No abstract

This paper reviews the evidence for the effectiveness and cost-effectiveness of policies to reduce alcohol-related harm. Policies focus on price, marketing, availability, information and education, the drinking environment, drink-driving, and brief interventions and treatment. Although there is variability in research design and measured outcomes, evidence supports the effectiveness and cost-effectiveness of policies that address affordability and marketing. An adequate reduction in temporal availability, particularly late night on-sale availability, is effective and cost-effective. Individually-directed interventions delivered to at-risk drinkers and enforced legislative measures are also effective. Providing information and education increases awareness, but is not sufficient to produce long-lasting changes in behaviour. At best, interventions enacted in and around the drinking environment lead to small reductions in acute alcohol-related harm. Overall, there is a rich evidence base to support the decisions of policy makers in implementing the most effective and cost-effective policies to reduce alcohol-related harm.

Objective To investigate the extent to which people change their views about priority setting in health care as a result of discussion and deliberation.

Background: A recent assessment of childcare in OECD (Organisation for Economic Co-operation and Development) countries highlighted the potential for childcare to widen inequalities. Although childcare offers a potential setting for obesity prevention, little research has analysed the association between childcare and overweight, particularly in different socio-economic groups. Objectives: Our primary objective was to explore the association between childcare and overweight (including obesity), both overall and by socio-economic background, in a contemporary UK cohort of children at age 3 years (N ¼ 12 354). Our secondary objective was to explore infant feeding as a potential mediator between childcare in infancy and overweight at age 3 years. Results: After controlling for confounders, children who were cared for in informal childcare (75% grandparents) between the age of 9 months and 3 years were more likely to be overweight than those cared for only by a parent (adjusted risk ratio (aRR) ¼ 1.15, 95% confidence interval (CI) 1.04-1.27), particularly if they were in full-time childcare (aRR ¼ 1.34, 95% CI 1.15-1.57). When stratifying by socio-economic background, the increased risk of overweight in informal childcare (compared with parental care) was limited to children from more advantaged groups: those whose mother was from a managerial or professional background (aRR ¼ 1.23, 95% CI 1.02-1.47), had a degree (RR ¼ 1.43, 95% CI 1.13-1.83) or lived in a couple household (RR ¼ 1.18, 95% CI 1.06-1.32). There was no association between formal childcare and overweight. Infant feeding did not mediate the association between childcare use in infancy and overweight at age 3 years. Conclusions: Children from more advantaged families who use informal childcare are at increased risk of overweight. The UK government's drive to support parents into paid employment should be accompanied by health-related information and support for both informal and formal carers. As the majority of informal carers were grandparents, the recent government announcement to provide grandparents with National Insurance credits for caring for grandchildren provides a potential opportunity for health promotion. ; childcare therefore has the potential to be a valuable setting for obesity prevention.9 Childcare might influence weight status through affecting infant feeding (such as the propensity to breastfeed) and the diets and physical activity levels of toddlers. However, there is little research analysing the association between childcare and overweight, 10,11 particularly in the United Kingdom. International Journal of Obesity (2010) Three US-based studies found that children cared for in informal childcare were at an increased risk of overweight. [12][13][14] In contrast, two studies set in Japan using the same cohort found no association between childcare (informal or formal) and obesity, 15,16 whereas another US-based study found that formal childcare had a protective influence. 17 An assessment of childcare in OECD countries recently highl...