Alcohol Misuse: Electronic Longitudinal Alcohol Study in Communities (ELAStiC)

Lead Research Organisation: Cardiff University
Department Name: Dentistry

Abstract

There exists a unique opportunity to exploit existing UK data to better understand alcohol misuse across the life course. The overall goals of this project are to 1) incorporate data into the UK Secure eResearch Platform (UKSeRP) and develop facilities to enable research access, 2) undertake hypothesis driven research using this platform to provide critical insights into alcohol use, it's effects and pathways into harm, 3) exploit the current research group's expertise to capitalise on the most recent developments in analytical methodology, and 4) make explicit the policy relevance of the work and exploit opportunities to interface with possible intervention development. This project therefore aims to leverage the value of a broad set of longitudinal studies and data linkage facilities to construct an analytical platform within UKSeRP that facilitates the investigation of harmful alcohol use across the life course. The proposal is balanced, it combines a broad skillset, with considerable expertise with the available data together with techniques in the analysis of such data.

The data itself covers youngsters, those in mid- and later-life. These data are then linked to routine administrative data including those from schools (e.g. educational attainment), the NHS (health), the police (anti-social behaviour) and other sources including births and deaths. These then allow us to understand how alcohol affects general health, health service use, mental health, educational attainment and criminality. The nature of these data also allow us to understand how alcohol use affects cognitive decline in later life, and emotional and cognitive development in young people.

There has already been considerable activity generating opportunities to use longitudinal data for research, although only limited work has looked at alcohol specifically. We are therefore able to exploit these on-going investments and collaborate with the UK Dementia Platform, Centre for the Improvement of Population Health through e-Records Research (CIPHER) at Swansea University (funded by a consortium led by the Medical Research Council) which will provide technical and financial support for data linkage. In addition, the project will explicitly examine the policy and impact relevance of outputs, use outputs to investigate opportunities to develop novel interventions with, for example, the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (funded by the Economic and Social Research Council, amongst others). These collaborations bring together a unique set of skills that are required for such work as well as technical support.

Fundamental to the project is the opportunity to bring together a diverse skillset. Investigators come from a broad range of backgrounds and have varying skills in relation to the analysis and interpretation of longitudinal data. This provides opportunities for work in specific areas to inform the project as a whole. Although the project is based on specific research hypotheses, these feed into work packages that use the project team's skills as a whole to develop relevant outputs. This added value is realised through organising resources to maximise collaborative working and therefore go beyond the fundamental questions asked of the data.

Planned Impact

Academics nationally and internationally will benefit through documenting and making available the enhanced data created as a part of this project (see Data Management Plan). Peer reviewed journal articles will contribute to numerous fields including epidemiology, alcohol, psychology, health and sociology. Moreover, while a data driven study, this project does overlap with key theoretical constructs associated with behaviour (e.g. disinhibition), the socio-ecology of alcohol misuse and mechanistic approaches including brain function and damage.

Research outputs are varied and are likely to be of interest to, not only academics but also, given the nature of some of the work (e.g. the effect of mother's alcohol consumption on their child's development) the public as well. Indeed, research surrounding health generally and alcohol in particular regularly feature in national and international media. Through disseminating our findings in partnership with media outlets we will be able to enrich the public's own knowledge of the harms that alcohol might elicit.

We aim to contribute towards evidence based policy-making and influence public debate and legislation at a local, regional, national and international level. End users include national and local policy makers and statutory authorities including social services, education and the police. Nationally there is interest in which policy mechanisms could curb the growing costs of alcohol-related harm. There are numerous way our work impacts at this level, probably of greatest significance is the work streams on well-being, alcohol price and availability. Also, at a local level, Local Authorities are now required to clearly state how they are working towards ensuring their residents health and well-being. For example, planning departments will be interested in the effects of alcohol availability; education services will be interest in the effects of alcohol on children's development. Internationally, we will engage with organisations including the World Health Organisation.

There are likely significant opportunities with the third sector. We have engaged with Alcohol Concern and Newlink to facilitate opportunities to work across policy makers and the third sector to realise outputs in a manner that can inform the development and implementation of interventions to challenge alcohol misuse and related harms.

The project further has a strong emphasis on advancing early career researchers. Daniel Farewell is a MRC fellow, and postdoctoral researchers will be employed on the project and a training budget requested in order to consolidate and extend their skill base. We therefore aim to contribute to the knowledge economy through delivering highly skilled researchers in an area of considerable interest (the use of "big data" and alcohol-related harm).

Publications

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Edwards AC (2017) The Rate of Change in Alcohol Misuse Across Adolescence is Heritable. in Alcoholism, clinical and experimental research

 
Description The ELAStiC project aimed bring together various sources of information concerned with health and alcohol related harm. The NHS holds data on patients' interactions with services, whereas survey data (e.g. the Welsh Health Survey) has information on how much people drink, and other characteristics. By bringing these data together we can understand the relationship between alcohol use and the burden on the NHS for alcohol-related harm. ELAStiC has been partially successful in its scope. There are considerable barriers to linking data, administrative but also privacy issues. The ELAStiC database has been confirmed and the meta data published (Trefan, et al. 2019), and ELAStiC is now inspiring future work. However, some data, notably held by NHS England and the Ministry of Justice were not successfully linked. Never-the-less, the ELAStiC data now provides a unique insight into alcohol related health across the lifespan and is live and available to researchers going forward. Notable outputs have identified the effect of parental alcohol use on child outcomes, which has fed into the Adverse Childhood Experience agenda, as such, the ELAStiC data is a new research resource.
Through ELAStiC several postgraduate researchers have been able to develop their skills. Notably in structural equation modelling and the application of computer science methods to large data.
New research questions have been identified and are receiving attention. In particular, the observation that up to 20% of parents who drink hazardously also misuse illicit substances. This has important implications for treatment and is to be discussed in the upcoming Commission on alcohol related harm.
In sum, ELAStiC continues, and the data and skills involved in it's management and analysis are feeding into other research areas.
Exploitation Route The ELAStiC platform is being actively developed for further research and as a policy evaluation tool. Current plans are to capitalise in this investment and use these data in natural experiments evaluating policy outcomes.
Sectors Healthcare

 
Title ELAStiC 
Description ALSPAC has been successfully linked to primary care data with Section 251 approval (following delays), and to Key Stage education data. The Millenium Cohort Study (Wales) has been successfully linked to health data (patient episode data base, GP data) and key stage data. Caerphilly Health and Social Needs Electronic Cohort Study has been linked to Patient Episode Database for Wales, GP Data, ONS Births Table, Emergency Department Dataset. 
Type Of Material Database/Collection of data 
Year Produced 2019 
Provided To Others? Yes  
Impact This is the first time routine data (Welsh Electronic Cohort for Children, Patient Episode Database for Wales, GP Data, Office for National Statistics Mortality Data, ONS Births table, Emergency Department Data Set) has been linked to cohort data in the study of alcohol-related harms. There have been significant delays and challenges bringing these data together, but it is now availble to future projects and is informing research opportunities across a number of teams. 
URL http://www.cardiff.ac.uk/violence-research-group/research-projects/alcohol-misuse
 
Description Andrea Gartner presented "Does the type of alcohol drunk, smoking and BMI explain socioeconomic inequalities in alcohol-related hospital admission: a record-linked cohort study?" at a meeting at the Public Health Wales on 28th November 2018. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Policymakers/politicians
Results and Impact Andrea Gartner did the presentation at a meeting at the Public Health Wales and there were the alcohol and licencing leads from all health boards, Beverley Morgan from WG presenting on Minimum Unit Price and Andrew Misell from Alcohol Change (formerly Alcohol Concern).
Year(s) Of Engagement Activity 2018
 
Description Andrea Gartner presented a paper entitled "Do people in more deprived areas have a higher risk of alcohol-related hospital admission, after accounting for individually record-linked data on alcohol consumption and smoking?" at the Annual conference of the Society for Social Medicine and Population Health in Glasgow, U.K. on 5-7 September 2018 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Andrea Gartner proactively discussed the findings with researchers from Glasgow University after the presentation. She has been invited by PHW to present at a meeting on 28th November 2018 with the alcohol and licencing leads (in health boards) and will be using some of the results of this study in that.
Year(s) Of Engagement Activity 2018
URL https://socsocmed.org.uk/annual-scientific-meeting/
 
Description European Research Area Network on Illicit Drugs 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Rapporteur and committee member for the ERANID funding body, a component of the EU 7th Framework Programme
Year(s) Of Engagement Activity 2016
URL http://www.eranid.eu/home/
 
Description NICE Expert Witness 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Expert witness to the National Institute for Health and Care Excellence for the "Drug misuse prevention: targeted interventions" guidance development
Year(s) Of Engagement Activity 2016
URL https://www.nice.org.uk/guidance/indevelopment/gid-phg90
 
Description Presentation of "ELASTiC - progress, challenges, potential for future work and impact" at the Population Health Conference in Cardiff on 16th May 2017 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Simon Moore presented a talk that updates the progress of ELAStiC project and the challenges it faced at the Population Health Conference in Cardiff on 16th May 2017.
Year(s) Of Engagement Activity 2017
 
Description Presentation of a conference poster entitled ELAStiC: Electronic Longitudinal Alcohol Study in Communities 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Type Of Presentation poster presentation
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This output raised awareness of this newly funded project in one relevant community.

None
Year(s) Of Engagement Activity 2015
URL http://www.farrinstitute.org/
 
Description Presentation of a paper entitled "The effect of parental drinking on adolescent alcohol use: the mediating role of parental monitoring and peer deviance" at the KBS annual meeting in Sheffield on 5-9 June 2017 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact The paper sparked questions, discussion and many constructive suggestions which contributed to the revision of the paper.
Year(s) Of Engagement Activity 2017
 
Description Presentation of a poster entitled "How does parental drinking, smoking and substance use affect children's well-being - a meta analysis" at Population Health Conference in Cardiff on 16th May 2017 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Vanessa Gross presented the poster on parental drinking, smoking and substance use's effect on children's well-being at the Population Health Conference in Cardiff on 16th May 2017.
Year(s) Of Engagement Activity 2017
 
Description Presentation of a poster entitled "The ELAStiC (Electronic Longitudinal Alcohol Study in Communities) project " at ADRN 2017 conference in Edinburgh, U.K. on 1-2 June 2017 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Ashley Akbari, Senior Research Analyst, presented the poster that introduced the objectives and designs of the ELAStiC project at the ADRN 2017 conference in Edinburgh on 1-2 June 2017.
Year(s) Of Engagement Activity 2017
URL https://adrn.ac.uk/understand-data/courses/eventitem?eventid=4807
 
Description Presentation of a poster entitled "The ELAStiC (Electronic Longitudinal Alcohol Study in Communities) project " at Informatics for Health 2017 in Manchester, U.K. on 24-26 April 2017 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Ashley Akbari, Senior Research Analyst, presented a poster that introduced the project's objectives and designs at the conference of Informatics for Health 2017 in Manchester, U.K. on 24-26 April 2017.
Year(s) Of Engagement Activity 2017
URL http://www.farrinstitute.org/events-courses/event/informatics-for-health-2017
 
Description Presentation of a poster entitled Electronic Longitudinal Alcohol Study in Communities at the International Population Data Linkage Conference 2016 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Ashley Akbari, Senior Research Analyst, presented a poster about the ELAStiC project at the International Population Data Linkage Conference 2016 on 24-26 August at Swansea University. The purpose of the presentation was to introduce the project to the research community interested in data linkage and to build up collaborative links for future research.
Year(s) Of Engagement Activity 2016
URL http://www.ipdlnconference2016.org/
 
Description Presentation of a poster on the overview of the ELAStiC project at the Alcohol and Criminal Justice System Conference in Darlington on 5th October 2017 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact The poster generated interest and sparked questions about the ELAStiC project.
Year(s) Of Engagement Activity 2017