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Correia D, Tran A, Kokole D, Neufeld M, Olsen A, Likki T, Ferreira‐Borges C, Rehm J. Designing and implementing an experimental survey on knowledge and perceptions about alcohol warning labels. Int J Methods Psychiatr Res 2024; 33:e2016. [PMID: 38760902 PMCID: PMC11101666 DOI: 10.1002/mpr.2016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 01/02/2024] [Accepted: 02/28/2024] [Indexed: 05/20/2024] Open
Abstract
OBJECTIVES This paper describes the design and implementation of an online survey experiment to investigate the effects of alcohol warning labels on alcohol-related knowledge, risk perceptions and intentions. METHOD The survey collected self-reported data from 14 European countries through two waves of data collection with different recruitment strategies: dissemination via social media and public health agencies was followed by paid-for Facebook ads. The latter strategy was adopted to achieve broader population representation. Post-stratification weighting was used to match the sample to population demographics. RESULTS The survey received over 34,000 visits and resulted in a sample size of 19,601 participants with complete data on key sociodemographic characteristics. The responses in the first wave were over-representing females and higher educated people, thus the dissemination was complemented by the paid-for Facebook ads targeting more diverse populations but had higher attrition rate. CONCLUSION Experiments can be integrated into general population surveys. Pan-European results can be achieved with limited resources and a combination of sampling methods to compensate for different biases, and statistical adjustments.
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Affiliation(s)
- Daniela Correia
- WHO Regional Office for EuropeCopenhagenDenmark
- EPIUnit – Institute of Public HealthUniversity of PortoPortoPortugal
| | - Alexander Tran
- WHO Regional Office for EuropeCopenhagenDenmark
- Institute for Mental Health Policy ResearchCentre for Addiction and Mental HealthTorontoOntarioCanada
| | - Daša Kokole
- WHO Regional Office for EuropeCopenhagenDenmark
- Department of Health PromotionCAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtthe Netherlands
| | | | | | - Tiina Likki
- WHO Regional Office for EuropeCopenhagenDenmark
| | | | - Jürgen Rehm
- Institute for Mental Health Policy ResearchCentre for Addiction and Mental HealthTorontoOntarioCanada
- Campbell Family Mental Health Research InstituteCentre for Addiction and Mental HealthTorontoOntarioCanada
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Center for Interdisciplinary Addiction Research (ZIS)Department of Psychiatry and PsychotherapyUniversity Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
- Faculty of MedicineInstitute of Medical ScienceUniversity of TorontoTorontoOntarioCanada
- Program on Substance AbusePublic Health Agency of CataloniaProgram on Substance Abuse & WHO CCPublic Health Agency of CataloniaBarcelonaSpain
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Neufeld M, Kokole D, Correia D, Ferreira-Borges C, Olsen A, Tran A, Rehm J. How much do Europeans know about the link between alcohol use and cancer? Results from an online survey in 14 countries. BMC Res Notes 2024; 17:56. [PMID: 38378598 PMCID: PMC10880362 DOI: 10.1186/s13104-024-06707-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/26/2024] [Indexed: 02/22/2024] Open
Abstract
OBJECTIVE In the EU, which has the highest drinking levels worldwide, cancer is the primary cause of alcohol-attributable deaths. Existing studies show gaps in public knowledge, but there is lack of systematic appraisal. The report presents original data from a cross-sectional survey conducted within the framework of an online experimental study in 14 European countries, which among other things assessed baseline knowledge of the alcohol-NCD link, particularly cancer. METHODS Online questionnaire among adults who consume alcohol conducted in 14 countries in 2022-2023 using different recruitment strategies and applying population weights for the final sample. Baseline assessments measured participants' knowledge of alcohol-attributable health issues (with a specific focus on cancer). RESULTS Baseline knowledge assessment showed that 90% indicated a causal role of alcohol for liver disease, 68% for heart diseases, and only 53% for cancer. Knowledge of specific alcohol-attributable cancer types was lower, with 39% aware of the link between alcohol use and colon cancer, 28% regarding oral cancer, and only 15% regarding female breast cancer. Knowledge levels varied across different countries and population groups. CONCLUSION Most Europeans do not know which cancers can be caused by alcohol use and knowledge is low specifically for female breast cancer. More awareness raising and prevention efforts are needed, such as the placement of cancer-specific health warnings on alcohol container labels.
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Affiliation(s)
- Maria Neufeld
- WHO Regional Office for Europe, UN City, Marmorvej 51, 2100, Copenhagen, Denmark.
| | - Daša Kokole
- WHO Regional Office for Europe, UN City, Marmorvej 51, 2100, Copenhagen, Denmark
- CAPHRI Care and Public Health Research Institute, Maastricht University, 6200, Maastricht, MD, POB 616, the Netherlands
| | - Daniela Correia
- WHO Regional Office for Europe, UN City, Marmorvej 51, 2100, Copenhagen, Denmark
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | | | - Aleksandra Olsen
- WHO Regional Office for Europe, UN City, Marmorvej 51, 2100, Copenhagen, Denmark
| | - Alexander Tran
- Research Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, M5S 2S1, Toronto, ON, Canada
| | - Jürgen Rehm
- Research Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, M5S 2S1, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, Canada
- University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, Hamburg, Germany
- Public Health Agency of Catalonia, WHO Collaborating Centre on Substance Use, Noncommunicable Diseases and Policy Impact, 81-95 Roc Boronat St, 08005, Barcelona, Spain
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Kokole D, Ferreira-Borges C, Galea G, Tran A, Rehm J, Neufeld M. Public awareness of the alcohol-cancer link in the EU and UK: a scoping review. Eur J Public Health 2023; 33:1128-1147. [PMID: 37802887 PMCID: PMC10710347 DOI: 10.1093/eurpub/ckad141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Alcohol increases cancer risk, but less is known about public awareness of this link. This scoping review summarizes recent findings on the public awareness of alcohol as a cancer risk factor in European Union and UK. METHODS Four databases (Web of Science, MEDLINE, PsycInfo, CINAHL) were searched for papers containing data on awareness of alcohol as cancer risk factor in EU or UK published between January 2017 and December 2022, and complemented with grey literature searches. RESULTS In total, 45 studies were included covering 18 EU countries (Austria, Belgium, Cyprus, Czechia, Denmark, Finland, France, Germany, Hungary, Ireland, Italy, Netherlands, Poland, Romania, Slovakia, Slovenia, Spain, Sweden) and UK, presenting data collected between 2009 and 2022. Studies covered general population (17 studied a nationally representative sample), women, health professionals, patients and young people. Awareness of alcohol causing cancer in general was higher and studied more often than awareness of alcohol's impact on specific cancers. Among the EU general population, awareness of the link between alcohol and breast cancer ranged between 10% and 20%, head and neck cancer 15-25%, colorectal and oesophagus cancer 15-45% and liver cancer 40%. Awareness was higher among young people and specialized health professions and lower among women (the latter specifically for the breast cancer). CONCLUSIONS While awareness rates varied depending on the exact question wording, many studies showed low awareness of the alcohol-cancer link, especially for specific types such as breast and colon cancer. Public should be better informed about alcohol consumption-related cancer risk.
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Affiliation(s)
- Daša Kokole
- WHO Regional Office for Europe, UN City, Copenhagen, Denmark
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | | | - Gauden Galea
- WHO Regional Office for Europe, UN City, Copenhagen, Denmark
| | - Alexander Tran
- WHO Regional Office for Europe, UN City, Copenhagen, Denmark
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jürgen Rehm
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, World Health Organization/Pan American Health Organization Collaborating Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
- Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany
| | - Maria Neufeld
- WHO Regional Office for Europe, UN City, Copenhagen, Denmark
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Rehm J, Ferreira-Borges C, Kokole D, Neufeld M, Olsen A, Rovira P, Segura Garcia L, Tran A, Colom J. Assessing the impact of providing digital product information on the health risks of alcoholic beverages to the consumer at point of sale: A pilot study. Drug Alcohol Rev 2023; 42:1332-1337. [PMID: 37132168 DOI: 10.1111/dar.13676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 04/15/2023] [Accepted: 04/16/2023] [Indexed: 05/04/2023]
Abstract
INTRODUCTION There is an ongoing policy debate in the European Union regarding the best method of providing information to consumers on the health risks of alcohol use. One of the proposed channels is via the provision of QR codes. This study tested the usage rate of QR codes placed on point-of-sale signs in a supermarket in Barcelona, Catalonia over a 1-week period. METHODS Nine banners with beverage-specific health warnings in large text were prominently displayed in the alcohol section of a supermarket. Each banner provided a QR code of relatively large image size that linked to a government website providing further information on alcohol-related harms. A comparison was made between the number of visits to the website and the number of customers in the supermarket (number of unique sales receipts) in a single week. RESULTS Only 6 out of 7079 customers scanned the QR code during the week, corresponding to a usage rate of 0.085%, less than 1 per 1000. The usage rate was 2.6 per 1000 among those who purchased alcohol. DISCUSSION AND CONCLUSIONS Despite the availability of prominently displayed QR codes, the overwhelming majority of customers did not make use of the QR codes to obtain further information on alcohol-related harms. This corroborates the results from other studies investigating customers' use of QR codes to obtain additional product information. Based on the current evidence, providing online access to information through QR codes will likely not reach a significant portion of consumers.
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Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- World Health Organization/Pan American Health Organization Collaborating Centre, Centre for Addiction and Mental Health, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
- Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany
| | - Carina Ferreira-Borges
- WHO European Office for Prevention and Control of Noncommunicable Diseases, WHO European Office for the Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
| | - Daša Kokole
- WHO European Office for Prevention and Control of Noncommunicable Diseases, WHO European Office for the Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
| | - Maria Neufeld
- WHO European Office for Prevention and Control of Noncommunicable Diseases, WHO European Office for the Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
| | - Aleksandra Olsen
- WHO European Office for Prevention and Control of Noncommunicable Diseases, WHO European Office for the Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
| | - Pol Rovira
- Program on Substance Abuse, Public Health Agency of Catalonia, Barcelona, Spain
| | - Lidia Segura Garcia
- Program on Substance Abuse, Public Health Agency of Catalonia, Barcelona, Spain
| | - Alexander Tran
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Joan Colom
- Program on Substance Abuse, Public Health Agency of Catalonia, Barcelona, Spain
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Manthey J, Kokole D, Riedel-Heller S, Rowlands G, Schäfer I, Schomerus G, Soellner R, Kilian C. Improving alcohol health literacy and reducing alcohol consumption: recommendations for Germany. Addict Sci Clin Pract 2023; 18:28. [PMID: 37161561 PMCID: PMC10169338 DOI: 10.1186/s13722-023-00383-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 04/24/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Although the detrimental health effects of alcohol are well established, consumption levels are high in many high-income countries such as Germany. Improving alcohol health literacy presents an integrated approach to alcohol prevention and an important complement to alcohol policy. Our aim was to identify and prioritize measures to enhance alcohol health literacy and hence to reduce alcohol consumption, using Germany as an example. METHODS A series of recommendations for improving alcohol health literacy were derived from a review of the literature and subsequently rated by five experts. Recommendations were rated according to their likely impact on enhancing (a) alcohol health literacy and (b) reducing alcohol consumption. Inter-rater agreement was assessed using a two-way intra-class correlation coefficient (ICC). RESULTS Eleven recommendations were established for three areas of action: (1) education and information, (2) health care system, and (3) alcohol control policy. Education and information measures were rated high to increase alcohol health literacy but low to their impact on alcohol consumption, while this pattern was reversed for alcohol control policies. The ratings showed good agreement (ICC: 0.85-0.88). CONCLUSIONS Improving alcohol health literacy and reducing alcohol consumption should be considered complementary and become part of a comprehensive alcohol strategy to curb the health, social, and economic burden of alcohol.
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Affiliation(s)
- Jakob Manthey
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany.
- Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
| | - Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands
| | - Steffi Riedel-Heller
- Public Health Sciences Institute, Campus for Ageing & Vitality, Westgate Rd, Newcastle Upon Tyne, NE4 6BE, UK
| | - Gill Rowlands
- Institute of Social Medicine, Medical Faculty, Occupational Health and Public Health (ISAP), University of Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Ingo Schäfer
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Georg Schomerus
- Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - Renate Soellner
- Institute for Psychology, University of Hildesheim, Universitätsplatz 1, 34414, Hildesheim, Germany
| | - Carolin Kilian
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research (IMHPR), 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada
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Kokole D, Jané-Llopis E, Mercken L, Natera Rey G, Arroyo M, Pérez Gómez A, Mejía-Trujillo J, Piazza M, Bustamante I, O'Donnell A, Kaner E, Schulte B, de Vries H, Anderson P. Protocol for a process evaluation of SCALA study - Intervention targeting scaling up of primary health care-based prevention and management of heavy drinking and comorbid depression in Latin America. Eval Program Plann 2023; 97:102217. [PMID: 36603348 DOI: 10.1016/j.evalprogplan.2022.102217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/18/2020] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
This paper describes the plan for a process evaluation of a quasi-experimental study testing the municipal level scale-up of primary health care-based measurement and brief advice programmes to reduce heavy drinking and comorbid depression in Colombia, Mexico, and Peru. The main aims of the evaluation are to assess the implementation of intervention components; mechanisms of impact that influenced the outcomes; and characteristics of the context that influenced implementation and outcomes. Based on this information, common drivers of successful outcomes will be identified. A range of data collection methods will be used: questionnaires; interviews; observations; logbooks; and document analysis. All participating providers will complete a pen-and-paper questionnaire at recruitment and two time points during the implementation period. Providers attending training will complete post-training questionnaires. Additionally, 1080 patients will be invited to self-complete a patient questionnaire. One-in-ten participating providers and fifteen other key stakeholders will participate in semi-structured interviews. Training sessions and community advisory board meetings will be observed by a neutral observer. Logbooks will be kept by local research teams to document events affecting the implementation. Project related documentation and other relevant reports describing the context will be examined.
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Affiliation(s)
- Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD Maastricht, the Netherlands.
| | - Eva Jané-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD Maastricht, the Netherlands; Univ. Ramon Llull, ESADE, Avenida de Pedralbes, 60, 62, 08034 Barcelona, Spain; Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada.
| | - Liesbeth Mercken
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD Maastricht, the Netherlands; Department of Health Psychology, Open University, Valkenburgerweg 1776419 AT Heerlen, the Netherlands.
| | - Guillermina Natera Rey
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Calz México-Xochimilco 101, Huipulco, 14370 Ciudad de México, CDMX, Mexico.
| | - Miriam Arroyo
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Calz México-Xochimilco 101, Huipulco, 14370 Ciudad de México, CDMX, Mexico.
| | | | | | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Ave. Honorio Delgado 430, Urb. Ingeniería, S.M.P. Lima - Perú.
| | - Ines Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Ave. Honorio Delgado 430, Urb. Ingeniería, S.M.P. Lima - Perú.
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK.
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK.
| | - Bernd Schulte
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD Maastricht, the Netherlands.
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD Maastricht, the Netherlands; Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK.
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Anderson P, Kokole D. Substitution of higher-strength beers with zero-alcohol beers: Interrupted time series analyses of Spanish household purchase data, 2017-2022. Adicciones 2023; 0:1866. [PMID: 36975074 DOI: 10.20882/adicciones.1866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
In its action plan (2022-2030) to reduce the harmful use of alcohol, WHO calls on economic operators to "substitute, whenever possible, higher-alcohol products with no-alcohol and lower-alcohol products in their overall product portfolios, with the goal of decreasing the overall levels of alcohol consumption in populations and consumer groups". This paper investigates substitution within beer brands at the level of the consumer, based on Spanish household purchase data using interrupted time series analysis. For households (n = 1791, 9.1% of all households) that newly bought at least one of eleven branded zero-alcohol beers (responsible for over three-quarters of all zero-alcohol beer purchased), the associated purchases of all grams of alcohol after the first purchase of zero-alcohol beer were reduced by 5.5%, largely due to substituting every one litre of higher strength beer (ABV > 3.5%) with 0.75 litres of same-branded zero-alcohol beer (ABV = 0.0%). For households (n = 337, 1.8% of all households) that had never previously purchased a same-branded higher-strength beer, but newly purchasing a same-branded zero-alcohol beer, the associated purchases of all grams of alcohol after the first purchase of zero-alcohol beer were reduced by 14%; this reduction was largely due to such households' decreasing their associated purchases of wines and spirits. Thus, at the level of the consumer, based on Spanish household purchase data of branded zero-alcohol beers, the evidence behind WHO's call for substitution appears to be substantiated.
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Affiliation(s)
- Peter Anderson
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.
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Kokole D, Mercken L, Anderson P, Mejía-Trujillo J, Perez-Gomez A, Bustamante I, Piazza M, Natera Rey G, Arroyo M, Pérez De León A, Bautista Aguilar N, Medina Aguilar PS, Schulte B, O'Donnell A, de Vries H, Jané-Llopis E. Country and policy factors influencing the implementation of primary care-based alcohol screening: A comparison of Colombia, Mexico and Peru. Glob Public Health 2023; 18:2207410. [PMID: 37156224 DOI: 10.1080/17441692.2023.2207410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Researchers and practitioners recognise the importance of context when implementing healthcare interventions, but the influence of wider environment is rarely mapped. This paper identifies the country and policy-related factors potentially explaining the country differences in outcomes of an intervention focused on improving detection and management of heavy alcohol use in primary care in Colombia, Mexico and Peru. Qualitative data obtained through interviews, logbooks and document analysis are used to explain quantitative data on number of alcohol screenings and screening providers in each of the countries. Existing alcohol screening standards in Mexico, and policy prioritisation of primary care and consideration of alcohol as a public health issue in Colombia and Mexico positively contributed to the outcome, while the COVID-19 pandemic had a negative impact. In Peru, the context was unsupportive due to a combination of: political instability amongst regional health authorities; lack of focus on strengthening primary care due to the expansion of community mental health centres; alcohol considered as an addiction rather than a public health issue; and the impact of COVID-19 on healthcare. We found that wider environment-related factors interacted with the intervention implemented and can help explain country differences in outcomes.
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Affiliation(s)
- Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Liesbeth Mercken
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Department of Health Psychology, Open University, Heerlen, Netherlands
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Ines Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Perú
| | | | - Miriam Arroyo
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | | | | | | | - Bernd Schulte
- Department of Psychiatry and Psychotherapy, Centre for Interdisciplinary Addiction Research (ZIS), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Eva Jané-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- ESADE, Universitat Ramon Llull, Barcelona, Spain
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O'Donnell A, Anderson P, Schmidt C, Braddick F, Lopez-Pelayo H, Mejía-Trujillo J, Natera G, Arroyo M, Bautista N, Piazza M, Bustamante IV, Kokole D, Jackson K, Jane-Llopis E, Gual A, Schulte B. Tailoring an evidence-based clinical intervention and training package for the treatment and prevention of comorbid heavy drinking and depression in middle-income country settings: the development of the SCALA toolkit in Latin America. Glob Health Action 2022; 15:2080344. [PMID: 35867541 PMCID: PMC9310809 DOI: 10.1080/16549716.2022.2080344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Effective interventions exist for heavy drinking and depression but to date there has been limited translation into routine practice in global health systems. This evidence-to-practice gap is particularly evident in low- and middle-income countries. The international SCALA project (Scale-up of Prevention and Management of Alcohol Use Disorders and Comorbid Depression in Latin America) sought to test the impact of multilevel implementation strategies on rates of primary health care-based measurement of alcohol consumption and identification of depression in Colombia, Mexico, and Peru. OBJECTIVE To describe the process of development and cultural adaptation of the clinical intervention and training package. METHODS We drew on Barrero and Castro's four-stage cultural adaption model: 1) information gathering, 2) preliminary adaption, 3) preliminary adaption tests, and 4) adaption refinement. The Tailored Implementation in Chronic Diseases checklist helped us identify potential factors that could affect implementation, with local stakeholder groups established to support the tailoring process, as per the Institute for Healthcare Improvement's Going to Scale Framework. RESULTS In Stage 1, international best practice guidelines for preventing heavy drinking and depression, and intelligence on the local implementation context, were synthesised to provide an outline clinical intervention and training package. In Stage 2, feedback was gathered from local stakeholders and materials refined accordingly. These materials were piloted with local trainers in Stage 3, leading to further refinements including developing additional tools to support delivery in busy primary care settings. Stage 4 comprised further adaptions in response to real-world implementation, a period that coincided with the onset of the COVID-19 pandemic, including translating the intervention and training package for online delivery, and higher priority for depression screening in the clinical pathway. CONCLUSION Our experience highlights the importance of meaningful engagement with local communities, alongside the need for continuous tailoring and adaptation, and collaborative decision-making.
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Affiliation(s)
- Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Peter Anderson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Christiane Schmidt
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fleur Braddick
- Addictions Unit, Psychiatry Department, Hospital Clínic, Barcelona, Spain
| | - Hugo Lopez-Pelayo
- Addictions Unit, Psychiatry Department, Hospital Clínic, Barcelona, Spain.,Red de Trastornos Adictivos, Instituto Carlos III. Sinesio Delgado, Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS); Rosselló, Barcelona, Spain
| | | | - Guillermina Natera
- Instituto Nacional de Psiquiatría Ram´on de la Fuente, Ciudad de México, Mexico
| | - Miriam Arroyo
- Instituto Nacional de Psiquiatría Ram´on de la Fuente, Ciudad de México, Mexico
| | - Natalia Bautista
- Instituto Nacional de Psiquiatría Ram´on de la Fuente, Ciudad de México, Mexico
| | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, San Martin de Porres, Peru
| | - Ines V Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, San Martin de Porres, Peru
| | - Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Katherine Jackson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eva Jane-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Institute for Mental Health Policy Research, Toronto, Ontario, Canada.,Univ. Ramon Llull, ESADE, Barcelona, Spain
| | - Antoni Gual
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS); Rosselló, Barcelona, Spain
| | - Bernd Schulte
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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10
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Anderson P, Kokole D, Jané Llopis E, Burton R, Lachenmeier DW. Lower Strength Alcohol Products—A Realist Review-Based Road Map for European Policy Making. Nutrients 2022; 14:nu14183779. [PMID: 36145155 PMCID: PMC9500668 DOI: 10.3390/nu14183779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/02/2022] [Accepted: 09/08/2022] [Indexed: 12/16/2022] Open
Abstract
This paper reports the result of a realist review based on a theory of change that substitution of higher strength alcohol products with lower strength alcohol products leads to decreases in overall levels of alcohol consumption in populations and consumer groups. The paper summarizes the results of 128 publications across twelve different themes. European consumers are increasingly buying and drinking lower strength alcohol products over time, with some two fifths doing so to drink less alcohol. It tends to be younger more socially advantaged men, and existing heavier buyers and drinkers of alcohol, who take up lower strength alcohol products. Substitution leads to a lower number of grams of alcohol bought and drunk. Although based on limited studies, buying and drinking lower strength products do not appear to act as gateways to buying and drinking higher strength products. Producer companies are increasing the availability of lower strength alcohol products, particularly for beer, with extra costs of production offset by income from sales. Lower strength alcohol products tend to be marketed as compliments to, rather than substitutes of, existing alcohol consumption, with, to date, the impact of such marketing not evaluated. Production of lower strength alcohol products could impair the impact of existing alcohol policy through alibi marketing (using the brand of lower strength products to promote higher strength products), broadened normalization of drinking cultures, and pressure to weaken policies. In addition to increasing the availability of lower strength products and improved labelling, the key policy that favours substitution of higher strength alcohol products with lower strength products is an alcohol tax based on the dose of alcohol across all products.
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Affiliation(s)
- Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
- Correspondence:
| | - Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Eva Jané Llopis
- ESADE Business School, Ramon Llull University, 08034 Barcelona, Spain
| | - Robyn Burton
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Dirk W. Lachenmeier
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Weissenburger Straße 3, 76187 Karlsruhe, Germany
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11
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Solovei A, Jané-Llopis E, Mercken L, Bustamante I, Kokole D, Mejía-Trujillo J, Medina Aguilar PS, Natera Rey G, O'Donnell A, Piazza M, Schmidt CS, Anderson P, de Vries H. Effect of Community Support on the Implementation of Primary Health Care-Based Measurement of Alcohol Consumption. Prev Sci 2022; 23:224-236. [PMID: 35032246 PMCID: PMC8760585 DOI: 10.1007/s11121-021-01329-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 10/25/2022]
Abstract
Alcohol measurement delivered by health care providers in primary health care settings is an efficacious and cost-effective intervention to reduce alcohol consumption among patients. However, this intervention is not yet routinely implemented in practice. Community support has been recommended as a strategy to stimulate the delivery of alcohol measurement by health care providers, yet evidence on the effectiveness of community support in this regard is scarce. The current study used a pre-post quasi-experimental design in order to investigate the effect of community support in three Latin American municipalities in Colombia, Mexico, and Peru on health care providers' rates of measuring alcohol consumption in their patients. The analysis is based on the first 5 months of implementation. Moreover, the study explored possible mechanisms underlying the effects of community support, through health care providers' awareness of support, as well as their attitudes, subjective norms, self-efficacy, and subsequent intention toward delivering the intervention. An ANOVA test indicated that community support had a significant effect on health care providers' rates of measuring alcohol consumption in their patients (F (1, 259) = 4.56, p = 0.034, ηp2 = 0.018). Moreover, a path analysis showed that community support had a significant indirect positive effect on providers' self-efficacy to deliver the intervention (b = 0.07, p = 0.008), which was mediated through awareness of support. Specifically, provision of community support resulted in a higher awareness of support among health care providers (b = 0.31, p < 0.001), which then led to higher self-efficacy to deliver brief alcohol advice (b = 0.23, p = 0.010). Results indicate that adoption of an alcohol measurement intervention by health care providers may be aided by community support, by directly impacting the rates of alcohol measurement sessions, and by increasing providers' self-efficacy to deliver this intervention, through increased awareness of support. Trial Registration ID: NCT03524599; Registered 15 May 2018; https://clinicaltrials.gov/ct2/show/NCT03524599.
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Affiliation(s)
- Adriana Solovei
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
| | - Eva Jané-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.,Univ. Ramon Llull, ESADE, Barcelona, Spain.,Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, Canada
| | - Liesbeth Mercken
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.,Department of Health Psychology, Faculty of Psychology, Open University, Heerlen, The Netherlands
| | - Inés Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | | | | | | | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Christiane Sybille Schmidt
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.,Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
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12
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Kokole D, Jané-Llopis E, Natera Rey G, Aguilar NB, Medina Aguilar PS, Mejía-Trujillo J, Mora K, Restrepo N, Bustamante I, Piazza M, O’Donnell A, Solovei A, Mercken L, Schmidt CS, Lopez-Pelayo H, Matrai S, Braddick F, Gual A, Rehm J, Anderson P, de Vries H. Training primary health care providers in Colombia, Mexico and Peru to increase alcohol screening: Mixed-methods process evaluation of implementation strategy. Implement Res Pract 2022; 3:26334895221112693. [PMID: 37091075 PMCID: PMC9924276 DOI: 10.1177/26334895221112693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Initial results from the SCALA study demonstrated that training primary health care providers is an effective implementation strategy to increase alcohol screening in Colombia, Mexico and Peru, but did not show evidence of superior performance for the standard compared to the shorter training arm. This paper elaborates on those outcomes by examining the relationship of training-related process evaluation indicators with the alcohol screening practice. Methods A mix of convergent and exploratory mixed-methods design was employed. Data sources included training documentation, post-training questionnaires, observation forms, self-report forms and interviews. Available quantitative data were compared on outcome measure - providers' alcohol screening. Results Training reach was high: three hundred fifty-two providers (72.3% of all eligible) participated in one or more training or booster sessions. Country differences in session length reflected adaptation to previous topic knowledge and experience of the providers. Overall, 49% of attendees conducted alcohol screening in practice. A higher dose received was positively associated with screening, but there was no difference between standard and short training arms. Although the training sessions were well received by participants, satisfaction with training and perceived utility for practice were not associated with screening. Profession, but not age or gender, was associated with screening: in Colombia and Mexico, doctors and psychologists were more likely to screen (although the latter represented only a small proportion of the sample) and in Peru, only psychologists. Conclusions The SCALA training programme was well received by the participants and led to half of the participating providers conducting alcohol screening in their primary health care practice. The dose received and the professional role were the key factors associated with conducting the alcohol screening in practice.Plain Language Summary: Primary health care providers can play an important role in detecting heavy drinkers among their consulting patients, and training can be an effective implementation strategy to increase alcohol screening and detection. Existing training literature predominantly focuses on evaluating trainings in high-income countries, or evaluating their effectiveness rather than implementation. As part of SCALA (Scale-up of Prevention and Management of Alcohol Use Disorders in Latin America) study, we evaluated training as implementation strategy to increase alcohol screening in primary health care in a middle-income context. Overall, 72.3% of eligible providers attended the training and 49% of training attendees conducted alcohol screening in practice after attending the training. Our process evaluation suggests that simple intervention with sufficient time to practice, adapted to limited provider availability, is optimal to balance training feasibility and effectiveness; that booster sessions are especially important in context with lower organizational or structural support; and that ongoing training refinement during the implementation period is necessary.
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Affiliation(s)
- Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health
Research Institute, Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands
| | - Eva Jané-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health
Research Institute, Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands
- Univ. Ramon Llull, ESADE, Avenida de Pedralbes, 60, 62, 08034 Barcelona, Spain
- Institute for Mental Health Policy
Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada
| | - Guillermina Natera Rey
- Instituto Nacional de Psiquiatría Ramón
de la Fuente Muñiz, Calz México-Xochimilco 101, Huipulco, 14370 Ciudad de México,
CDMX, Mexico
| | - Natalia Bautista Aguilar
- Instituto Nacional de Psiquiatría Ramón
de la Fuente Muñiz, Calz México-Xochimilco 101, Huipulco, 14370 Ciudad de México,
CDMX, Mexico
| | - Perla Sonia Medina Aguilar
- Instituto Nacional de Psiquiatría Ramón
de la Fuente Muñiz, Calz México-Xochimilco 101, Huipulco, 14370 Ciudad de México,
CDMX, Mexico
| | | | - Katherine Mora
- Corporación Nuevos Rumbos, Calle 108 A # 4-15, Bogotá,
Colombia
| | | | - Ines Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano
Heredia, Ave. Honorio Delgado 430, Urb. Ingeniería, S.M.P. Lima -
Perú
| | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano
Heredia, Ave. Honorio Delgado 430, Urb. Ingeniería, S.M.P. Lima -
Perú
| | - Amy O’Donnell
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne
NE2 4AX, UK
| | - Adriana Solovei
- Department of Health Promotion, CAPHRI Care and Public Health
Research Institute, Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands
| | - Liesbeth Mercken
- Department of Health Promotion, CAPHRI Care and Public Health
Research Institute, Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands
- Department of Health Psychology, Open University, Valkenburgerweg 177, 6419 AT Heerlen, the Netherlands
| | - Christiane Sybille Schmidt
- Centre for Interdisciplinary Addiction Research (ZIS), Department of
Psychiatry and Psychotherapy, University Medical Centre
Hamburg-Eppendorf, Hamburg, Germany
| | - Hugo Lopez-Pelayo
- Addictions Unit, Psychiatry Dept, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain
- Red de Trastornos Adictivos, Instituto Carlos III, Sinesio Delgado, 4, 28029 – Madrid, Spain
- Institut d’Investigacions Biomèdiques
August Pi Sunyer (IDIBAPS), Rosselló, 149-153, 08036 Barcelona, Spain
| | - Silvia Matrai
- Addictions Unit, Psychiatry Dept, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain
| | - Fleur Braddick
- Addictions Unit, Psychiatry Dept, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain
| | - Antoni Gual
- Addictions Unit, Psychiatry Dept, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain
- Red de Trastornos Adictivos, Instituto Carlos III, Sinesio Delgado, 4, 28029 – Madrid, Spain
- Institut d’Investigacions Biomèdiques
August Pi Sunyer (IDIBAPS), Rosselló, 149-153, 08036 Barcelona, Spain
| | - Jürgen Rehm
- Institute for Mental Health Policy
Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany
- Dalla Lana School of Public
Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON M5T 3M7,
Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8,
Canada
- Department of International Health Projects, Institute for
Leadership and Health Management, I.M. Sechenov First Moscow State Medical
University, Trubetskaya str., 8, b. 2, 119992, Moscow, Russian Federation
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health
Research Institute, Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne
NE2 4AX, UK
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health
Research Institute, Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands
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13
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Kokole D, Jané Llopis E, Anderson P. Non-alcoholic beer in the European Union and UK: Availability and apparent consumption. Drug Alcohol Rev 2021; 41:550-560. [PMID: 34957634 PMCID: PMC9305855 DOI: 10.1111/dar.13429] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/02/2021] [Accepted: 12/02/2021] [Indexed: 01/24/2023]
Abstract
Introduction Market research indicates an increasing interest in low‐ and no‐alcohol drinks in Europe, but there is no systematic overview of their availability and consumption. In this article, we present data on the availability and apparent consumption of non‐alcoholic beer in the European Union and the UK. Methods We use Sold production, exports and imports by PRODCOM list (NACE Rev. 2) dataset, available in Eurostat, to extract the available data on sold production, exports and imports of non‐alcoholic beer in the EU‐27 (total and country‐level) and the UK between 2013 and 2019, and additionally calculate the apparent consumption. Results Between 2013 and 2019, the sold production volume in the EU increased from 0.59 to 1.38 billion litres, the value from 0.42 to 1.28 billion EUR and value per litre from 0.72 to 0.93 EUR/L. In 2019, the share of non‐alcoholic beer represented 3.8% of all beer volume and 4.1% of all beer value produced. Five countries accounted for 80.8% of sold production volume: Germany, the Netherlands, Spain, Poland and Czechia. The Netherlands and Germany were the largest exporters, while importing was distributed more equally. Per capita, average apparent consumption (2017–2019) was highest in Czechia, followed by the Netherlands, Spain, Luxembourg and Germany. Discussion and Conclusions Our results show the increasing availability of non‐alcoholic beer in the EU‐27, although overall changes seem to be driven by a small number of countries. More research is needed at the country‐level on no‐ and low‐alcohol consumption trends and drivers, and their impact on alcohol‐related harm reduction.
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Affiliation(s)
- Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Eva Jané Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,University of Ramon Llull, ESADE, Barcelona, Spain.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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14
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Anderson P, Kokole D, Jané Llopis E. Impact of minimum unit pricing on shifting purchases from higher to lower strength beers in Scotland: Controlled interrupted time series analyses, 2015-2020. Drug Alcohol Rev 2021; 41:646-656. [PMID: 34791729 DOI: 10.1111/dar.13408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/21/2021] [Accepted: 10/21/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION On 1 May 2018 Scotland introduced a minimum unit price (MUP) of GB50 pence per unit of alcohol (8 g) sold. We analysed household purchase data to assess the impact of MUP in shifting purchases from higher to lower strength beers. METHODS Data from Kantar Worldpanel's household shopping panel, with 75 376 households and 4.76 million alcohol purchases, 2015-2020. We undertook interrupted time series analyses of the impact of introducing MUP in Scotland on changes in the proportion of the volume of purchased beer with an alcohol by volume (ABV) ≤3.5% using purchases in England as control. We analysed the moderating impact of the volume of purchased beer with an ABV ≤3.5% on the size of the associated impact of MUP in reducing purchases of grams of alcohol within beer. RESULTS MUP was associated with a relative increase in the proportion of the volume of beer purchased with an ABV ≤3.5%, Scotland minus England, of 10.9% (95% CI 10.6-11.1), following a 43.6% (95% CI 40.1-47.1) increase in the volume of beer purchased with an ABV ≤3.5%, and a 9.6% (95% CI 9.4-9.8) decrease in the volume of beer purchased with an ABV >3.5%. MUP was associated with reduced purchases of grams of alcohol within beer by 8% (95% CI 7.8-8.3), increasing to 9.6% (95% CI 9.3-9.9), when accounting for the moderating impact of shifts to lower strength beer. DISCUSSION AND CONCLUSIONS MUP seems an effective policy to reduce off-trade purchases of alcohol and encourage shifts to lower strength beers.
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Affiliation(s)
- Peter Anderson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Eva Jané Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,ESADE Business School, Ramon Llull University, Barcelona, Spain
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15
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Anderson P, O'Donnell A, Kokole D, Jané Llopis E, Kaner E. Is Buying and Drinking Zero and Low Alcohol Beer a Higher Socio-Economic Phenomenon? Analysis of British Survey Data, 2015-2018 and Household Purchase Data 2015-2020. Int J Environ Res Public Health 2021; 18:10347. [PMID: 34639647 PMCID: PMC8508356 DOI: 10.3390/ijerph181910347] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 11/20/2022]
Abstract
Zero and low alcohol products, particularly beer, are gaining consideration as a method to reduce consumption of ethanol. We do not know if this approach is likely to increase or decrease health inequalities. The aim of the study was to determine if the purchase and consumption of zero and low alcohol beers differs by demographic and socio-economic characteristics of consumers. Based on British household purchase data from 79,411 households and on British survey data of more than 104,635 adult (18+) respondents, we estimated the likelihood of buying and drinking zero (ABV = 0.0%) and low alcohol (ABV > 0.0% and ≤ 3.5%) beer by a range of socio-demographic characteristics. We found that buying and consuming zero alcohol beer is much more likely to occur in younger age groups, in more affluent households, and in those with higher social grades, with gaps in buying zero alcohol beer between households in higher and lower social grades widening between 2015 and 2020. Buying and drinking low alcohol beer had less consistent relationships with socio-demographic characteristics, but was strongly driven by households that normally buy and drink the most alcohol. Common to many health-related behaviours, it seems that it is the more affluent that lead the way in choosing zero or low alcohol products. Whilst the increased availability of zero and low alcohol products might be a useful tool to reduce overall ethanol consumption in the more socially advantageous part of society, it may be less beneficial for the rest of the population. Other evidence-based alcohol policy measures that lessen health inequalities, need to go hand-in-hand with those promoting the uptake of zero and low alcohol beer.
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Affiliation(s)
- Peter Anderson
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle NE2 4AX, UK
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, 6211 LK Maastricht, The Netherlands
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle NE2 4AX, UK
| | - Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, 6211 LK Maastricht, The Netherlands
| | - Eva Jané Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, 6211 LK Maastricht, The Netherlands
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON M5T 1R8, Canada
- ESADE Business School, Ramon Llull University, 08034 Barcelona, Spain
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle NE2 4AX, UK
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16
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Anderson P, Kokole D, Llopis EJ. Production, Consumption, and Potential Public Health Impact of Low- and No-Alcohol Products: Results of a Scoping Review. Nutrients 2021; 13:3153. [PMID: 34579030 PMCID: PMC8466998 DOI: 10.3390/nu13093153] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 12/30/2022] Open
Abstract
Switching from higher strength to low- and no-alcohol products could result in consumers buying and drinking fewer grams of ethanol. We undertook a scoping review with systematic searches of English language publications between 1 January 2010 and 17 January 2021 using PubMed and Web of Science, covering production, consumption, and policy drivers related to low- and no-alcohol products. Seventy publications were included in our review. We found no publications comparing a life cycle assessment of health and environmental impacts between alcohol-free and regular-strength products. Three publications of low- and no-alcohol beers found only limited penetration of sales compared with higher strength beers. Two publications from only one jurisdiction (Great Britain) suggested that sales of no- and low-alcohol beers replaced rather than added to sales of higher strength beers. Eight publications indicated that taste, prior experiences, brand, health and wellbeing issues, price differentials, and overall decreases in the social stigma associated with drinking alcohol-free beverages were drivers of the purchase and consumption of low- and no-alcohol beers and wines. Three papers indicated confusion amongst consumers with respect to the labelling of low- and no-alcohol products. One paper indicated that the introduction of a minimum unit price in both Scotland and Wales favoured shifts in purchases from higher- to lower-strength beers. The evidence base for the potential beneficial health impact of low- and no-alcohol products is very limited and needs considerable expansion. At present, the evidence base could be considered inadequate to inform policy.
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Affiliation(s)
- Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands; (D.K.); (E.J.L.)
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
| | - Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands; (D.K.); (E.J.L.)
| | - Eva Jané Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands; (D.K.); (E.J.L.)
- ESADE Business School, University Ramon Llull, 08034 Barcelona, Spain
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON M5S 2S1, Canada
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17
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Kokole D, Anderson P, Jané-Llopis E. Nature and Potential Impact of Alcohol Health Warning Labels: A Scoping Review. Nutrients 2021; 13:3065. [PMID: 34578942 PMCID: PMC8469468 DOI: 10.3390/nu13093065] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 01/16/2023] Open
Abstract
Alcohol is toxic to human health. In addition to providing nutritional information, labels on alcohol products can be used to communicate warnings on alcohol-related harms to consumers. This scoping review examined novel or enhanced health warning labels to assess the current state of the research and the key studied characteristics of labels, along with their impact on the studied outcomes. Four databases (Web of Science, MEDLINE, PsycInfo, CINAHL) were searched between January 2010 and April 2021, and 27 papers were included in the review. The results found that most studies were undertaken in English-speaking populations, with the majority conducted online or in the laboratory setting as opposed to the real world. Seventy percent of the papers included at least one cancer-related message, in most instances referring either to cancer in general or to bowel cancer. Evidence from the only real-world long-term labelling intervention demonstrated that alcohol health warning labels designed to be visible and contain novel and specific information have the potential to be part of an effective labelling strategy. Alcohol health warning labels should be seen as tools to raise awareness on alcohol-related risks, being part of wider alcohol policy approaches.
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Affiliation(s)
- Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD Maastricht, The Netherlands; (P.A.); (E.J.-L.)
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD Maastricht, The Netherlands; (P.A.); (E.J.-L.)
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK
| | - Eva Jané-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD Maastricht, The Netherlands; (P.A.); (E.J.-L.)
- ESADE Business School, University Ramon Llull, Avenida de Pedralbes, 60-62, 08034 Barcelona, Spain
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada
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Kokole D, Jané-Llopis E, Mercken L, Piazza M, Bustamante I, Natera Rey G, Medina P, Pérez-Gómez A, Mejía-Trujillo J, O'Donnell A, Kaner E, Gual A, Schmidt CS, Schulte B, Candel MJJM, de Vries H, Anderson P. Factors associated with primary health care providers' alcohol screening behavior in Colombia, Mexico and Peru. Subst Abus 2021; 42:1007-1015. [PMID: 33849396 DOI: 10.1080/08897077.2021.1903658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background: Screening for unhealthy alcohol use in routine consultations can aid primary health care (PHC) providers in detecting patients with hazardous or harmful consumption and providing them with appropriate care. As part of larger trial testing strategies to improve implementation of alcohol screening in PHC, this study investigated the motivational (role security, therapeutic commitment, self-efficacy) and organizational context (leadership, work culture, resources, monitoring, community engagement) factors that were associated with the proportion of adult patients screened with AUDIT-C by PHC providers in Colombia, Mexico and Peru. Additionally, the study investigated whether the effect of the factors interacted with implementation strategies and the country. Methods: Pen-and-paper questionnaires were completed by 386 providers at the start of their study participation (79% female, Mage = 39.5, 37.6% doctors, 15.0% nurses, 9.6% psychologists, 37.8% other professional roles). They were allocated to one of four intervention arms: control group; short training only; short training in presence of municipal support; and standard (long) training in presence of municipal support. Providers documented their screening practice during the five-month implementation period. Data were collected between April 2019 and March 2020. Results: Negative binomial regression analysis found an inverse relationship of role security with the proportion of screened patients. Self-efficacy was associated with an increase in the proportion of screened patients only amongst Mexican providers. Support from leadership (formal leader in organization) was the only significant organizational context factor, but only in non-control arms. Conclusion: Higher self-efficacy is a relevant factor in settings where screening practice is already ongoing. Leadership support can enhance effects of implementation strategies.
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Affiliation(s)
- Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Eva Jané-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Univ. Ramon Llull, ESADE, Barcelona, Spain.,Institute for Mental Health Policy Research, CAMH, Toronto, ON, Canada
| | - Liesbeth Mercken
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ines Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Guillermina Natera Rey
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, CDMX, Mexico
| | - Perla Medina
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, CDMX, Mexico
| | | | | | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Antoni Gual
- Red de Trastornos Adictivos. Instituto Carlos III, Madrid, Spain.,Addictions Unit, Psychiatry Department Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Christiane Sybille Schmidt
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Schulte
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Math J J M Candel
- Department of Methodology & Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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19
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Jané-Llopis E, Anderson P, Piazza M, O'Donnell A, Gual A, Schulte B, Pérez Gómez A, de Vries H, Natera Rey G, Kokole D, V Bustamante I, Braddick F, Mejía Trujillo J, Solovei A, Pérez De León A, Kaner EF, Matrai S, Manthey J, Mercken L, López-Pelayo H, Rowlands G, Schmidt C, Rehm J. Implementing primary healthcare-based measurement, advice and treatment for heavy drinking and comorbid depression at the municipal level in three Latin American countries: final protocol for a quasiexperimental study (SCALA study). BMJ Open 2020; 10:e038226. [PMID: 32723746 PMCID: PMC7390229 DOI: 10.1136/bmjopen-2020-038226] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Eva Jané-Llopis
- ESADE Business School, Ramon Llull University, Barcelona, Catalunya, Spain
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, CAMH, Toronto, Ontario, Canada
| | - Peter Anderson
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Marina Piazza
- Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Antoni Gual
- Addiction Unit, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Red de Trastornos Adictivos, Instituto Carlos III, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Bernd Schulte
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | | | - Hein de Vries
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Guillermina Natera Rey
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico, DF, Mexico
| | - Daša Kokole
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Ines V Bustamante
- Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Fleur Braddick
- Addiction Unit, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | | | - Adriana Solovei
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Alexandra Pérez De León
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico, DF, Mexico
| | - Eileen Fs Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Silvia Matrai
- Addiction Unit, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - Jakob Manthey
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - Liesbeth Mercken
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Hugo López-Pelayo
- Addiction Unit, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Red de Trastornos Adictivos, Instituto Carlos III, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Gillian Rowlands
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Christiane Schmidt
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, CAMH, Toronto, Ontario, Canada
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
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Stewart KFJ, Kokole D, Wesselius A, Schols AMWJ, Zeegers MP, de Vries H, van Osch LADM. Factors Associated with Acceptability, Consideration and Intention of Uptake of Direct-To-Consumer Genetic Testing: A Survey Study. Public Health Genomics 2018; 21:45-52. [PMID: 30359983 DOI: 10.1159/000492960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 08/16/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND With interest in personalised health care growing, so is interest in personal genetic testing. This is now offered direct-to-consumer, thereby referred to as direct-to-consumer genetic testing (DTC-GT). Criticisms have been expressed on whether a truly informed decision to undergo testing is made with regard to these services. In order to provide relevant information to achieve this, knowing the characteristics of the expected user population is helpful. Therefore, the aim of this study is to identify characteristics of individuals who (1) find the concept of DTC-GT acceptable and (2) consider undergoing DTC-GT in the distant or near future. METHODS This cross-sectional study investigated factors associated with acceptability, consideration and intention in the Dutch general population. Studied variables included awareness, principles and how-to knowledge, attitude, innovativeness, and multiple demographic characteristics. Generalised linear models were applied to identify associated variables. RESULTS Full data was obtained for 836 respondents. Of those, 18.3% found DTC-GT somewhat or totally acceptable, whereas 12.6% considered and 5.5% intended to undergo DTC-GT in the distant or near future. Acceptability was greater with lower principles knowledge, and consideration and intention with lower how-to knowledge. A more positive attitude and greater innovativeness were associated with an increase in all 3 outcomes. CONCLUSION Informed decision making may be hampered as individuals with lower how-to knowledge were found to be more interested in pursuing testing. The identified characteristics can be used in development and distribution of public and personalized information, in order to help consumers make a truly informed decision.
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Affiliation(s)
- Kelly F J Stewart
- Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, The .,CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The
| | - Daša Kokole
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, The Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Anke Wesselius
- Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Annemie M W J Schols
- Department of Respiratory Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre Maastricht, Maastricht, The Netherlands
| | - Maurice P Zeegers
- Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, The Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hein de Vries
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, The Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Liesbeth A D M van Osch
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, The Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
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