The spatial epidemiology of alcohol availability, consumption and harm

Abstract

Alcohol misuse has been one of the major public health concerns in the UK as a significant source of health and social problems. Much research has tried to identify, qualify, and quantify the factors (socio-economic, cultural) that lead to or foster alcohol misuse and their impact on health. Nonetheless, the extent of the impact of many of these factors is still not fully understood.

Recent research infers on the existence of an association between high density of alcohol outlets and alcohol related incidents (e.g. alcohol consumption, mortality, driving under the influence, violence). Other studies have addressed the trends in alcohol availability (density or proximity), associations with geographical areas of deprivation, or with alcohol related hospital admissions.

However, the quantification of the impact of these relations and a causality link between them has yet to be established, particularly in the UK, where tailored recommendations (considering outlet type and demographic characteristics) of limit densities of alcohol availability could inform the development of more effective alcohol policies.

This project proposes to understand the public health impact of geographical alcohol availability in the UK and to explore its associations to behaviours of consumption and misuse. We propose to investigate the spatial relationship between harm and consumption, and in particular, to characterise the spatial aspects of the relationship between demographics and outlets that are responsible for harm and problematic consumption.

The project aims to increase the effectiveness of policy making (with regards to limiting alcohol availability) and to feed into the work undertaken by many public services affected by alcohol misuse (NHS, emergency services, local councils, police, and community groups).

Technical Summary

The purpose of the project is to investigate the spatial epidemiology of alcohol availability, consumption and harm.
Understanding the impact of the geographical density of alcohol availability and to explore its associations to behaviours of consumption and misuse, is of great importance to inform alcohol regulation and prevention of misuse and harm in the UK.

We propose a spatial analysis of the relationship between alcohol outlet density and incidence of alcohol misuse and harm. To achieve this, we will develop
a model of spatial availability of alcohol (outlets) at local authority level for three urban areas in the UK, using spatial mathematics, graph theory, (network) topology, and spatial statistics to properly capture the notion of alcohol availability, considering density, proximity, accessibility (hours of operation, logistics). The use of spatial epidemiology, and uncertainty quantification will play an important role in this part of the project.
These models will be used to compare evidence regarding measures of outlet availability, and to explore the existence of local predicting mechanisms for harm and misuse based on outlet utility and availability. The project will also investigate trends in alcohol availability, consumption, and harm, in view of examining the existence of a causal relationship between them.

We propose the use of geographically fine, longitudinal data on type, location, and temporal availability of alcohol outlets; and will resource to the analysis of large routinely collected data. Data on operating alcohol outlets is usually not readily available from the UK government, thus will be obtained from commercial sources (market research companies) which are deemed to cover 98% of the UK's alcohol outlets. Geospatial data will then be obtained from the Office of National Statistics and large routine data on hospital admission and emergency services data will be obtained from NHS digital and ambulance trusts.

Planned Impact

It is anticipated that policy-makers within national, and local government, will benefit from this research, as science based evidence that would inform protocols and policy regulating alcohol availability. The project has the potential to increase the effectiveness of policy making (with regards to limiting alcohol availability) and to feed into the work undertaken by many public services affected by alcohol misuse (NHS, emergency services, local councils, police, and community groups).
It is expected that these findings will influence and inform alcohol policy within the time frame of the fellowship, the benefits of which could be measurable within a five to ten-year period.

Publications

10 25 50
 
Description Evaluating later or expanded premises hours for alcohol in the night-time economy (ELEPHANT): A mixed-methods, natural experiment evaluation 
Organisation University of Stirling
Department School of Health Sciences
Country United Kingdom 
Sector Academic/University 
PI Contribution This partnership/collaboration is awaiting funding annoucements and is planned to start in. My contribtions to this work will fall into a workpackage (WP3) looking at evaluating impact of extended opening hoursof alcohol trading outelts on harm. This will include spatio-temporal paterning of harms using Bayesian spatiotemporal models to evaluate if changes in alcohol-related ambulance call-outs and assaults have resulted from the later opening hours, including impact on different subgroups and changes in call-out locations.
Collaborator Contribution This study will describe, understand and evaluate the introduction, operation and impact of later trading hours for licensed alcohol premises in two Scottish cities (Glasgow and Aberdeen). Late night alcohol sales are associated with increased rates of assaults, injuries & disorder. Alcohol is linked to ~ 50% of weekend ambulance call-outs and up to 70% of assaults presenting to A&E in Scotland. International systematic reviews find that extensions in late night opening of alcohol premises are linked to increased intoxication, assaults, injuries, and use of services. Recent studies using robust methods found significant impacts on assaults (Norway, 16% increase with 1 hour extension; Australia 21% increase with each extra hour) and alcohol-related ambulance call-outs (Amsterdam, 34% increase with 1 hour extension). The remaining collaborators and reserachers on the project will be conducting four other research packages: WP1: Understanding the Changes at System Level: will use documentary analysis and interviews to understand what led to the changes and explore their expected and actual impact [Fitzgerald]. - WP2: Understanding the Changes at Venue Level: will use venue observation, staff interviews and social media feeds to establish whether and when premises are opening later; and what happens during the later opening period. - WP4: Evaluating Economic Impact: will evaluate any associated costs of the changes to NHS, police services and local businesses. - WP5: Evaluating Impact on Inequalities, Long-Term NHS Costs and for other UK Local Authorities (LAs): will identify whether other UK LAs are considering similar changes, and model the likely impact of the changes on inequalities, long-term health and healthcare costs for the two cities and other UK LAs.
Impact The collaboration has just started and outcomes will be announced in due time. The collaboration is multi-disciplinary and involves collaborators from local licensing teams, and police srevices in Scotland, Medical Statisticians, Spatial epidemiologists, Health economic modellers, Ambulance service research specialists, and qualitative researchers.
Start Year 2020
 
Description Integrating longitudinal and cross-national evaluations of community alcohol availability and impacts on adolescents 
Organisation Deakin University
Country Australia 
Sector Academic/University 
PI Contribution The main aim of the proposed research collaboration is to bring international reserach expertise to draw comparative analysis of the link between community alcohol availability, and both alcohol uptake and use, and mental health and wellbeing, in young people in Australia (Victoria) and England (Avon). My contribution to this particular project is to lead a work package on Spatial availability and local policy, aimed at developping harmonised and comparable measures of alcohol availability that allow comparison of young people's longitudinal exposure to alcohol availability in both countries (regions). These measures will feed into several statistical and economical analysis, inclusing analysis of associations and causal links between alcohol outlet exposure and harms to be conducted by my collaborators in Bristol and Australia. The particular aims involve: 1. drawing a typology of outlet that unifies the classifications used in both countries, 2. develop small-scale harmonised metrics of alcohol outlet availability, accounting for exposure to different types of outlets, that can be used to 3. compare exposure metrics and examine geographical patterns of change in urban availability in Australia and the UK. Towards the mid/end of the project I will aslo contribute to the promotion of findings to local communities and governments in the form of evidence-based policy recommendations tailored to local needs and legislative and policy contexts.
Collaborator Contribution The contributions of my partners to this project include: 1. The harmonisation of existing, similar, high-quality, large, prospective longitudinal data sets from England and Australia to facilitate comparable modelling of the temporal associations and processes that may link alcohol sales outlets (objective 1) with: adolescent uptake and consumption of alcohol and increased resource use. 2. Evaluation of cross-national differences in any associations examined between England and Australia. 4. Scoping the economic impact (notably costs and educational attainment) of varied levels of growth in alcohol sales in both countries, with a focus on alcohol-related misuse. 5. Evaluation of the lifetime physical and mental health costs of increased alcohol availability leading from increased alcohol consumption 6. Identification of maximum and minimum threshold of availability levels at which alcohol availability impacts on adolescent alcohol uptake 7. Identification critical developmental periods/ages where level of availability impacts on age of uptake; 8. Identification whether mechanisms of supply (parents, illegal purchasing) are associated with availability or changes in availability to children and adolescents; 9. Identification whether the association with alcohol availability with uptake and consumption varies between SES groups. 10. Investigations and description of current legislative and policy contexts and implementation processes that direct alcohol outlet density in Australia and England. 11. Promotion of findings to local communities and governments in the form of evidence-based policy recommendations, tailored to local needs and legislative and policy contexts.
Impact To be announced. The proposed research will be conducted by a world-leading and multidisciplinary team of public health, health psychology, life-course development, epidemiology and health economics scientists with extensive track records in research on alcohol-related harms from different research institutes from Australia and the UK.
Start Year 2020
 
Description Integrating longitudinal and cross-national evaluations of community alcohol availability and impacts on adolescents 
Organisation La Trobe University
Country Australia 
Sector Academic/University 
PI Contribution The main aim of the proposed research collaboration is to bring international reserach expertise to draw comparative analysis of the link between community alcohol availability, and both alcohol uptake and use, and mental health and wellbeing, in young people in Australia (Victoria) and England (Avon). My contribution to this particular project is to lead a work package on Spatial availability and local policy, aimed at developping harmonised and comparable measures of alcohol availability that allow comparison of young people's longitudinal exposure to alcohol availability in both countries (regions). These measures will feed into several statistical and economical analysis, inclusing analysis of associations and causal links between alcohol outlet exposure and harms to be conducted by my collaborators in Bristol and Australia. The particular aims involve: 1. drawing a typology of outlet that unifies the classifications used in both countries, 2. develop small-scale harmonised metrics of alcohol outlet availability, accounting for exposure to different types of outlets, that can be used to 3. compare exposure metrics and examine geographical patterns of change in urban availability in Australia and the UK. Towards the mid/end of the project I will aslo contribute to the promotion of findings to local communities and governments in the form of evidence-based policy recommendations tailored to local needs and legislative and policy contexts.
Collaborator Contribution The contributions of my partners to this project include: 1. The harmonisation of existing, similar, high-quality, large, prospective longitudinal data sets from England and Australia to facilitate comparable modelling of the temporal associations and processes that may link alcohol sales outlets (objective 1) with: adolescent uptake and consumption of alcohol and increased resource use. 2. Evaluation of cross-national differences in any associations examined between England and Australia. 4. Scoping the economic impact (notably costs and educational attainment) of varied levels of growth in alcohol sales in both countries, with a focus on alcohol-related misuse. 5. Evaluation of the lifetime physical and mental health costs of increased alcohol availability leading from increased alcohol consumption 6. Identification of maximum and minimum threshold of availability levels at which alcohol availability impacts on adolescent alcohol uptake 7. Identification critical developmental periods/ages where level of availability impacts on age of uptake; 8. Identification whether mechanisms of supply (parents, illegal purchasing) are associated with availability or changes in availability to children and adolescents; 9. Identification whether the association with alcohol availability with uptake and consumption varies between SES groups. 10. Investigations and description of current legislative and policy contexts and implementation processes that direct alcohol outlet density in Australia and England. 11. Promotion of findings to local communities and governments in the form of evidence-based policy recommendations, tailored to local needs and legislative and policy contexts.
Impact To be announced. The proposed research will be conducted by a world-leading and multidisciplinary team of public health, health psychology, life-course development, epidemiology and health economics scientists with extensive track records in research on alcohol-related harms from different research institutes from Australia and the UK.
Start Year 2020
 
Description Integrating longitudinal and cross-national evaluations of community alcohol availability and impacts on adolescents 
Organisation Queensland University of Technology (QUT)
Country Australia 
Sector Academic/University 
PI Contribution The main aim of the proposed research collaboration is to bring international reserach expertise to draw comparative analysis of the link between community alcohol availability, and both alcohol uptake and use, and mental health and wellbeing, in young people in Australia (Victoria) and England (Avon). My contribution to this particular project is to lead a work package on Spatial availability and local policy, aimed at developping harmonised and comparable measures of alcohol availability that allow comparison of young people's longitudinal exposure to alcohol availability in both countries (regions). These measures will feed into several statistical and economical analysis, inclusing analysis of associations and causal links between alcohol outlet exposure and harms to be conducted by my collaborators in Bristol and Australia. The particular aims involve: 1. drawing a typology of outlet that unifies the classifications used in both countries, 2. develop small-scale harmonised metrics of alcohol outlet availability, accounting for exposure to different types of outlets, that can be used to 3. compare exposure metrics and examine geographical patterns of change in urban availability in Australia and the UK. Towards the mid/end of the project I will aslo contribute to the promotion of findings to local communities and governments in the form of evidence-based policy recommendations tailored to local needs and legislative and policy contexts.
Collaborator Contribution The contributions of my partners to this project include: 1. The harmonisation of existing, similar, high-quality, large, prospective longitudinal data sets from England and Australia to facilitate comparable modelling of the temporal associations and processes that may link alcohol sales outlets (objective 1) with: adolescent uptake and consumption of alcohol and increased resource use. 2. Evaluation of cross-national differences in any associations examined between England and Australia. 4. Scoping the economic impact (notably costs and educational attainment) of varied levels of growth in alcohol sales in both countries, with a focus on alcohol-related misuse. 5. Evaluation of the lifetime physical and mental health costs of increased alcohol availability leading from increased alcohol consumption 6. Identification of maximum and minimum threshold of availability levels at which alcohol availability impacts on adolescent alcohol uptake 7. Identification critical developmental periods/ages where level of availability impacts on age of uptake; 8. Identification whether mechanisms of supply (parents, illegal purchasing) are associated with availability or changes in availability to children and adolescents; 9. Identification whether the association with alcohol availability with uptake and consumption varies between SES groups. 10. Investigations and description of current legislative and policy contexts and implementation processes that direct alcohol outlet density in Australia and England. 11. Promotion of findings to local communities and governments in the form of evidence-based policy recommendations, tailored to local needs and legislative and policy contexts.
Impact To be announced. The proposed research will be conducted by a world-leading and multidisciplinary team of public health, health psychology, life-course development, epidemiology and health economics scientists with extensive track records in research on alcohol-related harms from different research institutes from Australia and the UK.
Start Year 2020
 
Description Integrating longitudinal and cross-national evaluations of community alcohol availability and impacts on adolescents 
Organisation University of Bristol
Department School of Social and Community Medicine
Country United Kingdom 
Sector Academic/University 
PI Contribution The main aim of the proposed research collaboration is to bring international reserach expertise to draw comparative analysis of the link between community alcohol availability, and both alcohol uptake and use, and mental health and wellbeing, in young people in Australia (Victoria) and England (Avon). My contribution to this particular project is to lead a work package on Spatial availability and local policy, aimed at developping harmonised and comparable measures of alcohol availability that allow comparison of young people's longitudinal exposure to alcohol availability in both countries (regions). These measures will feed into several statistical and economical analysis, inclusing analysis of associations and causal links between alcohol outlet exposure and harms to be conducted by my collaborators in Bristol and Australia. The particular aims involve: 1. drawing a typology of outlet that unifies the classifications used in both countries, 2. develop small-scale harmonised metrics of alcohol outlet availability, accounting for exposure to different types of outlets, that can be used to 3. compare exposure metrics and examine geographical patterns of change in urban availability in Australia and the UK. Towards the mid/end of the project I will aslo contribute to the promotion of findings to local communities and governments in the form of evidence-based policy recommendations tailored to local needs and legislative and policy contexts.
Collaborator Contribution The contributions of my partners to this project include: 1. The harmonisation of existing, similar, high-quality, large, prospective longitudinal data sets from England and Australia to facilitate comparable modelling of the temporal associations and processes that may link alcohol sales outlets (objective 1) with: adolescent uptake and consumption of alcohol and increased resource use. 2. Evaluation of cross-national differences in any associations examined between England and Australia. 4. Scoping the economic impact (notably costs and educational attainment) of varied levels of growth in alcohol sales in both countries, with a focus on alcohol-related misuse. 5. Evaluation of the lifetime physical and mental health costs of increased alcohol availability leading from increased alcohol consumption 6. Identification of maximum and minimum threshold of availability levels at which alcohol availability impacts on adolescent alcohol uptake 7. Identification critical developmental periods/ages where level of availability impacts on age of uptake; 8. Identification whether mechanisms of supply (parents, illegal purchasing) are associated with availability or changes in availability to children and adolescents; 9. Identification whether the association with alcohol availability with uptake and consumption varies between SES groups. 10. Investigations and description of current legislative and policy contexts and implementation processes that direct alcohol outlet density in Australia and England. 11. Promotion of findings to local communities and governments in the form of evidence-based policy recommendations, tailored to local needs and legislative and policy contexts.
Impact To be announced. The proposed research will be conducted by a world-leading and multidisciplinary team of public health, health psychology, life-course development, epidemiology and health economics scientists with extensive track records in research on alcohol-related harms from different research institutes from Australia and the UK.
Start Year 2020
 
Description Integrating longitudinal and cross-national evaluations of community alcohol availability and impacts on adolescents 
Organisation University of Melbourne
Country Australia 
Sector Academic/University 
PI Contribution The main aim of the proposed research collaboration is to bring international reserach expertise to draw comparative analysis of the link between community alcohol availability, and both alcohol uptake and use, and mental health and wellbeing, in young people in Australia (Victoria) and England (Avon). My contribution to this particular project is to lead a work package on Spatial availability and local policy, aimed at developping harmonised and comparable measures of alcohol availability that allow comparison of young people's longitudinal exposure to alcohol availability in both countries (regions). These measures will feed into several statistical and economical analysis, inclusing analysis of associations and causal links between alcohol outlet exposure and harms to be conducted by my collaborators in Bristol and Australia. The particular aims involve: 1. drawing a typology of outlet that unifies the classifications used in both countries, 2. develop small-scale harmonised metrics of alcohol outlet availability, accounting for exposure to different types of outlets, that can be used to 3. compare exposure metrics and examine geographical patterns of change in urban availability in Australia and the UK. Towards the mid/end of the project I will aslo contribute to the promotion of findings to local communities and governments in the form of evidence-based policy recommendations tailored to local needs and legislative and policy contexts.
Collaborator Contribution The contributions of my partners to this project include: 1. The harmonisation of existing, similar, high-quality, large, prospective longitudinal data sets from England and Australia to facilitate comparable modelling of the temporal associations and processes that may link alcohol sales outlets (objective 1) with: adolescent uptake and consumption of alcohol and increased resource use. 2. Evaluation of cross-national differences in any associations examined between England and Australia. 4. Scoping the economic impact (notably costs and educational attainment) of varied levels of growth in alcohol sales in both countries, with a focus on alcohol-related misuse. 5. Evaluation of the lifetime physical and mental health costs of increased alcohol availability leading from increased alcohol consumption 6. Identification of maximum and minimum threshold of availability levels at which alcohol availability impacts on adolescent alcohol uptake 7. Identification critical developmental periods/ages where level of availability impacts on age of uptake; 8. Identification whether mechanisms of supply (parents, illegal purchasing) are associated with availability or changes in availability to children and adolescents; 9. Identification whether the association with alcohol availability with uptake and consumption varies between SES groups. 10. Investigations and description of current legislative and policy contexts and implementation processes that direct alcohol outlet density in Australia and England. 11. Promotion of findings to local communities and governments in the form of evidence-based policy recommendations, tailored to local needs and legislative and policy contexts.
Impact To be announced. The proposed research will be conducted by a world-leading and multidisciplinary team of public health, health psychology, life-course development, epidemiology and health economics scientists with extensive track records in research on alcohol-related harms from different research institutes from Australia and the UK.
Start Year 2020
 
Description Alcohol availability and harm exhibition and public engagement event as part of the 2019 MRC Festival of Medical Research (two day event in Sheffield) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Study participants or study members
Results and Impact two days of interactive medical exploration and learn about fighting disease. Talk to our leading medical scientists about their research and how they are finding new ways to combat disease and keep us healthy.
There were a range of activities, exhibits and demonstrations including:
1. Fighting Motor Neuron Disease
2. Bacteria: The Hidden Army
3. Genetics and Disease
4. Mapping Alcohol Consumption in Sheffield
5. Exploring Hearing Loss
6. The Big Blood Vessel Build
7. Can Your Diet Affect Pain?
8. Meet the Virtual Doctor
9. Cooking for Cognition
The events were open to everyone and aimed at a public audience, including families and children.
Year(s) Of Engagement Activity 2019
URL https://www.sheffield.ac.uk/pre/public-engagement/mrcfestival