Introduction: Late-night alcohol trading hours are generally associated with increased alcohol-related harm. Since 2018, two Scottish cities have allowed extensions in late-night alcohol trading hours with the aim of revitalising the night-time economy. This is the first study to directly observe whether and how bars and nightclubs use these extensions, and collect rich qualitative data about venue environment and staff behaviour. Methods: Trained, paired fieldworkers, behaving as customers, completed semi-structured observation schedules on mobile devices during repeated visits to 15 purposively sampled venues in 2023-24 (5 venues in Glasgow and 10 in Aberdeen: total of 313 h of observation). In-depth qualitative fieldnotes were completed within 48 h of visits. Results: Half of the venues closed early on at least one fieldworker visit without using all of their later trading hours. Venues using their extended hours were observed to be at low occupancy on at least one visit. Fieldworkers observed bar staff serving alcohol to intoxicated customers in every venue. In half of the venues, 'shot girls' were observed persistently approaching customers, including those who appeared intoxicated. Conclusions: Extensions in late-night alcohol trading hours granted in two Scottish cities were not used consistently by venues due to lack of demand by customers. The late-night sale of alcohol to intoxicated customers was routine. Our findings challenge the assumption that later trading hours benefit the night-time economy and highlight the likelihood of associated alcohol-related harms.

BACKGROUND:Hand-rolling tobacco (HRT) remains more affordable than factory-made (FM) cigarettes in the UK, which could undermine the health benefits of tobacco tax increases. This study modelled health and economic impacts of raising HRT duty annually to reduce this affordability gap. METHODS:We used the Sheffield Tobacco and Alcohol Policy Model V.2.5.0, an individual-level microsimulation, to project tobacco consumption, spending and health outcomes for adults in England aged 18-89 from 2024 to 2030. Four duty policies were compared against a business-as-usual scenario of duty rising 2% above the Retail Price Index (RPI) annually: Policy A increased duty by RPI+12% in 2024 only (the UK Government's October 2023 policy); Policy B applied RPI+10% annually to align with FM duty by 2030; Policy C applied RPI+12% annually; and Policy D applied RPI+18% annually to equalise average HRT and FM prices by 2030. RESULTS:Policy A was estimated to prevent 1770 deaths, add 36 947 life years and save the National Health Service £12 million, with greater gains in deprived areas. Policies B-D achieved larger health benefits and reduced inequalities, but increased spending by people who smoke. Policy D generated £3.19 billion additional tax revenue and reduced tobacco industry revenue by £400 million by 2030. Revenue effects depended on assumptions about how higher HRT prices affected FM consumption. CONCLUSIONS:Sustained duty increases on the least expensive tobacco products could deliver substantial public health gains and reduce health inequalities. Such measures should coincide with strong enforcement against illicit tobacco and comprehensive smoking cessation support.

BACKGROUND:Governments in several countries have introduced a minimum unit price (MUP) for alcohol. Evaluation studies suggest this has reduced alcohol-related harm, but MUPs must increase with inflation to remain effective. This paper estimates the impact of the impact of the Scottish Government's decision to increase its MUP from £0.50 to £0.65 in September 2024 and, alternative options where the MUP changes to between £0.40 and £0.80. It examines impacts on alcohol consumption, spending, and related health outcomes, how impacts vary across the population with regard to deprivation, and how drinkers move between lighter and heavier alcohol consumption groups. METHODS AND FINDINGS:Policy appraisal using the Sheffield Tobacco and Alcohol Policy Model, a dynamic microsimulation model that combines data on alcohol purchasing and consumption for 10 beverage types and 800 subgroups comprising adults in the Scottish population with price elasticities and an epidemiological model. Deprivation is measured using quintiles of the Scottish Index of Multiple Deprivation. Drinker group is categorised as moderate (<14 units/week, 1 UK unit = 8 g ethanol), hazardous (>14 to ≤35/ ≤50 units/week for women/men), and harmful (>35/50 units/week for women/men). The policy appraisal estimates that, compared to retaining Scotland's MUP at £0.50, increasing the MUP to £0.65 leads to an estimated 12.0% decrease in alcohol consumption, 2.1% decrease in alcohol spending, 3,385 fewer deaths overall, and 2,578 fewer deaths wholly attributable to alcohol over 20 years. Estimated effects are largest in the quintile of the population living in the most deprived areas. Increasing the MUP to £0.65 is also estimated to reduce the proportion of drinkers consuming at harmful levels by 29.4% and the proportion consuming at hazardous levels by 8.0%. Key limitations of the study include relying on data on alcohol consumption and spending collected before the COVID-19 pandemic, synthesising consumption and spending data from separate datasets, and assuming no supply-side responses (e.g., price changes above the MUP threshold). CONCLUSIONS:Increasing the threshold of an established MUP can lead to additional reductions in alcohol consumption, related harm, and health inequalities. Benefits accrue particularly to the most deprived and heaviest drinkers.

INTRODUCTION:In the UK, consumption of alcohol-free (< 0.05% ABV) and low-alcohol (≤ 1.2% ABV; NoLo) drinks is more prevalent among heavier drinkers and socially advantaged groups. If heavier drinkers are substituting alcoholic drinks with NoLo drinks, this could improve public health. However, socioeconomic differences in consumption could exacerbate alcohol-related health inequalities. Socioeconomic groups vary in their reasons for drinking alcohol, with less advantaged individuals more likely to drink alcohol to cope. This study examined whether alcohol drinking motives can help explain differences in NoLo consumption. METHODS:A total of 2549 adults residing in Great Britain provided data on at least monthly NoLo consumption, hazardous drinking (AUDIT-C), alcohol drinking motives, social grade, education, age and gender, via the Alcohol Toolkit Study. Path analysis explored mediating effects of drinking motives between sociodemographic characteristics, hazardous drinking and NoLo consumption. RESULTS:Drinking alcohol to conform, education and hazardous drinking were positively associated with NoLo consumption. Drinking alcohol to cope with depression was a serial mediator between social grade and NoLo. Drinking to cope with depression, more frequently reported among lower social grades, weakened the positive relationship between hazardous drinking and NoLo consumption (β = -0.001, 95% CI -0.002, -0.000). Enhancement and social motives also weakened this relationship, partially mediating pathways between age, gender, education and NoLo consumption. DISCUSSION AND CONCLUSIONS:While hazardous drinking is positively associated with NoLo consumption, for those drinking to cope with depression, for enhancement or for social reasons, this effect diminishes, potentially limiting the public health potential for those who drink for these reasons, including disadvantaged groups.

Background:Alcohol and tobacco are risk factors for non-communicable disease and deaths in England. People using both substances have increased health risks. While increasing tax on each product has been shown to reduce consumption and harm, little research has examined effects of changing both taxes together. Objectives:Work package 1: describe potential tobacco and alcohol tax policies; work package 2: analyse purchasing patterns across population subgroups; work package 3: estimate industry tax-pass-through; consumer response to price changes for 12 products; work package 4: simulate impact of 33 policy options, United Kingdom Government 2021 proposals to restructure alcohol duty and (after project end date) 2023 alcohol duty reform. Design:Work package 1 reviewed literature and interviewed stakeholders to identify policy options. Work package 2 analysed repeat cross-sectional survey data on purchasing. Work package 3 used quantile regression on market research data to estimate tax pass-through and a two-stage Tobit model to estimate consumer responses (own-price and cross-price elasticities) for 12 products (beer, cider, wine, spirits and ready-to-drinks, split off-trade/on-trade; cigarettes, roll-your-own tobacco). Work package 4 developed tax modelling for the Sheffield Tobacco and Alcohol Policy Model (v2.1.0) to analyse work package 1 policy options. Later, version v2.4.2 was used to analyse emerging policy on alcohol duty reforms. Setting:Effects of United Kingdom tax policies in England, covering 2017-50. Participants:Life course simulation of individuals aged 18-89; 2017-50. Interventions:Tax policies changes: (1) specific duty per product, (2) duty escalators for alcohol and tobacco, and Minimum Excise Tax on tobacco, (3) hypothetical strength-based alcohol taxes, (4) United Kingdom Government's 2021 proposals for alcohol duty reform and (5) analysis of United Kingdom Government's implemented Alcohol Duty Reform 2023. Outcome measures:Changes in participation in drinking or smoking, amounts consumed, expenditures, Government tax revenues, retailer revenues, risks of hospitalisation and death from over 60 clinical conditions, National Health Service secondary costs, quality-adjusted life-years, mortality and health inequalities. Results:Work package 1 identified policy options. Work package 2 showed variations in expenditure by subgroup. Work package 3 showed that retailers increased prices of expensive products by more than expected after tax rises, keeping cheap product prices lower. Work package 3 showed statistically significant participation and consumption price responsiveness for all 12 products. Work package 4 compared 33 policies, showing that higher tax increases, especially for cider and hand-rolled tobacco, are effective at reducing smoking rates, drinking and deaths over 20 years. Effects were largest for people living in more deprived areas. Tailored modelling (after project end date) examined United Kingdom Government's 2023 implemented alcohol duty reform, estimating a small reduction in alcohol consumption and deaths. In contrast, a policy to increase cider taxes to be in line with beer could result in a 30 times larger reduction in deaths. Limitations:Uncertainty in estimates remains. Data used were collected pre-coronavirus disease discovered in 2019. Sales data were from legal retailers; illicit tobacco was not examined. Each sub-study has its own data limitations. Conclusions:Combined increases in tax on tobacco and alcohol could potentially be more effective at reducing disease, National Health Service costs, deaths and health inequalities than raising tax on only one product. Potential trade-offs could exist between health benefits and effects of tobacco and alcohol tax increases on financial burden for those who continue consuming both products. Future tobacco or alcohol tax analyses should factor in inter-linkages between both commodities. Future work:We are adapting modelling infrastructure to deliver responsive within-days modelling for new government proposals and budgets. Further work on price elasticities in other countries would be useful. Future analyses will incorporate post-coronavirus disease discovered in 2019 data. We are extending modelling to other United Kingdom countries, and pricing policies beyond tax (e.g. minimum pricing). We are extending analyses to no and low alcohol products and to evaluate observed impacts of the government's alcohol duty reforms. Funding:This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number 16/105/26.

BACKGROUND AND AIMS:Alcohol-free and low alcohol [no/lo; ≤1.2% alcohol by volume (ABV)] drinks are increasingly popular in some high-income countries and offer potential public health benefits if used as substitutes for regular-strength drinks; however, perceived high prices may deter people from buying these products. This paper explored whether no/lo drinks are more expensive than regular-strength drinks. We compared for no/lo and regular-strength drinks: (i) average prices and price distributions; (ii) prices of products matched on brand and pack size; and (iii) average prices across different multipack sizes, container sizes and container types (e.g. bottle vs. can). DESIGN:Cross-sectional analysis of population-level, off-trade (i.e. shops) sales data. SETTING:Great Britain, 2024. CASES:N = 21 147 no/lo and regular-strength stock-keeping units (SKUs, e.g. 6x300ml Heineken 0.0). MEASUREMENTS:We analysed data from the market research company Circana. Analyses were stratified by beverage categories: beer, cider, wine, spirits and ready-to-drinks (RTDs). Our primary measures were median prices of all products available and median purchase prices (i.e. weighted by sales volume). Prices were per standard serving size for each beverage type. We used quantile regression to test differences in median prices. FINDINGS:In 2024, the median price of no/lo drinks available was lower than for regular-strength drinks (ranging from beer -19% to wine -44%; P < 0.001), except for RTDs (11% higher; P = 0.390). In contrast, the purchase price of no/lo drinks was 7% higher for beer (P < 0.001), similar for cider (0.4% difference; P < 0.001) and lower for wine (-47%; P < 0.001), spirits (-10%; P < 0.001) and RTDs (-31%; P < 0.001). Top-selling no/lo products were cheaper than matched regular-strength products of the same brand and pack size. For example, 15 of the 17 top-selling no/lo beers were between 6% and 42% cheaper than their regular-strength equivalents; however, the top-selling no/lo products were primarily premium brands, and no/lo beers and ciders were typically sold in smaller, less cost-efficient pack and container sizes. CONCLUSIONS:In Great Britain, the alcohol-free and low alcohol (no/lo) products available to buy in the off-trade (i.e. in shops) are cheaper on average than regular-strength drinks, but people still tend to pay more for no/lo beer than regular-strength beer and pay a similar price for no/lo cider as regular-strength cider. This discrepancy is partially because no/lo beers and ciders are often sold in smaller, less cost-efficient pack and container sizes. The premium branding of top-selling no/lo products may also contribute to higher prices.

INTRODUCTION:In August 2023, the United Kingdom introduced alcohol taxation reforms designed to encourage alcohol producers to lower the alcoholic strength of their products. This study aims to quantify the extent of reformulation of alcoholic drinks sold in the off-trade in Great Britain between 2018 and 2025 and explore the role the tax reforms may have played. METHODS:We used continuous longitudinal data on alcohol purchases from Worldpanel by Numerator's Take Home data to examine changes between 2018 and 2025 in the mean alcohol-by-volume (ABV) of all alcohol sold, identify specific product reformulations and examine how their timing related to the 2023 tax reforms. We also explored growth in the < 3.5% ABV beer market, for which tax rates were cut in the reforms. RESULTS:The average ABV of all alcohol rose from 17.2% in late 2018 to 17.7% in June 2022, before falling to 16.7% in December 2025. We identified 557 reformulations, of which 50% were for wine and 17% were for beer. Reformulations increased substantially following the reforms, with the proportion of the beer market, measured in pure alcohol, sold below 3.5% ABV increasing from 1.1% in 2022 to 18.1% in 2025. DISCUSSION AND CONCLUSIONS:Our findings suggest that the 2023 UK alcohol tax reforms appear to have contributed to an increase in reformulations that reduced the strength of alcoholic drinks. In turn, these may have played a role in reductions in the overall ABV of alcoholic drinks purchases. Following the reforms, there was a large and immediate increase in the market share of lower-strength beers.

OBJECTIVES:In conventional quality-adjusted life-year maximization, each unit of health is valued equally. It overlooks distributional preferences, such as whether health improvements should be concentrated on a smaller number of individuals or dispersed across a larger population. It is plausible that these preferences follow an S-shaped pattern, in which marginal social value of health gains initially increases before diminishing after a threshold. This review aims to identify and evaluate the methods used in empirical studies to elicit S-shaped preferences. METHODS:Searches were conducted in PubMed, PsycINFO, and EconLit in August 2024 and October 2025, with 1 round of citation chasing for 4 key articles. Studies were included if they elicited preferences on concentration and dispersion of health gains among otherwise identical individuals. Data synthesis was conducted narratively. RESULTS:Thirteen studies published between 1994 and 2025 were included, collectively involving 6799 participants. All studies used a Person Trade-Off (PTO) approach, but 2 also used Time Trade-off. Five key methodological themes emerged: whether health gains should be measured in life-years or health-related quality of life, the threshold between concentration and dispersion, perspective, framing effects, and specification of the social welfare functions. CONCLUSIONS:This review highlights methodological challenges associated with eliciting preferences for concentration and dispersion. Although there is a consensus on the use of PTO, other heterogeneity such as pool size or perspective and sparse evidence on the threshold effect warrants further research.

Introduction Alcohol-related harms are prevalent late at night, especially on weekends, when high levels of intoxication contribute to increased rates of injury and violence. Reducing or increasing alcohol trading hours late at night in bars and clubs is generally associated with reduced and increased harms, respectively. This study evaluates the impact of later alcohol trading hours in the Scottish cities of Aberdeen and Glasgow on alcohol-related ambulance call-outs and crimes. Under local policy changes, 38 bars in Aberdeen had trading hours extended between 1 and 3 h up to 3am, and 10 nightclubs in Glasgow had a 1-h extension to 4am.Methods Following a natural experiment evaluation framework, we used a controlled interrupted time series design to compare outcomes before and after policy changes, from May 2015 to March 2020. The primary outcome was a count of total weekend night-time alcohol-related ambulance call-outs. Secondary outcomes included weekend night-time crimes.Results In Aberdeen, the policy led to a significant relative increase of 11.4% (effect size=4.643; 95% CI 0.292 to 8.994; p=0.036) in alcohol-related ambulance call-outs, and 8.5% (effect size=3.442; 95% CI 0.239 to 6.645; p=0.035) in reported crimes, at weekend night-times compared with Edinburgh (control). Findings were not significant and robust across analyses for Glasgow.Conclusion Later alcohol trading hours had a significant negative impact on alcohol-related ambulance call-outs and reported crimes in Aberdeen (where more premises had longer extensions) but not in Glasgow, suggesting the number, capacity and type of premises moderated outcomes. This is important for the design of future national and local licensing policies and regulations.

BackgroundThe effectiveness of tax increases in reducing tobacco consumption relies on the tobacco retailers and producers passing on increases to consumers (tax pass-through). Previous UK research on supermarkets found heterogeneous levels of tax pass-through across the market segments and price distribution of tobacco products. This study uses data from small retailers across the UK to assess whether recent tax changes have been passed on to consumers and if this varies across the price distribution, between countries of the UK and by neighbourhood deprivation.MethodsWe use panel data quantile regression analysis of tobacco sales in small retailers in the UK from March 2017 to December 2021 combined with UK tax rates and store-level index of multiple deprivation (IMD). We calculated the rate of tax pass-through for factory-made cigarettes (FM) and roll-your-own tobacco (RYO).ResultsFollowing increases in the duty payable on tobacco, we find evidence of overshifting across the entire price distribution for FM and RYO. For England, Scotland and Wales, the rate of the overshift in tax increased with product price. For Scotland, we find that stores in the least deprived IMD pass-through taxes at a higher rate.ConclusionsOur evidence shows heterogeneous levels of tax pass-through by price, region and level of deprivation. The findings emphasise the importance of understanding the pricing strategies of the tobacco industry (TI) and how these vary across the UK to develop robust approaches to mitigate the pricing strategies of the TI.

BACKGROUND:Rising living costs and changes to alcohol taxation influence drinking behaviours. This study aimed to examine associations between financial hardship and alcohol reduction attempts in the context of a cost-of-living crisis and alcohol tax reforms in Great Britain. METHODS:We analysed data from 6063 adults (≥18 years) drinking at risky levels (AUDIT-C ≥5) participating in a nationally representative survey during January-March 2023, 2024, and 2025. Data were analysed cross-sectionally and pooled across years for the primary analysis. Participants were asked whether they had attempted to reduce their alcohol consumption in the past year and, if so, whether the most recent attempt was motivated by cost. They also reported their level of alcohol consumption, perceived financial situation, housing tenure, past-year rent/mortgage arrears, and past-month psychological distress. RESULTS:Overall, 38.3% [36.9-39.7%] reported attempting to reduce their alcohol consumption, and 7.3% [6.5-8.1%] reported cost as a motive for these attempts. Cost-motivated attempts were strongly patterned by socioeconomic circumstances, being most common among those experiencing financial hardship, younger adults, women, those drinking more heavily, and individuals with elevated psychological distress. Odds of cost-motivated reduction attempts increased progressively with greater financial hardship (e.g., adjusted OR up to 5.42 [95%CI 3.13-9.40] among those finding their financial situation very difficult vs. those living comfortably). By contrast, there was no clear association between hardship and alcohol reduction attempts in general. Associations between hardship and cost-motivated reduction attempts were consistent across levels of alcohol consumption, psychological distress, and survey year. CONCLUSIONS:Amid the cost-of-living crisis and recent alcohol duty reforms, cost has emerged as a key motive for alcohol reduction attempts among adults drinking at risky levels, particularly those facing financial and psychological vulnerability. Support for these groups is critical to ensure cost-driven attempts translate into meaningful reductions in alcohol-related harm.

Background: In England, alcohol-related hospital admissions exceed 1million per annum. Alcohol care teams (ACT) have evolved in response to this, yet limited generalisable evidence exists about their effectiveness. This study will evaluate the clinical and cost effectiveness of ACT targeting adults with alcohol dependence admitted to NHS Hospitals. Methods: This prospective pragmatic quasi-experimental study will evaluate the effectiveness and cost-effectiveness of ACTs by assessing patient outcomes recruited from three hospitals in England with optimised ACT (oACT) compared to a cohort of participants recruited from similar hospitals with no, or minimal alcohol support (NoACT). N=545 adults (>=18 years) with alcohol dependence admitted (N=245 from three oACT hospitals and N=300 from three NoACT sites) will be recruited. To draw causal inferences of the relative effect of oACTs, a counterfactual control group will be derived, using propensity score matching. We anticipate 70% of participants will be followed up at 6-month (N=175 oACT group; N=210 NoACT (control) group), which allows for a potential unmatched pool in the control group of 20%. The primary outcome measure is total alcohol consumption in the 28 days prior to the 6-month follow-up measured in units of alcohol derived using Timeline Follow Back 28 (TLFB-28). Secondary outcomes include quantity and frequency of substance use in the 28-day period prior to the 6-month assessment, changes in alcohol risk and consequences assessed by Alcohol Use Disorder Identification Test (AUDIT), Severity of Alcohol Dependence Questionnaire (SADQ) and Alcohol Problems Questionnaire (APQ) collected at baseline and at 6-months. Mental health and well-being will be measured at 6-month follow-up using the short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS), Personal Health Questionnaire-9 items (PHQ-9) and Generalised Anxiety Disorder assessment (GAD-7). Consent will be requested to access individual health records to calculate the Charlson Comorbidity Index (CCI) at baseline. Economic outcomes will be assessed using the Client Service Receipt Inventory (CSRI) and the cost-effectiveness of oACTs, calculated as the cost per Quality-Adjusted Life Year (QALY) gained compared to control. QALYs will be derived from the EuroQol-5D-5L data. Discussion: Our findings will provide evidence to patients, clinicians, policy makers and commissioners about the best use of NHS funds. Trial registration: ISRCTN10723141. Registration data 1 November 2023

Introduction Our systematic evidence map aimed to identify lung-related epidemiological estimates to populate the International Respiratory Coalition's Lung Facts website. We highlight important evidence gaps, suggest how they could be filled, and provide bespoke societal cost estimates to inform resource allocation. Methods We examined 14 lung conditions across 53 World Health Organization Europe countries, seeking incidence, prevalence, mortality, years of life lost, years lived with disability, and disability-adjusted life year (DALY) estimates by age/sex. Global Burden of Disease (GBD) study estimates were obtained for nine GBD-included lung conditions: asthma, COPD, interstitial lung disease and pulmonary sarcoidosis, lower respiratory infections, lung cancer/tracheal, bronchus and lung cancer, tuberculosis, mesothelioma, COVID-19 and pulmonary arterial hypertension. Systematic searches of bibliographic databases were necessary for five non-GBD-included lung conditions: cystic fibrosis, obstructive sleep apnoea (OSA), influenza, alpha-1 antitrypsin deficiency (A1AD) and bronchiectasis. All-age country-specific DALY estimates were multiplied by gross domestic product per capita as a proxy for a country's wealth and prosperity to estimate societal costs. Results Complete data for nine lung conditions for all countries were extracted from GBD, enabling societal cost estimation. Significant gaps were found for A1AD (only prevalence for 24 countries) and bronchiectasis (incidence, prevalence and mortality for between one and five countries), with more, but incomplete, estimates for cystic fibrosis, OSA and influenza. Conclusions More epidemiological evidence is required for A1AD, bronchiectasis, cystic fibrosis, OSA, and influenza. Inclusion in the GDB study could help address these gaps. Lung Facts provides comprehensive lung-related epidemiological and societal cost estimates covering 53 countries to support policy-makers advocating for respiratory interventions.

Background: Clinical guidance exists on the provision of care for co-occurring mental health and substance use conditions in the UK. This systematic review aimed to identify the extent to which the guidance has been applied, including barriers and facilitators to delivery, and to examine use of strategies to support implementation of the guidance. Methods: We searched PsychINFO, MEDLINE, CINAHL, Embase, and Web of Science for articles published between 1st January 2017 (when the guidance was published) to 28th January 2025. Studies were eligible if they focused on service use and/or treatment provision for adults in the UK with co-occurring substance use and mental health conditions. The findings were analyzed using a thematic synthesis, through line-by-line coding of study findings to develop analytical themes. Results: Three themes were identified from 17 eligible studies. Theme one reflects "challenges to care for co-occurring conditions", which describes how service users face 'wrong doors'; issues surrounding the recognition of co-occurring conditions; and access to care when and where it is needed, despite guidance recommending the 'no wrong doors' approach. Theme two reflects approaches for the "integration of care" as recommended in the guidance, such as communication across services and ensuring that support for people with co-occurring conditions is 'everyone's job'. The third theme highlights barriers (e.g., stigma) and facilitators (e.g., therapeutic optimism) to applying the guidance. Conclusion: This review identified an implementation gap between best practice guidance and the provision of care for co-occurring conditions in the UK setting, which needs to be explored across a global context. There were positive examples of strategies to implement the guidance, particularly from small-scale intervention evaluations, yet studies of larger scale real-world intervention implementation are needed.

BACKGROUND:Previous work with reflectance confocal microscopy (RCM) has shown high sensitivity and specificity for basal cell carcinoma (BCC); however, to date, there have been few studies in UK cohorts. OBJECTIVES:To assess the potential of RCM to accurately diagnose BCC in a private UK secondary care, single-clinician setting, and to investigate the potential of RCM as a routine diagnostic procedure. METHODS:In total, 522 lesions where BCC featured in the differential diagnosis after clinical examination were prospectively recruited; 78 lesions were subsequently excluded. We used an arm-mounted confocal microscope unless access to the lesion was awkward and required a handheld probe to be used. The likelihood of BCC was scored for each modality (clinical examination, dermoscopy and RCM), with each diagnosis building on the last. Histology was assessed by a single blinded histopathologist. The study was registered with ClinicalTrials.gov (NCT03509415). RESULTS:The analysis included 444 lesions (327 BCCs) from 326 patients. The median maximum lesion diameter was 6 mm. The sensitivity and specificity for BCC were 69.4% [95% confidence interval (CI) 64.1-74.4] and 53.0% (95% CI 43.6-62.3), respectively, for clinical examination alone; 91.8% (95% CI 88.3-94.5) and 41.0% (95% CI 32.0-50.5), respectively, for clinical examination plus dermoscopy; and 98.8% (95% CI 96.9-99.7) and 85.5% (95% CI 77.8-91.3), respectively, for clinical examination plus dermoscopy plus RCM. For RCM, the positive predictive value in diagnosing BCC was 95.0% (95% CI 92.1-97.1) and the negative predictive value was 96.2% (95% CI 90.4-98.9). The area under the curve increased from 0.61 to 0.66 to 0.92 as the respective modalities were added. CONCLUSIONS:This study demonstrates that RCM can reliably and quickly diagnose BCC, and that the addition of RCM to dermoscopy permits higher diagnostic accuracy for BCC in the UK. The specificity and sensitivity of the RCM diagnosis did not alter significantly with experience, reflecting the ease and speed of acquiring the skills required to use this modality.

BACKGROUND:We explored the potential impact of changes to the UK alcohol tax system implemented in August 2023 on increases on consumer spending, the separate impacts of the changes to the duty structures, and how these impacts vary between households depending on their level of alcohol purchasing and their socioeconomic position. METHODS:We used household-level purchasing data from Kantar's Worldpanel to analyse four alternative scenarios, reflecting the three separate components of the duty reforms (the changes to the duty structures, the temporary wine easement, and the additional 10.1% increase in duty rates). RESULTS:In the 12 months prior to the implementation of the reforms, the average household spend on off-trade alcohol in Kantar's Worldpanel was £324.37 (August 2022-July 2023). This average conceals a heavily skewed distribution, with the lowest-purchasing 20% of households spending an average of £20.47 per year compared to £1206.68 for the highest-purchasing quintile. On average, households in higher socioeconomic position spend more on alcohol than those in lower socioeconomic positions-£339.19 compared to £302.37. CONCLUSION:Our results provide support for the structural reforms to alcohol duty introduced in the UK being effectively targeted at the heaviest alcohol purchasers, with no evidence to suggest that they are likely to increase economic inequalities.

OBJECTIVES:Alcohol consumption and its associated harms pose a significant challenge to public health in the UK. To address this issue, Wales implemented a Minimum Unit Price policy (MUP) in February 2020, setting a minimum price of 50p per UK unit of alcohol (10 ml/8 g). In this study we evaluate the policy's impact on alcohol sales metrics to gauge its effectiveness in improving public health outcomes. STUDY DESIGN:Controlled interrupted time series study. METHODS:Analysis was conducted on alcohol sales data from February 2016 to February 2022, using the Kantar WorldPanel dataset, which tracks household alcohol purchases. The study employed a difference-in-difference and dynamic differences approach with controls for year fixed effects and a control for COVID-19, comparing the impact of the MUP in Wales to England, where no policy was introduced. Key outcomes included mean spend on alcohol per shopping trip, mean price per litre, proportion of households purchasing each type of alcohol (penetration), and average volume of alcohol purchased (average weekly purchase in volume and spend). RESULTS:MUP was associated with reduced alcohol purchases, notably among drinkers under 28 favouring cheap high-strength alcohol like cider. Effects varied by demographics and alcohol type. Those aged under 28 decreased cider consumption by 50 % compared to England, possibly switching to lager, which saw a 33 % spending increase. Older consumers exhibit short-term price insensitivity. Additionally, there was a 1.33 percentage point rise in wine consumption among lower socioeconomic groups. CONCLUSIONS:MUP in Wales changed purchasing behaviour, which should lead to public health benefits in the longer term. There were some interesting effects by age group and alcohol type.

Introduction The night-time economy comprises various sectors, including hospitality, transportation and entertainment, which generate substantial revenues and contribute to employment opportunities. Furthermore, the night-time economy provides spaces for leisure activities, cultural expression and social interaction. On-trade alcohol premises (places where consumers can buy and consume alcohol such as bars, pubs, clubs and restaurants) are a significant component of this night-time economy, functioning as focal points for socialising, entertainment and cultural events. However, when on-trade alcohol premises stay open later at night, this can be associated with negative public health impacts including increased alcohol consumption, intoxication, assaults, injuries and burden on public services including ambulance call outs, hospitalisations and increased impacts on criminal justice services. The evidence on the societal impact of policies to ‘later’ trading hours for bars and clubs in the night-time economy is limited. This protocol details the design of an economic evaluation of policy to later trading hours for bars and clubs in the night-time economy alongside the ELEPHANT study (National Institute for Health and Care Research (NIHR) Public Health Research, ref:129885).Methods and analysis The research design is an economic evaluation alongside a natural experiment within the ELEPHANT study carried out in Glasgow and Aberdeen. The economic evaluation has been designed to identify, measure and value prospective resource impacts and outcomes to assess the costs and consequences of local policy changes regarding late night trading hours for bars and clubs. A number of economic evaluation frameworks will be employed. A cost-effectiveness analysis (CEA) is appropriate for assessing the effectiveness of complex interventions when the impacts of policy are measured in natural units. Therefore, a CEA will be conducted for the primary consequence, alcohol-related ambulance call-outs, using a health service sector perspective. Since this outcome is essentially a cost, the CEA will also be reported as a cost-analysis. A cost-consequence analysis will also be performed for the primary and secondary consequences including all ambulance call-outs and reported crimes to evaluate the full economic impacts of later trading hours for bars and clubs in the night-time economy. The analysis will be conducted from a wider societal perspective, including health sector, criminal justice system, business and third sector perspectives and will be in line with the recent National Institute for Health and Care Excellence guidance and recommendations.Ethics and dissemination The economic evaluation of the ELEPHANT study will be conducted using secondary data. Thus, no ethical approval is required for this economic evaluation. However, ethical approval for the ELEPHANT study has been granted from the University of Stirling’s General Research Ethics Committee, and prior consent has also been obtained from the participants, if involved. The results of this study will be disseminated through peer-reviewed publications in journals and national and international conferences.

AIMS:This study aimed to identify (i) the number of alcohol care teams (ACTs) in England, (ii) the characteristics of patients supported by ACTs, and (iii) the service structure and care components offered by ACTs. METHODS:All acute hospitals (i.e. those providing short-term high-dependency medical care) in England were approached to complete a survey of alcohol care provision. Surveys were completed through researcher-guided interviews by staff familiar with the hospital's alcohol provision. It featured questions on service structure, patient characteristics, service functions, and policies. Data collection took place between May and October 2023. RESULTS:Of 170 hospitals approached, 122 completed a survey and 80 reported having an ACT. Most ACT patients were male (mean 64.1%; 95% confidence interval (CI) 61.8-66.4), white (mean 79.2%; 95% CI 75.1-83.4), aged 45-54 (mean 27.8%; 95% CI 25.0-30.5), and experiencing severe alcohol dependence (mean 66.2%; 95% CI 36.8-95.7). Most services had a clinical lead but only 58% funded this role. Fifty-nine percent of services operated 7 days per week. Most services reported identification and brief advice, though it was rarely systematized. Nearly all supported medically assisted alcohol withdrawal, though a quarter of patients did not complete medically assisted alcohol withdrawal before discharge. CONCLUSIONS:ACT numbers increased significantly between 2019 and 2024. They offer a clinical service to highly vulnerable and complex patients. There is significant variation in ACT operational models, training, and leadership which will impact the effectiveness of identification strategies and management of patients with comorbid alcohol use disorder within acute medical settings.