John Mooney

Measurable effects of local alcohol licensing policies on population health in England

Background English alcohol policy is implemented at local government level, leading to variations in how it is put into practice. We evaluated whether differences in the presence or absence of cumulative impact zones and the ‘intensity’ of licensing enforcement—both aimed at regulating the availability of alcohol and modifying the drinking environment—were associated with harm as measured by alcohol-related hospital admissions. Methods Premises licensing data were obtained at lower tier local authority (LTLA) level from the Home Office Alcohol and Late Night Refreshment Licensing data for 2007–2012, and LTLAs were coded as ‘passive’, low, medium or highly active based on whether they made use of cumulative impact areas and/or whether any licences for new premises were declined. These data were linked to 2009–2015 alcohol-related hospital admission and alcohol-related crime rates obtained from the Local Alcohol Profiles for England. Population size and deprivation data were obtained from the Office of National Statistics. Changes in directly age-standardised rates of people admitted to hospital with alcohol-related conditions were analysed using hierarchical growth modelling. Results Stronger reductions in alcohol-related admission rates were observed in areas with more intense alcohol licensing policies, indicating an ‘exposure–response’ association, in the 2007–2015 period. Local areas with the most intensive licensing policies had an additional 5% reduction (p=0.006) in 2015 compared with what would have been expected had these local areas had no active licensing policy in place. Conclusions Local licensing policies appear to be associated with a reduction in alcohol-related hospital admissions in areas with more intense licensing policies.

Local policies to tackle a national problem: Comparative qualitative case studies of an English local authority alcohol availability intervention

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.

Testing the impact of local alcohol licencing policies on reported crime rates in England

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.

[Accepted Manuscript] Local policies to tackle a national problem: Comparative qualitative case studies of an English local authority alcohol availability intervention.

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.

Experiences of knowledge brokering for evidence-informed public health policy and practice: three years of the Scottish Collaboration for Public Health Research and Policy

Background Despite interest in knowledge translation and exchange (KTE) in public health, few reports provide an account of knowledge brokerage organisations such as the Scottish Collaboration for Public Health Research and Policy (SCPHRP). SCPHRPs role is to identify public health interventions that equitably address major health priorities, foster collaboration between public health stakeholders, and build capacity for collaborative intervention research.

Workplace dietary improvement initiatives ought not to be discouraged by modest returns from low-intensity interventions.

We would like to thank Maes and colleagues for their timely and comprehensive summary of European-based studies on the effectiveness of workplace-based interventions to promote healthy eating.1 Their broad inclusion in particular, of a wide range of study designs and efforts to grade both study reporting and intervention quality are to be commended. However, they may be doing their own efforts a disservice, in that their discussion and conclusions seem overly cautious and conservative. For example, the results cited include: Given the widely acknowledged difficulties around implementing sustainable dietary behaviour change, we feel that the review as presented should be considered as encouragement for further workplace-based interventions, aimed at improving dietary quality. Another recent review not restricted to European-only studies also found that worksite health promotion programmes …

Propensity score matching for selection of local areas as controls for evaluation of effects of alcohol policies in case series and quasi case–control designs

OBJECTIVES Area-level public health interventions can be difficult to evaluate using natural experiments. We describe the use of propensity score matching (PSM) to select control local authority areas (LAU) to evaluate the public health impact of alcohol policies for (1) prospective evaluation of alcohol policies using area-level data, and (2) a novel two-stage quasi case-control design. STUDY DESIGN Ecological. METHODS Alcohol-related indicator data (Local Alcohol Profiles for England, PHE Health Profiles and ONS data) were linked at LAU level. Six LAUs (Blackpool, Bradford, Bristol, Ipswich, Islington, and Newcastle-upon-Tyne) as sample intervention or case areas were matched to two control LAUs each using PSM. For the quasi case-control study a second stage was added aimed at obtaining maximum contrast in outcomes based on propensity scores. Matching was evaluated based on average standardized absolute mean differences (ASAM) and variable-specific P-values after matching. RESULTS The six LAUs were matched to suitable control areas (with ASAM < 0.20, P-values >0.05 indicating good matching) for a prospective evaluation study that sought areas that were similar at baseline in order to assess whether a change in intervention exposure led to a change in the outcome (alcohol related harm). PSM also generated appropriate matches for a quasi case-control study--whereby the contrast in health outcomes between cases and control areas needed to be optimized in order to assess retrospectively whether differences in intervention exposure were associated with the outcome. CONCLUSIONS The use of PSM for area-level alcohol policy evaluation, but also for other public health interventions, will improve the value of these evaluations by objective and quantitative selection of the most appropriate control areas.

Investigating local policy drivers for alcohol harm prevention: a comparative case study of two local authorities in England

BackgroundThe 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.MethodsData 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.ResultsThree 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.ConclusionNew 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.

Estimating the measurable impact of local alcohol licensing policies on population health in England using ecological longitudinal data

Abstract Background Alcohol policy in England is determined at local government level, and as a result differences between local authorities in priorities around how best to reduce the effects of alcohol consumption have led to variability in local composition of alcohol control policies and interventions. An important policy area is that of regulating the physical availability of alcohol and modifying the commercial drinking environment. We evaluated whether the intensity with which local licensing policies, including specifically cumulative impact zones, were implemented and enforced has resulted in measurable differences in local population health. Methods Alcohol and late night refreshment licensing data (2007–12) from the Home Office were linked to alcohol-related hospital admissions from the Local Alcohol Profiles for England, and to population size and area deprivation at local area level. Cumulative policy and enforcement intensity was coded as passive, medium, or high on the basis of presence of cumulative impact zones, whether any new licence applications were successfully challenged, or both. Changes in directly age-standardised rates of people admitted to hospital with alcohol-related conditions in 2009 to quarter one of 2015 were analysed with mixed-effects log-rate models adjusted for seasonality, population size, deprivation, and alcohol-related crime rate. Findings Data were obtained for all 326 lower tier local authority areas in England, of which 319 provided licensing activity data. Spatial autocorrelation in licensing policy intensity was negligible (Morans I=0·02). An exposure-response association was observed, with an additional average decrease in alcohol-related hospital admission rates in the areas with the highest intensity policies compared with passive areas of 2% annually (95% CI −3 to −2, p=0·006). Accounting for other population changes, this equated to a modest additional 5% reduction, or about eight unique admissions per 100 000 people, in 2015 compared with what would have been expected had these areas not had active policies in place. Interpretation Although these analyses do not directly prove causality, they add to the available evidence about the efficacy of alcohol licensing policies specifically for England. Despite the fairly modest average effect, the intensity of alcohol licensing policies implementation and enforcement is related to measurable health gain. Funding This work was funded by the National Institute for Health Research School for Public Health Research (NIHR SPHR).

Should UK Pneumococcal Vaccine Eligibility Criteria Include Alcohol Dependency in Areas with High Alcohol-Related Mortality?

A recently reported steep increase in the incidence of invasive pneumococcal disease (IPD) in adults in the North East of England was primarily associated with pneumococcal sero-types found in the 23-valent pneumococcal polysaccharide vaccine (PPSV23). This region also has one of the highest rates of alcohol-related premature mortality and morbidity in the UK. Given that alcohol dependence is long acknowledged as one of the strongest risk factors for IPD mortality, we feel there is an increasingly compelling case to look again at the divergence of UK vaccine guidance from that of the World Health Organisation and the Centre for Disease Control in the USA, in the non-inclusion of alcoholism as an indicator condition that would potentially benefit from receiving PPSV23 vaccine. Such a re-think would represent a responsible evaluation of vaccination guidance in the face of newly emerging epidemiological findings and would have the potential to save lives in a very marginalised and vulnerable section of the population. We propose therefore that alcohol dependency (now referred to as alcohol use disorder), should be re-considered an indicator condition for receiving pneumococcal vaccine in North East England, where mortality from pneumococcal disease has been rising and which already has an excessive burden of alcohol-related mortality.