A systematic review of interventions that impact alcohol and other drug-related harms in licensed entertainment settings and outdoor music festivals.

BACKGROUND: Harms associated with the use of alcohol and other drugs (AOD) in licensed entertainment settings (LES) and outdoor music festivals (OMF) are ongoing public health and criminal justice concerns. This systematic review provides a comprehensive, synthesized report on the evidence base of interventions that impact harm in these settings, and how they affect health, behavioral, and criminal justice outcomes. METHODS: Nine databases were searched for experimental and observational studies published between 2010 and 2021. Studies were included if they were peer-reviewed, published in English, described interventions which could impact AOD-related harms in LES or OMF (and were delivered in these environments), and reported on health, criminal justice and/or behavioral outcomes. Methodological quality was assessed using the Effective Public Health Practice Project's Quality Assessment Tool for Quantitative Studies and the Critical Appraisal Skills Program for qualitative studies. A narrative synthesis was conducted to synthesize outcomes across studies. The review protocol was registered in PROSPERO (CRD42020140004). RESULTS: Of the 48,303 studies screened, 100 met the inclusion criteria. 86 focused solely on reducing alcohol-related harm, 7 on reducing illicit drug-related harm, and 7 on both. Most (n = 88) focused on LES and evaluated changes in laws and regulations (n = 28) and/or multicomponent interventions/policies (n = 41). Multicomponent interventions showed the best results for both health (62% positive) and criminal justice (84% positive) outcomes, with 71% of studies being rated as strong quality. There was also good evidence to support the careful application of trading hour restrictions and limited but promising evidence to support medical services and drug checking. CONCLUSION: The breadth, quality and volume of evidence regarding what works in reducing AOD-related harm in recreational settings have increased in the past decade, particularly regarding LES. Findings support onsite medical services (reducing ambulance transfer rates), multicomponent interventions targeting alcohol accessibility and availability (reducing assaults), and drug checking services, but suggest other interventions such as drug detection dogs may exacerbate harm. Further, higher quality research is required to address identified gaps in the evidence base, particularly on optimal interventions within OMF, around illicit drugs more broadly and in the Global South.

"It's like a safety net for when things go wrong": key stakeholder and program user perspectives on a peer-led safe space program in Sydney, Australia.

BACKGROUND: Safe Spaces are a harm reduction approach commonly utilised in nightlife and festival settings to address alcohol and other drug-related harms. Despite increasing use, there has been little independent evaluation of safe space programs. This study aimed to explore (1) program user satisfaction with and use of a safe space program implemented in Sydney, Australia (The Take Kare Safe Space (TKSS)), and (2) the strengths and weaknesses of TKSS from the perspective of key stakeholders. METHODS: Semi-structured, in-depth, interviews lasting between 30 min to 1 h were conducted with 38 key program stakeholders, including staff from police (n = 4), ambulance (n = 4), a local hospital accident and emergency room (n = 4), local council (n = 2), city 'rangers' (n = 2), the TKSS program (n = 4), licensed venues and other nightlife service providers (n = 4), and program users (n = 14). Purposive sampling was used to identify key stakeholders to participate in interviews. RESULTS: Stakeholders stated that the TKSS program had a number of core benefits, including that it filled a service gap in nightlife settings; improved the efficiency and effectiveness of emergency services and other stakeholders operating in nightlife precincts; provided welfare services through proactive and non-judgmental interventions; and facilitated a means to de-escalate conflict without engaging police. Perceived weaknesses of the program included a lack of public awareness about the program; staff and volunteer levels; and misunderstandings regarding the scope and function of the TKSS program by some stakeholders. CONCLUSION: This study demonstrates the complex relationships that exist around the delivery of harm reduction in nightlife settings. In particular, it highlights the relative lack of servicing of public nightlife settings and the value of safe spaces/peer-to-peer safety ambassador programs in linking up care and filling this service gap. Further, it documents the extended benefit across key stakeholder groups of delivering proactive and non-judgemental harm reduction services and, in doing so, provides critical evidence around their efficacy in reducing AOD-related harms in the night-time economy.

Gendered Responses to Gendered Harms: Sexual Violence and Bystander Intervention at Australian Music Festivals.

Bystander intervention has shown promise in preventing sexual violence in certain social contexts. Despite emerging evidence of pervasive sexual violence at music festivals, no research has considered bystander intervention in this setting. Drawing on an online survey conducted with 371 Australian festival attendees, we explore the role of gender on bystander intervention at music festivals. Findings point to significant gender differences, with women more willing and likely to intervene in a broader range of scenarios. We argue that responses to sexual violence are a collective responsibility shared by both women and men, as well as festival organizers and industry bodies.

Impact and Return on Investment of the Take Kare Safe Space Program-A Harm Reduction Strategy Implemented in Sydney, Australia.

Safe spaces are increasingly utilized to reduce alcohol-related harm, violence, crime and improve public safety in nightlife settings. This study aimed to determine the impact and return on investment of the Take Kare Safe Space (TKSS) program-a harm reduction program implemented to address alcohol-related violence and disorder in three locations in Sydney's night-time economy between 2014 and 2019. TKSS ambassadors provided support at static safe spaces and patrolled designated nightlife precincts to provide practical assistance to vulnerable and intoxicated people. Ambassadors recorded information relating to these interactions including 'client' age, gender, perceived level of intoxication, time and length of engagement with the program. Costs of program implementation and benefits of major incidents averted were obtained to allow calculation of return on investment. From December 2014 to April 2019, 66,455 people were supported by TKSS ambassadors. Most users were male (62%) and aged 18-25 years (66%). Of 3633 interventions by ambassadors, serious risk of harm was averted in 735 cases (20%). The program's return on investment is estimated at 2.67, suggesting that a $1 investment results in $2.67 in benefits. Safe Spaces are extensively utilized, particularly by young males with high levels of intoxication, and represent a positive return on investment. Despite the growth of such services, there remains a notable absence of rigorous, independent evaluation regarding the outcomes and/or social benefit of safe space programs. From a policy perspective, there is a need for more high-quality economic evaluations to better inform decisions about competing uses of limited resources.

What do we know about alcohol mixed with energy drink (AmED) use in Australia? Expanding local evidence.

OBJECTIVES: Despite continued health concerns associated with the practice of consuming alcohol mixed with energy drinks (AmED), few Australian studies have examined the popularity of this combination or attempted to characterise AmED consumers. The purpose of this paper is to replicate two previously used survey approaches to consolidate a national picture of AmED consumption in Australia. METHODS: The survey approaches used were: an online survey with a convenience sample of New South Wales (NSW), Australia, residents (n = 1931; 63.7% female; median age 23.0 years); and street intercept surveys in regional and metropolitan entertainment precincts in NSW (n = 1265; 58.2% male; median age 21.0 years). Analyses explored the rates and frequency of AmED use across both samples, and the sociodemographic and substance use predictors of AmED consumption in the past 12 months. RESULTS: More than 90% of participants in both samples reported alcohol consumption in the past 12 months, with approximately 40% of current drinkers also reporting AmED use in the past 12 months. Three-quarters of participants interviewed in entertainment precincts reported alcohol consumption in the previous 12 hours, with one in six of these also reporting AmED consumption in the past 12 hours. AmED users across both samples were more likely than alcohol-only consumers to be younger and male, and to report riskier substance use practices. CONCLUSIONS: Health promotion activities are warranted to promote awareness of energy drink guidelines, and the potential harms of exceeding these guidelines, among alcohol consumers. In addition, health workers should consider enquiring about AmED use as an indicator of risk related to substance use.

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.