption in young people, according to an article published in the Oxford Journal of Public Health (01 Jul).

A study led by Dr Alex Barker at the University of Nottingham concluded that alcohol content before the television watershed is so common that it exposes audiences to billions of viewer impressions. Alcohol impressions were identified in 83 out of 88 episodes (95% of the time).

Beer and cider were the main types of alcohol consumed (46% of the time), as well as 53% of those consuming alcohol being women. In addition, where alcohol appearances were implicit, it was identified that actors were seen either holding a drink, or through alcohol branding (through labels on bottles in the backgrounds) displayed on set.

This implies that alcohol appearances in television are not only potential stimuli for increasing alcohol consumption at home, but also provide a means of normalising such behaviours, since soap operas often reflect the lives of British families. Young people and children are particularly susceptible, since many soap operas with alcohol branding are also broadcast before the 9pm watershed period, thus providing a significant impression of alcohol to millions.

In other research 

A poll held by pricing comparison site Confused.com has shown that a large number of drivers share potentially dangerous views on drink-driving that could have been acted upon during the lockdown. Their survey suggests that a third (33%) of drinking pub goers plan to drive, a quarter (24%) of drivers admit driving after a drink because they don’t ‘feel drunk’, and one in twenty (5%) believe it was fine to drive over the limit when the roads were quieter during the lockdown.

Car insurance expert Alex Kindred said (you can listen to the full statement in the podcast) that drivers ‘need to clue up on the drink drive laws, as there is a steep price to pay when putting yourself and others at risk.’

A systematic review of evidence on the impact of graphic warning labels for alcohol and food products found that health warning labels reduced selection of labelled products by 26% (Health Psychology Review, 02 Jul). However, the authors cautioned against drawing conclusions on the available data as all studies that looked at alcohol labels were conducted online or in laboratory settings. The research team called for further studies from real-world environments to improve knowledge about the impact of pictorial warning labels on drinking behaviours amongst the population. (IAS blog, 16 Jul).

Failure to promote the drinking guidelines may be reflected in their lack of effectiveness on consumption levels, according to the results of a paper conducted by researchers at the School of Health and Related Research (ScHARR) at the University of Sheffield. The team found that apart from a brief drop in consumption in the first few months, the current drinking guidelines – announced in January 2016 – did not appear to bring significant changes in alcohol consumption within the first eighteen months (BMJ JECH, 19 Jul). The team were wary of the fact that at the time, ‘there was no large-scale promotion of the revised guidelines beyond the initial media announcement’.

Alcohol contributed to a loss of 178,933 working years of life in 2018, 18% of total working years lost, and the highest level in seven years (Gov.uk, 17 Jul). Public Health England (PHE) estimate that a third of those years were lost among those aged 45-54 years (57,558). The top three causes of working years of life lost (WYLL) due to alcohol alone were liver disease (84.5%), accidental poisoning (44.5%) and intentional self-harm (32.8%). The figures also show disparities by socioeconomic status: the number of WYLL for those in the ‘most deprived’ decile was three times higher (34,697) than those in the ‘least deprived’ decile (8,748), and by sex: men lost almost three times more working years (131,403) than women (47,530). PHE aim to support the potential use of WYLL due to alcohol as a new indicator in Local Alcohol Profiles for England (LAPE).

The Health Research Board (HRB) (BMJ Open, 22 Jul) have found that many people with harmful and hazardous drinking behaviours in Ireland are underestimating how much they drink. Based on data from Ireland’s Drug Prevalence Study 2014/15, which interviewed a representative sample of the Irish population on how much they thought they drank, and whether they deemed themselves to be light, moderate or heavy drinkers, they found that only one in three people who binge-drink were aware of their drinking habits. In addition, women were less likely to report heavy-drinking behaviour (just one in 10) as opposed to men (one in five). 

This study comes as annual alcohol treatment data show a total of 7,546 treatment cases in 2019, a slight increase from 7,464 in 2018 (HRB, 28 Jul). These results indicate that many of those with heavy-drinking behaviour in Ireland may be unaware of the risks of doing so, which potentially endangers them since they are most at risk of harm due to alcohol. HRB interim chief executive Dr Mairead O’Driscoll affirmed that ‘further initiatives to reduce overall consumption and hazardous and harmful drinking patterns, and raise awareness around drinking patterns are required’.

UCL researchers come up with new iDEAS

The University College London Tobacco and Alcohol Research Group have launched a new trial offering digital support to help drinkers reduce their alcohol consumption (UCL, 24 Jul).

The iDEAS trial is seeking over 5,000 volunteers nationally to test two digital support tools for drinkers who want to cut down. Digital support tools for reducing alcohol intake, such as apps and websites, are thought to overcome some of the barriers encountered by traditional face-to-face support and may have potential for decreasing drinking. Research team member Dr Melissa Oldham says that iDEAS will ‘inform the recommendations we can make for alcohol reduction’ (full statement in the podcast), which with the apparent rise in drinking during the UK lockdown, makes the trial a timely one.

 

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#ECARS2020 conference

Coverage of the event from Ines Henriques-Cadby

In a time where research interactions have been constrained or halted, particularly for doctoral students and other early career researchers, the Sheffield Alcohol Research Group (SARG) launched its first Early Career Alcohol Research Symposium (ECARS). The symposium aimed to give early career researchers, from first year doctoral students to more experienced postdocs, a platform to network, share their work and experiences, and interact with colleagues at different career stages.

This year’s meeting took place online on 07 and 08 July, and included 16 research talks on four themes: Epidemiology and trends (featuring talks on inequalities in alcohol-related harm); Harmful drinking; Alcohol and cognitive processes; and Alcohol policy.

The meeting also included a career progression panel, which was extremely well-received by the delegates. The panel gave delegates an opportunity to ask questions and gather advice on career progression and opportunities. The panel itself featured four guests from a diverse range of backgrounds, disciplines and experiences: Dr Sadie Boniface (IAS), Dr Lucy Gavens (University of Sheffield), Dr Andy Jones (University of Liverpool), and Professor Dorothy Newbury-Birch (Teesside University).

The organisers of ECARS are Dr Ines Henriques-Cadby (an MRC Research Fellow with a Maths and Stats background), Dr Inge Kersbergen (an SSA Research Fellow with a quantitative psychology background), Ms Jane Hughes (a qualitative researcher in Public Health, with an economics background), and Professor John Holmes (the new director of SARG, with a background in Social policy). As a diverse team of researchers, they were eager to promote diversity and inclusivity in both speakers and delegates. The symposium counted 72 delegates, from 35 academic institutions (six international). As well as academic researchers, delegates came from public health teams in national government, local authorities, and health and prevention services, as well as UK-based charities such as the IAS, Alcohol Change UK (ACUK), and Have Your Tomorrows (HURT).

The feedback received from delegates was extremely positive and highlighted the need for an on-going platform to support interactions between ECRs, and more senior members of the alcohol research community, both within and outside of academia.

The organisers plan to make the symposium an annual event and planning for 2021 is already taking place. They also aim to facilitate the creation of an ECR mailing list that will allow dissemination of research and career opportunities and support networking amongst the next generation of alcohol researchers.

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Government promises addiction strategy

The Bury Times (16 Jul) reports that one of the region’s most prominent politicians – Christian Wakeford MP for Bury South – urged fellow ministers to ‘adopt a wide-ranging strategy’ to tackle alcohol addiction, drawing on the experience of how his family struggled to find help for his late older brother, who died five years ago.

Wakeford spoke in the House of Commons about how securing assistance for Mark Jones had been ‘a postcode lottery’. Leader of the House Jacob Rees-Mogg replied (you can hear his full response in the podcast):

The government are committed to tackling health harms from alcohol and supporting the most vulnerable to risk from alcohol misuse. We do aim to publish a new UK-wide cross-government addiction strategy that will include alcohol.

Wakeford’s appeal came the day after he attended an online event for parliamentarians hosted by the Alcohol Health Alliance UK, Healthy recovery: Alcohol harm, COVID-19, and your constituency.

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Alcohol calorie labelling in Obesity Strategy

Labelling alcoholic beverages with calorie information is potentially among ‘a raft of measures’ the UK Government is set to include as part of a new Obesity Strategy to get the nation fit and healthy (Department of Health and Social Care, 27 Jul).

The new campaign comes after a ‘COVID-19 wake-up call’ in which the impact of the virus revealed how excess weight puts people who contracted it at greater risk of serious illness or death.

The strategy’s plan to mandate the display of ‘liquid calories’ on alcoholic drinks will be put to a new consultation before the end of the year.

Alcohol consumption has been estimated to account for nearly 10% of the calorie intake of those who drink, with around 3.4 million adults consuming an additional days’ worth of calories each week – totalling an additional two months of food each year. But research shows the majority of the public (80%) is unaware of the calorie content of common drinks and many typically underestimate the true content. It is hoped alcohol labelling could lead to a reduction in consumption, improving people’s health and reducing their waistline.

Following the announcement, Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance UK said:

The government’s plans to consult on ending the current exemption for alcohol products from calorie labelling requirements are very welcome. When the calorie equivalent of a large glass of white wine is the same as a slice of pizza or a cocktail is the equivalent of a cheeseburger, it is clear why alcohol products should be included in the government’s plans to tackle the obesity crisis.

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Licensing laws relaxed in Northern Ireland

Stormont Assembly has approved plans to relax rules on the sale of alcohol, such as streamlining pub opening hours by removing Easter weekend restrictions (Northern Ireland Department for Communities, 16 Jul). Some of the other key changes include:

  • the introduction of an occasional additional late opening hour for certain licensed premises

  • the doubling of ‘drinking-up time’ after last orders, from 30 minutes to an hour

  • the alignment of the alcohol and entertainment licensing systems;
    changes relating to children on licensed premises

  • the prohibition of self-service and vending machines

  • formal approval for codes of practice on responsible retailing

  • changes to the law affecting private members clubs.

These changes come as Minister of Health in the Northern Ireland Assembly Robin Swann committed to holding ‘a full public consultation’ on introducing minimum unit pricing for alcohol (MUP) ‘within a year’, a move welcomed by Hospitality Ulster chief executive Colin Neill (Belfast Telegraph, 29 Jul), who said that he expected ‘the days of alcohol being sold at pocket money prices’ will come to an end under the legislation.

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In Memoriam: Roger Williams, ‘a true giant in the field of liver health’

Roger Williams

The public health world was saddened to learn of the passing of professor Roger Williams over the weekend of 26-27 July.

Professor Williams CBE FRCS FRCP FRCPE FRACP FMedSci (born 28 August 1931 – 25 July 2020) was a pioneer in many areas of hepatology, including the delivery of an integrated model of liver care and being a key part of the team that performed the first liver transplant in the UK at King’s College Hospital London in 1968.

His influence was also felt in liver disease research, publishing many of the key papers advancing care in liver disease, and founding institutes at King’s and University College London to further hepatology research.

He founded The Lancet commission on liver disease in 2013, in addition to the European Association for the Study of the Liver (EASL), on which he served as a chairman in 1983 and as honorary president in 2008.

In 1993 professor Williams was given an CBE for his services to medicine. He remained an active and passionate advocate for improvement in the care of patients with liver disease to the end of his life.

Tributes poured in from colleagues, acquaintances and fellow public health experts who worked with him over the years.

Richard Horton, editor of The Lancet, said: ‘Roger Williams. I miss this man. We didn’t agree about politics, but he was my friend, my mentor, and an inspiration. RIP Roger. I loved you.’

Prof Rajiv Jalan wrote: ‘it is with a very heavy heart that I share the terrible news that Prof Roger Williams died yesterday after battling with a cardiac event. A really sad day for Hepatology. Will miss his spirit...’

Professor of Hepatology at King’s, Michael Heneghan, concurred: ‘The passing of a giant. Roger Williams, The Father of Transplant Hepatology and a founding Father of Hepatology. Fondly Missed.’

‘Roger was a towering figure in British and indeed global hepatology’ wrote professor Steve Ryder, chair of the British Liver Trust medical advisory group.

Dr Alastair McKinlay’s tribute in the British Society of Gastroenterology noted not only that ‘the lives of many patients with liver disease were greatly improved by his work’, but also that Williams was an inspiration to ‘a huge cohort of hepatology trainees’ ensuring that his legacy will be felt across the world well beyond his death.

Commenting on his legacy, IAS chief Dr Katherine Severi said:

‘Professor Roger Williams was a true giant in the field of liver health, and demonstrated tremendous leadership in convening the Lancet Standing Commission on Liver Disease. Liver disease affects some of the most vulnerable members of our society and Roger used his indefatigable energies and powers of persuasion to raise awareness of its impact amongst UK policy makers, bringing an issue into the spotlight which for too long has been hidden behind closed doors.

‘Roger was an inspirational role model who proactively sought out opportunities to support early career researchers and build enthusiasm for change. It is a privilege to have been his colleague and I will miss him dearly. He leaves behind an exceptional legacy and an abundance of fond memories.’

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