Camden and Islington Public Health team and the London School of Hygiene & Tropical Medicine (LSHTM) teamed up to evaluate a Reduce The Strength scheme in two London boroughs (Camden & Islington). In their paper (available here), published in BMC Public Health journal they asked whether and why retailers choose or refuse to self-impose restrictions on alcohol sales in this way. Compliance rates and the cheapest available unit of alcohol at each store were assessed. Qualitative interviews with retailer managers and staff explored attitudes towards the intervention and perceptions of its impacts.
The projects were designed and implemented by licensing teams in partnership with police and public health leads. Visits were Initially made to off licenses to advocate for voluntary participation on grounds of social responsibility, and a launch event helped to raise the profile. Retailers were re-visited 3 and 6 months after the scheme started, for follow up interviews. The researchers explored retailers’ views on the scheme, reasons for (not) participating in RtS, and views on how the scheme impacted on purchasing amongst the target population as well as broader impacts on the retailer and community. Due to the short time span between implementation and evaluation no efforts were made to assess the wider impact of the scheme on levels of drinking, health harms or anti-social behaviour.
Key Findings included:
Overall there was a significant reduction over the time period in availability of high strength alcohol from off-licenses. Pre-intervention 55% out of 141 retailers stocked high strength drinks, compared with 18% post-intervention.
Researchers found relatively high rates of participation by off-licences in the intervention areas
There was an increase in the price of the cheapest alcohol unit available in 17 of the 33 shops surveyed (52%). Of the shops that took part in RtS (n = 22), 85% saw an increase in the price of the cheapest available unit and the median cheapest available unit across all participating shops rose from £0.33 to £0.43.
Reasons for joining RtS centred on a desire to co-operate with the licensing authorities and wanting to “keep the council happy” by participating. Some retailers understood the positive effect that a reduction in ASB associated with street drinking could have on the community. Across the sample, different perspectives of what constituted ‘voluntary’ emerged, with some believing that the intervention was not voluntary.
Reasons for not participating in the scheme included the perception of loss of profits and unfair competition if not all retailers complied. Some believed that nothing short of an outright ban on high strength drinks would result in 100% compliance.
There was a widely held belief among interviewees that the majority of customers were now going elsewhere to buy super-strength beers and ciders.
The evaluation provides some demonstrable initial positive outcomes from the schemes, however because of the short timescales of the follow up they were unable to demonstrate any longer term outcomes such as reduced crime, anti-social behaviour, acute health harms or improved long-term health.
It remains to be seen whether retailers continue to comply with the RtS schemes after the evaluation stage and whether the reduction in availability of high strength beer and cider can be sustained. Furthermore from the local authority’s perspective, organising retailers to voluntarily participate in RtS may be considered a resource intensive way of achieving outcomes that health advocates argue would be more effectively delivered by a national Minimum Unit Price.
Guidance from the LGA on establishing RtS schemes also demonstrates the need for careful consideration and development in order to ensure legal compliance.
An evaluation of a 'wet centre' to reduce street drinking issues in Liverpool has been released by Liverpool John Moores University's Centre for Public Health.
The Rehabilitation, Education, Support & Treatment (REST) Centre ran as a pilot from June to September 2015. Delivered by local homeless providers commissioned by Liverpool's Citysafe Partnership, it has since been set up on a more permanent basis.
Hospital Emergency Departments are often at the frontline when it comes to dealing with the harmful effects of alcohol. Although we lack precise details, it is estimated that up to 35% of ED and ambulance costs may be alcohol-related.
A recent report provides further insight into the nature of drinking amongst older adults as an issue of increasing attention across the UK. Produced by the Glasgow Centre for Population Health, the research explores the complex range of factors and influences affecting drinking in later life, and how retirement and other significant changes can trigger changes in drinking patterns.
The recently amended alcohol guidelines have come under attack in a number of media reports, including a Times piece titled 'Anti-drink lobby drew up official safety limits'. The Times, followed by the Daily Mail, claimed that a number of members of the expert group behind the new guidelines were anti-drink lobbyists because they were associated with the Institute of Alcohol Studies (IAS), but The Times subsequently corrected inaccuracies in the report.
Though central to implementing policy and embedding evidence in practice, the process of ensuring that the pattern of services in an area efficiently meets local needs is itself relatively unevidenced. Such reports as we have from the UK often graphically portray the shortfalls. Is payment-by-results the answer? Not yet, it seems from early results.
Selected alcohol events and opportunities forthcoming in 2016:
'Digital' IBA symposium
An event exploring the role of 'digital' (aka online or app technologies) 'Identification & Brief Advice' takes place in London on Wednesday 15 June. The symposium aims to explore: How can digital enhance and amplify IBA approaches in local settings? In which settings and for which audiences do digital IBA approaches work best? How can digital IBA lead to increased equity and access in preventative intervention in alcohol related harm? See here for more information and registration.
Back in 2014 we looked at available online alcohol resources to help support drinking behaviour change. A number of new apps have since arrived, with more likely to follow as part of a wider growth in digital health.
However last year the largest review into the effectiveness of digital interventions found only a small impact, with shorter duration effects than may be seen from face to face brief interventions - Findings review here. Nonetheless, the potential reach and relative low cost per person suggests digital approaches may still make a useful contribution as part of the 'intervention mix'.
Research debates and politics aside, the fundamental purpose of a guideline is to help drinkers evaluate how their own drinking levels might affect their chances of alcohol-related harms. But how many 'at risk' drinkers really consider themselves as such?
Alcohol-related hospital admissions have been rising steadily over the last decade or so, but the latest LAPE release suggests the effect of falling consumption since 2004 may now be beginning to show. Interpreting the data is however a rather complex issue, not just given variations amongst age groups and regions, but owing to the number of ways the data is recorded and measured.
The industry funded alcohol education charity Drinkaware has launched a new campaign targeting middle aged men who drink at home, following previous work identifying middle aged people as the nation's 'hidden risky drinkers'.
Drinkaware say the Have a little less, feel a lot better campaign aims to help men aged 45-64 make better choices about their drinking by understanding that drinking even a little less each day can benefit their health. Targeting men in the Midlands, the North of England, Scotland and Wales, it will use advertising, video content and an online tool to 'help this audience understand how alcohol can affect the body and provide simple steps to support them to reduce their drinking'.