Background and AimsA ban on multi-buy discounts of off-trade alcohol was introduced as part of the Alcohol Act in Scotland in October 2011. The aim of this study was to assess the impact of this legislation on alcohol sales, which provide the best indicator of population consumption.Design, Setting and ParticipantsInterrupted time–series regression was used to assess the impact of the Alcohol Act on alcohol sales among off-trade retailers in Scotland. Models accounted for underlying seasonal and secular trends and were adjusted for disposable income, alcohol prices and substitution effects. Data for off-trade retailers in England and Wales combined (EW) provided a control group.MeasurementsWeekly data on the volume of pure alcohol sold by off-trade retailers in Scotland and EW between January 2009 and September 2012.FindingsThe introduction of the legislation was associated with a 2.6% (95% CI = −5.3 to 0.2%, P = 0.07) decrease in off-trade alcohol sales in Scotland, but not in EW (−0.5%, 95% CI = −4.6 to 3.9%, P = 0.83). A statistically significant reduction was observed in Scotland when EW sales were adjusted for in the analysis (−1.7%, 95% CI = −3.1 to −0.3%, P = 0.02). The decline in Scotland was driven by reduced off-trade sales of wine (−4.0%, 95% CI = −5.4 to −2.6%, P < 0.001) and pre-mixed beverages (−8.5%, 95% CI = −12.7 to −4.1%, P < 0.001). There were no associated changes in other drink types in Scotland, or in sales of any drink type in EW.ConclusionsThe introduction of the Alcohol Act in Scotland in 2011 was associated with a decrease in total off-trade alcohol sales in Scotland, largely driven by reduced off-trade wine sales.

Employment status has a dynamic relationship with health and disability. There has been a striking increase in the working age population receiving out-of-work disability benefits in many countries, including the UK. In response, recent UK welfare reforms have tightened eligibility criteria and introduced new conditions for benefit receipt linked to participation in return-to-work activities. Positive and negative impacts have been suggested but there is a lack of high quality evidence of the health impact when those receiving disability benefits move towards labour market participation. Using four waves of the UK’s Understanding Society panel survey (2009–2013) three different types of employment and welfare transition were analysed in order to identify their impact on health. A difference-in-difference approach was used to compare change between treatment and control groups in mental and physical health using the SF-12. To strengthen causal inference, sensitivity checks for common trends used pre-baseline data and propensity score matching. Transitions from disability benefits to employment (n = 124) were associated on average with an improvement in the SF12 mental health score of 5.94 points (95% CI = 3.52–8.36), and an improvement in the physical health score of 2.83 points (95% CI = 0.85–4.81) compared with those remaining on disability benefits (n = 1545). Transitions to unemployed status (n = 153) were associated with a significant improvement in mental health (3.14, 95% CI = 1.17–5.11) but not physical health. No health differences were detected for those who moved on to the new out-of-work disability benefit. It remains rare for disability benefit recipients to return to the labour market, but our results indicate that for those that do, such transitions may improve health, particularly mental health. Understanding the mechanisms behind this relationship will be important for informing policies to ensure both work and welfare are ‘good for health’ for this group.

BackgroundThe UK general practitioner (GP) appraisal system is deemed to be an inadequate source of performance evidence to inform a future medical revalidation process. A long-running voluntary model of external peer review in the west of Scotland provides feedback by trained peers on the standard of GP colleagues' core appraisal activities and may 'add value' in strengthening the robustness of the current system in support of revalidation. A significant minority of GPs has participated in the peer feedback model, but a clear majority has yet to engage with it. We aimed to explore the views of non-participants to identify barriers to engagement and attitudes to external peer review as a means to inform the current appraisal system.MethodsWe conducted semi-structured interviews with a sample of west of Scotland GPs who had yet to participate in the peer review model. A thematic analysis of the interview transcriptions was conducted using a constant comparative approach.Results13 GPs were interviewed of whom nine were males. Four core themes were identified in relation to the perceived and experienced 'value' placed on the topics discussed and their relevance to routine clinical practice and professional appraisal: 1. Value of the appraisal improvement activity. 2. Value of external peer review. 3. Value of the external peer review model and host organisation and 4. Attitudes to external peer review.ConclusionsGPs in this study questioned the 'value' of participation in the external peer review model and the national appraisal system over the standard of internal feedback received from immediate work colleagues. There was a limited understanding of the concept, context and purpose of external peer review and some distrust of the host educational provider. Future engagement with the model by these GPs is likely to be influenced by policy to improve the standard of appraisal and contractual related activities, rather than a self-directed recognition of learning needs.

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BackgroundHealth inequalities have persisted or increased across Western Europe. In Scotland, population health is poorer than in comparable countries and health inequalities are alarmingly high, particularly among young adults. Addressing health inequalities is a priority for UK and international governments. The aim was to determine the trends and socioeconomic inequalities in cause specific mortality among Scottish men aged 15–44 from 1980–2013.MethodsRoutine death data were linked to mid-year population estimates for men aged 15–44 in Scotland for 1980–2013. Directly standardised mortality rates were calculated for all-cause and suicide, drug and alcohol related harm. Trends in inequalities were examined for 2002–2013 using deprivation measured by the income domain of the Scottish Index of Multiple Deprivation. Inequalities were measured using the slope index of inequality (SII) and the relative index of inequality (RII).ResultsOverall there were 52,551 deaths in men aged 15–44 from 1980–2013. All-cause mortality decreased from 159 per 100,000 in 1980 to 130 per 100,000 in 2013. Mortality rates from suicide increased from 22 to 41 per 100,000 from 1980 to 2000, then decreased to 29 in 2013. Mortality from drug related deaths increased from 1 to 25 per 100,000 from 1980–2013; and alcohol related deaths increased from 5 to 12 per 100,000. In 1980 18% of deaths were due to suicide, drug and alcohol related mortality; by 2013 the contribution from these three causes increased to 51%.Inequalities in mortality in 2002–04 were high, with SII for suicide 59.3 (95% CI = 52–66); drug 64.0 (59–69) and alcohol 53.4 (49–57). For 2011–13 the SII for suicide remained the same at 55.4 (95% CI = 49–62); drug increased to 63.8 (59–69) and alcohol reduced to 34.4 (31–38). During both time periods 60% of the SII for total mortality was due to these 3 causes. In 2011–13 ischaemic heart disease (the next highest) contributed 7.3%.The RII remained constant for suicide 2002–04: 0.37 (95% CI = 0.33–0.41), 2011–13: 0.40 (0.35–0.45); increased for drugs 2002–04: 0.40 (95% CI = 0.37–0.43), 2011–13: 0.46 (0.42–0.50); and decreased for alcohol 2002–04: 0.33 (0.31–0.36), 2011–13: 0.25 (0.22–0.27).ConclusionAlthough deaths in men aged 15–44 are relatively uncommon, the use of population data enabled detailed examination of the causes of death. While there has been a reduction in mortality the underlying causes have changed and in the last decade inequalities in mortality remain high. Efforts to reduce suicide, drug and alcohol related mortality in young men living in deprived areas should be a priority for policy.

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