Alcohol Policy Interventions in Scotland and England: APISE

Given growing concerns about alcohol misuse and its harms, new interventions to control alcohol use are being considered in both Scotland and England. The SNP Government in Scotland, plan to introduce a Minimum Pricing Bill while, in England, a new Alcohol Strategy is underway.

Some evidence exists about the effectiveness of specific alcohol policy interventions but there are many shortcomings in what is known about how effective these interventions are. In particular, it is not clear whether policies work differently with different groups in the population (eg. Men v women). Ideally a long-term study is required with strong baseline data collected in the first year against which data from many subsequent years can be compared and analysed relative to policy changes in Scotland and England. Given that differences exist between Scotland and England in terms of alcohol policy and that the SNP Government in Scotland are planning to implement minimum unit pricing, a natural experiment opportunity exists to compare the drinking behaviours of adult drinkers in Scotland and England before and after policy implementation.

This proposed research will conduct the first two years of such a study, and, subject to availability of future funding, will have the potential for longer term monitoring. This would enable a system to be set in place whereby future policies could be evaluated as and when they occur.

The aim of this study is to establish whether and how a range of alcohol policy interventions impact on alcohol use. The first survey will be conducted in 2012 and a follow-up survey, with the same people, will take place one year later in 2013.

Telephone interviews will be conducted with 2000 adult drinkers (aged 16-65) in Scotland and 2000 in England at the beginning of the study. These same people will be interviewed again 12 months later to examine whether and how their knowledge, attitudes and behaviour about drinking change. By comparing a country which does introduce a new policy with another, where policies remain unchanged, we can begin to assess the changes which may result from policy changes. Importantly we will look, not only at drinking behaviour, but also at how adult drinkers respond to different policy interventions by examining measures which are most strongly related to the policy. For example, if a minimum unit pricing policy was introduced we would ask people about the affordability of alcohol, if the policy was concerned with unit labelling on drinks we would ask about noticing and paying attention to the labels. In this way we can gain a better understanding of whether and how individual policies are working and how for example perceptions of affordability of alcohol change after a policy is implemented. Furthermore, how, if at all, these link with changes in drinking behaviour. Having two countries with different alcohol policies and the likelihood of one country introducing alcohol policy between the first and second surveys improves our opportunities for establishing whether and how alcohol policies work. The study will provide valuable information on the way that adult drinkers respond to alcohol policy interventions and will contribute to the debate and consultation processes around future reviews of national alcohol strategies in the UK.

Furthermore, we are collaborating with colleagues in New Zealand, Australia, the USA, Thailand and South Korea who are planning to conduct similar studies in their countries. This would provide further opportunities for identifying changes, given the broader range of countries involved and increased opportunities for differences in policy implementation. The findings from this study will provide data to help inform the development of international guidelines on alcohol policy in the future and contribute to national and international efforts to reduce alcohol related harm.

Heightened awareness of the extent and range of the global burden of disease from alcohol has led to new commitment, at national and international levels, to make policy change. While a body of research evidence exists on the effectiveness of specific alcohol policy interventions there are very significant shortcomings in the evidence base. There is a need for a long term-monitoring study, with a strong baseline data collection, which can then regularly monitor responses to policy changes as they occur.

This proposal is for the first two waves of such a study: Alcohol Policy Interventions in Scotland and England (APISE). New alcohol policy interventions are actively being considered in both Scotland and England, providing an opportunity for a natural experiment to evaluate the impact of the different policies which are likely to be put in place in each country. The study also has an international component with parallel studies being conducted in a number of other countries.

The study aims to yield robust evidence on the effectiveness and mechanisms of macro-level alcohol policy interventions. Three linked stages of research include an audit of alcohol control strategies in each country, exploratory research with adult drinkers and a longitudinal survey. The baseline survey, planned for 2012, will recruit a cohort of 2000 adult drinkers in England and 2000 in Scotland. The cohort follow-up survey will take place 12 months later. The survey will be conducted by telephone and collect data on a range of policy related variables (proximal variables), moderating and mediating variables as well as behavioural outcomes. By including proximal variables, for each policy, there is potential to trace the effects of each policy, over time, to their ultimate effects on behaviour through different mediational routes and thus strengthen the ability to attribute impact to specific policies.

Alcohol policies are governmental interventions that aim to minimise the health and social harms that arise from the use of alcohol. Our previous work estimated annual health and social service costs of £3.1b and an annual loss of 183,000 quality-adjusted life years. The total financial burden in England is estimated at between £17.7bn and £25.1bn. With such large implications, policymakers need to know whether policies they put in place have the desired effects in reducing consumption and harm and improving public health. This study will help uncover what works, how it does so and what the public thinks and feels about this. In this way it will enable more informed alcohol policy interventions to be developed to reduce the harms from alcohol. Organisations, such as government departments and non-governmental organisations, will be better equipped to identify effective and ineffective alcohol policy interventions and will gain a better understanding of how the adult drinking population respond to alcohol policy interventions. Results from the study will therefore contribute to the debate and consultation processes around future reviews of alcohol strategy in the UK.

The international collaboration in the study will further strengthen the findings and relevance of these internationally. The WHO is highly interested in the study and has sent representatives to attend early meetings with the collaborators.

Secondary questions this study will address are the time to effect, whether effects are seen equally in all groups of the population and the pathways by which policies affect consumption and harm (e.g. via changes in attitudes or purchasing behaviour). Our study will allow us to play a meaningful role in providing this information, by providing the capacity to evaluate any macro-level policy interventions that are put in place in England or Scotland. Results will also inform the design of new policies by providing information on advantageous external conditions for policies, likely effects of policy combinations, and on groups who are and who are not responding to certain policy measures. Whilst focused on alcohol policy, the work programme will lead to insights that are of relevance to the wider public policy field.

The study will also benefit other academic researchers by building an evidence base on effectiveness of alcohol policy interventions, generating new research ideas and developing appropriate methods and measures for evaluating impact of alcohol policies.

The public will benefit from better informed alcohol policy interventions which have a greater likelihood of desired response from adult drinkers.