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Hatchard J, Buykx P, Brennan A, Gillespie D. Options for modifying UK alcohol and tobacco tax: A rapid scoping review of the evidence over the period 1997-2018. NIHR OPEN RESEARCH 2023; 3:26. [PMID: 37881457 PMCID: PMC10593339 DOI: 10.3310/nihropenres.13379.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/27/2023]
Abstract
Background Increased taxation is recognised worldwide as one of the most effective interventions for decreasing tobacco and harmful alcohol use, with many variations of policy options available. This rapid scoping review was part of a NIHR-funded project ('SYNTAX' 16/105/26) and was undertaken during 2018 to inform interviews to be conducted with UK public health stakeholders with expertise in alcohol and tobacco pricing policy. Methods Objectives: To synthesise evidence and debates on current and potential alcohol and tobacco taxation options for the UK, and report on the underlying objectives, evidence of effects and mediating factors.Eligibility criteria: Peer-reviewed and grey literature; published 1997-2018; English language; UK-focused; include taxation interventions for alcohol, tobacco, or both. Sources of evidence: PubMed, Scopus, Cochrane Library, Google, stakeholder and colleague recommendations.Charting methods: Excel spreadsheet structured using PICO framework, recording source characteristics and content. Results Ninety-one sources qualified for inclusion: 49 alcohol, 36 tobacco, 6 both. Analysis identified four policy themes: changes to excise duty within existing tax structures, structural reforms, industry measures, and hypothecation of tax revenue for public benefits. For alcohol, policy options focused on raising the price of cheap, high-strength alcohol. For tobacco, policy options focused on raising the price of all tobacco products, especially the cheapest products, which are hand-rolling tobacco. For alcohol and tobacco, there were options such as levies that take money from the industries to help reduce the societal costs of their products. Due to the perceived social and economic importance of alcohol in contrast to tobacco, policy options also discussed supporting pubs and small breweries. Conclusions This review has identified a set of tax policy options for tobacco and alcohol, their objectives, evidence of effects and related mediating factors. The differences between alcohol and tobacco tax policy options and debates suggest an opportunity for cross-substance policy learning.
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Affiliation(s)
- Jenny Hatchard
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
| | - Penny Buykx
- School of Humanities and Social Science, University of Newcastle, Australia, New South Wales, Australia
- Sheffield Centre for Health and Related Research (SCHARR), Division of Population Health, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Alan Brennan
- Sheffield Centre for Health and Related Research (SCHARR), Division of Population Health, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Duncan Gillespie
- Sheffield Centre for Health and Related Research (SCHARR), Division of Population Health, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
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Fone D, Morgan J, Fry R, Rodgers S, Orford S, Farewell D, Dunstan F, White J, Sivarajasingam V, Trefan L, Brennan I, Lee S, Shiode N, Weightman A, Webster C, Lyons R. Change in alcohol outlet density and alcohol-related harm to population health (CHALICE): a comprehensive record-linked database study in Wales. PUBLIC HEALTH RESEARCH 2016. [DOI: 10.3310/phr04030] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundExcess alcohol consumption has serious adverse effects on health and results in violence-related harm.ObjectiveThis study investigated the impact of change in community alcohol availability on alcohol consumption and alcohol-related harms to health, assessing the effect of population migration and small-area deprivation.DesignA natural experiment of change in alcohol outlet density between 2006 and 2011 measured at census Lower Layer Super Output Area level using observational record-linked data.SettingWales, UK; population of 2.5 million aged ≥ 16 years.Outcome measuresAlcohol consumption, alcohol-related hospital admissions, accident and emergency (A&E) department attendances from midnight to 06.00 and violent crime against the person.Data sourcesLicensing Act 2003 [Great Britain.Licensing Act 2003. London: The Stationery Office; 2003. URL:www.legislation.gov.uk/ukpga/2003/17/contents(accessed 8 June 2015)] data on alcohol outlets held by the 22 local authorities in Wales, alcohol consumption data from annual Welsh Health Surveys 2008–12, hospital admission data 2006–11 from the Patient Episode Database for Wales (PEDW) and A&E attendance data 2009–11 were anonymously record linked to the Welsh Demographic Service age–sex register within the Secure Anonymised Information Linkage Databank. A final data source was recorded crime 2008–11 from the four police forces in Wales.MethodsOutlet density was estimated (1) as the number of outlets per capita for the 2006 static population and the per quarterly updated population to assess the impact of population migration and (2) using new methods of network analysis of distances between each household and alcohol outlets within 10 minutes of walking and driving. Alcohol availability was measured by three variables: (1) the previous quarterly value; (2) positive and negative change over the preceding five quarters; and (3) volatility, a measure of absolute quarterly changes during the preceding five quarters. Longitudinal statistical analysis used multilevel Poisson models of consumption and Geographically Weighted Regression (GWR) spatial models of binge drinking, Cox regression models of hospital admissions and A&E attendance and GWR models of violent crime against the person, each as a function of alcohol availability adjusting for confounding variables. The impact on health inequalities was investigated by stratifying models within quintiles of the Welsh Index of Multiple Deprivation.ResultsThe main finding was that change in walking outlet density was associated with alcohol-related harms: consumption, hospital admissions and violent crime against the person each tracked the quarterly changes in outlet density. Alcohol-related A&E attendances were not clinically coded and the association was less conclusive. In general, social deprivation was strongly associated with the outcome measures but did not substantially modify the associations between the outcomes and alcohol availability. We found no evidence for an important effect of population migration.LimitationsLimitations included the absence of any standardised methods of alcohol outlet data collation, processing and validation, and incomplete data on on-sales and off-sales. We were dependent on the quality of clinical coding and administrative records and could not identify alcohol-related attendances in the A&E data set.ConclusionThis complex interdisciplinary study found that important alcohol-related harms were associated with change in alcohol outlet density. Future work recommendations include defining a research standard for recording outlet data and classification of outlet type, the methodological development of residence-based density measures and a health economic analysis of model-predicted harms.FundingThe National Institute for Health Research Public Health Research programme. Additional technical and computing support was provided by the Farr Institute at Swansea University, made possible by the following grant:Centre for the Improvement of Population Health through E-records Research (CIPHER) and Farr Institute capital enhancement. CIPHER and the Farr Institute are funded by Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Chief Scientist Office (Scottish Government Health Directorates), the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, the Medical Research Council, the National Institute for Health Research, the National Institute for Social Care and Health Research (Welsh Government) and the Wellcome Trust (grant reference MR/K006525/1).
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Affiliation(s)
- David Fone
- Farr Institute, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Jennifer Morgan
- Farr Institute, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Richard Fry
- Farr Institute, Swansea University Medical School, Swansea, UK
| | - Sarah Rodgers
- Farr Institute, Swansea University Medical School, Swansea, UK
| | - Scott Orford
- School of Geography and Planning, Cardiff University, Cardiff, UK
- Wales Institute of Social and Economic Research, Data and Methods (WISERD), Cardiff University, Cardiff, UK
| | - Daniel Farewell
- Farr Institute, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Frank Dunstan
- Farr Institute, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - James White
- Farr Institute, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Medicine, Cardiff University, Cardiff, UK
| | - Vas Sivarajasingam
- Violence and Society Research Group, School of Dentistry, Cardiff University, Cardiff, UK
| | - Laszlo Trefan
- Farr Institute, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Iain Brennan
- Violence and Society Research Group, School of Dentistry, Cardiff University, Cardiff, UK
| | - Shin Lee
- School of Geography and Planning, Cardiff University, Cardiff, UK
| | - Narushige Shiode
- School of Geography and Planning, Cardiff University, Cardiff, UK
| | - Alison Weightman
- Specialist Unit for Research Evidence, University Library Service, Cardiff University, Cardiff, UK
| | - Chris Webster
- School of Geography and Planning, Cardiff University, Cardiff, UK
| | - Ronan Lyons
- Farr Institute, Swansea University Medical School, Swansea, UK
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Bosque-Prous M, Espelt A, Guitart AM, Bartroli M, Villalbí JR, Brugal MT. Association between stricter alcohol advertising regulations and lower hazardous drinking across European countries. Addiction 2014; 109:1634-43. [PMID: 24690020 DOI: 10.1111/add.12562] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 11/05/2013] [Accepted: 03/20/2014] [Indexed: 11/25/2022]
Abstract
AIMS To analyse the association between alcohol advertising restrictions and the prevalence of hazardous drinking among people aged 50-64 years in 16 European countries, taking into account both individual and contextual-level factors (alcohol taxation, availability, etc.). DESIGN Cross-sectional study based on SHARE project surveys. SETTING AND PARTICIPANTS A total of 27 773 subjects, aged 50-64 years, from 16 European countries who participated in wave 4 of the SHARE (Survey of Health, Ageing and Retirement in Europe) project. MEASUREMENTS We estimated the prevalence of hazardous drinking (through adaptation of the SHARE questions to the scheme used by the Alcohol Use Disorders Identification Test Consumption (AUDIT-C) for each country. To determine whether the degree of advertising restrictions was associated with prevalence of hazardous drinking, we fitted robust variance multi-level Poisson models, adjusting for various individual and contextual variables. Prevalence ratios (PR) and their 95% confidence intervals (95% CI) were obtained. FINDINGS The observed prevalence of hazardous drinking was 24.1%, varying by sex and country. Countries with greater advertising restrictions had lower prevalence of hazardous drinking: 30.6% (95% CI = 29.3-31.8) in countries with no restrictions, 20.3% (95% CI = 19.3-21.2) in countries with some restrictions and 14.4% (95% CI = 11.9-16.8) in those with greatest restrictions. The PR found (with respect to countries with greatest restrictions) were 1.36 (95% CI = 0.90-2.06) for countries with some restrictions and 1.95 (95% CI = 1.31-2.91) for those with no advertising restrictions. CONCLUSIONS The extent of advertising restrictions in European countries is associated inversely with prevalence of hazardous drinking in people aged 50-64 years.
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Affiliation(s)
- Marina Bosque-Prous
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
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Fone D, Dunstan F, White J, Webster C, Rodgers S, Lee S, Shiode N, Orford S, Weightman A, Brennan I, Sivarajasingam V, Morgan J, Fry R, Lyons R. Change in alcohol outlet density and alcohol-related harm to population health (CHALICE). BMC Public Health 2012; 12:428. [PMID: 22691534 PMCID: PMC3409073 DOI: 10.1186/1471-2458-12-428] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 06/12/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Excess alcohol consumption has serious adverse effects on health and violence-related harm. In the UK around 37% of men and 29% of women drink to excess and 20% and 13% report binge drinking. The potential impact on population health from a reduction in consumption is considerable. One proposed method to reduce consumption is to reduce availability through controls on alcohol outlet density. In this study we investigate the impact of a change in the density of alcohol outlets on alcohol consumption and alcohol-related harms to health in the community. METHODS/DESIGN A natural experiment of the effect of change in outlet density between 2005-09, in Wales, UK; population 2.4 million aged 16 years and over. Data on outlets are held by the 22 local authorities in Wales under The Licensing Act 2003. The study outcomes are change in (1) alcohol consumption using data from annual Welsh Health Surveys, (2) alcohol-related hospital admissions using the Patient Episode Database for Wales, (3) Accident & Emergency department attendances between midnight-6am, and (4) alcohol-related violent crime against the person, using Police data. The data will be anonymously record-linked within the Secure Anonymised Information Linkage Databank at individual and 2001 Census Lower Super Output Area levels. New methods of network analysis will be used to estimate outlet density. Longitudinal statistical analysis will use (1) multilevel ordinal models of consumption and logistic models of admissions and Accident & Emergency attendance as a function of change in individual outlet exposure, adjusting for confounding variables, and (2) spatial models of the change in counts/rates of each outcome measure and outlet density. We will assess the impact on health inequalities and will correct for population migration. DISCUSSION This inter-disciplinary study requires expertise in epidemiology and public health, health informatics, medical statistics, geographical information science, and research into alcohol-related violence. Information governance requirements for the use of record-linked data have been approved together with formal data access agreements for the use of the Welsh Health Survey and Police data. The dissemination strategy will include policy makers in national and local government. Public engagement will be through the Clinical Research Collaboration-Cymru "Involving People" network, which will provide input into the implementation of the research.
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Affiliation(s)
- David Fone
- Institute of Primary Care & Public Health, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK
| | - Frank Dunstan
- Institute of Primary Care & Public Health, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK
| | - James White
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK
| | - Chris Webster
- School of City and Regional Planning, Cardiff University, Glamorgan Building, King Edward VII Avenue, Cardiff, CF10 3WA, UK
| | - Sarah Rodgers
- Health Information Research Unit, School of Medicine, Swansea University, Swansea, SA2 8PP, UK
| | - Shin Lee
- School of City and Regional Planning, Cardiff University, Glamorgan Building, King Edward VII Avenue, Cardiff, CF10 3WA, UK
| | - Narushige Shiode
- School of City and Regional Planning, Cardiff University, Glamorgan Building, King Edward VII Avenue, Cardiff, CF10 3WA, UK
| | - Scott Orford
- School of City and Regional Planning, Cardiff University, Glamorgan Building, King Edward VII Avenue, Cardiff, CF10 3WA, UK
- Wales Institute of Social and Economic Research, Data and Methods (WISERD), Cardiff University, 46 Park Place, Cardiff, CF10 3BB, UK
| | - Alison Weightman
- Support Unit for Research Evidence, Information Services, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK
| | - Iain Brennan
- Department of Social Sciences, University of Hull, Cottingham Road, Hull, HU6 7RX, UK
| | - Vas Sivarajasingam
- School of Dentistry, Cardiff University, Heath Park, Cardiff, CF14 4XY, UK
| | - Jennifer Morgan
- Institute of Primary Care & Public Health, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK
| | - Richard Fry
- Health Information Research Unit, School of Medicine, Swansea University, Swansea, SA2 8PP, UK
| | - Ronan Lyons
- Health Information Research Unit, School of Medicine, Swansea University, Swansea, SA2 8PP, UK
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Ward B, Snow P. Supporting parents to reduce the misuse of alcohol by young people. DRUGS-EDUCATION PREVENTION AND POLICY 2010. [DOI: 10.3109/09687630902806723] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Williamson L. Public policy on alcohol in the United Kingdom: towards a safety net for the alcohol-dependent. JOURNAL OF LAW AND MEDICINE 2009; 17:386-99. [PMID: 20169799 PMCID: PMC2875108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Public policy on alcohol in the United Kingdom fails to support, and may even undermine, the wellbeing of those with the worst alcohol misuse problems, the alcohol-dependent. This is partly because it evades the thorny issue of impaired control that characterises dependence. In addition, until recently, all United Kingdom alcohol policy focused on improving individualised treatment for the dependent, rather than attending to the wider social and environmental factors that influence the condition. The efforts of policy to normalise "sensible" drinking, while stigmatising drunkenness, also risk exacerbating the social vulnerability of the alcohol-dependent. The article examines these issues and concludes by pointing to a number of developments that are required to help ensure that the dependent do not continue to fall through policy that claims to be inclusive.
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Affiliation(s)
- Laura Williamson
- Institute of Health and Wellbeing, Glasgow Caledonian University, Buchanan House, Cowcaddens Road, Glasgow G4 OBA, Scotland.
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Mahaffey PJ. Tackling alcohol misuse: Typical British malaise. BMJ 2008; 336:573. [PMID: 18340049 PMCID: PMC2267950 DOI: 10.1136/bmj.39513.714664.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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