Alcohol licensing data: Why is it an underused resource in public health?

An observational study to examine how cumulative impact zones influence alcohol availability from different types of licensed outlets in an inner London Borough

OBJECTIVES

Cumulative impact zones (CIZs) are a widely implemented local policy intended to restrict alcohol availability in areas proliferated with licensed outlets. Limited previous research has questioned their effectiveness and suggested they may play a more nuanced role in shaping local alcohol environments. This study evaluates the association between CIZ implementation and the number of licence applications made, and the number issued, relative to a control region.

DESIGN

A quantitative observational study.

SETTING

The inner London Borough of Southwark, which currently enforces three CIZs.

POPULATION

Licence applications received by Southwark Council's Licensing Authority between 1 April 2006 and 31 March 2017 (n=1254).

INTERVENTIONS

CIZ implementation.

PRIMARY OUTCOME MEASURES

Five outlet types were categorised and evaluated: drinking establishments, eateries, takeaways, off sales and other outlets. Primary outcome measures were the number of applications received and the number of licences issued. These were analysed using Poisson regression of counts over time.

RESULTS

Across all CIZs, implementation was associated with greater increases in the number of eateries in CIZ regions (incidence rate ratio (IRR)=1.58, 95% CI: 1.02-2.45, p=0.04) and number of takeaway venues (IRR=3.89, 95% CI: 1.32-11.49, p=0.01), relative to the control area. No discernible association was found for the remaining outlet types. Disaggregating by area indicated a 10-fold relative increase in the number of new eateries in Peckham CIZ (IRR=10.38, 95% CI: 1.39-77.66, p=0.02) and a fourfold relative increase in the number of newly licensed takeaways in Bankside CIZ (IRR=4.38, 95% CI: 1.20-15.91, p=0.03).

CONCLUSIONS

CIZs may be useful as policy levers to shape local alcohol environments to support the licensing goals of specific geographical areas and diversify the night-time economy.

Controlling alcohol availability through local policy: an observational study to evaluate Cumulative Impact Zones in a London borough

Background

Cumulative impact zones (CIZs) are a discretionary policy lever available to local government, used to restrict the availability of alcohol in areas deemed already saturated. Despite little evidence of their effect, over 200 such zones have been introduced. This study explores the impact of three CIZs on the licensing of venues in the London Borough of Southwark.

Methods

Using 10 years of licensing data, we examined changes in the issuing of licences on the introduction of three CIZs within Southwark, relative to control areas. The number of licence applications made (N = 1110), the number issued, and the proportion objected to, were analysed using negative binomial regression.

Results

In one area tested, CIZ implementation was associated with 119% more licence applications than control areas (incidence rate ratios (IRR) = 2.19, 95% confidence intervals (CI): 1.29-3.73, P = 0.004) and 133% more licences granted (IRR = 2.33, 95% CI: 1.31-4.16, P = 0.004). No significant effect was found for the other two areas. CIZs were found to have no discernible effect on the relative proportion of licence applications receiving objections.

Conclusions

CIZs are proposed as a key lever to limit alcohol availability in areas of high outlet density. We found no evidence that CIZ establishment reduced the number of successful applications in Southwark.

Change in alcohol outlet density and alcohol-related harm to population health (CHALICE): a comprehensive record-linked database study in Wales

Background

Excess alcohol consumption has serious adverse effects on health and results in violence-related harm.

Objective

This study investigated the impact of change in community alcohol availability on alcohol consumption and alcohol-related harms to health, assessing the effect of population migration and small-area deprivation.

Design

A natural experiment of change in alcohol outlet density between 2006 and 2011 measured at census Lower Layer Super Output Area level using observational record-linked data.

Setting

Wales, UK; population of 2.5 million aged ≥ 16 years.

Outcome measures

Alcohol consumption, alcohol-related hospital admissions, accident and emergency (A&E) department attendances from midnight to 06.00 and violent crime against the person.

Data sources

Licensing Act 2003 [Great Britain.Licensing Act 2003. London: The Stationery Office; 2003. URL:www.legislation.gov.uk/ukpga/2003/17/contents(accessed 8 June 2015)] data on alcohol outlets held by the 22 local authorities in Wales, alcohol consumption data from annual Welsh Health Surveys 2008–12, hospital admission data 2006–11 from the Patient Episode Database for Wales (PEDW) and A&E attendance data 2009–11 were anonymously record linked to the Welsh Demographic Service age–sex register within the Secure Anonymised Information Linkage Databank. A final data source was recorded crime 2008–11 from the four police forces in Wales.

Methods

Outlet density was estimated (1) as the number of outlets per capita for the 2006 static population and the per quarterly updated population to assess the impact of population migration and (2) using new methods of network analysis of distances between each household and alcohol outlets within 10 minutes of walking and driving. Alcohol availability was measured by three variables: (1) the previous quarterly value; (2) positive and negative change over the preceding five quarters; and (3) volatility, a measure of absolute quarterly changes during the preceding five quarters. Longitudinal statistical analysis used multilevel Poisson models of consumption and Geographically Weighted Regression (GWR) spatial models of binge drinking, Cox regression models of hospital admissions and A&E attendance and GWR models of violent crime against the person, each as a function of alcohol availability adjusting for confounding variables. The impact on health inequalities was investigated by stratifying models within quintiles of the Welsh Index of Multiple Deprivation.

Results

The main finding was that change in walking outlet density was associated with alcohol-related harms: consumption, hospital admissions and violent crime against the person each tracked the quarterly changes in outlet density. Alcohol-related A&E attendances were not clinically coded and the association was less conclusive. In general, social deprivation was strongly associated with the outcome measures but did not substantially modify the associations between the outcomes and alcohol availability. We found no evidence for an important effect of population migration.

Limitations

Limitations included the absence of any standardised methods of alcohol outlet data collation, processing and validation, and incomplete data on on-sales and off-sales. We were dependent on the quality of clinical coding and administrative records and could not identify alcohol-related attendances in the A&E data set.

Conclusion

This complex interdisciplinary study found that important alcohol-related harms were associated with change in alcohol outlet density. Future work recommendations include defining a research standard for recording outlet data and classification of outlet type, the methodological development of residence-based density measures and a health economic analysis of model-predicted harms.

Funding

The National Institute for Health Research Public Health Research programme. Additional technical and computing support was provided by the Farr Institute at Swansea University, made possible by the following grant:

Centre for the Improvement of Population Health through E-records Research (CIPHER) and Farr Institute capital enhancement. CIPHER and the Farr Institute are funded by Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Chief Scientist Office (Scottish Government Health Directorates), the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, the Medical Research Council, the National Institute for Health Research, the National Institute for Social Care and Health Research (Welsh Government) and the Wellcome Trust (grant reference MR/K006525/1).

Public Health and Alcohol Licensing in the UK

This article discusses the role of public health in alcohol licensing in the UK, with a particular focus on the implementation of national legislation and guidance in local regulatory environments. It identifies a number of practical and theoretical challenges through an analysis of historical trends in licensing practice, recent policy developments, and key licensing decisions and appeals. There are strong historical precedents for a focus on strategic harm reduction in UK licensing; however, because licensing primarily addresses the proximate effects of retail, the incorporation of health considerations presents novel difficulties. These center on the identification and deployment of data, the attribution of population-level harms to individual outlets, alcohol industry resistance, local authority risk aversion, and epistemological tensions between public health and licensing. The conclusion proposes that for public health perspectives to gain traction in the licensing environment, clear and realistic goals need to be established, research needs to emphasize local data, and there needs to be a better understanding of the approaches to evidence, knowledge, and decision making that characterize licensing and other local regulatory services.

The development of alcohol policy in contemporary China

Over recent years, an increase in alcohol-related problems has been noted in China. Taking effective measures against the problem requires clear reviewing and understanding of the evolution of the Chinese alcohol policy. This study is aimed to evaluate the alcohol policy with special focus on reviewing the alcohol production and consumption situation in China and assessing the changes in Chinese alcohol policy along with other related fields. This article finishes with a set of recommended policy changes that could help solve the recent alcohol-related problems and analyze the major impediments.

Talking about alcohol: communities of practice and patient pathways

It is widely argued in policy circles and academic research that the health and social care needs of people with multiple and complex needs are greatly enhanced through a shared commitment to inter-professional practice and transformational learning. We take this assumption to task by examining a ‘community of practice’ (a working group for high-impact users facilitated by a large inner-city GP surgery), which brings together frontline practitioners and statutory commissioners working at the interface between homelessness, health and substance use. We then go on to identify four areas: (1) knowledge exchange and critical reflection; (2) networks of intervention; (3) inequality in relations and resources and (4) competition and congruence – that demand critical attention if we are to understand more fully the potential role of ‘communities of practice’ in acting as bridgeheads to health and social care integration.