Friday, 16 March 2018

Knowledge mobilisation: relationship guidance for ‘stubborn’ practitioners and ‘smug’ scientists

Posted by Peter van der Graaf, AskFuse Research Manager, Teesside University

Last week, I presented at the UK Knowledge Mobilisation Forum in Bristol, which is an annual event for all those with a passion for ensuring that knowledge makes a positive difference to society. The Forum brings together practitioners, researchers, students, administrators and public representatives who are engaged in the art and science of sharing knowledge and ensuring that it can be used.

Getting creative sticking to ‘unconference’ principles
One of the key note speaker, Dez Holmes who is the Director of Research in Practice with 20 years of experience in championing evidence-informed practice in social care, vented her frustration about a question she was often asked by people interested in knowledge mobilisation (KMb): where can I access training in this? Her response: you can’t! Knowledge sharing is personal and therefore a social skill that you can only develop by practising it.

The skills needed to practice KMb are everyday skills, such as listening, emotional intelligence and persuasion. Reciprocity and mutual respect are crucial in relationships and therefore in knowledge mobilisation. Knowledge mobilisers use these skills to make knowledge relatable and therefore relevant to people’s lives. Dez used a Japanese word to sum up these skills: ‘ikigai’ (meaning “reason for being”): if we can’t relate knowledge to people’s sense of self they won’t be inclined to use it.

Acknowledging feelings in knowledge mobilisation is therefore important, not least because implementation barriers for knowledge are often personal. Dez quoted the common misperception between practitioners and academics that are at the heart of the so-called knowledge-to-action gap: “scientist blame the stubbornness of practitioners for insisting on doing it their way, believing they know their patients best, while practitioners lamented the smugness of scientists who believe that if they publish it practitioners will use it”. These misperceptions signify emotions at work in the knowledge gap that need to be addressed before we can start mobilising knowledge.

A great example of on the job knowledge mobilisation learning was captured in a story told by Vicky Ward, Associate Professor in Knowledge Mobilisation at Leeds University and one of the organisers of the Forum, who reflected on her research about knowledge sharing between professionals in social care. The story, titled ‘Dealing with the carousal of knowledge’, illustrates how practitioners continuously added new and different types of knowledge to their team meetings but never really made use of this knowledge until Vicky started asking some ‘constructively clue less’ questions. These questions helped them to recognise the emotions they attached to the client cases that they were discussing and enabled them to discover patterns in their carousel of knowledge. Identifying patterns allowed the professionals to select knowledge that was most useful for each case and made this knowledge transferable.

The conference format itself acknowledged the relational and context-specific work involved in knowledge mobilisation: participants were encouraged to hone their skills in randomised coffee trials, open space discussions, interactive poster sessions, market stalls, short presentations and practical, interactive workshops. The programme was deliberately based on ‘unconference’ principles, which means that it focused on offering opportunities for conversations, creativity and collaborative learning, with much of the direction being driven by the participants instead of the conference organisers. In this sense, the conference was a training ground for knowledge mobilisers to practice and learn new skills.

Friday, 9 March 2018

How industry-funded organisations mislead the public on alcohol & cancer

Guest post by Dr Nason Maani Hessari, Research Fellow, London School of Hygiene and Tropical Medicine

When it comes to the risk of cancer associated with alcohol consumption, there is a significant disconnect between scientific evidence and public opinion.

The evidence of the independent link between alcohol consumption and cancer is clear, as emphasised by recent comprehensive reviews by the UK Committee on Carcinogenicity* (Committee on Carcinogenicity of chemicals in food, 2015), and the International Agency for Research on Cancer (IARC, 2012). Drinking alcohol can cause a range of cancers, including oral cavity, pharynx (cavity behind the nose and mouth), larynx (voice box), oesophagus (gullet), colorectal (bowel and colon), breast and liver cancer. Furthermore, the risk of developing cancers of the mouth, throat and breast increases with any amount consumed on a regular basis (Department of Health, 2016). However, public awareness of this link remains low, with a 2016 survey reporting only 12.9% of respondents identifying cancer as a potential consequence of drinking too much alcohol (Buykx et al., 2016).

What does this have to do with the alcohol industry? Well, in the UK and many other countries, alcohol-industry funded organisations, called Social Aspects Public Relations Organisations (SAPROs), present themselves as sources of health information to the public, particularly around ‘responsible drinking’, underage drinking and drink driving (Maani Hessari and Petticrew, 2017). These organisations have been criticised for their inherent conflict of interest, as they are linked to large multinational alcohol producers, for whom a large proportion of profits come from harmful drinking (Casswell et al., 2016). The industry has a track record of focusing on education and individual responsibility, while lobbying against population-level measures to reduce alcohol-related harm (Babor and Robaina, 2013), even though these are evidence-based (Burton et al., 2017), and form the basis of the WHO Global Alcohol Strategy, in which alcohol producers participated (World Health Organisation, 2010).

Considering the role of the alcohol industry in providing information to consumers, we decided to examine the extent to which the industry fully and accurately communicated the scientific evidence on alcohol and cancer. To do this, we systematically examined the content of 27 industry-funded organisations or websites. In each case, we analysed how information regarding alcohol and cancer was presented, and whether the statements they made about cancer risk were in agreement with the scientific evidence, as presented in the Committee on Carcinogenicity (COC) and IARC reviews.

We found that most alcohol industry SAPROs appeared to misrepresent evidence by denying, distorting or distracting from links to cancer, particularly breast cancer (Petticrew et al., 2017, Petticrew et al., 2018). A full list of examples can be found in our paper and the supplementary information, but as an example of denial, consider this:
“Moderate wine intake may actually reduce the risk of oesophagus, thyroid, lung, kidney and colorectal cancers as well as Non-Hodgkin’s Lymphoma…Concerning breast cancer, there may also be a protective role for wine.” [Wine Information Council].
When some risk was acknowledged, it was often presented alongside a range of other confounders, thus undermining the evidence that there is an independent relationship. For example:
“Alcohol has been identified as a known human carcinogen by IARC, along with over 1,000 others, including solvents and chemical compounds, certain drugs, viral infection, solar radiation from exposure to sunlight, and processed meat.” [International Alliance for Responsible Drinking]
Or in another instance:
“Not all heavy drinkers get cancer, as multiple risk factors are involved in the development of cancers including genetics and family history of cancer, age, environmental factors, and behavioural variables, as well as social determinants of health.” [Australia: Drinkwise].
It is not clear how the consumer is meant to interpret this information. The use of such descriptions to describe risk of cancer from smoking would in essence be both equally correct, and equally misleading. In fact, this type of language is highly reminiscent of arguments used by the tobacco industry, which emphasise the complex causes of lung cancer and coronary heart disease, in order to help deny the scientific evidence and identify other independent risk factors for smoking-related diseases to deflect focus from their products (Petticrew and Lee, 2011).

Since the publication of our findings (Petticrew et al., 2017, Petticrew et al., 2018), additional examples of alcohol industry representatives openly disputing the link between alcohol and cancer continue to emerge. For example, a recent study in the Yukon, Canada, examining the effects of adding a cancer warning label to alcohol (as one of three potential labelling options) has been suspended due to industry pressure.

Perhaps even more striking: as part of the ongoing debate in Ireland regarding the Public Health Alcohol Bill (PHAB), when a physician noted on live TV that alcohol was a carcinogen, a leading alcohol industry spokesperson countered inaccurately that alcohol was in fact, not a carcinogen, and that there were “…as many studies, medical studies, as there are on the ‘pro’ side…” (clip below).


It has been argued that greater public awareness, particularly of the risk of breast cancer, poses a significant threat to the alcohol industry (Connor, 2017). In response to other threats to profits, there is evidence that the industry has attempted to engage in “denialism” (Katikireddi and Hilton, 2015), and it appears this may also be the case for cancer, particularly breast cancer.

Currently, the alcohol industry remains involved in developing alcohol policy in many countries, and in disseminating health information to the public, including school children. Our research findings, which build on existing evidence regarding the activities of SAPROs (Babor and Robaina, 2013, McCambridge et al., 2014, Moodie et al., 2013), should be cause for a re-evaluation of such arrangements. The World Health Organisation has previously stated that ‘In the view of the WHO, the alcohol industry has no role in the formulation of alcohol policies, which must be protected from distortion by commercial or vested interests.’(Chan, 2013). The clear and obvious similarities to tobacco industry tactics that we report, which reflect the inherent conflict of interest, serve as a reminder that policies are but one aspect at risk of industry distortion.


All views expressed are those of the author.


References

BABOR, T. F. & ROBAINA, K. 2013. Public health, academic medicine, and the alcohol industry's corporate social responsibility activities. Am J Public Health, 103, 206-14.

BURTON, R., HENN, C., LAVOIE, D., O'CONNOR, R., PERKINS, C., SWEENEY, K., GREAVES, F., FERGUSON, B., BEYNON, C., BELLONI, A., MUSTO, V., MARSDEN, J. & SHERON, N. 2017. A rapid evidence review of the effectiveness and cost-effectiveness of alcohol control policies: an English perspective. Lancet, 389, 1558-1580.

BUYKX, P., LI, J., GAVENS, L., HOOPER, L., LOVATT, M., GOMES DE MATOS, E., MEIER, P. & HOLMES, J. 2016. Public awareness of the link between alcohol and cancer in England in 2015: a population-based survey. BMC Public Health, 16, 1194.

CASSWELL, S., CALLINAN, S., CHAIYASONG, S., CUONG, P. V., KAZANTSEVA, E., BAYANDORJ, T., HUCKLE, T., PARKER, K., RAILTON, R. & WALL, M. 2016. How the alcohol industry relies on harmful use of alcohol and works to protect its profits. Drug Alcohol Rev, 35, 661-664.

CHAN, M. 2013. WHO's response to article on doctors and the alcohol industry. Bmj, 346, f2647.

COMMITTEE ON CARCINOGENICITY OF CHEMICALS IN FOOD, C. P. A. T. E. C. 2015. Statement 2015/S2.

CONNOR, J. 2017. Alcohol consumption as a cause of cancer. Addiction, 112, 222-228.

DEPARTMENT OF HEALTH 2016. UK Chief Medical Officers' Alcohol Guidelines Review - Summary of the proposed new guidelines.

IARC 2012. Personal habits and indoor combustions. IARC monographs on the evaluation of carcinogenic risks to humans.

KATIKIREDDI, S. V. & HILTON, S. 2015. How did policy actors use mass media to influence the Scottish alcohol minimum unit pricing debate? Comparative analysis of newspapers, evidence submissions and interviews. Drugs (Abingdon Engl), 22, 125-134.

MAANI HESSARI, N. & PETTICREW, M. 2017. What does the alcohol industry mean by 'Responsible drinking'? A comparative analysis. J Public Health (Oxf), 1-8.

MCCAMBRIDGE, J., KYPRI, K., MILLER, P., HAWKINS, B. & HASTINGS, G. 2014. Be aware of Drinkaware. Addiction, 109, 519-24.

MOODIE, R., STUCKLER, D., MONTEIRO, C., SHERON, N., NEAL, B., THAMARANGSI, T., LINCOLN, P. & CASSWELL, S. 2013. Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. Lancet, 381, 670-9.

PETTICREW, M., MAANI HESSARI, N., KNAI, C. & WEIDERPASS, E. 2017. How alcohol industry organisations mislead the public about alcohol and cancer. Drug Alcohol Rev.

PETTICREW, M., MAANI HESSARI, N., KNAI, C. & WEIDERPASS, E. 2018. The strategies of alcohol industry SAPROs: Inaccurate information, misleading language and the use of confounders to downplay and misrepresent the risk of cancer. Drug Alcohol Rev.

PETTICREW, M. P. & LEE, K. 2011. The "father of stress" meets "big tobacco": Hans Selye and the tobacco industry. Am J Public Health, 101, 411-8.

WORLD HEALTH ORGANISATION 2010. Global Strategy to Reduce the Harmful Use of Alcohol.

*Carcinogen is any substance or agent that promotes the formation of cancer


Image: ‘Spilling wine’ (3375802661_fc4ff615ba_z) by Gunnar Grimnes via Flickr.com, copyright © 2009: https://www.flickr.com/photos/gromgull/3375802661

Friday, 9 February 2018

How I chanced upon the 70 year War in Public Health: Aye vs Nay for Water Fluoridation

Guest post by Priyanka Vasantavada, PhD student, School of Health and Social Care, Teesside University

Exactly a year ago to this day, I embarked on my PhD at Teesside University. Little did I know then that a year later I would find myself working on one of the most widely debated and contentious issues in public health.

Water Fluoridation is the controlled addition or removal of fluoride to water supply. Fluoride level of water is maintained at a level that is optimum for preserving dental health by making teeth resistant to decay. The practice of water fluoridation remains controversial even though half a century has passed since its first introduction. This is attributed to various issues such as, the possible negative health effects of fluoridation, lack of dose regulation at the individual level, if fluoride is mass medication and the ethical issues of consent or lack thereof.

Most academics seem surprised when I mention that water fluoridation is controversial. This may be because of the amount of research that already exists supporting the notion of the intervention being both efficient and safe. Water fluoridation happens to be one of the most widely researched topics in public health. Countries that artificially fluoridate water undertake systematic reviews every 5-10 years to update the evidence base. Studies conducted in areas with naturally high fluoride levels (i.e., fluoride endemic regions in parts of Asia) have linked high fluoride levels to skeletal disorders, and cancers etc. However, these studies are not relevant to artificial water fluoridation schemes as the health effects are dose dependent.

I vividly remember my first meeting with my Director of Studies Professor Vida Zohoori who had then asked me to come up with an original research idea and remarked, “A PhD is to foster independent scientific thought and not merely to work on a previously designed project”. I was a little taken aback by that as I had indeed applied for, and was selected to work on, an advertised PhD project! I ended up asking her what was left for me to research on this subject as seemingly all bases had already been covered. (I was neither completely wrong nor completely correct as I would realise in the months that followed.)

So, that day when I went home, I did what any millennial would do and Googled ‘water fluoridation’. Now before any of my readers from academia roll their eyes at this, I would like to clarify that I had already done a fair amount of background reading on water fluoridation from scientific databases and I also happen to be a dentist!

Through the looking glass

The search results were in equal parts exciting and exasperating. With each search results page I visited, my heart sank a little more. Every single idea that floated in my head was destroyed by the discovery of a research paper on the same. Then half exhausted and half asleep, I followed the millennial motto of ‘If you can’t read, why not watch it’!

I clicked on YouTube and just like Alice, fell right into a world I had never known existed! The ‘water fluoridation’ videos on YouTube were more mindboggling and engaging than any literature I had ever read (including but not limited to Game of Thrones). The videos attributed properties to water fluoridation or fluorides, which I had neither heard, read nor even imagined in my wildest dreams.

My curiosity peaked, and I kept trying to look for the scientific basis for the content in the videos. This search led me right into the thick of the controversy: the seemingly contradictory evidence, the prejudices, the sides and the politics around it. I found that it was not merely a controversy but an ongoing war where no one trusts one another and where battle lines are clearly demarcated. Pardon my use of dramatic language but this is the only way the situation can be described.

There are two major parties: those in favour of fluoridation and those against it. These groups are very heterogenous in their composition and no generalisations can be made. Both lobby for their own point of view and battle it out at every place across the world where water fluoridation as a public health measure is considered. And in this cacophony, I felt that the real opinion of the public is lost.

I then discovered that scientific studies on public opinion had been conducted in the US, Canada, Australia, New Zealand, Europe, Japan, South Korea, South Africa, Norway, Denmark and Brazil. Small fluoridation opinion studies have been conducted amongst dentists and in certain localised parts of UK as well. However, a comprehensive study examining the aspects of public perception and engagement had not yet been undertaken in the UK. I had finally found a gap and thank God for it as in the months to follow, the advertised study I had applied for had to be shelved due to ethical concerns.


Since the fluoridation debates and discussions mostly take place on the web, I felt that this the ideal platform to engage people about the issue. To examine the public’s awareness and attitude towards water fluoridation in the UK, I have designed a 10-minute web survey (with optional follow-up e-mail interviews). There is even a prize draw for 10 e-shopping vouchers worth £10 each up for grabs! So, if you are interested to know more about the research or would like to participate, please follow the links below or email me at P.Vasantavada@tees.ac.uk.

You can complete the survey here



Image: By josconklin (Own work) [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

Friday, 26 January 2018

'Not making decisions on our behalf': Empowering communities to tackle health inequalities

Guest post by Sue Lewis, Senior Research Associate, Institute of Health & Society, Newcastle University and Emma Halliday, Senior Research Fellow, Lancaster University

Community empowerment and the mobilisation of resident knowledge have long been seen as fundamental in tackling health inequalities. Recent strategic documents (e.g., Public Health England’s A guide to community-centred approaches for health and wellbeing and The National Institute for Health and Care Excellence community engagement guidance have, more recently, also drawn attention to the need to place communities at the centre of approaches to reduce damaging differentials in health and wellbeing.

Photo: Courtesy of Liz Kessler
Are we – practitioners and public – ready to make this happen? What do we know (from research, from local experience) and what do we still need to understand or address? Delegates at the recent Fuse Quarterly Research Meeting (QRM) spent a lively morning pondering these important questions.

Emma’s reflections on her experience of research in this field sets the scene:
“Since joining Lancaster University, much of my time has been spent interviewing residents and practitioners about community engagement in area based initiatives.

One of my first encounters was a retrospective look at New Deal for Communities (NDC) approaches to engagement. In some areas, people shared powerful examples of what had been achieved from collaboration placed on a more equal footing. As one resident explained: ‘it was physically, mentally everything, you were involved in it all and you feel proud because you’ve had, you’ve taken part in something good…there’s an awful lot of these projects have come to fruition and you can see, you know, you can actually see the difference that it’s made.’
Yet within the same programme, experiences varied significantly. Elsewhere, residents were left disillusioned about the falling away of an early commitment to engagement where the model became increasingly driven by ‘top down’ pressures. 
‘It moved away from gathering the views of the people and acting on the views of the people to involving the people in New Deal for Communities’, explained another resident.

More recently, the Big Local programme, funded by the Big Lottery and managed by Local Trust, has been the focus of research. The NIHR School for Public Health Research (SPHR) Communities in Control study, undertaken by a collaboration of academic partners including Fuse (Fuse lead, Professor Clare Bambra; researchers Dr Sue Lewis and Dr Vicki McGowan) and led by Professor Jennie Popay at LiLaC, is evaluating the health and social impacts of the resident led programme. While still early days, latest findings show positive impacts for wellbeing for residents actively involved in the programme but also that experiences of involvement can at times also be stressful and challenging.”
So the Fuse QRM (Empowering communities and mobilising resident knowledge to tackle health inequalities, January 11th, 2018) was an important opportunity for public health partners in the North East to reflect on ways of working that enable more equitable collaboration between citizens, the public and the third sector. An exercise to warm people to the topic indicated that many in the audience agreed that there were opportunities in the region (and beyond) for citizens to influence decisions that affect the places where they live. In contrast, far fewer felt that public sector agencies had a sufficiently good understanding of the barriers that impede participation. We clearly have a lot still to learn from one another.

James Hadman, Stockton Catalyst, stimulated thinking
 about grassroots projects having positive impacts but also
drew attention to the times when things don’t work so well
It’s important, then, to share what we already know. The morning included presentations that provided complementary perspectives on the issues at hand. Insights from James Hadman from Stockton Catalyst stimulated thinking about grassroots projects having positive impacts including the role of the Stockton Voice Forum (which gives Stockton’s voluntary, community and social enterprise sector a say in strategic developments in the Borough). Importantly, however, he also drew attention to the times when things don’t work so well, including barriers that were also identified in the New Deal for Communities (NDC) research: where engagement is top down, or driven by professionals’ agendas.

Alison Patey (Yorkshire and Humber Public Health England) gave the national picture, arguing that working with communities should be considered as valid as any other social determinant. A new programme of support is also offering online training for practitioners. And presentations from Emma and myself (Sue) offered the view from research, including findings from the Communities in Control study (in which three North East Big Local areas participated).

Looking ahead, the Communities in Control programme has received SPHR funding to produce resources for residents and practitioners. These will draw attention to the public health evidence already available for place based initiatives and take inspiration from stories of community action that illustrate the potential effects (positive and negative) for community participation and collaboration and, ultimately, empowerment, control and health inequalities.

There aren’t quick fixes to overcoming the imbalances of power between citizens and agencies. But it is, as a resident interviewed in the Communities in Control study put it, about creating a public health system where decisions don’t get ‘made on our behalf as to what they think we should have.’

Friday, 12 January 2018

Kale and running shoes

Posted by Amelia Lake, Associate Director of Fuse, Dietitian and Reader in Public Health Nutrition at Teesside University

"January is our busiest month" said Hayley in the bustling fruit and vegetable shop in the small North Yorkshire market town where I live. This was on the first Saturday of January. She said their sales of kale had rocketed as people started juicing, eating better and generally trying to improve their diet. All this following the excesses of Christmas.

On Sunday morning, when I was out running (or trying to run on the icy pavements!), I was surprised at the number of runners pounding the streets in our small town. Then I remembered, it's the first weekend in January. Maybe, like me they have a shiny new gadget that they are somewhat obsessed with (how many steps have I done today?). There must be an exponential increase in the number of runners and kale consumers.

What is it about 'New Year, New You' that never fails to deliver and how long will these new behaviours be sustained? Why is it that our print and broadcast media don't grow tired of feeding us (excuse the pun) the same January story of …”you've eaten and drunk to excess in December now it's time to abstain from alcohol (Dry January) and go on an excessive unsustainable dietary regime”... Or the most recent health “craze” of ‘raw water’.

Our social media feeds are filled with so called 'nutrition and fitness experts'. The Instagram squares show us before and after pictures of success stories, quick fixes, rapid weight loss etc. etc... Not so many squares saying - look at your diets, your lifestyle, make sustainable changes as these are more likely to succeed in the long term (well apart from one of my professional organisations The British Dietetic Association).

What about the evidence? Does it advocate New Year's resolutions? Are we programmed to wait for the longer term goals or do we need to have instant results? A study published in 2016 suggests that while individuals may exercise for the long term goal of improved health, it is actually the immediate reward that predicts their persistence in that behaviour.

Ultimately these resolutions are about an individual's behaviour change. Much of our public health policy focuses on individuals changing their behaviours. Anyone who has tried to do this knows how difficult it is. Yet, we (professionals, the media, society) continue to focus on the individual who is generally living in an environment where kale isn't an everyday option and running shoes only go on at the weekend – or sit looking pristine in the cupboard.

What we need is a change in the system or what is called a 'whole systems approach' to health and lifestyle problems. The most obvious lifestyle related problem is that of obesity. There is a chronic problem of energy imbalance affecting our whole population young, middle-aged and old. We are encouraged to eat less and exercise more but really, the environment doesn't support those changes (for the majority of the population). Will our policy makers have any New Year's resolutions to focus less on the individual and more on the system in which we make our behaviours? With changes such as a sugar levy coming into play, we are seeing food manufacturers reformulate or change product size. But we also hear reports of people stockpiling sugary drinks that are about to be reformulated. Is this the start of a shift away from the individual and to systems thinking? I very much hope so.

Kale and running shoes are not the answer to addressing a health and lifestyle crisis but long term supported and sustainable changes are.


Image: 'Marinated Kale Salad-2' (23204695074_92c53db643_z) by 'jules' via Flickr.com, copyright © 2015: https://www.flickr.com/photos/stone-soup/23204695074

Friday, 22 December 2017

Merry Christmas from Fuse

We would like to wish all of our readers and contributors a very happy festive season. We will return in the New Year - why not make a resolution to blog in 2018 and send us your posts?


Friday, 15 December 2017

Not addicted but still having an impact: children living with parents who misuse drugs and alcohol

Guest post by Dr Ruth McGovern, Institute of Health & Society, Newcastle University

There is growing political interest in the misuse of alcohol and drugs by parents and its impact upon children. The newly published Drug Strategy 2017 highlights drug and alcohol dependent parents as a priority group with an estimated 360,000 children living with parents who are dependent upon alcohol or heroin.

As a registered social worker, I have often identified ‘dependent parental substance misuse’ as a risk factor in many ‘child in need’ assessments conducted by Children’s Services. Around half of all child protection cases, recurring care proceedings (repeat children removed and placed into local authority care) and serious case reviews (enquiries following child death or serious injury where neglect or abuse is known or suspected) involve parents who misuse substances. However, the impact of parental substance misuse is not limited to addicts. The number of children living with parents who misuse but aren’t dependent upon alcohol and drugs is likely to be substantially more than the number of children living with those who are addicts. As such, greater harm in the population as a whole is likely to be experienced by these children.

I have been part of a group of academics and clinicians who have recently concluded a rapid evidence review funded by Public Health England (PHE). The review found evidence that parents who misuse, but aren’t dependent on substances, can have a significant impact on the physical, psychological and social health of their child. For instance, in early childhood we found that children of mothers misusing alcohol [1] were twice as likely to suffer a long bone fracture and five times as likely to be accidentally poisoned, than children whose mothers do not drink heavily. Children of mothers misusing alcohol or drugs are also more likely to require outpatient care or to be hospitalised due to injury or illness, and for longer. The impact of substance misuse by parents continues into adolescence, with our review showing an increased likelihood of antisocial, defiant and violent behaviour in late adolescence as well as substance misuse by the child. However, many of these children and families are not identified as being affected by the substance misuse of a parent and subsequently do not receive the help they need in the form of an intervention.

Therefore, our review also examined the evidence for effective interventions to help reduce the numbers of parents misusing alcohol and drugs. Family-level interventions, particularly those that offer intensive case management, or those which provide parents with a clear motivation (such as those linked to care proceedings) show promise in reducing the problem. Unfortunately, there was little research examining the effectiveness of interventions for parents misusing but not dependent on alcohol and drugs.

PAReNTS study logo
To respond to this evidence gap, we designed the PAReNTS study (Promoting Alcohol Reduction in Non Treatment Seeking parents). Within this study we are examining the feasibility and acceptability of alcohol screening (using the AUDIT-C questionnaire [2]) and brief interventions with parents involved in early help and statutory children’s social care services. The brief intervention is an adapted version of the ‘How much is too much?’ programme for parents [3] which combines advice and behaviour change activities and is delivered by both social care practitioners and the local alcohol service. Whilst alcohol brief interventions have been found to be effective in adults who misuse alcohol, little is known about the effectiveness of such interventions for parents with additional and complex needs. This presents unique challenges, for instance, parents may be concerned about the stigma of being labelled as having an alcohol problem, particularly if this could be used as a reason to remove their child from their care. There is clearly a need for a sensitive approach. In future blog posts, I hope to update you on the progress we make with the PAReNTS study and whether it is feasible to deliver early interventions with alcohol misusing parents to improve the wellbeing of children, who are often overlooked in public health.

References:
  1. Below the age of 10 years, much of the evidence focuses on mothers with alcohol misuse problems as most caregiving is carried out by mothers during early years. 
  2. The AUDIT-C is a 3-item alcohol screen that can help identify persons who are hazardous drinkers or have active alcohol use disorders (including alcohol abuse or dependence): https://www.integration.samhsa.gov/images/res/tool_auditc.pdf
  3. This programme was highlighted by the National Institute for Health and Clinical Excellence alcohol prevention guidance (PH24): https://www.nice.org.uk/guidance/ph24.
Image credits: