Preventing alcohol-related violence: a public health approach

Most common principal diagnoses assigned to Australian emergency department presentations involving alcohol use: a multi-centre study

OBJECTIVES

Alcohol is the most widely consumed psychoactive substance in Australia and the consequences of alcohol consumption have enormous personal and social impacts. This study aimed to describe the principal diagnoses of emergency department (ED) presentations involving alcohol use in the previous 12 hours at eight hospitals in Victoria and the Australian Capital Territory, Australia.

METHODS

Twelve months' data (1 July 2018 - 30 June 2019) were collected from eight EDs, including demographics, ICD-10 codes, hospital location and self-reported drinking in the preceding 12 hours. The ten most common ICD-10 discharge codes were analysed based on age, sex and hospital geographic area.

RESULTS

ICD codes pertaining to mental and behavioural disorders due to alcohol use accounted for the highest proportion in most EDs. Suicide ideation/attempt was in the five highest ICD codes for all but one hospital. It was the second most common alcohol-related presentation for both males and females.

CONCLUSIONS

Alcohol plays a major role in a range of presentations, especially in relation to mental health and suicide.

IMPLICATIONS FOR PUBLIC HEALTH

The collection of alcohol involvement in ED presentations represents a major step forward in informing the community about the burden of alcohol on their health resources.

Assault-related injuries reported to police and treated by healthcare providers in the United States

Research suggests that assault-related injuries known by the police significantly differ from those known by healthcare providers, but the magnitude and nature of these differences are poorly understood. To address this gap, our study examined the empirical differences between assault-related injuries reported to police and treated by healthcare providers. In June of 2021, we analyzed the National Crime Victimization Survey (1993-2019) to estimate the prevalence of police reporting and healthcare use among 5093 nonfatal victimizations that caused injury and were either reported to the police or treated by healthcare in the United States. Quasi-Poisson models identified the factors associated with whether people who sustained the injuries used healthcare (v. only reported to police) and reported to police (v. only used healthcare). Among victimizations that caused only minor injuries, 43% involved only a police report, 11% involved only healthcare, and 46% involved both services. Among victimizations that caused serious injuries, 14% involved only a police report, 13% involved only healthcare, and 73% involved both services. Whether people with violent injuries used healthcare (v. only reported to police) and reported to police (v. only used healthcare) was significantly associated with 13 different person- and incident-level factors. The number and nature of assault-related injuries reported to law enforcement significantly differ from those treated by healthcare providers. Therefore, public health efforts to link police and healthcare data are warranted and recommended.

Association of alcohol and drug use with use of electronic cigarettes and heat-not-burn tobacco products among Korean adolescents

Background

The tobacco industry has aggressively introduced new and diverse products in the market, including electronic cigarettes (e-cigarettes) and heat-not-burn (HNB) tobacco products, to which adolescents are readily susceptible. Conventional cigarettes have a well-established relationship with adolescent risky behaviors such as alcohol and drug use; however, no studies exist on the association between alcohol consumption and use of e-cigarettes or HNB tobacco products among Korean adolescents. This study evaluated alcohol-related behaviors and drug use in relation to whether a Korean nationally representative adolescent sample had ever used e-cigarettes and HNB tobacco products.

Methods

Data from the 2018 Korean Youth Risk Behavior Web-based Survey were analyzed. The final study sample comprised 60,040 adolescents. Chi-square and logistic regression were used to examine whether the ever having used e-cigarettes and HNB tobacco products was associated with alcohol-related behaviors and drug use. P-values for trends were calculated to examine the dose-response relationship for each variable.

Results

Respondents with higher drinking frequency, drinking quantity, alcohol intoxication, alcohol availability, and drug use were more likely to report having used e-cigarettes and HNB tobacco products, thus implying a significant relationship between substance use and novel tobacco product (P < .001).

Conclusions

Our findings suggest that at-risk adolescents who are engaged in other forms of risk-taking behaviors are prone to attract the experimentation with e-cigarettes or HNB tobacco products. Thus, smoking cessation programs related to substance use should be implemented, and there is an urgent need to monitor and regulate these products effectively.

Risk-based licensing of alcohol venues and emergency department injury presentations in two Australian states

BACKGROUND

Risk-based licensing (RBL) is among the more recent policy interventions to reduce alcohol-related harm in and around licensed venues. RBL sets licence fees to reflect the venue's propensity to cause harm as a means of encouraging operators to improve their practices. We assessed whether the introduction of RBL in the Australian states of Queensland and Victoria was associated with a reduction in the incidence of emergency department (ED) injury presentations.

METHODS

We employed an interrupted time series design using Prais-Winsten and Cochrane-Orcutt regression modelling to estimate step and slope parameters in injury incidence rates in each state. We defined the population as residents of the state, aged 15-54 years, the age group we considered most likely to be exposed to the night-time economy. To reduce noise, we confined cases to presentations during times previously identified as correlated with a high probability of alcohol involvement, namely 'high alcohol hours' (HAH). We adjusted our models for the alcopops tax, implemented shortly before RBL, and for assaults during low alcohol hours (LAH) as a proxy for other risk factors for assault.

RESULTS

RBL was not associated with an overall reduction in the incidence of ED injury presentations during HAH in Queensland (β = 0.003; 95% CI: -0.010, 0.003, p = 0.318) or Victoria (β=-0.010; 95% CI: -0.021, 0.001, p = 0.087). Post-hoc subgroup analyses showed a reduction in ED injury presentations among men aged 20-39 years in Victoria (β=-0.026; 95% CI:-0.012, -0.040, p-0.0003) but this was not replicated in Queensland.

CONCLUSION

There was little evidence that RBL affected the incidence of ED presentations for injury. This may be due to weak financial penalties being applied to venues assessed as high-risk.

Alcohol-related harm in emergency departments: a prospective, multi-centre study

BACKGROUND AND AIMS

Emergency department (ED) alcohol-related presentation data are not routinely collected in Australia and New Zealand. It is likely that previous research has underestimated the numbers of patients presenting with alcohol-related conditions. This study aimed to quantify the level of alcohol harm presenting to EDs in Australia and New Zealand [Correction added on 23 Jan 2018, after first online publication: The 'aims' section was missing and is updated in this version].

DESIGN

Multi-centre, prospective study. Patients were screened prospectively for alcohol-related presentations during a 7-day period in December 2014. Part 1 involved screening to determine alcohol-positive ED presentations and data collection of patient demographic and clinical information. Part 2 involved a consent-based survey conducted with patients aged ≥ 14 years to perform Alcohol Use Disorders Identification Test (AUDIT) scores.

SETTING

Eight EDs in Australia and New Zealand, representing differing hospital role delineations.

PARTICIPANTS

A total of 8652 patients aged ≥ 14 years attended and 8435 (97.5%) were screened.

MEASUREMENTS

The main outcome measure was the proportion of patients who had an alcohol-related presentation termed 'alcohol-positive', using pre-defined criteria. It included injuries, intoxication, medical conditions and injuries caused by an alcohol-affected third party. Secondary outcomes included demographic and clinical information, the type of alcohol-related presentations and AUDIT scores.

FINDINGS

A total of 801 [9.5%; 95% confidence interval (CI) = 8.9-10.1%] presentations were identified as alcohol-positive, ranging between 4.9 and 15.2% throughout sites. Compared with alcohol-negative patients, alcohol-positive patients were more likely to be male [odds ratio (OR) = 1.90, 95% CI = 1.63-2.21], younger (median age 37 versus 46 years, P < 0.0001), arrive by ambulance (OR = 1.94, 95% CI = 1.68-2.25) or police/correctional vehicle (OR = 4.56, 95% CI = 3.05-6.81) and require immediate treatment (OR = 3.20, 95% CI = 2.03-05.06). The median AUDIT score was 16 (interquartile range = 10-24).

CONCLUSIONS

Almost one in 10 presentations to emergency departments in Australia and New Zealand are alcohol related.

Trouble in paradise: The crime and health outcomes of the Surfers Paradise licensed venue lockout

INTRODUCTION AND AIMS

The lockout intervention has become embedded in Australian alcohol policy with little scientific evidence of its effectiveness in reducing violence and disorder. This paper reports an evaluation of the Queensland lockout pilot in Surfers Paradise. Patrons could not enter or re-enter licensed venues after 3 am, while patrons inside at this time could stay until close.

DESIGN AND METHODS

Using police and ambulance data, time series analyses examined the impact of tourism seasons and the lockout on rates of crime, violence, injury and intoxication. Additional analyses were also conducted to show spatial and temporal changes in crime over time.

RESULTS

Both police and ambulance data showed that the lockout introduction had no statistically significant impact on rates of crime, violence, head and neck injuries, and intoxication over the 2 years following lockout. Hot spot maps indicated limited spatial shift of crime within Surfers Paradise following the lockout introduction, with evidence of a temporary intensification of crime in already established hot spots. We found a moderate statistically significant change in the 24 h distribution of crime after the lockout implementation, suggesting temporal displacement of crime.

DISCUSSION

Results support the small existing body of evidence on lockouts that indicates they are largely ineffective in reducing crime and injuries in entertainment districts.

CONCLUSION

As multi-pronged strategies that include a lockout gain in popularity, further investigation should focus on identifying the key drivers of successful interventions such as the Newcastle strategy, to better refine these interventions for replication and evaluation elsewhere. [De Andrade D, Homel R, Townsley M. Trouble in paradise: The crime and health outcomes of the Surfers Paradise licensed venue lockout. Drug Alcohol Rev 2016;35:564-572].

Crime, fear of crime and mental health: synthesis of theory and systematic reviews of interventions and qualitative evidence

Background

Crime and fear of crime may impact negatively on health and well-being. Interventions to reduce crime and fear of crime, particularly interventions in the physical environment, may be a promising way to improve population-level well-being.

Project components

(1) Mapping review of theories and pathways; (2) systematic review of effectiveness; (3) systematic review of UK qualitative data; and (4) focus groups and interviews with stakeholders.

Methods

(1) The mapping review was a pragmatic non-systematic review focusing on theoretical literature and observational quantitative studies and development of a theoretical model of pathways. (2 and 3) The systematic reviews followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. In total, 18 databases including EMBASE, MEDLINE, PsycINFO and Science Citation Index were searched from inception to 2010. Studies presenting data on the built environment and the fear of crime were included. Quality assessment was conducted. Data synthesis was conducted narratively for the intervention review, with harvest plots to synthesise data on inequalities, and by thematic analysis for the review of qualitative evidence. (4) Semistructured interviews with nine stakeholders working in community safety and two focus groups with members of the public were conducted to inform the methods of the project and the dissemination of findings. Data were analysed thematically.

Results

(1) There are complex and often indirect links between crime, fear of crime, environment, and health and well-being at both individual and population levels. Fear of crime is associated with poorer health outcomes. There is considerable debate about the measurement of fear of crime. Both fear of crime and crime are associated with a range of environmental factors. (2) A total of 12,093 references were screened on abstract for the two systematic reviews. Of these, 47 effectiveness studies (22 controlled and 25 uncontrolled) were included in the systematic review of effectiveness, with 36 conducted in the UK, 10 in the USA and one in the Netherlands. There is some evidence that home security improvements and non-crime-related environmental improvements may improve some fear of crime outcomes. There is little evidence that the following reduce fear of crime: street lighting improvements, closed-circuit television, multicomponent environmental crime prevention programmes or regeneration programmes. The evidence on housing improvement is mixed. Very few data on the health and well-being outcomes of crime reduction interventions were located and the study quality overall is poor. (3) A total of 39 studies were included in the systematic review of qualitative data. Several factors in the physical environment are perceived to impact on fear of crime. However, factors in the local social environment appear to be more important as drivers of fear of crime. There is considerable evidence for limitations on physical activity as a result of fear of crime, but less for mental health impacts. (4) Stakeholders see fear of crime as harder to address than crime and as linked to health and well-being. Environmental interventions, such as Secured by Design, are widely used and positively regarded.

Limitations

The review is relatively restricted in its scope and a number of relevant interventions and themes are excluded. The underlying evidence base is of limited quality, particularly for the effectiveness review, and is heterogeneous.

Conclusions

Broader social interventions appear more promising than crime-focused environmental interventions as a means of improving fear of crime, health and well-being. The qualitative evidence suggests that fear of crime may impact on physical activity. More broadly, crime and fear of crime appear to be linked to health and well-being mainly as aspects of socioeconomic disadvantage. This review indicates the following gaps in the literature: evaluation research on the health impacts of crime reduction interventions; more robust research on interventions to reduce fear of crime; systematic reviews of non-environmental interventions to reduce fear of crime and systematic reviews of qualitative evidence on other crime-related topics.

Funding

The National Institute for Health Research Public Health Research programme.

Crime, fear of crime, environment, and mental health and wellbeing: mapping review of theories and causal pathways

This paper presents the findings from a review of the theoretical and empirical literature on the links between crime and fear of crime, the social and built environment, and health and wellbeing. A pragmatic approach was employed, with iterative stages of searching and synthesis. This produced a holistic causal framework of pathways to guide future research. The framework emphasises that crime and fear of crime may have substantial impacts on wellbeing, but the pathways are often highly indirect, mediated by environmental factors, difficult to disentangle and not always in the expected direction. The built environment, for example, may affect health via its impacts on health behaviours; via its effects on crime and fear of crime; or via the social environment. The framework also helps to identify unexpected factors which may affect intervention success, such as the risk of adverse effects from crime prevention interventions as a result of raising awareness of crime.

Deadly partners: interdependence of alcohol and trauma in the clinical setting

Trauma is the leading cause of death for Americans aged 1 to 45. Over a third of all fatal motor vehicle collisions and nearly eighty percent of completed suicides involve alcohol. Alcohol can be both a cause of traumatic injury as well as a confounding factor in the diagnosis and treatment of the injured patient. Fortunately, brief interventions after alcohol-related traumatic events have been shown to decrease both trauma recidivism and long-term alcohol use. This review will address the epidemiology of alcohol-related trauma, the influence of alcohol on mortality and other outcomes, and the role of prevention in alcohol-related trauma, within the confines of the clinical setting.