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LIquidity and Validity - Jan Gill

Presented at Conference on Data in Health and Social Care

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LIquidity and Validity - Jan Gill

  1. 1. Liquidity and Validity. Challenges in measuring alcohol consumption at a population and individual level. Dr Jan Gill School of health and Social Care Wednesday 5th October 2016
  2. 2. • 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: • • 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
  3. 3. Source: 00.%20Alcohol%20consumption%20and%20price%20in%20Scotland%202015%20-%20May2016.pdf
  4. 4. Responses- Scotland’s Alcohol Strategy Licensing (Scotland) Act 2005- Implemented 2009  Test purchasing  Ban on irresponsible promotions in on-trade  Restrictions on place of display in off trade  Plus other measures Framework for Action 2009 • ABIs in NHS • Initiatives in alcohol and care services etc Alcohol 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 • etc Alcohol (Minimum Pricing) (Scotland) Act 2012 • Minimum unit price for alcohol sold in licensed premises
  5. 5. Specific Challenges for Public Health messages. • Terminology employed. • Public awareness/understanding of that terminology.
  6. 6. 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
  7. 7. UK Health Guidelines
  8. 8. 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.
  9. 9. 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).
  10. 10. 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)
  11. 11. 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).
  13. 13. 0 5 10 15 20 25 Scottish Health Survey (2015) Sales records (Mesas,2015) UKUNITS/WEEK Estimation of consumption by Scottish Adults (2014 data)
  14. 14. Source: 00.%20Alcohol%20consumption%20and%20price%20in%20Scotland%202015%20-%20May2016.pdf
  15. 15. Most reliable measure may be…………..
  16. 16. 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
  17. 17. 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
  18. 18. SALES DATA information
  19. 19. Henderson et al (2015) Alcohol and Alcoholism DOI: Estimated size of biases linked to per adult consumption extrapolated from sales data (Scotland).
  20. 20. 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
  21. 21. Assuming 1 glass= 1 unit Assuming 175 ml glass = 2 units
  22. 22. From Britton et al (2016) Alc and Alcoholism doi: 10.1093/alcalc/agw027
  23. 23. 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.
  24. 24. 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