A feasibility study of a licensed premise intervention to reduce alcohol misuse and violent injury

A feasibility study of a licensed premise intervention to reduce alcohol misuse and violent injury
We aim to better understand how interventions designed to curb alcohol misuse and violence in licensed premises can be implemented, how to measure the effects of interventions and what, if any, barriers there are to implementation.
Alcohol misuse damages health and busy licensed premises are prone to disorder and violence. Alcohol places an unnecessary and preventable burden on health services.
Researchers only partially understand how interventions reduce the risk of alcohol misuse and violence. The lack of reliable ways of measuring harm and the lack of watertight research methods mean that there are many uncertainties. This project addresses these problems by rigorously assessing how changes within licensed premises might impact on injury and illness. First, reliable measures of alcohol misuse and violence will be developed and, second, the effects of implementing changes will be measured. Measures which will be assessed include precisely targeted breath analysis and police and accident and emergency data. If reliable measures and evidence that the intervention works emerge then a large scale experiment will be the subject of a further application.

The health and economic costs of alcohol misuse in the UK are estimated to be between 2% and 5% of UK gross domestic product and reflect sexual health outcomes, injury, stroke and cancer as well as lost productivity and absenteeism in the workplace. Evidence suggests that interventions targeted at licensed premises which address known risk factors (e.g. serving alcohol to intoxicated customers, irresponsible alcohol promotions, deficits in server training) can be effective in reducing the health costs associated with alcohol misuse. This project builds on the applicants? previous research by assessing the feasibility of a premises-level intervention designed to reduce alcohol misuse, and outcomes of misuse including disorder and violent injury. It is necessarily a feasibility study since available evidence suffers from poorly defined outcome measures which are too diverse to be generalisable and inappropriate methodology ? for example, randomised controlled trials (RCT) have been rarely been used. The interventions will be based on identification of premises risk factors. Experts in auditing the licensed trade and researchers will work with licensees to address shortcomings. The key intervention component involves feedback: experimental premises will receive feedback and be subject to action plans whereas control premises will not. Although the means of identifying shortcomings in premises management has been used across England and Wales and interventions which raise standards appear to have reduced disorder according to various police and health indicators (usually injury measures) this process has not been evaluated using a randomised controlled trial. This feasibility study will pilot the intervention using a RCT design to provide effect sizes. This study will pilot a breathalyser survey to measure the prevalence of alcohol intoxication in drinkers and will utilise police and accident and emergency data to measure the incidence and prevalence of violence and alcohol problems. A process evaluation will involve interviewing staff within the licensed trade both in intervention premises and senior staff in large licensed premise chains to determine barriers, fidelity of the intervention, acceptability and sustainability. Premises level interventions which reduce misuse are strategically relevant to a range of partnership activities, policy initiatives and funding streams across health and criminal justice. However, Primary Care Trusts and other agencies are required to develop plans which are evidence based. The proposed feasibility study begins to address the deficit in evidence for such interventions to inform a future definitive trial.