Effectiveness of community-based interventions for reducing alcohol-related harm in two metropolitan and two regional sites in Victoria, Australia.

INTRODUCTION AND AIMS: The relationship between alcohol intoxication and harm is well known, and many community-based interventions have been introduced in an attempt to reduce the rates of alcohol-related harm. The current paper uses two metropolitan and two regional Australian cities as sites to investigate the impact of community-based interventions on the reduction of alcohol-related harms. DESIGN AND METHODS: Data for injury-related emergency department (ED) presentations and police attended assaults during high-alcohol hours (i.e. 20:00-06:00 h, Friday and Saturday nights) were obtained for each site from 2000 to 2015 for ED presentations and from 2000 to 2016 for police assaults. Autoregressive integrated moving average time series analyses were conducted to determine the impact of the community-based interventions introduced at each site for reducing these rates of ED injury presentations and police attended assaults. RESULTS: None of the community-level interventions that were introduced across the four sites resulted in a reduction in ED presentation rates or assault rates. DISCUSSION AND CONCLUSIONS: The majority of interventions introduced across the four sites were proposed and implemented by local liquor accords. Given none of the interventions demonstrated a reduction in ED injury presentation rates or police attended assault rates, it is argued that local liquor accords may not be best placed to propose alcohol-related harm reduction measures, and instead, there should be a focus on the implementation of evidence-based regulatory strategies, such as restricted trading hours. [Curtis A, Coomber K, Droste N, Hyder S, Palmer D, Miller PG. Effectiveness of community-based interventions for reducing alcohol-related harm in two metropolitan and two regional sites in Victoria, Australia. Drug Alcohol Rev 2017;36:359-368].

Patron Banning in the Nightlife Entertainment Districts: A Key Informant Perspective.

OBJECTIVE: Alcohol-related harm in and around licensed venues is associated with substantial costs. Many interventions have been introduced in an effort to combat these harms, and one such intervention is known as patron banning. Patron banning involves prohibiting patrons who have been violent or disorderly in a licensed venue in an attempt to reduce alcohol-related harm. It can be implemented by the venue, by members of police, or by liquor accords. This study aimed to obtain key informant perspectives on the benefits of patron banning as well as on the effectiveness of patron banning in reducing alcohol-related harm. METHOD: Thirty-six key informants provided perspectives on patron banning through in-depth interviews that were part of a larger study. RESULTS: Key informants were supportive of patron banning for reducing alcohol-related harm, noting that it had many benefits including increased venue safety, general risk management, and deterrence of antisocial behavior. Although processes for banning were not always consistent, identification scanners were generally recognized as a way to ensure that patron banning was enforced. CONCLUSIONS: Key informants viewed patron banning as an effective measure for increasing patron safety and reducing alcohol-related harms.

'The ones that turn up are the ones that are responsible': Key stakeholders perspectives on liquor accords.

INTRODUCTION AND AIMS: Liquor accords were introduced as an intervention to reduce alcohol-related harm in and around licensed venues. There have been very few evaluations of the accords, made all the more difficult given the multitude of measures that are often implemented under their banner. This study provides perspectives on the effectiveness of the liquor accords from key stakeholders who were involved in the strategy. DESIGN AND METHODS: In-depth interviews were conducted with 97 key stakeholders as part of a larger study, of which 46 spoke about the effectiveness of liquor accords. Responses were analysed using thematic analysis. RESULTS: Stakeholders reported the greatest benefit of liquor accords to be their ability to improve communication. Many stakeholders recognised the need for mandatory attendance and discussed whether the accords are a waste of time of resources. Stakeholders did not generally view liquor accords as effective means of reducing alcohol-related harm. DISCUSSION: There was a lack of positive feedback about liquor accords provided by stakeholders, indicating a clear need to better understand the role of liquor accords, and what they aim to achieve. Responsive regulation theory suggests that the dual roles of communication and intervention are confused, leading to some of the inherent problems with accords. CONCLUSIONS: The role and aims of liquor accords need to be clearly defined. The findings suggest that separating the communication and regulatory functions from accords will lead to a clearer role for accords, and interventions and regulation might be better placed in the hands of regulators and enforcement. [Curtis A, Miller P, Droste N, McFarlane E, Martino F, Palmer D. 'The ones that turn up are the ones that are responsible': Key stakeholders perspectives on liquor accords. Drug Alcohol Rev 2016;35:273-279].

Correlates and motives of pre-drinking with intoxication and harm around licensed venues in two cities.

INTRODUCTION AND AIMS: The study investigates the prevalence of pre-drinking culture in the night-time economy (NTE) and its impact upon intoxication and alcohol-related harm and violence experienced by patrons. DESIGN AND METHODS: Cross-sectional surveys were conducted in and around licensed venues in Newcastle (NSW) and Geelong (Victoria) during peak trading hours (typically 9pm-1am). Participants completed a five minute structured interview which targeted: demographics, past and planned movements on the survey night, safety/experience of harm, and patron intoxication. 3949 people agreed to be interviewed, a response rate of 90.7%. Around half (54.9%) of interviewees were male and mean age was 24.4 years (SD = 5.8). RESULTS: 66.8% of participants reported pre-drinking prior to attending licensed venues. On a 1-10 scale measuring self-rated intoxication, pre-drinkers scored significantly higher compared to non pre-drinkers (P < 0.001). Compared to non-pre-drinkers, patrons who had consumed 6-10 standard pre-drinks were 1.5 times more likely to be involved in a violent incident in the past 12 months (OR = 1.50, 95%CI 1.03-2.19, P = 0.037) increasing to 1.8 times more likely for patrons who had 11-15 drinks (OR = 1.80, 95%CI 1.04-3.11 P = .036). Pre-drinking was also associated with both self-rated and observer-rated intoxication, as well as increased probability of illicit drug use. Amongst pre-drinkers, price was the most commonly reported motive for pre-drinking (51.8%). DISCUSSION AND CONCLUSIONS: 'Pre-drinking' was normal behaviour in the current sample and contributes significantly to the burden of harm and intoxication in the NTE. Price disparity between packaged vs. venue liquor is a key motivator for pre-drinking.

Alcohol-related crime in city entertainment precincts: Public perception and experience of alcohol-related crime and support for strategies to reduce such crime.

INTRODUCTION AND AIMS: Bars, pubs and taverns in cities are often concentrated in entertainment precincts that are associated with higher rates of alcohol-related crime. This study assessed public perception and experiences of such crime in two city entertainment precincts, and support for alcohol-related crime reduction strategies. DESIGN AND METHODS: A cross-sectional household telephone survey in two Australian regions assessed: perception and experiences of crime; support for crime reduction strategies; and differences in such perceptions and support. RESULTS: Six hundred ninety-four people completed the survey (32%). Most agreed that alcohol was a problem in their entertainment precinct (90%) with violence the most common alcohol-related problem reported (97%). Almost all crime reduction strategies were supported by more than 50% of participants, including visitors to the entertainment precincts, with the latter being slightly less likely to support earlier closing and restrictions on premises density. Participants in one region were more likely to support earlier closing and lock-out times. Those at-risk of acute alcohol harm were less likely to support more restrictive policies. DISCUSSION AND CONCLUSIONS: High levels of community concern and support for alcohol harm-reduction strategies, including restrictive strategies, provide policy makers with a basis for implementing evidence-based strategies to reduce such harms in city entertainment precincts. [Tindall J, Groombridge D, Wiggers J, Gillham K, Palmer D, Clinton-McHarg T, Lecathelinais C, Miller P. Alcohol-related crime in city entertainment precincts: Public perception and experience of alcohol-related crime and support for strategies to reduce such crime. Drug Alcohol Rev 2016;35:263-272].

A comparative study of blood alcohol concentrations in Australian night-time entertainment districts.

INTRODUCTION AND AIMS: There is little research describing how intoxication levels change throughout the night in entertainment districts. This research aims to describe levels of alcohol intoxication across multiple Australian metropolitan and regional nightlife districts. DESIGN AND METHODS: This study was conducted in the night-time entertainment districts of three metropolitan cities (Sydney, Melbourne and Perth) and two regional cities (Wollongong and Geelong) in Australia. Data collection occurred approximately fortnightly in each city on a Friday or Saturday night between 8 pm and 5 am. Brief structured interviews (3-10 min) and breathalyser tests were undertaken in busy thoroughfares over six months. RESULTS: Of the 7037 individuals approached to participate in the study, 6998 [61.8% male, mean age 24.89 years (standard deviation 6.37; range 18-73)] agreed to be interviewed. There was a linear increase in blood alcohol concentration (BAC) levels throughout the night. Post hoc testing revealed significantly more highly intoxicated participants (i.e. BAC above 0.10 mg of alcohol per 100 mL of blood) after midnight (P < 0.05). The overall mean BAC was 0.06 mg/100 mL. Men were more intoxicated than women earlier in the night, but gender differences disappeared by 3 am. There was no age differences in intoxication earlier in the night, but after midnight, patrons over the age of 21 showed increasing BAC levels. DISCUSSION AND CONCLUSIONS: There is a consistent trend across the cities of high to very high levels of intoxication later in the night, with trends after midnight being significantly different to those before.

Changes in injury-related hospital emergency department presentations associated with the imposition of regulatory versus voluntary licensing conditions on licensed venues in two cities.

INTRODUCTION AND AIMS: Regulatory and collaborative intervention strategies have been developed to reduce the harms associated with alcohol consumption on licensed venues around the world, but there remains little research evidence regarding their comparative effectiveness. This paper describes concurrent changes in the number of night-time injury-related hospital emergency department presentations in two cities that implemented either a collaborative voluntary approach to reducing harms associated with licensed premises (Geelong) or a regulatory approach (Newcastle). DESIGN AND METHODS: This paper reports findings from Dealing with Alcohol-Related problems in the Night-Time Economy project. Data were drawn from injury-specific International Classification of Disease, 10th Revision codes for injuries (S and T codes) presenting during high-alcohol risk times (midnight--5.59 am, Saturday and Sunday mornings) at the emergency departments in Geelong Hospital and Newcastle (John Hunter Hospital and the Calvary Mater Hospital), before and after the introduction of licensing conditions between the years of 2005 and 2011. Time-series, seasonal autoregressive integrated moving average analyses were conducted on the data obtained from patients' medical records. RESULTS: Significant reductions in injury-related presentations during high-alcohol risk times were found for Newcastle since the imposition of regulatory licensing conditions (344 attendances per year, P < 0.001). None of the interventions deployed in Geelong (e.g. identification scanners, police operations, radio networks or closed-circuit television) were associated with reductions in emergency department presentations. DISCUSSION AND CONCLUSIONS: The data suggest that mandatory interventions based on trading hours restrictions were associated with reduced emergency department injury presentations in high-alcohol hours than voluntary interventions.

Do community interventions targeting licensed venues reduce alcohol-related emergency department presentations?

INTRODUCTION AND AIMS: Excessive alcohol consumption is related to substantial health and social order costs. Many of the harms have been identified as coming from licensed venues. Most communities struggle to find interventions that are effective, particularly in an environment of little federal government action. Furthermore, most interventions are based on little or no empirical evidence. This study aims to investigate the effect of a suite of interventions on emergency department (ED) attendances in Geelong, Australia. DESIGN AND METHODS: This paper reports stage one findings from the Dealing with Alcohol-Related Problems in the Night-time Economy project (DANTE) and specifically examines all alcohol-related injury frequencies before to after intervention in the City of Greater Geelong of Victoria, Australia, from 2005 to 2009. Auto-regressive integrated moving average time-series were used to determine the effect of the interventions on ED attendances in Geelong. RESULTS: There were 3934 triage presentations involving alcohol. Over two-thirds (68.9%) of triage presentations were male and over half (58.5%) of alcohol-related attendances occurred on the weekend. The time-series analyses indicated that ID scanners (z = 2.66, P < 0.001) and the Just Think awareness campaign (z = 4.21, P < 0.001) were significant predictors of increases in alcohol-related injury presentation rates to the ED. DISCUSSION AND CONCLUSIONS: Overall, the community interventions implemented have not been associated with reduced alcohol-related attendances at the ED. The findings raise questions about whether targeting the night-time economy is effective and whether interventions should instead be targeted at reducing whole-of-community alcohol consumption.

Dealing with Alcohol-related problems in the Night-Time Economy: A Study Protocol for Mapping trends in harm and stakeholder views surrounding local community level interventions.

BACKGROUND: This project will provide a comprehensive investigation into the prevalence of alcohol-related harms and community attitudes in the context of community-based interventions being implemented to reduce harm in two regional centres of Australia. While considerable experimentation and innovation to address these harms has occurred in both Geelong and Newcastle, only limited ad-hoc documentation and analysis has been conducted on changes in the prevalence of harm as a consequence, leaving a considerable gap in terms of a systematic, evidence-based analysis of changes in harm over time and the need for further intervention. Similarly, little evidence has been reported regarding the views of key stakeholder groups, industry, government agencies, patrons or community regarding the need for, and the acceptability of, interventions to reduce harms. This project will aim to provide evidence regarding the impact and acceptability of local initiatives aimed at reducing alcohol-related harms. METHODS/DESIGN: This study will gather existing police data (assault, property damage and drink driving offences), Emergency Department presentations and Ambulance attendance data. Further, the research team will conduct interviews with licensed venue patrons and collect observational data of licensed venues. Key informant interviews will assess expert knowledge from key industry and government stakeholders, and a community survey will assess community experiences and attitudes towards alcohol-related harm and harm-reduction strategies. Overall, the project will assess: the extent of alcohol-related harm in the context of harm-reduction interventions, and the need for and acceptability of further intervention. DISCUSSION: These findings will be used to improve evidence-based practice both nationally and internationally. ETHICAL APPROVAL: This project has been approved by Deakin University HREC.