Critical analysis of the Armed Forces Covenant Fund Trust Aged Veterans Fund

BACKGROUND

Relatively little research is available regarding the specific needs of older military veterans and the services introduced to support them. In 2016, the Armed Forces Covenant Fund Trust launched the Aged Veterans Fund (AVF), to understand the impact that military service may have on ageing, and to support initiatives targeting their health and well-being. This fund was financed for 5 years and included 19 UK portfolio projects.

METHOD

The paper presents a retrospective evaluation on the processes and impact of the AVF, with the intent of informing policy, educational services, service providers and stakeholders of the lessons learnt. The inclusion criteria was veterans and their families aged 65 years of age or over. In 2019, data were drawn from documentary evidence related to the programmes. Qualitative analysis were performed on 78 eligible sources and 10 themes were identified.

RESULTS

Programmes were rolled out via collaborative partnerships referrals, focusing on person-centred or skill-exchange approaches. Challenges were encountered, such as capacity and timelines issues. A limited amount of associated cost-savings was observed, even if examples of sustainability and high satisfaction were reported. Evidence was found of programmes boosting health and well-being outcomes, in raising awareness, and in positively impacting on clinical practice, such as re-admission rates.

CONCLUSION

The AVF programmes were successful in their intent to provide support to older veterans and their families. The findings provide indicators of the next steps required for the support of ageing veterans. Further investigation of the cost-effectiveness of age-friendly veterans' services is needed.

Public acceptability of public health policy to improve population health: A population-based survey

BACKGROUND

For public health policies to be effective, it is critical that they are acceptable to the public as acceptance levels impact success rate.

OBJECTIVE

To explore public acceptance of public health statements and examine differences in acceptability across socio-demographics, health behaviours (physical activity, diet, binge drinking and smoking), health status and well-being.

METHOD

A cross-sectional survey was conducted with a nationally representative sample (N = 1001) using a random stratified sampling method. Face-to-face interviews were conducted at homes of residents in Wales aged 16+ years. Individuals reported whether they agreed, had no opinion, or disagreed with 12 public health statements.

RESULTS

More than half of the sample were supportive of 10 out of 12 statements. The three statements with the greatest support (>80% agreement) reflected the importance of: a safe and loving childhood to becoming a healthy adult, schools teaching about health, and healthier foods costing less. Individuals who engaged in unhealthy behaviours were less likely to agree with some of the statements (eg 39.8% of binge drinkers agreed alcohol adverts should be banned compared to 57.6% of those who never binge drink; P < .001).

CONCLUSIONS

Findings show an appetite for public health policies among the majority of the public. The relationship between supporting policies and engaging in healthy behaviours suggests a feedback loop that is potentially capable of shifting both public opinion and the opportunities for policy intervention. If a nation becomes healthier, this could illicit greater support for stronger policies which could encourage more people to move in a healthier direction.

Event-related and readiness potentials when preparing to approach and avoid alcohol cues following cue avoidance training in heavy drinkers

RATIONALE

Cue avoidance training (CAT) reduces alcohol consumption in the laboratory. However, the neural mechanisms that underlie the effects of this intervention are poorly understood.

OBJECTIVES

The present study investigated the effects of a single session of CAT on event-related and readiness potentials during preparation of approach and avoidance movements to alcohol cues.

METHODS

Heavy drinking young adults (N = 60) were randomly assigned to complete either CAT or control training. After training, we recorded participants' event-related and motor readiness potentials as they were preparing to respond.

RESULTS

In the CAT group, N200 amplitude was higher when preparing to approach rather than avoid alcohol pictures. In the control group, N200 amplitudes did not differ for approach and avoidance to alcohol pictures. Regarding the late positive potential (LPP), in the CAT group, the negativity of this was blunted when preparing to avoid alcohol pictures relative to when preparing to avoid control pictures. In the control group, the negativity of the LPP was blunted when preparing to approach alcohol pictures relative to when preparing to approach control pictures. There were no effects on motor readiness potentials. Behavioural effects indicated short-lived effects of training on reaction times during the training block that did not persist when participants were given time to prepare their motor response before executing it during the EEG testing block.

CONCLUSIONS

After a single session of CAT, the enhanced N200 when approaching alcohol cues may indicate the engagement of executive control to overcome the associations learned during training. These findings clarify the neural mechanisms that may underlie the effects of CAT on drinking behaviour.

The evidence base for routine enquiry into adverse childhood experiences: A scoping review

BACKGROUND

Exposure to adverse childhood experiences (ACEs; e.g., maltreatment, household dysfunction) is associated with a multiplicity of negative outcomes throughout the life course. Consequently, increasing interest is being paid to the application of routine enquiry for ACEs to enable identification and direct interventions to mitigate their harms.

OBJECTIVE

To explore the evidence base for retrospective routine enquiry in adults for ACEs, including feasibility and acceptability amongst practitioners, service user acceptability and outcomes from implementation.

METHODS

A scoping review of the literature was conducted, drawing upon three databases (CINAHL, MEDLINE, PsycINFO) and manual searching and citation tracking. Searches included studies published from 1997 until end of April 2018 examining enquiry into ACEs, or the feasibility/acceptability of such enquiry across any setting. All included studies presented empirical findings, with studies focusing on screening for current adversities excluded.

RESULTS

Searches retrieved 380 articles, of which 15 met the eligibility criteria. A narrative approach to synthesize the data was utilized. Four studies examined practitioner feasibility and/or acceptability of enquiry, three reported service user acceptability and six studies implemented routine ACE enquiry (not mutually exclusive categories). Further, eight studies explored current practice and practitioner attitudes towards ACE enquiry.

CONCLUSIONS

Limited literature was found providing evidence for outcomes from enquiry. No studies examined impacts on service user health or service utilization. Few studies explored feasibility or acceptability to inform the application of routine ACE enquiry. The implementation of routine ACE enquiry therefore needs careful consideration. Focus should remain on evaluating developing models of ACE enquiry to advance understanding of its impact.

Cue avoidance training and inhibitory control training for the reduction of alcohol consumption: a comparison of effectiveness and investigation of their mechanisms of action

RATIONALE

Both cue avoidance training (CAT) and inhibitory control training (ICT) reduce alcohol consumption in the laboratory. However, these interventions have never been directly compared and their mechanisms of action are poorly understood.

OBJECTIVES

We compared the effects of both types of training on alcohol consumption and investigated if they led to theoretically predicted changes in alcohol avoidance (CAT) or alcohol inhibition (ICT) associations and changes in evaluation of alcohol cues.

METHODS

Heavy drinking young adults (N = 120) were randomly assigned to one of four groups: (1) CAT (repeatedly pushing alcohol cues away with a joystick), (2) sham (control) CAT; (3) ICT (repeatedly inhibiting behaviour in response to alcohol cues); or (4) sham (control) ICT. Changes in reaction times and automatic evaluations of alcohol cues were assessed before and after training using assessment versions of tasks used in training and the implicit association test (IAT), respectively. Finally, participants completed a bogus taste test as a measure of ad libitum alcohol consumption.

RESULTS

Compared to sham conditions, CAT and ICT both led to reduced alcohol consumption although there was no difference between the two. Neither intervention affected performance on the IAT, and changes in reaction time did not suggest the formation of robust alcohol avoidance (CAT) or alcohol inhibition (ICT) associations after training.

CONCLUSIONS

CAT and ICT yielded equivalent reductions in alcohol consumption in the laboratory. However, these behavioural effects were not accompanied by devaluation of stimuli or the formation of alcohol avoidance or alcohol inhibition associations.

Inhibitory control training for appetitive behaviour change: A meta-analytic investigation of mechanisms of action and moderators of effectiveness

Inhibitory control training (ICT) is a novel intervention in which participants learn to associate appetitive cues with inhibition of behaviour. We present a meta-analytic investigation of laboratory studies of ICT for appetitive behaviour change in which we investigate candidate mechanisms of action, individual differences that may moderate its effectiveness, and compare it to other psychological interventions. We conducted random-effects generic inverse variance meta-analysis on data from 14 articles (18 effect sizes in total). Participants who received ICT chose or consumed significantly less food or alcohol compared to control groups (SMD = 0.36, 95% CIs [0.24, 0.47]; Z = 6.18, p < .001; I(2) = 71%). Effect sizes were larger for motor (Go/No-Go and Stop Signal) compared to oculomotor (Antisaccade) ICT. The effects of ICT on behaviour were comparable to those produced by other psychological interventions, and effects of ICT on food intake were greater in participants who were attempting to restrict their food intake. The magnitude of the effect of ICT on behaviour was predicted by the proportion of successful inhibitions but was unrelated to the absolute number of trials in which appetitive cues were paired with the requirement to inhibit, or the contingency between appetitive cues and the requirement to inhibit. The effect of ICT on cue devaluation (primarily assessed with implicit association tests) was not statistically significant. Our analysis confirms the efficacy of ICT for short-term behaviour change in the laboratory, and we have demonstrated that its effectiveness may depend on pairings between appetitive cues and successful inhibition. We highlight the need for further research to translate these findings outside of the laboratory.

Priming of conflicting motivational orientations in heavy drinkers: robust effects on self-report but not implicit measures

We report results from three experimental studies that investigated the independence of approach and avoidance motivational orientations for alcohol, both of which operate within controlled and automatic cognitive processes. In order to prime their approach or avoidance motivational orientations, participants watched brief videos, the content of which (positive or negative depictions of alcohol, or neutral) varied by experimental group. Immediately after watching the videos, participants completed self-report (Approach and Avoidance of Alcohol Questionnaire; all studies) and implicit (visual probe task in study 1, stimulus-response compatibility task in studies 2 and 3) measures of alcohol-related approach and avoidance. In study 3, we incorporated an additional experimental manipulation of thought suppression in an attempt to maximize the influence of the videos on implicit measures. Findings were consistent across all three studies: increases in self-reported approach inclinations were mirrored by decreases in avoidance inclinations, and vice versa. However, a combined analysis of data from all studies demonstrated that changes in approach inclinations were partially independent of changes in avoidance inclinations. There were no effects on implicit alcohol-related processing biases, although methodological issues may partially account for these findings. Our findings demonstrate that subjective approach and avoidance inclinations for alcohol tend to fluctuate in parallel, but changes in approach inclinations may be partially independent from changes in avoidance inclinations. We discuss methodological issues that may partially account for our findings.