Socioeconomic inequalities in the delivery of brief interventions for smoking and excessive drinking: findings from a cross-sectional household survey in England.

OBJECTIVES: Brief interventions (BI) for smoking and risky drinking are effective and cost-effective policy approaches to reducing alcohol harm currently used in primary care in England; however, little is known about their contribution to health inequalities. This paper aims to investigate whether self-reported receipt of BI is associated with socioeconomic position (SEP) and whether this differs for smoking or alcohol. DESIGN: Population survey of 8978 smokers or risky drinkers in England aged 16+ taking part in the Alcohol and Smoking Toolkit Studies. MEASURES: Survey participants answered questions regarding whether they had received advice and support to cut down their drinking or smoking from a primary healthcare professional in the past 12 months as well as their SEP, demographic details, whether they smoke and their motivation to cut down their smoking and/or drinking. Respondents also completed the Alcohol Use Disorders Identification Test (AUDIT). Smokers were defined as those reporting any smoking in the past year. Risky drinkers were defined as those scoring eight or more on the AUDIT. RESULTS: After adjusting for demographic factors and patterns in smoking and drinking, BI delivery was highest in lower socioeconomic groups. Smokers in the lowest social grade had 30% (95% CI 5% to 61%) greater odds of reporting receipt of a BI than those in the highest grade. The relationship for risky drinking appeared stronger, with those in the lowest social grade having 111% (95% CI 27% to 252%) greater odds of reporting BI receipt than the highest grade. Rates of BI delivery were eight times greater among smokers than risky drinkers (48.3% vs 6.1%). CONCLUSIONS: Current delivery of BI for smoking and drinking in primary care in England may be contributing to a reduction in socioeconomic inequalities in health. This effect could be increased if intervention rates, particularly for drinking, were raised.

Review of policies and guidelines concerning adults' alcohol consumption and promotion in Australian government schools.

ISSUE ADDRESSED: Schools are recognised as important settings for promoting student and community wellbeing through education, policies and the modelling of behaviour. Recently, there has been controversy regarding the promotion and use of alcohol by adults at school events. The aim of this study was to examine the policy approach of all Australian jurisdictions to the possession and use of alcohol, by adults, at government school events when students are present. METHODS: A desktop review of Australian governments' alcohol in schools policy/guidelines documents was undertaken. Results Eighteen documents across eight jurisdictions were retrieved. There were inconsistencies between jurisdictions and lack of policy clarity regarding the promotion and/or use of alcohol by adults at events organised by schools for recreation, celebration and fundraising purposes. DISCUSSION AND CONCLUSIONS: Clarity is needed about the role of alcohol in Australian schools, particularly in relation to its use of alcohol when there is a duty of care to children. The possession and/or use of alcohol by adults at school events may contribute to the pervasive role of drinking in Australian social life. SO WHAT? Clear and evidence-based guidelines are needed to inform school policies across all jurisdictions as to whether, when and under which circumstances it is appropriate for schools to promote and/or supply alcohol. This would also strengthen the ability of school principals and communities to make appropriate evidence-based decisions that focus on the interests of children.