Liquidity and Validity.

Challenges in measuring alcohol consumption at a population and individual level.

Dr Jan GillSchool of health and Social Care

Wednesday 5th October 2016

• Cost estimated at £ 3.56 billion (£900.00 per adult) using 2007/08 data.

• (Scottish Government. The societal cost of alcohol misuse in Scotland for 2007.• Online: Scottish Government; 2010. Available at:• http://www.gov.scot/Publications/2009/12/29122804/0.)

• Or £7.5 billion with 40% of the costs being linked to the most deprived 20% of the population.

• Johnson, M.C., Ludbrook, A., Jaffray, A. (2012) Inequalities in the distribution of the costs of alcohol misuse in Scotland: a cost of illness study. Alcohol and Alcoholism, 47(6), 725-731.

Impact of alcohol consumption on Scottish society

Source: http://www.healthscotland.com/uploads/documents/27345-00.%20Alcohol%20consumption%20and%20price%20in%20Scotland%202015%20-%20May2016.pdf

Responses- Scotland’s Alcohol StrategyLicensing (Scotland) Act 2005- Implemented 2009 Test purchasing Ban on irresponsible promotions in on-trade Restrictions on place of display in off trade Plus other measuresFramework for Action 2009• ABIs in NHS• Initiatives in alcohol and care services etcAlcohol etc. (Scotland) Act 2010 – implemented 2011• Ban on quantity discounts in off-sales• Restrictions on alcohol display and promotion in off sales• Mandatory Challenge 25 age verification policy• etcAlcohol (Minimum Pricing) (Scotland) Act 2012• Minimum unit price for alcohol sold in licensed premises

Specific Challenges for Public Health messages.

• Terminology employed.• Public awareness/understanding of

that terminology.

country Grams of pure ethanol

UK 8 = 1 UK Unit

Australia 10

Canada 13.6

Finland 12

France 10

Japan 19.75

Netherlands 9.9

United States 14

Standard Drink Definitions

UKHealth Guidelines

No-one can say that drinking alcohol is absolutely safe.

Men and women are advised not to regularly drink more than 14 units a week.

Spread your drinking over three days or more if you drink as much as 14 units a week.

Additionally within the UK• Hazardous drinking• Harmful drinking• Binge drinking• Those drinking above weekly guidelines but have not yet

experienced alcohol-related harm are regarded as hazardous, (increasing) risk of harm in the future.

• > 50 units of alcohol per day in men and 35 units in women is regarded as ‘definitely harmful’ (Royal College of Psychiatrists,1986).

• Those drinking more than eight units per day in men and six units in women are regarded by the Government as binge drinkers (Prime Minister‘s Strategy Unit, 2004).

Student definitions of Binge drinking• ‘Enough to make you violently ill’• ‘Depends on who you are how you would define binge

drinking’• ‘As many drinks as it takes to get you drunk’• ‘being drunk to the state where you’re having to kind of get

carried’• ‘hammered’

(Gill et al (2007) Health Education Research 22, 27-36)

Women’s (n=181) self-reported consumption in the index week expressed in multiples of the UK definition of harmful consumption (35 UK units per week).

SELF REPORT SURVEYS HAVE INHERENT PROBLEMS –BOTH IN REACHING A REPRESENTATIVE SAMPLE OF ALL DRINKERS AND IN MEASURING CONSUMPTION

Challenges for population surveys.

Scottish Health Survey (2015) Sales records (Mesas,2015)0

5

10

15

20

25

Estimation of consumption by Scottish Adults (2014 data)

UK

uni

ts/w

eek

Source: http://www.healthscotland.com/uploads/documents/27345-00.%20Alcohol%20consumption%20and%20price%20in%20Scotland%202015%20-%20May2016.pdf

Most reliable measure may be…………..

Source: Beeston C, McAdams R, Craig N, Gordon R, Graham L, MacPherson M, McAuley A, McCartney G, Robinson M, Shipton D, Van Heelsum A. Monitoring and Evaluating Scotland’s Alcohol Strategy. Final Report. Edinburgh: NHS Health Scotland; 2016

Source: Beeston C, McAdams R, Craig N, Gordon R, Graham L, MacPherson M, McAuley A, McCartney G, Robinson M, Shipton D, Van Heelsum A. Monitoring and Evaluating Scotland’s Alcohol Strategy. Final Report. Edinburgh: NHS Health Scotland; 2016

Mean = 229.8 UK units (95%CI= 216.5-243.1)N=458

Mean =179.2 UK units(95%CI= 161.4-197.1)N=181

SALES DATA information

Henderson et al (2015) Alcohol and Alcoholism DOI: http://dx.doi.org/10.1093/alcalc/agv109

Estimated size of biases linked to per adult consumption extrapolated from sales data (Scotland).

Implications for retrospective analysis• Whitehall II cohort study of civil servants. Data from 1997-

1999. n=7010. Took account of larger serving of wine and use of 175 ml glass in pubs.

• Traced deaths from all causes until June 2015.• Hazard Ratios estimated.

Britton, A O’Neill D and Bell,S. (2016) Underestimating the alcohol content of a glass of wine: the implications for estimates of mortality risk. Alcohol & Alcoholism doi: 10.1093/alcalc/agw027

From Britton et al (2016) Alc and Alcoholism doi: 10.1093/alcalc/agw027

Assuming 1 glass= 1 unitAssuming 175 ml glass = 2 units

From Britton et al (2016) Alc and Alcoholism doi: 10.1093/alcalc/agw027

Assuming higher wine alcohol content• Proportion of men and women within heavy/very heavy

category increased.• HR ratios reduced. (46% reduction in risk)• ? Overestimation of health risks associated with very

heavy drinking (>35/50 units) compared with moderate (14/21 units).

• ? partially due to increase in proportion of very heavy drinkers with good diet, physically active, higher SES.

In conclusion• Different population groups pose different challenges

when attempting to monitor accurately their alcohol consumption.

• Retrospective analysis of longitudinal data must be preceded by consideration of the precise wording, and consistency, of consumption questions employed at different time-points.

• THANK YOU