Plan lockdown alcohol study

[ld-archer]

First look through current literature and try to build a picture of how drinking habits changed in England's elderly population during and after the COVID-19 lockdowns.

Initial plans for this paper could be, to run the model as normal from 2012 to 2018, and from there diverge into 2 or more scenarios. One baseline scenario where we maintain pre-pandemic drinking habits throughout and assume the pandemic and lockdowns never happened, and another one (or more) scenarios where we model the change in habits during and after the lockdowns.

Idea: Still very early in the lit review stage but already it seems that there is much more information about how drinking habits changed during the lockdown but not after. In the case that we don't find much information for post-lockdowns, we could investigate a couple of different scenarios:

1. Drinking habits return immediately to pre-pandemic levels
2. Habits slowly return to pre-pandemic levels (i.e. 1-4 waves)
3. Drinking habits are maintained at new level

TODO:

• [ ] Check proportions within each consumption group and compare with Rao et al. paper.

[ld-archer]

Alcohol consumption during the COVID-19 pandemic in Europe: a large-scale cross-sectional study in 21 countries

Carolin Kilian et al. (2021)

This paper analysed the change in alcohol consumption behaviours across 21 European nations, and found that the only nations to not see a decline in alcohol consumption were Ireland (stayed roughly the same) and the United Kingdom (only nation to see an increase in alcohol consumption). In the UK, drinking frequencies and quantities consumed per occasion "increased considerably", but not the frequency of Heavy Episodic Drinking (HED) events.

The study also found that changes in consumption were associated with income and experiences of distress; low income drinkers generally saw a decline in consumption regardless of experiences of financial distress, however for those with average or high incomes changes were dependent upon experiences of financial distress.

The study used data from the cross-sectional online European Alcohol and COVID-19 survey that collected information on changes in alcohol consumption among European adults (http://www.COVID19-and-alcohol.eu). Participants were asked to grade their change in alcohol consumption from -2 (much less often) to +2 (much more often) for each of (i) frequency of drinking occasions, (ii) quantity of alcohol consumed per occasion and (iii) frequency of heavy episodic drinking. These answers were then summed and divided by 6 to get an aggregate consumption-change score scaled to a range of -1 to +1. This means we can't use these results directly, but it is interesting to find out that the UK is the only European nation included in the study to see an increase in consumption during the pandemic. It still may be worth looking into the survey to see if any more information can be extracted.

[ld-archer]

Characterising the patterns ofand factors associated with increased alcohol consumption since COVID-19 in a UK sample

Melissa Oldham et al. (2021)

Key Outcomes

Frequency

Amongst 50% of participants, there was no change in the frequency of drinking pre- and post-COVID-19. 30% of participants reported drinking more frequently, and the remaining 20% reported drinking less frequently.

Units per Occasion

61% of participants reported consuming the same amount per occasion. 16% reported drinking more, and 22% drinking less from pre- to post-COVID.

Heavy Episodic Drinking (HED)

61% reported no change in frequency of HED. 14% reported an increase. 26% reported a decrease.

Patterns of drinking for each outcome measure were roughly comparable across men and women with the most disparity in units consumed. Women were more likely to drink the same uniis as pre-COVID (66% of women vs 56% of men), and men were more likely to drink both more units (19% vs 14% of women) and less units (25% vs 20% of women).

Table here on the independant associations of drinking more frequently amongst men and women: There are two more of these tables, one each for increases in number of units drank per session, and for Heavy Episodic Drinking.

The main thing this paper can tell us is what factors influence an increase in the frequency, amount, and heavy episodic drinking for both men and women in the UK.

[ld-archer]

The impact of changes in COVID-19 lockdown restrictions on alcohol consumption and drinking occasion characteristics in Scotland and England in 2020: an interrupted time-series analysis

Iain Hardie et al. (2021)

Interesting study that tracks alcohol consumption in units from January 2009 - December 2020, including three interventions points:

1. March 2020 lockdown
2. July 2020 easing of restrictions
3. October 2020 re-introduction of some restrictions

Its maybe not as useful to creating an intervention as I initially thought, as the results are stratified by whether the units consumed were off-trade (i.e. shop-bought) or on-trade (i.e. licensed venue) and not by gender or other individual characteristic.

[ld-archer]

Severe alcohol-related liver disease admissions post COVID-19 lockdown: canary in the coal mine?

Zillah Cargill et al. (2021)

"Observational data have reported 28% of those that consume alcohol are drinking more heavily compared with pre-lockdown, with this increasing further if individuals had previously been a heavy drinker."

Not a huge amount to glean from this one, just more evidence that heavy drinkers developed more extreme relationships with alcohol, and that referrals and deaths from alcoholic liver disease increased during and post lockdown.

[ld-archer]

Risky alcohol consumption in older people before and during the COVID-19 pandemic in the United Kingdom

Rahul Rao et al. (2022)

Useful table showing proportions of people within each consumption group before and after lockdown: This is the first piece of information in this lit review that could be useful for planning interventions! Now need to check the proportions of both the raw ELSA population and the datasets I use to validate.

Here is another table from this paper with more detailed information about alcohol consumption changes before and after lockdown. This is all based on older people (50-64 & 65+) that were risky drinkers before lockdown.

[ld-archer]

Risky alcohol consumption in older people before and during the COVID-19 pandemic in the United Kingdom

Heber Rodrigues et al. (2020)

Interesting paper on the specific changes in consumption of different drink types (wine, beer, cider, whisky, etc.) but it goes into too much detail to be useful for this purpose.

[ld-archer]

Association of the COVID-19 lockdown with smoking, drinking and attempts to quit in England: an analysis of 2019–20 data

Sarah Jackson et al. (2021)

Good paper and could be very useful. Uses data from the Smoking and Alcohol Toolkit studies, which is a monthly cross-sectional survey of adults aged 16+ in England. A new representative sample of ~1700 adults are interviewed each month. The paper looks at both smoking and drinking so could enable us to model both at the same time.

Smoking

Change in prevalence of smoking was not significant, however there was a significant change in the quit rate that we can potentially use.

Drinking

Only high risk drinking is reported here, but we could plan an intervention to push some people from each other category into the high-risk drinkers. The table from Oldham et al. (2021) above shows the relationship of some characteristics that we could maybe use to decide who increases their consumption.

[ld-archer]

Alcohol use and mental health during COVID-19 lockdown: A cross-sectional study in a sample of UK adults

Louis Jacob et al. (2020)

Some useful information here to inform who increased their consumption in lockdown. The study looked at the relationship between increased alcohol consumption in lockdown and mental health outcomes. The table below shows the most useful information for our study:

Some interesting things from the table above (and some things to note):

• The study was mostly female (~61%)
• The vast majority of over 65s did not increase their alcohol consumption in lockdown
• Features that corresponded with an increase in alcohol consumption:
  • Female
  • 18-34 years
  • single/separated/divorced/widowed
  • Employed
  • Annual earnings over £40,000
  • English We can potentially use these features to pick who will increase their consumption. It might be difficult to put specific numbers with certain groups here, but some things we definitely can take away from this is that over 65s didn't really see an increase in their consumption through lockdown. Perhaps this age group tend to be more social drinkers? The authors had this to say:

It is also important to note that increased alcohol consumption was significantly more frequent in participants aged 18-34 years (50.4%) than in those aged 35-64 (45.4%) and >= 65 years (4.2%). Therefore, it may be hat COVID-19 social distancing measures are disproportionally affecting younger adults in relation to increased alcohol consumption. It is plausible that social distancing measures may have limited impact on those greater than 65 years in the UK, since b y this age both females and male will receive a state pension and thus likely retired with some financial security (Batchelor, 2017). Owing to COVID 19 social distancing younger adults may had been furloughed and thus concerned about their financial security and future per se, increasing their alcohol intake in the attempt to mitigate depressive symptoms. However, these hypotheses are untested and further research of a qualitative nature is now required.

[ld-archer]

Moving on from alcohol work and replacing consumption based variables with frequency based scako. Good literature here though so don't want to forget this.