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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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Thienpondt A, Van Cauwenberg J, Van Damme J, Deforche B. Process evaluation of the Belgian one-month-without alcohol campaign 'Tournée Minérale': a mixed method approach. BMC Public Health 2024; 24:383. [PMID: 38317089 PMCID: PMC10840226 DOI: 10.1186/s12889-024-17941-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 01/31/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND The Tournée Minérale campaign [TMC] is a mass media prevention campaign challenging Belgian adults to refrain from alcohol during one month. A process evaluation may help us better understand the effect of TMC and to formulate recommendations for future editions. The current study aimed to examine reach, experiences, perceived effectiveness and maintenance of TMC. METHODS A mixed method design was used to assess the process, using pre- and post-questionnaires (n = 49.022, 44.5 ± 13.1 years old, 37.0% men) and focus groups (n = 31, 47.3 ± 14.3 years old, 33.3% men). RESULTS Most campaign materials were considered useful and/or motivating. Facilitators for taking part in TMC were connectedness with other participants, stimulus control (e.g. removing alcohol at home) and a supportive social environment. Most difficulties were encountered with abstaining during social occasions as participants had to change a habit or find alternative non-alcoholic beverages. Participants reported both beneficial (e.g. sleeping better) and adverse effects (e.g. drinking more soft drinks). CONCLUSIONS Future editions of TMC should try to decrease perceived adverse effects (e.g. by providing attractive non-alcoholic beverages) and can benefit from having a forum where people can share experiences.
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Affiliation(s)
- Annelies Thienpondt
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Ghent, B- 9000, Belgium.
| | - Jelle Van Cauwenberg
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Ghent, B- 9000, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Joris Van Damme
- Flemish expertise centre on alcohol and other drugs, Vanderlindestraat 15, Schaarbeek, 1030, Belgium
| | - Benedicte Deforche
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Ghent, B- 9000, Belgium
- Movement and Nutrition for Health and Performance Research Unit, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Pleinlaan 2, Brussels, B-1050, Belgium
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Odeigah OW, Patton R, Trangenstein P. Alcohol outlet density and marketing in Abeokuta, Nigeria. Alcohol Alcohol 2023; 58:628-636. [PMID: 37706528 DOI: 10.1093/alcalc/agad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/07/2023] [Accepted: 08/19/2023] [Indexed: 09/15/2023] Open
Abstract
AIM The physical availability of alcohol is a modifiable determinant of alcohol consumption and related harm. However, Nigeria currently does not have national regulations restricting the physical availability of alcohol. The study measured alcohol outlet density and marketing in Abeokuta, Nigeria. METHODS A descriptive community design was employed. Seven wards in Abeokuta South local government were surveyed street by street for functional alcohol outlets and nearby public institutions (schools and worship centres). Outlet characteristics were documented, and the location of outlets and public institutions was geocoded using a global positioning system app. The density and proximity of outlets and public institutions were analysed using QGIS 3.22. RESULTS Four hundred and seventy-six alcohol outlets and 194 public institutions (82 schools, 87 churches, and 25 mosques) were sampled across the 7 wards. The most common type of alcohol premises and outlets was on/off-premises and liquor/non-alcoholic drinks stores. Alcohol banners on liquor store lintels were the most prevalent marketing item. Alcohol outlet density ranged from 8.06 to 200 per km2. The smallest average distance between alcohol outlets was 28 m in Sodeke, while Ago Egun/Ijesa had the highest number of outlets and on/off premises. The shortest distance from an outlet to a school was 18.77 m in Ijaiye and 44 (14.7%) schools were located within ≤100 m of an outlet. CONCLUSIONS Findings indicate high alcohol density, resulting in short distances between alcohol outlets and public institutions in Abeokuta South local government area. These results underscore the importance of implementing evidence-based alcohol availability policies in Nigeria.
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Affiliation(s)
- Ogochukwu W Odeigah
- Department of Psychology, Chrisland University, K/M 5 Ajebo Road, P. M. B. 2131, Abeokuta, Ogun State, Nigeria
| | - Robert Patton
- School of Psychology, University of Surrey, Guildford, Surrey GU2 7XH, United Kingdom
| | - Pamela Trangenstein
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Street, Suite 450, Emeryville, CA 94608, United States
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Dam JL, Nagorka-Smith P, Waddell A, Wright A, Bos JJ, Bragge P. Research evidence use in local government-led public health interventions: a systematic review. Health Res Policy Syst 2023; 21:67. [PMID: 37400905 DOI: 10.1186/s12961-023-01009-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 05/13/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Local governments play an important role in improving public health outcomes globally, critical to this work is applying the best-available research evidence. Despite considerable exploration of research use in knowledge translation literature, how research is practically applied by local governments remains poorly understood. This systematic review examined research evidence use in local government-led public health interventions. It focused on how research was used and the type of intervention being actioned. METHODS Quantitative and qualitative literature published between 2000 and 2020 was searched for studies that described research evidence use by local governments in public health interventions. Studies reporting interventions developed outside of local government, including knowledge translation interventions, were excluded. Studies were categorised by intervention type and their level of description of research evidence use (where 'level 1' was the highest and 'level 3' was the lowest level of detail). FINDINGS The search identified 5922 articles for screening. A final 34 studies across ten countries were included. Experiences of research use varied across different types of interventions. However, common themes emerged including the demand for localised research evidence, the legitimising role of research in framing public health issues, and the need for integration of different evidence sources. CONCLUSIONS Differences in how research was used were observed across different local government public health interventions. Knowledge translation interventions aiming to increase research use in local government settings should consider known barriers and facilitators and consider contextual factors associated with different localities and interventions.
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Affiliation(s)
- Jennifer L Dam
- Monash Sustainable Development Institute, Monash University, 8 Scenic Boulevard, Clayton Campus, Clayton, VIC, 3800, Australia.
| | - Phoebe Nagorka-Smith
- School of Health and Social Development, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - Alex Waddell
- Action Lab, Monash University, 8 Scenic Boulevard, Clayton Campus, Clayton, VIC, 3800, Australia
| | - Annemarie Wright
- Victorian Department of Health and Human Services, 50 Lonsdale Street, Melbourne, VIC, 3000, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, VIC, 3053, Carlton, Australia
| | - Joannette J Bos
- Monash Sustainable Development Institute, Monash University, 8 Scenic Boulevard, Clayton Campus, Clayton, VIC, 3800, Australia
| | - Peter Bragge
- Monash Sustainable Development Institute, Monash University, 8 Scenic Boulevard, Clayton Campus, Clayton, VIC, 3800, Australia
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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: 3] [Impact Index Per Article: 1.5] [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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de Vocht F, McQuire C, Ferraro C, Williams P, Henney M, Angus C, Egan M, Mohan A, Purves R, Maani N, Shortt N, Mahon L, Crompton G, O'Donnell R, Nicholls J, Bauld L, Fitzgerald N. Impact of public health team engagement in alcohol licensing on health and crime outcomes in England and Scotland: A comparative timeseries study between 2012 and 2019. THE LANCET REGIONAL HEALTH. EUROPE 2022; 20:100450. [PMID: 35799613 PMCID: PMC9253894 DOI: 10.1016/j.lanepe.2022.100450] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Public health teams (PHTs) in England and Scotland engage to varying degrees in local alcohol licensing systems to try to reduce alcohol-related harms. No previous quantitative evidence is available on the effectiveness of this engagement. We aimed to quantify the effects of PHT engagement in alcohol licensing on selected health and crime outcomes. Methods 39 PHTs in England (n = 27) and Scotland (n = 12) were recruited (of 40 contacted) for diversity in licensing engagement level and region, with higher activity areas matched to lower activity areas. Each PHT's engagement in licensing for each 6 month period from April 2012 to March 2019 was quantified using a new measure (PHIAL) developed using structured interviews, documentary analyses, and expert consultation. Outcomes examined were ambulance callouts, alcohol-related hospital admissions, alcohol-related and alcohol-specific mortality and violent, sexual and public order offences. Timeseries were analysed using multivariable negative binomial mixed-effects models. Correlations were assessed between each outcome and 18-month average PHIAL score (primary metric), cumulative PHIAL scores and change in PHIAL scores. Additionally, 6-month lagged correlations were also assessed. Findings There was no clear evidence of any associations between the primary exposure metric and the public health or crime outcomes examined, nor between cumulative PHIAL scores or change in PHIAL score and any outcomes. There were no significant associations in England or Scotland when analysed separately or between outcomes and lagged exposure metrics. Interpretation There is no clear evidence that allocating PHT resources to engaging in alcohol licensing is associated with downstream reductions in alcohol-related health harms or crimes, in the short term or over a seven year follow-up period. Such engagement likely has benefits in shaping the licensing system to take account of health issues longer term, but as current systems cannot reduce alcohol availability or contain online sales, their potential benefits are somewhat constrained. Funding The ExILEnS project is funded by the NIHR Public Health Research Programme (project number 15/129/11). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
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Affiliation(s)
- Frank de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
- NIHR School for Public Health Research, UK
- NIHR Applied Research Collaboration West, UK
| | - Cheryl McQuire
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
- NIHR School for Public Health Research, UK
| | - Claire Ferraro
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Philippa Williams
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Madeleine Henney
- School of Health and Related Research, University of Sheffield, UK
| | - Colin Angus
- School of Health and Related Research, University of Sheffield, UK
- SPECTRUM Consortium, UK
| | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, UK
| | - Andrea Mohan
- School of Health Sciences, University of Dundee, UK
| | - Richard Purves
- Institute for Social Marketing & Health, University of Stirling, UK
| | - Nason Maani
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, UK
- Boston University School of Public Health, USA
| | - Niamh Shortt
- SPECTRUM Consortium, UK
- School of GeoSciences, University of Edinburgh, UK
| | - Laura Mahon
- SPECTRUM Consortium, UK
- Institute for Social Marketing & Health, University of Stirling, UK
- Alcohol Focus Scotland, UK
| | | | - Rachel O'Donnell
- Institute for Social Marketing & Health, University of Stirling, UK
| | - James Nicholls
- Institute for Social Marketing & Health, University of Stirling, UK
| | - Linda Bauld
- SPECTRUM Consortium, UK
- Usher Institute, University of Edinburgh, UK
| | - Niamh Fitzgerald
- SPECTRUM Consortium, UK
- Institute for Social Marketing & Health, University of Stirling, 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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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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