A feasibility study of a licensed premise intervention to reduce alcohol misuse and violent injury

Lead Research Organisation: Cardiff University
Department Name: Dentistry

Abstract

A feasibility study of a licensed premise intervention to reduce alcohol misuse and violent injury
We aim to better understand how interventions designed to curb alcohol misuse and violence in licensed premises can be implemented, how to measure the effects of interventions and what, if any, barriers there are to implementation.
Alcohol misuse damages health and busy licensed premises are prone to disorder and violence. Alcohol places an unnecessary and preventable burden on health services.
Researchers only partially understand how interventions reduce the risk of alcohol misuse and violence. The lack of reliable ways of measuring harm and the lack of watertight research methods mean that there are many uncertainties. This project addresses these problems by rigorously assessing how changes within licensed premises might impact on injury and illness. First, reliable measures of alcohol misuse and violence will be developed and, second, the effects of implementing changes will be measured. Measures which will be assessed include precisely targeted breath analysis and police and accident and emergency data. If reliable measures and evidence that the intervention works emerge then a large scale experiment will be the subject of a further application.

Technical Summary

The health and economic costs of alcohol misuse in the UK are estimated to be between 2% and 5% of UK gross domestic product and reflect sexual health outcomes, injury, stroke and cancer as well as lost productivity and absenteeism in the workplace. Evidence suggests that interventions targeted at licensed premises which address known risk factors (e.g. serving alcohol to intoxicated customers, irresponsible alcohol promotions, deficits in server training) can be effective in reducing the health costs associated with alcohol misuse. This project builds on the applicants? previous research by assessing the feasibility of a premises-level intervention designed to reduce alcohol misuse, and outcomes of misuse including disorder and violent injury. It is necessarily a feasibility study since available evidence suffers from poorly defined outcome measures which are too diverse to be generalisable and inappropriate methodology ? for example, randomised controlled trials (RCT) have been rarely been used. The interventions will be based on identification of premises risk factors. Experts in auditing the licensed trade and researchers will work with licensees to address shortcomings. The key intervention component involves feedback: experimental premises will receive feedback and be subject to action plans whereas control premises will not. Although the means of identifying shortcomings in premises management has been used across England and Wales and interventions which raise standards appear to have reduced disorder according to various police and health indicators (usually injury measures) this process has not been evaluated using a randomised controlled trial. This feasibility study will pilot the intervention using a RCT design to provide effect sizes. This study will pilot a breathalyser survey to measure the prevalence of alcohol intoxication in drinkers and will utilise police and accident and emergency data to measure the incidence and prevalence of violence and alcohol problems. A process evaluation will involve interviewing staff within the licensed trade both in intervention premises and senior staff in large licensed premise chains to determine barriers, fidelity of the intervention, acceptability and sustainability. Premises level interventions which reduce misuse are strategically relevant to a range of partnership activities, policy initiatives and funding streams across health and criminal justice. However, Primary Care Trusts and other agencies are required to develop plans which are evidence based. The proposed feasibility study begins to address the deficit in evidence for such interventions to inform a future definitive trial.

Publications


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Moore S (2004) Can the process of experimentation lead to greater happiness? in Behavioral and Brain Sciences
Moore S (2002) Some long-term effects of emotion on cognition in British Journal of Psychology
Moore SC (2011) Predicting and measuring premises-level harm in the night-time economy. in Alcohol and alcoholism (Oxford, Oxfordshire)
 
Description Government and Partners Alcohol Working Group
Geographic Reach National 
Policy Influence Type Participation in advisory committee
 
Description Alcohol Misuse
Amount £1,222,628 (GBP)
Funding ID ES/L015471/1 
Organisation Economic and Social Research Council (ESRC) 
Sector Public
Country United Kingdom of Great Britain & Northern Ireland (UK)
Start 01/2015 
End 12/2017
 
Description Evaluation of Health Service Provision for the Severely Intoxicated
Amount £8,500 (GBP)
Organisation Welsh Assembly 
Sector Public
Country United Kingdom of Great Britain & Northern Ireland (UK)
Start 07/2012 
End 12/2013
 
Description NIHR Public Health Research programme
Amount £815,000 (GBP)
Funding ID 10/3010/21 
Organisation University College London Hospitals Charity (UCLH) 
Department National Institute for Health Research (NIHR)
Sector Public
Country United Kingdom of Great Britain & Northern Ireland (UK)
Start 04/2012 
End 09/2014
 
Description EHO 
Organisation Chartered Institute of Environmental Health
Country United Kingdom of Great Britain & Northern Ireland (UK) 
Sector Public 
PI Contribution Collaboration with Environmental Health Officers across Wales to take forward findings from the feasibility study to a full implementation trial
Collaborator Contribution Development and delivery of a bespoke intervention to licensed premises
Impact Ongoing
Start Year 2011
 
Title LPI 
Description Intervention for licensed premises to reduce alcohol-related harm 
Type Preventative Intervention - Behavioural risk modification
Current Stage Of Development Small-scale adoption
Year Development Stage Completed 2010
Development Status Under active development/distribution
Impact Potential for adoption into policing at the local level 
 
Description GPAWG 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Simon Moore and Jon Shepherd attended the Government and Partners Alcohol Working Group and disseminated key findings to this group orally and through minuted notes

Contribution towards the upcoming Department of Health Alcohol Strategy
Year(s) Of Engagement Activity 2011
 
Description HCW Seminar 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Key Home Office and Dept Health representatives attended seminar discussing preliminary results from the Project

Initial dissemination that aims to promote further work in this area
Year(s) Of Engagement Activity 2010
 
Description NICE Expert Witness 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Expert witness to the National Institute for Health and Care Excellence for the "Drug misuse prevention: targeted interventions" guidance development
Year(s) Of Engagement Activity 2016
URL https://www.nice.org.uk/guidance/indevelopment/gid-phg90
 
Description Presentation of a conference poster entitled ELAStiC: Electronic Longitudinal Alcohol Study in Communities 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Type Of Presentation poster presentation
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This output raised awareness of this newly funded project in one relevant community.

None
Year(s) Of Engagement Activity 2015
URL http://www.farrinstitute.org/
 
Description Presentation to police 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact On going collaboration with local and national police respresentatives

Developing opportunitites to carry project forward and inform policy
Year(s) Of Engagement Activity 2009,2010
 
Description Website 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Creation of project specific website (www.vrg.cf.ac.uk/lpi.html)

Traffic to the site has been steady with over 200 unique impressions to date
Year(s) Of Engagement Activity 2008,2009