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Fitzgerald N, O'Donnell R, Uny I, Martin JG, Cook M, Graham K, Stockwell T, Hughes K, Wilkinson C, McGill E, Miller PG, Reynolds J, Quigg Z, Angus C. Reducing alcohol harms whilst minimising impact on hospitality businesses: 'Sweetspot' policy options. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 129:104465. [PMID: 38843736 DOI: 10.1016/j.drugpo.2024.104465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 05/14/2024] [Accepted: 05/17/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND During COVID-19, hospitality businesses (e.g. bars, restaurants) were closed/restricted whilst off-sales of alcohol increased, with health consequences. Post-covid, governments face lobbying to support such businesses, but many health services remain under pressure. We appraised 'sweetspot' policy options: those with potential to benefit public services and health, whilst avoiding or minimising negative impact on the hospitality sector. METHODS We conducted rapid non-systematic evidence reviews using index papers, citation searches and team knowledge to summarise the literature relating to four possible 'sweetspot' policy areas: pricing interventions (9 systematic reviews (SR); 14 papers/reports); regulation of online sales (1 SR; 1 paper); place-shaping (2 SRs; 18 papers/reports); and violence reduction initiatives (9 SRs; 24 papers/reports); and led two expert workshops (n = 11). RESULTS Interventions that raise the price of cheaper shop-bought alcohol appear promising as 'sweetspot' policies; any impact on hospitality is likely small and potentially positive. Restrictions on online sales such as speed or timing of delivery may reduce harm and diversion of consumption from on-trade to home settings. Place-shaping is not well-supported by evidence and experts were sceptical. Reduced late-night trading hours likely reduce violence; evidence of impact on hospitality is scant. Other violence reduction initiatives may modestly reduce harms whilst supporting hospitality, but require resources to deliver multiple measures simultaneously in partnership. CONCLUSIONS Available evidence and expert views point to regulation of pricing and online sales as having greatest potential as 'sweetspot' alcohol policies, reducing alcohol harm whilst minimising negative impact on hospitality businesses.
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Affiliation(s)
- Niamh Fitzgerald
- Institute for Social Marketing & Health, University of Stirling/SPECTRUM Consortium, United Kingdom.
| | - Rachel O'Donnell
- Institute for Social Marketing & Health, University of Stirling, United Kingdom
| | - Isabelle Uny
- Institute for Social Marketing & Health, University of Stirling, United Kingdom
| | - Jack G Martin
- Institute for Social Marketing & Health, University of Stirling, United Kingdom
| | - Megan Cook
- Institute for Social Marketing & Health, University of Stirling, United Kingdom
| | - Kathryn Graham
- Centre for Addiction and Mental Health & Dalla Lana School of Public Health, University of Toronto, Canada
| | - Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Canada
| | | | - Claire Wilkinson
- Drug Policy Modelling Program, University of New South Wales, Sydney, Australia
| | - Elizabeth McGill
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Peter G Miller
- Deakin University School of Psychology, Geelong, Australia
| | | | - Zara Quigg
- Public Health Institute, World Health Organization Collaborating Centre for Violence Prevention, Liverpool John Moores University, United Kingdom
| | - Colin Angus
- Sheffield Alcohol Research Group, School of Health and Related Research, University of Sheffield, United Kingdom
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Fitzgerald N, Egan M, O'Donnell R, Nicholls J, Mahon L, de Vocht F, McQuire C, Angus C, Purves R, Henney M, Mohan A, Maani N, Shortt N, Bauld L. Public health engagement in alcohol licensing in England and Scotland: the ExILEnS mixed-method, natural experiment evaluation. PUBLIC HEALTH RESEARCH 2024:1-76. [PMID: 38345369 DOI: 10.3310/fsrt4135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
Background International systematic reviews suggest an association between alcohol availability and increased alcohol-related harms. Alcohol availability is regulated through separate locally administered licensing systems in England and Scotland, in which local public health teams have a statutory role. The system in Scotland includes a public health objective for licensing. Public health teams engage to varying degrees in licensing matters but no previous study has sought to objectively characterise and measure their activity, examine their effectiveness, or compare practices between Scotland and England. Aim To critically assess the impact and mechanisms of impact of public health team engagement in alcohol premises licensing on alcohol-related harms in England and Scotland. Methods We recruited 39 diverse public health teams in England (n = 27) and Scotland (n = 12). Public health teams more active in licensing were recruited first and then matched to lower-activity public health teams. Using structured interviews (n = 66), documentation analysis, and expert consultation, we developed and applied the Public Health Engagement In Alcohol Licensing (PHIAL) measure to quantify six-monthly activity levels from 2012 to 2019. Time series of PHIAL scores, and health and crime outcomes for each area, were analysed using multivariable negative binomial mixed-effects models to assess correlations between outcome and exposure, with 18-month average PHIAL score as the primary exposure metric. In-depth interviews (n = 53) and a workshop (n = 10) explored public health team approaches and potential mechanisms of impact of alcohol availability interventions with public health team members and licensing stakeholders (local authority licensing officers, managers and lawyers/clerks, police staff with a licensing remit, local elected representatives). Findings Nineteen public health team activity types were assessed in six categories: (1) staffing; (2) reviewing and (3) responding to licence applications; (4) data usage; (5) influencing licensing stakeholders/policy; and (6) public involvement. Usage and intensity of activities and overall approaches varied within and between areas over time, including between Scotland and England. The latter variation could be explained by legal, structural and philosophical differences, including Scotland's public health objective. This objective was felt to legitimise public health considerations and the use of public health data within licensing. Quantitative analysis showed no clear evidence of association between level of public health team activity and the health or crime outcomes examined, using the primary exposure or other metrics (neither change in, nor cumulative, PHIAL scores). Qualitative data suggested that public health team input was valued by many licensing stakeholders, and that alcohol availability may lead to harms by affecting the accessibility, visibility and norms of alcohol consumption, but that the licensing systems have limited power to act in the interests of public health. Conclusions This study provides no evidence that public health team engagement in local licensing matters was associated with measurable downstream reductions in crime or health harms, in the short term, or over a 7-year follow-up period. The extensive qualitative data suggest that public health team engagement is valued and appears to be slowly reorienting the licensing system to better address health (and other) harms, especially in Scotland, but this will take time. A rise in home drinking, alcohol deliveries, and the inherent inability of the licensing system to reduce - or in the case of online sales, to contain - availability, may explain the null findings and will continue to limit the potential of these licensing systems to address alcohol-related harms. Future work Further analysis could consider the relative success of different public health team approaches in terms of changing alcohol availability and retailing. A key gap relates to the nature and impact of online availability on alcohol consumption, harms and inequalities, alongside development and study of relevant policy options. A national approach to licensing data and oversight would greatly facilitate future studies and public health input to licensing. Limitations Our interview data and therefore PHIAL scores may be limited by recall bias where documentary evidence of public health activity was not available, and by possible variability in grading of such activity, though steps were taken to minimise both. The analyses would have benefited from additional data on licensing policies and environmental changes that might have affected availability or harms in the study areas. Study registration The study was registered with the Research Registry (researchregistry6162) on 26 October 2020. The study protocol was published in BMC Medical Research Methodology on 6 November 2018. Funding This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number 15/129/11.
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Affiliation(s)
- Niamh Fitzgerald
- Institute for Social Marketing and Health, University of Stirling, Scotland, UK
- SPECTRUM Consortium, UK
| | - Matt Egan
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- NIHR School for Public Health Research, Tyne and Wear, UK
| | - Rachel O'Donnell
- Institute for Social Marketing and Health, University of Stirling, Scotland, UK
| | - James Nicholls
- Faculty of Health Sciences and Sport, University of Stirling, Scotland, UK
| | - Laura Mahon
- Alcohol Focus Scotland, Glasgow, Scotland, UK
| | - Frank de Vocht
- NIHR School for Public Health Research, Tyne and Wear, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West, Bristol, UK
| | - Cheryl McQuire
- NIHR School for Public Health Research, Tyne and Wear, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Colin Angus
- SPECTRUM Consortium, UK
- School of Health and Related Research, University of Sheffield, UK
| | - Richard Purves
- Institute for Social Marketing and Health, University of Stirling, Scotland, UK
| | - Madeleine Henney
- School of Health and Related Research, University of Sheffield, UK
| | - Andrea Mohan
- School of Health Sciences, University of Dundee, Scotland, UK
| | - Nason Maani
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Niamh Shortt
- SPECTRUM Consortium, UK
- School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - Linda Bauld
- SPECTRUM Consortium, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
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O’Donnell R, Mohan A, Purves R, Maani N, Angus C, Egan M, Fitzgerald N. Mechanisms of impact of alcohol availability interventions from the perspective of 63 diverse alcohol licensing stakeholders: a qualitative interview study. DRUGS (ABINGDON, ENGLAND) 2023; 31:338-347. [PMID: 38835541 PMCID: PMC11147450 DOI: 10.1080/09687637.2023.2205991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/06/2023] [Indexed: 06/06/2024]
Abstract
Aims Interventions restricting temporal and spatial availability of alcohol are associated with reduced harm, but the pathways by which specific interventions have impact are poorly understood. We examined mechanisms of impact from the perspective of diverse licensing stakeholders. Methods Fifty-three in-depth interviews were conducted with licensing stakeholders (from public health teams [PHTs], police, local authority licensing teams and lawyers, and alcohol premises licensing committees) from 20 local government areas. Interviewees were recruited as part of the Exploring the impact of alcohol licensing in England and Scotland (ExILEnS) study. Data were analyzed thematically and preliminary themes/subthemes were discussed during online groups with a different sample of public health and licensing professionals (n = 10). Findings Most interviewees struggled to articulate how availability interventions might lead to changes in alcohol consumption or harms. Five overarching mechanisms were identified: access, visibility, premises and area-level norms, affordability, and management of the night-time economy, with specific pathways identified for certain subgroups/premises types. The mechanisms by which alcohol availability interventions may impact on alcohol consumption and harms are diverse, but were poorly understood. Conclusions These findings will inform licensing and availability policy and advocacy, highlighting the need for further scrutiny of the evidence underpinning identified mechanisms, and primary research to address knowledge gaps.
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Affiliation(s)
- R. O’Donnell
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - A. Mohan
- School of Health Sciences, University of Dundee, Dundee, UK
| | - R. Purves
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - N. Maani
- School of Social and Political Science, The University of Edinburgh, Edinburgh, UK
| | - C. Angus
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - M. Egan
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - N. Fitzgerald
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
- SPECTRUM Consortium, Edinburgh, UK
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Nicholls J, O'Donnell R, Mahon L, Fitzgerald N. 'Give us the real tools to do our jobs': views of UK stakeholders on the role of a public health objective for alcohol licensing. Public Health 2022; 211:122-127. [PMID: 36115137 DOI: 10.1016/j.puhe.2022.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/30/2022] [Accepted: 07/10/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study ascertains the views of UK stakeholders on the actual, and possible, impact of a public health licensing objective in their day-to-day work. STUDY DESIGN AND METHODS Twenty-eight interviews were conducted with members of public health teams who were actively engaged in alcohol licensing in their local area between 2017 and 2019. Six teams were based in Scotland (where there is a public health licensing objective) and 14 in England (where there is no similar objective). RESULTS Scottish participants reported that while challenges remained in applying the public health licensing objective, progress had been made and the objective was beneficial to their work. Participants in England felt that an objective would increase the legitimacy, value and impact of their contributions. In both Scotland and England, constructive relationships between PHTs, licensing authorities and other key stakeholders were developing suggesting that PHTs could have a sustainable and positive role in licensing. CONCLUSIONS In many Scottish areas, the alcohol licensing system is evolving to take constructive account of its public health objective. In England, PHTs that have invested resources in engaging in this area have demonstrated an ability to work effectively within licensing systems. Strong support for the adoption of a public health licensing objective among these PHTs adds weights to calls for the UK Government to reconsider its previous decision not to introduce such an objective.
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Affiliation(s)
- J Nicholls
- Faculty of Health and Sports Sciences, University of Stirling, Stirling FK9 4LA, UK.
| | - R O'Donnell
- Institute for Social Marketing & Health, University of Stirling, Stirling FK9 4LA, UK
| | - L Mahon
- Institute for Social Marketing & Health, University of Stirling, Stirling FK9 4LA, UK; Alcohol Focus Scotland, 166 Buchanan Street, Glasgow G1 2LW, UK; SPECTRUM Consortium, UK
| | - N Fitzgerald
- Institute for Social Marketing & Health, University of Stirling, Stirling FK9 4LA, UK; SPECTRUM Consortium, UK
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McGill E, Marks D, Petticrew M, Egan M. Addressing alcohol-related harms in the local night-time economy: a qualitative process evaluation from a complex systems perspective. BMJ Open 2022; 12:e050913. [PMID: 36008081 PMCID: PMC9422880 DOI: 10.1136/bmjopen-2021-050913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES English local authorities (LAs) are interested in reducing alcohol-related harms and may use discretionary powers such as the Late Night Levy (LNL) to do so. This study aims to describe how system stakeholders hypothesise the levy may generate changes and to explore how the system, its actors and the intervention adapt and co-evolve over time. DESIGN A process evaluation from a complex systems perspective, using qualitative methods. SETTING A London LA with high densities of residential and commercial properties, which implemented the LNL in 2014. PARTICIPANTS Data were generated through interviews with LNL implementers and alcohol consumers, observations in bars and during LNL patrols and documentary review. INTERVENTION The LNL allows LAs to charge late-night alcohol retailers an annual fee (£299-£4440) to manage and police the night-time economy (NTE). RESULTS When the LNL was being considered, stakeholders from different interest groups advanced diverse opinions about its likely impacts while rarely referencing supporting research evidence. Proponents of the levy argued it could reduce crime and anti-social behaviour by providing additional funds to police and manage the NTE. Critics of the levy hypothesised adverse consequences linked to claims that the intervention would force venues to vary their hours or close, cluster closing times, reduce NTE diversity and undermine public-private partnerships. In the first 2 years, levy-funded patrols developed relationships with the licensed trade and the public. The LNL did not undermine public-private partnerships and while some premises varied their hours, these changes did not undermine the intervention's viability, nor significantly cluster venue closing times, nor obviously damage the area's reputation for having a diverse NTE. CONCLUSIONS This study applies a framework for process evaluation from a complex systems perspective. The evaluation could be extended to measure alcohol-related outcomes and to consider the interplay between the national and local systems.
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Affiliation(s)
- Elizabeth McGill
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Dalya Marks
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Mark Petticrew
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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O’Donnell R, Mohan A, Purves R, Maani N, Egan M, Fitzgerald N. How public health teams navigate their different roles in alcohol premises licensing: ExILEnS multistakeholder interview findings. PUBLIC HEALTH RESEARCH 2022. [DOI: 10.3310/xcuw1239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
In England and Scotland, local governments regulate the sale of alcohol by awarding licences to premises to permit the sale of alcohol for consumption on or off the premises, under certain conditions; without such a licence, alcohol cannot be legally sold. In recent years, many local public health teams have become proactive in engaging with alcohol licensing, encouraging licensing authorities to act in ways intended to improve population health.
Objective
This research aimed to explore and understand the approaches and activities of public health stakeholders (i.e. NHS staff and other public health professionals) in seeking to influence local alcohol licensing policy and decisions, and the views of licensing stakeholders (i.e. licensing officers/managers, police staff with a licensing remit, elected members and licensing lawyers/clerks) on the acceptability and effectiveness of these approaches.
Participants
Local public health teams in England and Scotland were directly informed about this multisite study. Scoping calls were conducted with interested teams to explore their level of activity in alcohol licensing from 2012 across several categories. Twenty local authority areas with public health teams active in licensing matters were recruited purposively in England (n = 14) and Scotland (n = 6) to vary by region and rurality. Fifty-three in-depth telephone interviews (28 with public health stakeholders and 25 with licensing stakeholders outside health, such as local authority licensing teams/lawyers or police) were conducted. Interview transcripts were analysed thematically in NVivo 12 (QSR International, Warrington, UK) using inductive and deductive approaches.
Results
Public health stakeholders’ approaches to engagement varied, falling into three main (and sometimes overlapping) types. (1) Many public health stakeholders in England and all public health stakeholders in Scotland took a ‘challenging’ approach to influencing licensing decisions and policies. Reducing health harms was felt to necessitate a focus on reducing availability and generating longer-term culture change, citing international evidence on the links between availability and alcohol-related harms. Some of these stakeholders viewed this as being a narrow, ‘nanny state’ approach, whereas others welcomed public health expertise and its evidence-based approach and input. (2) Some public health stakeholders favoured a more passive, ‘supportive’ approach, with some reporting that reducing availability was unachievable. They reported that, within the constraints of current licensing systems, alcohol availability may be contained (at least in theory) but cannot be reduced, because existing businesses cannot be closed on availability grounds. In this ‘supportive’ approach, public health stakeholders supplied licensing teams with data on request or waited for guidance from licensing teams on when and how to get involved. Therefore, public health action supported the licensing team in their aim of promoting ‘safe’ and ‘responsible’ retailing of alcohol and/or focused on short-term outcomes other than health, such as crime. (3) Some public health stakeholders favoured a ‘collaborative’ approach in which they worked in close partnership with licensing teams; this could include a focus on containing availability or responsible retail of alcohol, or both.
Conclusions
In engaging with alcohol licensing, public health stakeholders adapted their approaches, sometimes resulting in a diminished focus on public health goals. Sampling did not include lower-activity areas, in which experiences might differ. The extent to which current licensing systems enable achievement of public health goals is questionable and the effectiveness of public health efforts merits quantitative evaluation.
Study registration
The study is registered with the Research Registry as researchregistry6162.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in Public Health Research. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rachel O’Donnell
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Andrea Mohan
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Richard Purves
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Nason Maani
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- SPECTRUM Consortium, Edinburgh, UK
| | - Matt Egan
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Niamh Fitzgerald
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
- SPECTRUM Consortium, Edinburgh, UK
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David G, Cooper R, Dixon S, Holmes J. Exploring the implementation of public involvement in local alcohol availability policy: the case of alcohol licensing decision-making in England. Addiction 2022; 117:1163-1172. [PMID: 34590367 DOI: 10.1111/add.15699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS In 2003, the UK government passed the Licensing Act for England and Wales. The Act provides a framework for regulating alcohol sale, including four licensing objectives with local governments having devolved responsibility for granting licences to sell alcohol. Members of the public can make representations of oppositions to licence applications. Applying the theories of the policy process, we explored the practices employed by licensing authorities when deciding on alcohol licences in situations of conflict between licence applicants and members of the public. DESIGN Qualitative study comprising a framework analysis of in-depth semi-structured interviews and application of the theories of institutionalism, the advocacy coalition framework and role of ideas. SETTING Eleven local authorities in five regions in England in 2019. PARTICIPANTS Purposive sample of 15 licensing officers, licensing subcommittee chairs, public health leads for licensing and police licensing officers. MEASUREMENTS The interview schedule included mechanisms of public involvement in licensing, parties involved, the subject of conflicts and how licensing authorities made decisions. FINDINGS When members of the public opposed licence applications, licensing authorities employed three key decision-making practices: procedural fairness, partnership working and framing. The normativity of procedural fairness was an important institutional structure within which conflicts were resolved. Licensing authorities also worked in partnership with the involved parties, who often appeared as advocacy coalitions that shared beliefs and advanced specific issues to determine mutually acceptable solutions. At times, licensing authorities framed issues through ideational processes to solve problems. CONCLUSION Licensing decision-making under the United Kingdom's Licensing Act for England and Wales appear in many cases to focus on resolution of conflicts between licence applicants and members of the public rather than on promotion of licensing objectives. This raises uncertainty regarding the impact of public involvement on reducing alcohol availability, but ultimately represents a pragmatic process that seeks to restore balance in powers, improve transparency in decision-making and empower communities.
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Affiliation(s)
- Genevieve David
- ClinChoice Inc., Medical Device Development, The University of Sheffield School of Health and Related Research, Mandaluyong City, Philippines
| | - Richard Cooper
- The University of Sheffield School of Health and Related Research, Sheffield, UK
| | - Simon Dixon
- The University of Sheffield School of Health and Related Research, Sheffield, UK
| | - John Holmes
- The University of Sheffield School of Health and Related Research, Sheffield, UK
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Reynolds J, McGrath M, Halliday E, Ogden M, Hare S, Smolar M, Lafortune L, Lock K, Popay J, Cook P, Egan M. 'The opportunity to have their say'? Identifying mechanisms of community engagement in local alcohol decision-making. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 85:102909. [PMID: 32861980 DOI: 10.1016/j.drugpo.2020.102909] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/02/2020] [Accepted: 08/05/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Engaging the community in decisions-making is recognised as important for improving public health, and is recommended in global alcohol strategies, and in national policies on controlling alcohol availability. Yet there is little understanding of how to engage communities to influence decision-making to help reduce alcohol-related harms. We sought to identify and understand mechanisms of community engagement in decision-making concerning the local alcohol environment in England. METHODS We conducted case studies in three local government areas in England in 2018, purposively selected for examples of community engagement in decisions affecting the local alcohol environment. We conducted 20 semi-structured interviews with residents, workers, local politicians and local government practitioners, and analysed documents linked to engagement and alcohol decision-making. RESULTS Four rationales for engaging the community in decision-making affecting the alcohol environment were identified: i) as part of statutory decision-making processes; ii) to develop new policies; iii) as representation on committees; and iv) occurring through relationship building. Many of the examples related to alcohol licensing processes, but also local economy and community safety decision-making. The impact of community inputs on decisions was often not clear, but there were a few instances of engagement influencing the process and outcome of decision-making relating to the alcohol environment. CONCLUSIONS While influencing statutory licensing decision-making is challenging, community experiences of alcohol-related harms can be valuable 'evidence' to support new licensing policies. Informal relationship-building between communities and local government is also beneficial for sharing information about alcohol-related harms and to facilitate future engagement. However, care must be taken to balance the different interests among diverse community actors relating to the local alcohol environment, and extra support is needed for those with least capacity to engage but who face more burden of alcohol-related harms, to avoid compounding existing inequalities.
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Affiliation(s)
- Joanna Reynolds
- Department of Psychology, Sociology and Politics, Collegiate Crescent, Sheffield Hallam University, Sheffield S10 2BP, United Kingdom; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, LondonWC1H 9SH, United Kingdom.
| | - Michael McGrath
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, LondonWC1H 9SH, United Kingdom
| | - Emma Halliday
- Department of Health Research, Lancaster University, Bailrigg, LancasterLA1 4YW, United Kingdom
| | | | - Sue Hare
- Public contributor; no institutional affiliation
| | - Maria Smolar
- Public Health England, Wellington House, 133-155 Waterloo Rd, LondonSE1 8UG, United Kingdom
| | - Louise Lafortune
- School of Medicine; University of Cambridge; Cambridge Institute of Public Health; Cambridge Biomedical Campus, CambridgeCB2 0SR, United Kingdom
| | - Karen Lock
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, LondonWC1H 9SH, United Kingdom
| | - Jennie Popay
- Department of Health Research, Lancaster University, Bailrigg, LancasterLA1 4YW, United Kingdom
| | - Penny Cook
- School of Health and Society, University of Salford, Mary Seacole Building, Frederick Road Campus, SalfordM6 6PU, United Kingdom
| | - Matt Egan
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, LondonWC1H 9SH, United Kingdom
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Boshari T, Sharpe CA, Poots AJ, Watt H, Rahman S, Pinder RJ. Observational study of the association between diverse licensed premises types and alcohol-related violence in an inner-London borough. J Epidemiol Community Health 2020; 74:1016-1022. [PMID: 32759288 DOI: 10.1136/jech-2020-213840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/24/2020] [Accepted: 07/13/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND An ecological correlation has been observed between licensed premises and alcohol-related violence (ARV). In the UK to date, no evidence directly connects alcohol-related harm to a single premises type. Recent policies have called for a diversified alcohol offer, yet quantitative evidence in support remains sparse. This study aims to inform policy by determining whether diversification of the alcohol economy is desirable and to inform the licensing process and submission of public health evidence. METHODS Using 11 years of local licensing data from the London Borough of Southwark, alcohol availability over time was approximated by the number of extant alcohol licences, categorised by outlet type: drinking establishments, eateries, takeaways, off-sales and 'other'. Harm was quantified drawing on law enforcement intelligence that recorded ARV. A linked data set was analysed using negative binomial regression, contrasting cumulative impact zones (CIZ)-a common alcohol control policy-with non-CIZ geographies. RESULTS Each licensed drinking establishment was associated with a 1.6% (95% CI 0.7% to 2.6%; p=0.001) increase in ARV, respectively. 'Other' outlets had a protective effect and were associated with a 1.8% (95% CI 1.0% to 2.5%; p<0.001) decrease in ARV. CONCLUSION This study provides direct evidence for an association between alcohol-related harm and licensed premises. The varying associations between outlet type and ARV provide local public health stakeholders with an evidence base upon which to advocate for licensing policies that diversify alcohol availability.
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Affiliation(s)
- Talia Boshari
- Public Health Directorate, Southwark Council, London, UK .,Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Carolyn A Sharpe
- Public Health Directorate, Southwark Council, London, UK.,Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | | | - Hillary Watt
- Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | | | - Richard J Pinder
- Public Health Directorate, Southwark Council, London, UK.,Primary Care and Public Health, Imperial College London School of Public Health, London, UK
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Miller PG, Curtis A, Graham K, Kypri K, Hudson K, Chikritzhs T. Understanding risk-based licensing schemes for alcohol outlets: A key informant perspective. Drug Alcohol Rev 2020; 39:267-277. [PMID: 32064692 DOI: 10.1111/dar.13043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 01/03/2020] [Accepted: 01/26/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS Risk-based alcohol licensing (RBL) has been introduced in several jurisdictions in Australia, New Zealand and Canada with the intention of reducing harm in and around alcohol outlets. RBL involves tailoring licence fees or regulatory agency monitoring levels according to risk criteria such as trading hours, venue size and compliance history. The aim of this study was to document key informant perspectives including their perceptions of the purpose of RBL, how it works and its active ingredients. DESIGN AND METHODS We conducted semi-structured in-depth interviews with 28 key informants, including four government policy makers, four liquor licensing representatives, four local council members, eight police officers, six licensees, one academic and one community advocate from Victoria, Queensland, the Australian Capital Territory and Ontario, Canada. We analysed the transcripts using a thematic approach. RESULTS Informants varied in their opinions about whether RBL achieved its objective of reducing alcohol-related harm. They identified difficulties in enforcing the compliance history component of the scheme due to loopholes in legislation as a major shortfall, and the need to apply RBL to packaged liquor (off-licence) outlets. They also discussed the need to consider outlet density associated with the location of a venue when assessing venue risk. DISCUSSION AND CONCLUSIONS RBL schemes vary by jurisdiction and emphasise different components. In general, informants surmised that RBL as implemented has probably had little or no preventive effect but suggested that it may be effective with greater monitoring and penalties large enough to deter bad practice.
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Affiliation(s)
- Peter G Miller
- Deakin University Centre for Drug use, Addictive and Anti-social behaviour Research (CEDAAR), Deakin University, Geelong, Australia
| | - Ashlee Curtis
- Deakin University Centre for Drug use, Addictive and Anti-social behaviour Research (CEDAAR), Deakin University, Geelong, Australia
| | - Kathryn Graham
- Social Prevention and Health Policy Research, Centre for Addiction and Mental Health, London, Canada
| | - Kypros Kypri
- Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Kate Hudson
- Deakin University Centre for Drug use, Addictive and Anti-social behaviour Research (CEDAAR), Deakin University, Geelong, Australia
| | - Tanya Chikritzhs
- National Drug Research Institute, Curtin University, Perth, Australia
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11
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Wright A. Local Alcohol Policy Implementation in Scotland: Understanding the Role of Accountability within Licensing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111880. [PMID: 31141952 PMCID: PMC6603643 DOI: 10.3390/ijerph16111880] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 05/09/2019] [Accepted: 05/20/2019] [Indexed: 11/17/2022]
Abstract
Scotland has been ambitious in its policy and legislative efforts to tackle alcohol-related harm, efforts which include the innovative feature of a ‘public health objective’ within local alcohol licensing. However, the persistence of alcohol-related harms and inequalities requires further examination of both the overarching Scottish alcohol strategy and its specific implementation. A qualitative case study was undertaken to explore how alcohol policy is implemented locally in Scotland, with data generated from (i) documentary analysis of 12 relevant policies, legislation, and guidance documents; and (ii) a thematic analysis of semi-structured interviews with 54 alcohol policy implementers in three Scottish localities and nine national-level stakeholders. The data suggest there is a tension between the intentions of licensing legislation and the way it is enacted in practice, and that accountability emerges as an important factor for understanding why this occurs. In particular, there are a lack of accountability mechanisms acting upon Scottish Licensing Boards to ensure they contribute to the public health goals of the Scottish alcohol strategy. From a public health perspective, this has perpetuated a system in which Licensing Boards continue to act with autonomy from the rest of the alcohol policy implementation system, creating a challenge to the achievement of public health goals. Alcohol policy in Scotland is likely to fall short of intended goals as long as the tension between licensing legislation and enacted licensing practices remains.
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Affiliation(s)
- Alex Wright
- Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinburgh, Edinburgh, EH8 9LD, UK.
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12
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Gavens L, Holmes J, Buykx P, de Vocht F, Egan M, Grace D, Lock K, Mooney JD, Brennan A. Processes of local alcohol policy-making in England: Does the theory of policy transfer provide useful insights into public health decision-making? Health Place 2019. [DOI: 10.1016/j.healthplace.2017.05.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Reynolds J, McGrath M, Engen J, Pashmi G, Andrews M, Sharpe C, Egan M, Lim J, Lock K. 'A true partner around the table?' Perceptions of how to strengthen public health's contributions to the alcohol licensing process. J Public Health (Oxf) 2019; 41:e1-e8. [PMID: 29860414 DOI: 10.1093/pubmed/fdy093] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 05/01/2018] [Accepted: 05/08/2018] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION There are increased opportunities for public health practitioners (PHPs) in England to shape alcohol availability and reduce harms through a statutory role in licensing processes in local government. However, how public health can effectively influence alcohol licence decision-making is little understood. METHODS A mixed methods study was conducted to identify challenges faced by PHPs and mechanisms to strengthen their role. This involved a survey of practitioners across London local authorities (n = 18) and four focus group discussions with a range of licensing stakeholders (n = 36). RESULTS Survey results indicated a varied picture of workload, capacity to respond to licence applications and levels of influence over decision-making among PHPs in London. Practitioners described a felt lack of status within the licence process, and difficulties using and communicating public health evidence effectively, without a health licensing objective. Strategies considered supportive included engaging with other responsible authorities and developing understanding and relationships over time. CONCLUSIONS Against political and resource constraints at local and national government levels, pragmatic approaches for strengthening public health influence over alcohol licensing are required, including promoting relationships between stakeholders and offering opportunities for PHPs to share best practice about making effective contributions to licensing.
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Affiliation(s)
- Joanna Reynolds
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine
| | - Michael McGrath
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine
| | - Jessica Engen
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine
| | | | | | | | - Matt Egan
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine
| | - Jin Lim
- London Borough of Southwark.,London Healthy Place Network
| | - Karen Lock
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine
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14
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Reynolds J, McGrath M, Engen J, Pashmi G, Andrews M, Lim J, Lock K. Processes, practices and influence: a mixed methods study of public health contributions to alcohol licensing in local government. BMC Public Health 2018; 18:1385. [PMID: 30563484 PMCID: PMC6299525 DOI: 10.1186/s12889-018-6306-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 12/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Public health in England has opportunities to reduce alcohol-related harms via shaping the availability and accessibility of alcohol through the licensing function in local government. While the constraints of licensing legislation have been recognised, what is currently little understood are the day-to-day realities of how public health practitioners enact the licensing role, and how they can influence the local alcohol environment. METHODS To address this, a mixed-methods study was conducted across 24 local authorities in Greater London between 2016 and 17. Data collection involved ethnographic observation of public health practitioners' alcohol licensing work (in eight local authorities); a survey of public health practitioners (n = 18); interviews with licensing stakeholders (n = 10); and analysis of public health licensing data from five local authorities. Fieldnotes and interview transcripts were analysed thematically, and quantitative data were analysed using descriptive statistics. RESULTS Results indicated that some public health teams struggle to justify the resources required to engage with licensing processes when they perceive little capacity to influence licensing decisions. Other public health teams consider the licensing role as important for shaping the local alcohol environment, and also as a strategic approach for positioning public health within the council. Practitioners use different processes to assess the potential risks of licence applications but also the potential strengths of their objections, to determine when and how actions should be taken. Identifying the direct influence of public health on individual licences is challenging, but the study revealed how practitioners did achieve some level of impact, for example through negotiation with applicants. CONCLUSIONS This study shows public health impact following alcohol licensing work is difficult to measure in terms of reducing alcohol-related harms, which poses challenges for justifying this work amid resource constraints. However, there is potential added value of the licensing role in strategic positioning of public health in local government to influence broader determinants of health.
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Affiliation(s)
- Joanna Reynolds
- Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Michael McGrath
- Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Jessica Engen
- Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Ghazaleh Pashmi
- Safe Sociable London Partnership, Peckham Levels, Level 4, 95A Rye Lane, London, SE15 4ST, UK
| | - Matthew Andrews
- Safe Sociable London Partnership, Peckham Levels, Level 4, 95A Rye Lane, London, SE15 4ST, UK
| | - Jin Lim
- Southwark Council, 160 Tooley St, London, SE1 2QH, UK.,London Healthy Place Network, London, UK
| | - Karen Lock
- Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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15
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Fitzgerald N, Egan M, de Vocht F, Angus C, Nicholls J, Shortt N, Nichols T, Maani Hessari N, McQuire C, Purves R, Critchlow N, Mohan A, Mahon L, Sumpter C, Bauld L. Exploring the impact of public health teams on alcohol premises licensing in England and Scotland (ExILEnS): procotol for a mixed methods natural experiment evaluation. BMC Med Res Methodol 2018; 18:123. [PMID: 30400776 PMCID: PMC6219046 DOI: 10.1186/s12874-018-0573-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 10/12/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Recent regulatory changes in the system by which premises are licensed to sell alcohol, have given health representatives a formal role in the process in England and Scotland. The degree to which local public health teams engage with this process varies by locality in both nations, which have different licensing regimes. This study aims to critically assess the impact on alcohol-related harms - and mechanisms - of public health stakeholders' engagement in alcohol premises licensing from 2012 to 2018, comparing local areas with differing types and intensities of engagement, and examining practice in Scotland and England. METHODS The study will recruit 20 local authority areas where public health stakeholders have actively engaged with the alcohol premises licensing system (the 'intervention') and match them to a group of 20 lower activity areas using genetic matching. Four work packages are included: (1) Structured interviews and documentary analysis will examine the type and level of intervention activity from 2012 to 2018, creating a novel composite measure of the intensity of such activity and will assess the local licensing system and potential confounding activities over the same period. In-depth interviews with public health, licensing, police and others will explore perceived mechanisms of change, acceptability, and impact. (2) Using longitudinal growth models and time series analyses, the study will evaluate the impact of high and low levels of activity on alcohol-related harms using routine data from baseline 2009 to 2018. (3) Intervention costs, estimated National Health Service cost savings and health gains will be evaluated using the Sheffield Alcohol Policy Model to estimate impact on alcohol consumption and health inequalities. (4) The study will engage public health teams to create a new theory of change for public health involvement in the licensing process using our data. We will share findings with local, national and international stakeholders. DISCUSSION This interdisciplinary study examines, for the first time, whether and how public health stakeholders' involvement in alcohol licensing impacts on alcohol harms. Using mixed methods and drawing on complex systems thinking, it will make an important contribution to an expanding literature evaluating interventions not suited to traditional epidemiological research.
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Affiliation(s)
- Niamh Fitzgerald
- Institute of Social Marketing, UK Centre for Tobacco & Alcohol Studies, University of Stirling, Stirling, FK9 4LA UK
| | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Frank de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Colin Angus
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Niamh Shortt
- School of Geosciences, University of Edinburgh, Edinburgh, UK
| | - Tim Nichols
- formerly Brighton & Hove City Council, Brighton, UK
| | - Nason Maani Hessari
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Cheryl McQuire
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Richard Purves
- Institute of Social Marketing, University of Stirling, Stirling, UK
| | - Nathan Critchlow
- Institute of Social Marketing, University of Stirling, Stirling, UK
| | - Andrea Mohan
- Institute of Social Marketing, University of Stirling, Stirling, UK
| | | | - Colin Sumpter
- Institute of Social Marketing, University of Stirling, Stirling, UK
| | - Linda Bauld
- Institute of Social Marketing, UK Centre for Tobacco & Alcohol Studies, University of Stirling, Stirling, FK9 4LA UK
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16
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Fitzgerald N, Winterbottom J, Nicholls J. Democracy and power in alcohol premises licensing: A qualitative interview study of the Scottish public health objective. Drug Alcohol Rev 2018; 37:607-615. [DOI: 10.1111/dar.12819] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/01/2018] [Accepted: 05/07/2018] [Indexed: 01/30/2023]
Affiliation(s)
- Niamh Fitzgerald
- Institute for Social Marketing, UK Centre for Tobacco and Alcohol Studies, Faculty of Health Sciences and Sport; University of Stirling; Stirling UK
| | - Jo Winterbottom
- West Dunbartonshire Health and Social Care Partnership; Dumbarton UK
| | - James Nicholls
- Alcohol Research UK; London UK
- Centre for History in Public Health, London School of Hygiene and Tropical Medicine; London UK
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17
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Jackson N, Kypri K. A tentative win for the people of Auckland in New Zealand’s liquor licensing court. Drug Alcohol Rev 2018; 37:159-161. [DOI: 10.1111/dar.12658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | - Kypros Kypri
- School of Medicine and Public Health; University of Newcastle; Newcastle Australia
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18
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Mooney JD, Holmes J, Gavens L, de Vocht F, Hickman M, Lock K, Brennan A. Investigating local policy drivers for alcohol harm prevention: a comparative case study of two local authorities in England. BMC Public Health 2017; 17:825. [PMID: 29047389 PMCID: PMC5648432 DOI: 10.1186/s12889-017-4841-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 10/06/2017] [Indexed: 11/30/2022] Open
Abstract
Background The considerable challenges associated with implementing national level alcohol policies have encouraged a renewed focus on the prospects for local-level policies in the UK and elsewhere. We adopted a case study approach to identify the major characteristics and drivers of differences in the patterns of local alcohol policies and services in two contrasting local authority (LA) areas in England. Methods Data were collected via thirteen semi-structured interviews with key informants (including public health, licensing and trading standards) and documentary analysis, including harm reduction strategies and statements of licensing policy. A two-stage thematic analysis was used to categorize all relevant statements into seven over-arching themes, by which document sources were then also analysed. Results Three of the seven over-arching themes (drink environment, treatment services and barriers and facilitators), provided for the most explanatory detail informing the contrasting policy responses of the two LAs: LA1 pursued a risk-informed strategy via a specialist police team working proactively with problem premises and screening systematically to identify riskier drinking. LA2 adopted a more upstream regulatory approach around restrictions on availability with less emphasis on co-ordinated screening and treatment measures. Conclusion New powers over alcohol policy for LAs in England can produce markedly different policies for reducing alcohol-related harm. These difference are rooted in economic, opportunistic, organisational and personnel factors particular to the LAs themselves and may lead to closely tailored solutions in some policy areas and poorer co-ordination and attention in others.
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Affiliation(s)
- John D Mooney
- Faculty of Health Sciences and Well-being, University of Sunderland, City Campus, Dale Building, Sunderland, SR1 3SD, UK.
| | - John Holmes
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, S1 4DA, Sheffield, UK
| | - Lucy Gavens
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, S1 4DA, Sheffield, UK
| | - Frank de Vocht
- School of Social and Community Medicine, University of Bristol, Canynge Hall, Whatley Road, Bristol, BS8 2PS, UK
| | - Matt Hickman
- School of Social and Community Medicine, University of Bristol, Canynge Hall, Whatley Road, Bristol, BS8 2PS, UK
| | - Karen Lock
- London School of Hygiene & Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, S1 4DA, Sheffield, UK
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19
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Fitzgerald N, Nicholls J, Winterbottom J, Katikireddi SV. Implementing a Public Health Objective for Alcohol Premises Licensing in Scotland: A Qualitative Study of Strategies, Values, and Perceptions of Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14030221. [PMID: 28241512 PMCID: PMC5369057 DOI: 10.3390/ijerph14030221] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 02/16/2017] [Accepted: 02/21/2017] [Indexed: 11/16/2022]
Abstract
The public health objective for alcohol premises licensing, established in Scotland in 2005, is unique globally. We explored how public health practitioners engaged with the licensing system following this change, and what helped or hindered their efforts. Semi-structured interviews were conducted with 13 public health actors, audio-recorded, and analysed using an inductive framework approach. Many interviewees viewed the new objective as synonymous with reducing population-level alcohol consumption; however, this view was not always shared by licensing actors, some of whom did not accept public health as a legitimate goal of licensing, or prioritised economic development instead. Some interviewees were surprised that the public health evidence they presented to licensing boards did not result in their hoped-for outcomes; they reported that licensing officials did not always understand or value health data or statistical evidence. While some tried to give "impartial" advice to licensing boards, this was not always easy; others were clear that their role was one of "winning hearts and minds" through relationship-building with licensing actors over time. Notwithstanding the introduction of the public health objective, there remain significant, and political, challenges in orienting local premises licensing boards towards decisions to reduce the availability of alcohol in Scotland.
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Affiliation(s)
- Niamh Fitzgerald
- Institute for Social Marketing, UK Centre for Tobacco and Alcohol Studies, Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK.
| | - James Nicholls
- Alcohol Research UK, London SW1H 0HW, UK.
- Centre for History in Public Health, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK.
| | - Jo Winterbottom
- West Dunbartonshire Health and Social Care Partnership, Dumbarton G82 3PU, UK.
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20
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De Vocht F, Heron J, Campbell R, Egan M, Mooney JD, Angus C, Brennan A, Hickman M. Testing the impact of local alcohol licencing policies on reported crime rates in England. J Epidemiol Community Health 2016; 71:137-145. [PMID: 27514936 PMCID: PMC5284476 DOI: 10.1136/jech-2016-207753] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/24/2016] [Accepted: 07/01/2016] [Indexed: 12/22/2022]
Abstract
Background Excessive alcohol use contributes to public nuisance, antisocial behaviour, and domestic, interpersonal and sexual violence. We test whether licencing policies aimed at restricting its spatial and/or temporal availability, including cumulative impact zones, are associated with reductions in alcohol-related crime. Methods Reported crimes at English lower tier local authority (LTLA) level were used to calculate the rates of reported crimes including alcohol-attributable rates of sexual offences and violence against a person, and public order offences. Financial fraud was included as a control crime not directly associated with alcohol abuse. Each area was classified as to its cumulative licensing policy intensity for 2009–2015 and categorised as ‘passive’, low, medium or high. Crime rates adjusted for area deprivation, outlet density, alcohol-related hospital admissions and population size at baseline were analysed using hierarchical (log-rate) growth modelling. Results 284 of 326 LTLAs could be linked and had complete data. From 2009 to 2013 alcohol-related violent and sexual crimes and public order offences rates declined faster in areas with more ‘intense’ policies (about 1.2, 0.10 and 1.7 per 1000 people compared with 0.6, 0.01 and 1.0 per 1000 people in ‘passive’ areas, respectively). Post-2013, the recorded rates increased again. No trends were observed for financial fraud. Conclusions Local areas in England with more intense alcohol licensing policies had a stronger decline in rates of violent crimes, sexual crimes and public order offences in the period up to 2013 of the order of 4–6% greater compared with areas where these policies were not in place, but not thereafter.
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Affiliation(s)
- F De Vocht
- NIHR School for Public Health Research (SPHR), Bristol, UK.,School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J Heron
- NIHR School for Public Health Research (SPHR), Bristol, UK.,School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - R Campbell
- NIHR School for Public Health Research (SPHR), Bristol, UK.,School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - M Egan
- NIHR School for Public Health Research (SPHR), Bristol, UK.,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - J D Mooney
- Health Sciences and Well-being Research Group, University of Sunderland, Sunderland, UK
| | - C Angus
- NIHR School for Public Health Research (SPHR), Bristol, UK.,ScHARR, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - A Brennan
- NIHR School for Public Health Research (SPHR), Bristol, UK.,ScHARR, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - M Hickman
- NIHR School for Public Health Research (SPHR), Bristol, UK.,School of Social and Community Medicine, University of Bristol, Bristol, UK
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21
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Local policies to tackle a national problem: Comparative qualitative case studies of an English local authority alcohol availability intervention. Health Place 2016; 41:11-18. [PMID: 27419612 DOI: 10.1016/j.healthplace.2016.06.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/31/2016] [Accepted: 06/24/2016] [Indexed: 11/21/2022]
Abstract
Cumulative impact policies (CIPs) are widely used in UK local government to help regulate alcohol markets in localities characterised by high density of outlets and high rates of alcohol related harms. CIPs have been advocated as a means of protecting health by controlling or limiting alcohol availability. We use a comparative qualitative case study approach (n=5 English local government authorities, 48 participants) to assess how CIPs vary across different localities, what they are intended to achieve, and the implications for local-level alcohol availability. We found that the case study CIPs varied greatly in terms of aims, health focus and scale of implementation. However, they shared some common functions around influencing the types and managerial practices of alcohol outlets in specific neighbourhoods without reducing outlet density. The assumption that this will lead to alcohol harm-reduction needs to be quantitatively tested.
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