Dataset Information

The intervention effect of local alcohol licensing policies on hospital admission and crime: a natural experiment using a novel Bayesian synthetictime-series method.

ABSTRACT: Control of alcohol licensing at local government level is a key component of alcohol policy in England. There is, however, only weak evidence of any public health improvement. We used a novel natural experiment design to estimate the impact of new local alcohol licensing policies on hospital admissions and crime.We used Home Office licensing data (2007-2012) to identify (1) interventions: local areas where both a cumulative impact zone and increased licensing enforcement were introduced in 2011; and (2) controls: local areas with neither. Outcomes were 2009-2015 alcohol-related hospital admissions, violent and sexual crimes, and antisocial behaviour. Bayesian structural time series were used to create postintervention synthetic time series (counterfactuals) based on weighted time series in control areas. Intervention effects were calculated from differences between measured and expected trends. Validation analyses were conducted using randomly selected controls.5 intervention and 86 control areas were identified. Intervention was associated with an average reduction in alcohol-related hospital admissions of 6.3% (95% credible intervals (CI) -12.8% to 0.2%) and to lesser extent with a reduced in violent crimes, especially up to 2013 (-4.6%, 95% CI -10.7% to 1.4%). There was weak evidence of an effect on sexual crimes up 2013 (-8.4%, 95% CI -21.4% to 4.6%) and insufficient evidence of an effect on antisocial behaviour as a result of a change in reporting.Moderate reductions in alcohol-related hospital admissions and violent and sexual crimes were associated with introduction of local alcohol licensing policies. This novel methodology holds promise for use in other natural experiments in public health.

SUBMITTER: de Vocht F

PROVIDER: S-EPMC5561361 | biostudies-other | 2017 Sep

REPOSITORIES: biostudies-other

ACCESS DATA

Similar Datasets

Project description: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.

Project description:BackgroundPublic 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.Methods39 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.FindingsThere 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.InterpretationThere 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.FundingThe 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.

Project description:OBJECTIVES:To coherently examine the responsiveness of the Swedish National Tobacco Quitline (SNTQ) to different types of anti-smoking policies over an extended period of calendar time. DESIGN:Quasi-experimental design with an intervention time-series analysis based on 19 years series of data collected between January 1999 and August 2017 (224 months). Statistical inference on calling rates and rate ratios was obtained using intervention time-series models (Poisson regression and transfer functions). PARTICIPANTS:A total of 179?851 phone calls to the SNTQ. INTERVENTIONS:Recent application of the 2014/40/ European Union (EU) Tobacco Products Directive in 2016. Historical interventions such as a campaign on passive smoking in January 2001; introduction of larger text warnings on cigarette packages since September 2002; banning smoking in restaurants since June 2005; and tobacco tax increase by 10% since January 2012. OUTCOME MEASURE:Calling rates to the SNTQ expressed per 100?000 smokers. SETTING:Sweden. RESULTS:The introduction of large pictorial warnings together with text warnings on cigarette packages (May 2016) was associated with a 35% increase in SNTQ calling rate (95% CI 1.16 to 1.57). The campaign on passive smoking (Jan 2001) was associated with a 61% higher calling rate (95% CI 1.06 to 2.45). Larger text warnings on cigarette packs (Sept 2002) conferred a 28% increment in the calling rate (95% CI 1.15 to 1.42); and prohibition to smoke in restaurants (Jun 2005) was associated with a 15% increase in the calling rate (95% CI 1.01 to 1.30). The 10% tobacco tax increase (Jan 2012) was associated with a 3% higher calling rate (95% CI 0.90 to 1.19). CONCLUSIONS:Within an overall decreasing trend of daily smoking in Sweden, we found that the recent introduction of pictorial warnings together with text warnings and referral text had a discernible positive impact on the calling rates to the smoking quitline. We were also able to detect a likely impact of earlier nationwide interventions.

Dataset Information

The intervention effect of local alcohol licensing policies on hospital admission and crime: a natural experiment using a novel Bayesian synthetictime-series method.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets