Preventing Sexual Harm in Nightlife Settings: A Scoping Review.

Sexual harm within nightlife settings is a pervasive global concern; however, little is known about the nature of available interventions. The current study aims to review the literature on the nature and effectiveness of nightlife-related sexual harm interventions. A systematic literature search of six databases was conducted to identify records that were published between 1970 and June 2023 and reported approaches that aimed to reduce or prevent nightlife-related sexual harm. Records were included if they theorized, discussed, or evaluated an intervention, prevention or response strategy; however, individual safety strategies were excluded. Results were categorized according to intervention type. Thirty-five peer-reviewed journal articles and 16 gray literature records were identified. The most common nightlife-related sexual harm intervention strategies covered by the literature included targeted policies, laws, and regulations, bystander interventions, and awareness-raising campaigns. Literature in the area is increasing, with the majority of the articles (77.1%) being published in the previous six years; however, there are very few interventions that have been critically evaluated (22.9%). Promising areas for intervention include targeted alcohol regulations (e.g., lockout policies), venue-level policies, and environmental interventions. However, an increase in rigorous evaluative practices is urgently required to ensure future interventions are based on sound theoretical work and empirical evidence.

The Mentors in Violence Prevention programme: impact on students' knowledge and attitudes related to violence, prejudice, and abuse, and willingness to intervene as a bystander in secondary schools in England.

BACKGROUND: Violence is a leading cause of death and disability for young people and has serious impacts on prospects across the lifecourse. The education sector is a crucial setting for preventing youth violence through incorporating programmes that address attitudes and behaviours. The Mentors in Violence Prevention (MVP) programme aims to change harmful attitudes and norms, and increase non-violent bystander intervention, through a peer mentoring approach. To date there is limited evidence on the effectiveness of the intervention in UK school settings. The aim of the current study was to evaluate the impact of the programme on students' attitudes and knowledge related to violence prevention. METHODS: The study employed a mixed methods design. Pre and post surveys measured changes in students' (aged 11-18) attitudes and knowledge related to violence prevention and bystander behaviour, gender stereotyping, acceptability of violence, and perceptions of others' willingness to intervene. Interviews/focus groups with programme delivers and students, and anonymised programme data were used to explore and supplement survey findings. RESULTS: Overall, perceptions of the programme content and delivery were positive. Several beneficial impacts of the programme were found for mentors (students delivering the programme), including significant positive changes on measures of knowledge and attitudes towards violence prevention and the bystander approach, acceptability of violence perpetration, and perceptions of other students' willingness to intervene (effect sizes were small-medium). However, the study found no significant change on any of the outcomes amongst mentees (younger students receiving the programme from mentors). Despite this, qualitative evidence suggested mentees enjoyed the content of the programme and the peer-led delivery, and this built relationships with older students. Qualitative evidence also identified additional benefits of the programme for mentors, including leadership and communication skills, and increased confidence and supportive relationships. CONCLUSIONS: Evidence from this study suggests MVP is effective as a targeted programme for mentors, but no significant evidence was found to demonstrate its effectiveness as a universal bystander and violence prevention programme for mentees. Whilst further research with more robust study design is needed, developing mentors as leaders in violence prevention is a valuable impact of the programme in its own right.

Sexual violence in nightlife and positive bystander intervention in an English city.

BACKGROUND: Nightlife environments are high risk settings for sexual violence and bystander intervention programmes are being developed in response. However, more research is needed to understand nightlife-related sexual violence, and factors that influence bystander interventions. This study examined nightlife patron's experiences of sexual violence and associated factors; and relationships between attitudes towards, awareness and experience of sexual violence, and confidence to intervene. METHODS: Cross-sectional on-street survey of nightlife patrons (N = 307, aged 18+) on a night out in an English city. Surveys (7.30pm-1.30am; Wednesday-Saturday) established sexual violence awareness, myth acceptance, and experience, and confidence to intervene. Participant's socio-demographics, nightlife alcohol consumption, and frequency of nightlife usage were collected. RESULTS: 58.0% had ever experienced sexual violence whilst on a night out. In adjusted analyses, sexual violence was higher amongst females (adjusted odds ratio [AOR] 4.0; p < 0.001), and regular nightlife patrons (AOR 2.1; p < 0.05). The majority agreed that they would feel confident asking someone who has experienced sexual violence if they are okay/would like support (92.2%). In adjusted analyses, confidence to intervene was higher amongst those who agreed that sexual violence was an issue in nightlife (AOR 3.6; p < 0.05), however it reduced as sexual violence myth acceptance increased (AOR 0.5; p < 0.05). CONCLUSION: Sexual violence is a pertinent issue in nightlife. Programmes aiming to address nightlife-related sexual violence must address the wider social norms that promote sexual violence, and ensure patrons understand the extent and significance of the issue, to increase confidence to positively intervene.

Harms from Other People's Gambling: Associations with an Individual's Own Gambling Behaviours, Health Risk Behaviours, Financial Problems, General Health, and Mental Wellbeing.

This study aimed to explore relationships between being an 'affected other' (AO) and an individual's own gambling, health risk behaviours, financial problems, poor general health, and low mental wellbeing. A cross-sectional survey using representative and supplementary convenience samples was undertaken with 1234 residents of a British Island aged 16 + years. Being an AO was measured as having a partner or relative who has been gambling regularly in the past 12 months. PGSI was used to assess gambling severity. Health risk behaviours included: poor diet, low physical activity, daily smoking, and binge drinking. Other measures included experiencing financial problems, poor general health, and low mental wellbeing. Analyses were performed using χ2 and binary logistic regressions. 11.0% of participants were AOs. AOs were more likely to gamble at at-risk/problem-gambling levels and experience financial problems compared to those who were not affected others. The significant relationship between being an AO and low mental wellbeing was mediated by experiencing financial problems. The relationship between being an AO and engaging in two or more health risk behaviours was no longer significant after controlling for sociodemographics and an individual's own gambling. The relationship between being an AO and poor general health was no longer significant after controlling for sociodemographics, health risk behaviours and an individual's own gambling. AOs experienced risks to health and wellbeing, with findings not limited to AOs specifically with a relationship to an individual with problem-gambling. Therefore, support for AOs should be more widely available, aiming to address AOs' needs holistically.

The impact of COVID-19 and associated public health restrictions on trends in police-recorded violence in an English police force area.

BACKGROUND: The COVID-19 pandemic, and associated public health measures, had a marked impact on a number of health and wellbeing outcomes, including alcohol use and violence. Current literature presents a mixed view of the impact of the pandemic on violence trends. The current study utilises police offence data from a region of northern England to examine the impact of lockdowns, and subsequent relaxation of restrictions, on trends in violent offences. METHODS: Time series analyses using seasonal auto-regressive integrated moving average (SARIMA) modelling was used to investigate the impacts of the COVID-19 public health measures on weekly offence trends from April 1 2018 to March 20 2021. Additionally, pre-pandemic data were used to forecast expected trends had the pandemic not occurred. These expected trends were then compared to actual data to determine if the average levels of violence were outside the forecasted expectations. Overall violence and six subtypes (violence with and without injury, sexual offences including rape, domestic violence, and alcohol-related violent offences) were examined. RESULTS: Overall, the observed trend in police recorded violent offences demonstrated fluctuating patterns in line with commencement and easing of public health restrictions. That is, offence numbers declined during lockdowns and increased after relaxation of restrictions. However, the majority of observed values fell within the expected range. This broad pattern was also found for subtypes of violent offences. CONCLUSIONS: While violent crime trends demonstrated fluctuations with lockdowns, and subsequent easing of restrictions, these changes were not demonstrably larger than expected trends within this English region, suggesting that a sustained amplification in violence was not observed within this data. However, it is important to acknowledge the high levels of violence reported in this region across the study period, which should be used as a key driver for investing in long-term approaches to violence prevention. Given the extent of unreported violence generally, and that victims/survivors may come into contact with other support services (without reporting to the police), it is vital that policy and practice decisions take a holistic approach, considering a broad range of data sources.

The impact of COVID-19 and associated measures on health, police, and non-government organisation service utilisation related to violence against women and children.

BACKGROUND: Globally, concerns have been raised that the priority implementation of public health measures in response to COVID-19 may have unintended negative impacts on a variety of other health and wellbeing factors, including violence. This study examined the impact of COVID-19 response measures on changes in violence against women and children (VAWC) service utilisation across European countries. METHODS: A rapid assessment design was used to compile data including a survey distributed across WHO Europe Healthy Cities Networks and Violence Injury Prevention Focal Points in WHO European Region member states, and a scoping review of media reports, journal articles, and reports. Searches were conducted in English and Russian and covered the period between 1 January 2020 and 17 September 2020. Data extracted included: country; violence type; service sector; and change in service utilisation during COVID-19. All data pertained to the period during which COVID-19 related public health measures were implemented compared to a period before restrictions were in place. RESULTS: Overall, findings suggested that there was a median reported increase in VAWC service utilisation of approximately 20% during the COVID-19 pandemic. Crucially, however, change in service utilisation differed across sectors. After categorising each estimate as reflecting an increase or decrease in VAWC service utilisation, there was a significant association between sector and change in service utilisation; the majority of NGO estimates (95.1%) showed an increase in utilisation, compared to 58.2% of law enforcement estimates and 42.9% of health and social care estimates. CONCLUSIONS: The variation across sectors in changes in VAWC service utilisation has important implications for policymakers in the event of ongoing and future restrictions related to COVID-19, and more generally during other times of prolonged presence in the home. The increased global attention on VAWC during the pandemic should be used to drive forward the agenda on prevention, increase access to services, and implement better data collection mechanisms to ensure the momentum and increased focus on VAWC during the pandemic is not wasted.

"If You Don't Drink at University, You're Going to Struggle to Make Friends" Prospective Students' Perceptions around Alcohol Use at Universities in the United Kingdom.

BACKGROUND: New students arrive at university with pre-determined perceptions around how alcohol can be used as a tool to overcome anxieties and secure new friendships, which in turn influences students' drinking behaviors. From a health promotion perspective, the transition to university may present a unique yet understudied opportunity to challenge and reframe situated drinking norms. This paper explores prospective university students' perceptions of the role that alcohol plays at university and the influence that these perceptions have on behavior. METHOD: Focus groups with 46 prospective university students (aged 16-20 years) recruited from colleges and sixth forms in the North West of England. RESULTS: Through various sources of information, new students arrive at university with pre-conceived perceptions of a heavy student drinking culture and knowledge around how alcohol can be used to aid successful integration with new peers. Alcohol was viewed by new students as a social lubricant which is key to accruing social capital. Cultural presentations of the student drinker identity led prospective students to formulate negative connotations of those students who transgress from the norms of drinking. CONCLUSIONS: The findings provide new insights into how young people conceptualize alcohol at university and the impact that these perceptions have on shaping ideology and influencing drinking behavior. Breaking down these norms presents real challenges for those trying to address excessive drinking in universities, therefore, early intervention which challenges, re-frames and modifies perceptions before students arrive on campus may help to reduce the pressure and expectations to drink in social situations.

STOP-sexual violence: evaluation of a community-based nightlife worker awareness raising bystander training programme.

BACKGROUND: Preventing sexual violence in nightlife environments is a pervasive issue across many countries. This study explored the associated impact of a nightlife worker sexual violence awareness raising/bystander training programme (STOP-SV) on trainees' sexual violence myth acceptance and readiness and confidence to intervene. METHODS: : Pre- and post-test (n = 118), and 3-month follow-up (n = 38) trainee surveys were implemented across three countries (Czech Republic, Portugal and Spain). Paired-sample tests examined changes across time-periods in participants' myth acceptance (e.g. unwanted sexual advances are a normal part of a night out), and readiness and confidence to intervene. Multi-nominal regression was used to examine the relationship between the change in pre-to-post-training scores and trainee characteristics. RESULTS: Compared to pre-training, post-training participants were significantly (P < 0.01) less likely to agree with sexual violence myths, and more likely to be ready and confident to intervene. In bi-variate and multi-variate analyses, we found no significant associations between the change in pre-to-post-training scores and trainee characteristics. Analyses of the small follow-up sub-sample illustrated some positive changes at the post-training and follow-up time-periods (i.e. reduction in sexual violence myth acceptance). CONCLUSION: This exploratory study suggests that the STOP-SV training programme was associated with a decrease in trainees' acceptance of sexual violence myths, and an increase in their readiness and confidence to intervene. Our findings support the case for further implementation and evaluation of awareness raising/bystander programmes for nightlife workers that aim to prevent and respond to sexual violence.

Cycles of violence in England and Wales: the contribution of childhood abuse to risk of violence revictimisation in adulthood.

BACKGROUND: Interpersonal violence is a leading cause of death and disability globally, has immediate and long-term impacts on individuals' health and wellbeing, and impacts global health care expenditures and national economies. A public health approach to violence prevention is crucial, and addressing risk factors is a key priority. Global research has demonstrated that childhood adversity increases risk of a range of poor outcomes across the lifecourse. This study examined the association between being a victim of child abuse and the risk of physical assault (PA), intimate partner violence (IPV), and sexual violence (SV) victimisation in adulthood. METHODS: Data from a nationally representative survey of household residents (adults aged 16 to 59 years; n = 21,845) was analysed. Types of child abuse examined included physical, sexual, and psychological abuse and witnessing domestic violence. Logistic regressions examined the independent relationships between child abuse types, experiencing multiple types, and adulthood violence outcomes. RESULTS: Most individual types of child abuse were significantly associated with each adulthood violence outcome, after controlling for sociodemographics and other abuse types. Compared to individuals who experienced no abuse in childhood, those who experienced one form of abuse were over twice as likely to experience PA in the past year and three times as likely to have experienced IPV and/or SV since age 16 years, whilst individuals who experienced multiple types were three, six, and seven times more likely to experience PA, IPV, and SV, respectively. After controlling for sociodemographics and multi-type childhood victimisation, the type or combination of types which remained significant differed by violence outcome; child psychological and physical abuse were significantly associated with IPV; psychological and sexual abuse with SV; and psychological abuse with PA. CONCLUSIONS: Prevention of child abuse is an important goal, and evidence from the current study suggests such efforts will have a downstream effect on preventing interpersonal violence across the lifecourse. With adulthood victimisation likely to compound the already detrimental effects of childhood abuse, and given that many associated outcomes also represent adversities for the next generation, breaking the cycle of violence should be a public health priority.

Gang membership and sexual violence: associations with childhood maltreatment and psychiatric morbidity.

BACKGROUND: Gang members engage in many high-risk sexual activities that may be associated with psychiatric morbidity. Victim-focused research finds high prevalence of sexual violence towards women affiliated with gangs. AIMS: To investigate associations between childhood maltreatment and psychiatric morbidity on coercive and high-risk sexual behaviour among gang members. METHOD: Cross-sectional survey of 4665 men 18-34 years in Great Britain using random location sampling. The survey oversampled men from areas with high levels of violence and gang membership. Participants completed questionnaires covering violent and sexual behaviours, experiences of childhood disadvantage and trauma, and psychiatric diagnoses using standardised instruments. RESULTS: Antisocial men and gang members had high levels of sexual violence and multiple risk behaviours for sexually transmitted infections, childhood maltreatment and mental disorders, including addictions. Physical, sexual and emotional trauma were strongly associated with adult sexual behaviour and more prevalent among gang members. Other violent behaviour, psychiatric morbidity and addictions accounted for high-risk and compulsive sexual behaviours among gang members but not antisocial men. Gang members showed precursors before age 15 years of adult preference for coercive rather than consenting sexual behaviour. CONCLUSIONS: Gang members show inordinately high levels of childhood trauma and disadvantage, sexual and non-sexual violence, and psychiatric disorders, which are interrelated. The public health problem of sexual victimisation of affiliated women is explained by these findings. Healthcare professionals may have difficulties promoting desistance from adverse health-related behaviours among gang members whose multiple high-risk and violent sexual behaviours are associated with psychiatric morbidity, particularly addictions.

Gambling with Your Health: Associations Between Gambling Problem Severity and Health Risk Behaviours, Health and Wellbeing.

The current study examined the association between gambling problem severity and health risk behaviours, health and wellbeing. A cross-sectional survey (including representative population and supplementary convenience samples) was conducted with 2303 adult residents of a British Island. Gambling problem severity was assessed using the Problem Gambling Severity Index. The EQ-5D-5L, WEMWBS and AUDIT-C were used to measure general health, mental wellbeing and alcohol use, respectively. Other measures included diet, physical exercise and tobacco use. Differences between gambling severity levels for each measure were analysed using logistic regression adjusting for age, sex and income. Compared to non-problem gamblers, moderate/high severity gamblers had higher odds of a poor diet, low physical exercise and poor general health. Tobacco use was associated with both low and moderate/high severity gambling. Low severity, but not moderate/high severity gambling, was significantly associated with binge and higher risk drinking behaviours. Health risk behaviours tended to cluster, with a graded relationship between gambling problem severity and odds of reporting at least two health risk behaviours. Compared to non-problem gamblers, low severity gamblers were approximately twice as likely and moderate/high severity gamblers were three times as likely, to have low mental wellbeing. Findings suggest associations between gambling problems and a range of health risk behaviours and health issues, and crucially that such issues are not limited to gamblers with the highest severity of problems. Addressing gambling across the whole continuum of risk should be a key public health priority.

Ideal, expected and perceived descriptive norm drunkenness in UK nightlife environments: a cross-sectional study.

BACKGROUND: Drunkenness is common in nightlife environments and studies suggest it can be considered both desirable and normal by nightlife users. We aimed to compare UK nightlife users' ideal levels of drunkenness to their expected drunkenness on a night out and their perceptions of descriptive nightlife norms. METHODS: A cross-sectional survey with nightlife patrons (n = 408, aged 18-35) in three cities. Using a scale from 1 (completely sober) to 10 (very drunk), participants rated: personal drunkenness at survey; expected drunkenness on leaving nightlife; perceived descriptive drunkenness norm in the city's nightlife; and ideal personal drunkenness. Analyses were limited to those who had or were intending to consume alcohol. RESULTS: Almost half of participants (46.8%) expected to get drunker than their reported ideal level on the night of survey, rising to four fifths of those with the highest levels of expected drunkenness. 77.9% rated typical nightlife drunkenness ≥8 but only 40.9% expected to reach this level themselves and only 23.1% reported their ideal drunkenness as ≥8. Higher expected drunkenness was associated with higher ideal drunkenness, higher perceived drunkenness norm and later expected home time. CONCLUSIONS: Nightlife users' perceptions of typical drunkenness in nightlife settings may be elevated and many of the heaviest drinkers are likely to drink beyond their ideal level of drunkenness. Findings can support emerging work to address cultures of intoxication in nightlife environments and suggest that interventions to correct misperceptions of normal levels of nightlife drunkenness may be of benefit.

New WHO Violence Prevention Information System, an interactive knowledge platform of scientific findings on violence.

Scientific information on violence can be difficult to compile and understand. It is scattered across websites, databases, technical reports and academic journals, and rarely addresses all types of violence. In response, in October 2017 WHO released the Violence Prevention Information System or Violence Info, an online interactive collection of scientific information about the prevalence, consequences, risk factors and preventability of all forms of interpersonal violence. It covers homicide, child maltreatment, youth violence, intimate partner violence, elder abuse and sexual violence.

Does continuous trusted adult support in childhood impart life-course resilience against adverse childhood experiences - a retrospective study on adult health-harming behaviours and mental well-being.

BACKGROUND: Adverse childhood experiences (ACEs) including child abuse and household problems (e.g. domestic violence) increase risks of poor health and mental well-being in adulthood. Factors such as having access to a trusted adult as a child may impart resilience against developing such negative outcomes. How much childhood adversity is mitigated by such resilience is poorly quantified. Here we test if access to a trusted adult in childhood is associated with reduced impacts of ACEs on adoption of health-harming behaviours and lower mental well-being in adults. METHODS: Cross-sectional, face-to-face household surveys (aged 18-69 years, February-September 2015) examining ACEs suffered, always available adult (AAA) support from someone you trust in childhood and current diet, smoking, alcohol consumption and mental well-being were undertaken in four UK regions. Sampling used stratified random probability methods (n = 7,047). Analyses used chi squared, binary and multinomial logistic regression. RESULTS: Adult prevalence of poor diet, daily smoking and heavier alcohol consumption increased with ACE count and decreased with AAA support in childhood. Prevalence of having any two such behaviours increased from 1.8% (0 ACEs, AAA support, most affluent quintile of residence) to 21.5% (≥4 ACEs, lacking AAA support, most deprived quintile). However, the increase was reduced to 7.1% with AAA support (≥4 ACEs, most deprived quintile). Lower mental well-being was 3.27 (95% CIs, 2.16-4.96) times more likely with ≥4 ACEs and AAA support from someone you trust in childhood (vs. 0 ACE, with AAA support) increasing to 8.32 (95% CIs, 6.53-10.61) times more likely with ≥4 ACEs but without AAA support in childhood. Multiple health-harming behaviours combined with lower mental well-being rose dramatically with ACE count and lack of AAA support in childhood (adjusted odds ratio 32.01, 95% CIs 18.31-55.98, ≥4 ACEs, without AAA support vs. 0 ACEs, with AAA support). CONCLUSIONS: Adverse childhood experiences negatively impact mental and physical health across the life-course. Such impacts may be substantively mitigated by always having support from an adult you trust in childhood. Developing resilience in children as well as reducing childhood adversity are critical if low mental well-being, health-harming behaviours and their combined contribution to non-communicable disease are to be reduced.

Violence-related ambulance call-outs in the North West of England: a cross-sectional analysis of nature, extent and relationships to temporal, celebratory and sporting events.

OBJECTIVE: The aim of this study was to explore the potential of ambulance call-out data in understanding violence to inform about prevention activity. METHOD: This cross-sectional (2013-2015) study examined the nature, extent and characteristics of violence-related ambulance call-outs (n=15 687) across North West England and relationships with temporal, celebratory and sporting events. RESULTS: The majority of call-outs were for men, with a mean age of 33 years. Most call-outs were to deprived (64.4%) and urban (65.4%) areas and occurred at night (18:00-5:59; 75.2%). Three-quarters (77.3%) were recorded as assault/sexual assault and 22.7% stab/gunshot/penetrating trauma. Significant differences in call-out characteristics were identified between the two violence types. Generalised linear modelling found that call-outs significantly increased on weekends, New Year's Eve and weekday bank holiday eves (except for stab/gunshot/penetrating trauma). No significant associations between all violence call-outs, the two violence categories and sporting or celebration events were identified. Two-thirds (66.1%) of the call-outs were transferred to another health service for further assessment and/or treatment. The odds of being transferred were significantly higher among men (adjusted OR (AOR) 1.5, 95%CI 1.4 to 1.6), those aged 13-24 years (AOR 1.2, 95%CI 1.0 to 1.4), call-outs for stab/gunshot/penetrating trauma (AOR 1.4, 95%CI 1.3 to 1.5) and call-outs on Fridays/Saturdays (AOR 1.1, 95%CI 1.0 to 1.2) and lower for call-outs on New Year's Eve (AOR 0.6, 95%CI 0.4 to 0.9). CONCLUSION: Ambulance call-out data can provide a wealth of information to understand violence and subsequently inform about violence prevention and response activity. Ambulance services and staff could play a key role in preventing violence through sharing data and identifying and supporting victims.

Relationships between adverse childhood experiences and adult mental well-being: results from an English national household survey.

BACKGROUND: Individuals' childhood experiences can strongly influence their future health and well-being. Adverse childhood experiences (ACEs) such as abuse and dysfunctional home environments show strong cumulative relationships with physical and mental illness yet less is known about their effects on mental well-being in the general population. METHODS: A nationally representative household survey of English adults (n = 3,885) measuring current mental well-being (Short Edinburgh-Warwick Mental Well-being Scale SWEMWBS) and life satisfaction and retrospective exposure to nine ACEs. RESULTS: Almost half of participants (46.4 %) had suffered at least one ACE and 8.3 % had suffered four or more. Adjusted odds ratios (AORs) for low life satisfaction and low mental well-being increased with the number of ACEs. AORs for low ratings of all individual SWEMWBS components also increased with ACE count, particularly never or rarely feeling close to others. Of individual ACEs, growing up in a household affected by mental illness and suffering sexual abuse had the most relationships with markers of mental well-being. CONCLUSIONS: Childhood adversity has a strong cumulative relationship with adult mental well-being. Comprehensive mental health strategies should incorporate interventions to prevent ACEs and moderate their impacts from the very earliest stages of life.

Drivers to implementing a whole-system approach to enquiring about adverse childhood experiences: A mixed methods evaluation from a single county in England.

BACKGROUND: Adverse childhood experiences (ACEs) can have substantial impacts on individuals' health and social prospects across the life course. Retrospectively enquiring with adults about their experience of ACEs to inform support provision is an emerging intervention across services/countries, however little is known about the processes of implementation. OBJECTIVES: The study aimed to examine the drivers to successful implementation of ACE enquiry. PARTICIPANTS AND SETTINGS: Nine services in a UK county participated in a test-and-learn project implementing ACE enquiry (i.e. the REACh™ programme). METHODS: Interviews with programme stakeholders (n = 37) and a follow-up survey exploring experiences of implementation (n = 72). Interviews were thematically analysed, with themes mapped against an implementation framework and triangulated with survey data. RESULTS: Analyses identify key implementation drivers across three domains: competency; organisational; and leadership. Findings suggest that implementing ACE enquiry requires ongoing and flexible training and supervision to increase staff knowledge and confidence. Supportive leadership is needed across all service levels to respond to routine and unforeseen barriers to implementation. Further, a flexible approach to implementation is needed which attunes to service and practitioner needs and adapts implementation to ensure a trauma-informed and person-centred approach to ACE enquiry. CONCLUSIONS: Study findings may assist programme implementers in the development of system-wide approaches to ACE enquiry. However, further data on implementation of ACE enquiry models is needed to increase evidence on implementing and maintaining such programmes in real-world public health settings. Critically, further research is needed to understand the impacts of such programmes when successfully implemented.

Working with the police service and homeless services in North West England to reduce alcohol harms: A feasibility study of a tailored Blue Light approach.

INTRODUCTION: Deaths caused by alcohol are increasing in England and 80 % of people with alcohol use disorders (AUDs) are not in treatment. The Blue Light approach (Alcohol Change UK) is an initiative to support people with AUDs who are not in treatment. This study aimed to tailor the Blue Light approach (combined with alcohol identification and alcohol brief interventions [ABI] training) for police officers and homeless service staff in North West England, and to qualitatively evaluate the feasibility and acceptability of the training. METHODS: The Blue Light approach was tailored using co-production activities, based on Transdisciplinary Action Research. Full-day and half-day training sessions were delivered to the police (full-day N = 14, half-day N = 54) and homeless service staff (full-day N = 11, half-day N = 32), in local police stations and online (four half-day sessions). Semi-structured interviews (N = 23) were conducted to evaluate implementation and integration, analysing the qualitative data in line with Normalisation Process Theory. RESULTS: Four themes were identified, each with two to three sub-themes, reflecting: (i) the importance of training for working practice, (ii) implementation of the interventions, (iii) changes to relationships within and between organizations, and (iv) recommendations for further changes to the training. Differences in findings across the organizations (police versus homeless services) and by training type attended (full-day versus half-day, in-person versus online) are presented. CONCLUSIONS: There is evidence to suggest that the training has provided worthwhile knowledge and intervention techniques that can become embedded into working practices. Nevertheless, structural barriers were apparent, primarily within the police service, with clear disparities between recognising the value of the training and what is achievable in practice, given the competing demands.

Reducing alcohol harms whilst minimising impact on hospitality businesses: 'Sweetspot' policy options.

BACKGROUND: During COVID-19, hospitality businesses (e.g. bars, restaurants) were closed/restricted whilst off-sales of alcohol increased, with health consequences. Post-covid, governments face lobbying to support such businesses, but many health services remain under pressure. We appraised 'sweetspot' policy options: those with potential to benefit public services and health, whilst avoiding or minimising negative impact on the hospitality sector. METHODS: We conducted rapid non-systematic evidence reviews using index papers, citation searches and team knowledge to summarise the literature relating to four possible 'sweetspot' policy areas: pricing interventions (9 systematic reviews (SR); 14 papers/reports); regulation of online sales (1 SR; 1 paper); place-shaping (2 SRs; 18 papers/reports); and violence reduction initiatives (9 SRs; 24 papers/reports); and led two expert workshops (n = 11). RESULTS: Interventions that raise the price of cheaper shop-bought alcohol appear promising as 'sweetspot' policies; any impact on hospitality is likely small and potentially positive. Restrictions on online sales such as speed or timing of delivery may reduce harm and diversion of consumption from on-trade to home settings. Place-shaping is not well-supported by evidence and experts were sceptical. Reduced late-night trading hours likely reduce violence; evidence of impact on hospitality is scant. Other violence reduction initiatives may modestly reduce harms whilst supporting hospitality, but require resources to deliver multiple measures simultaneously in partnership. CONCLUSIONS: Available evidence and expert views point to regulation of pricing and online sales as having greatest potential as 'sweetspot' alcohol policies, reducing alcohol harm whilst minimising negative impact on hospitality businesses.

Effects of the 2010 World Cup football tournament on emergency department assault attendances in England.

We explore the impact of the 2010 World Cup, held in South Africa, on levels of assault attendances to 15 emergency departments in England. The majority (70.1%) of assault attendees during the 2010 World Cup was male and aged 18-34 years (52.5%). Assault attendances increased by 37.5% on the days that England played (P 001). Preparation for major sporting events in non-host countries should include violence prevention activity. Emergency department data can be used to identify violence associated with such events and thus inform both the targeting of prevention efforts and assessments of their effectiveness.