Processes, practices and influence: a mixed methods study of public health contributions to alcohol licensing in local government

Innovation and diversity in public health team engagement in local alcohol premises licensing: qualitative interview findings from the ExILEnS study

Background

Evidence suggests that controls on the physical and temporal availability of alcohol can reduce alcohol-related harms. Public health teams in England and Scotland have in recent years been given a statutory role in licensing systems through which premises are granted permits to sell alcohol. The Exploring the Impact of alcohol premises Licensing in England and Scotland study examined public health team efforts to engage in alcohol licensing from 2012 to 2019.

Objective

We aimed to describe the range of public health team practice in engaging with alcohol licensing across England and Scotland, with a particular focus on unusual or innovative practices.

Methods

Two sets of interviews were conducted with 20 public health teams in England and Scotland who were actively engaged in alcohol premises licensing. Firstly, representatives of each public health team with experience of licensing activity took part in structured face-to-face or telephone interviews (n = 41) and provided documentation to identify how and when their team engaged with alcohol premises licensing. Secondly, members of public health teams took part in in-depth one-to-one interviews (n = 28) which focused on individual roles and responsibilities. Relevant public health team activity was analysed quantitatively within 19 activities in 6 categories using the 'Public Health engagement In Alcohol Licensing' measure, as well as qualitatively using NVivo (QSR International, Melbourne, Australia). Innovative practices were identified using the highest Public Health engagement In Alcohol Licensing scores for specific activity types across single or multiple 6-month periods.

Findings

Within each of the six activity categories, a range of practices were observed. More unusual practices included having a dedicated post to work full-time on alcohol licensing; developing a standardised reviewer tool allowing the team to respond to applications and provide the most relevant evidence in a consistent and systematic way; committing to additional scrutiny of occasional licences or temporary event notices; maintaining a detailed database recording applications made, whether the public health team decided to object and the outcome of the licensing board's decision; engaging with applicants prior to them submitting an application; visiting proposed/current licensed premises to gather bespoke data; leading the writing of local licensing policy; and working closely with licensing standards officers.

Conclusions

Across six categories of public health team activity relating to the local alcohol premises licensing system, public health team practices varied, and some public health teams stood out as engaging in more innovative or intensive activities. The identified examples will be of value in informing public health team practice in what remains a relatively new area of work for many, despite limitations in the system. The inclusion of examples from both England and Scotland and from many public health teams will facilitate cross-fertilisation of ideas and practice across public health teams.

Funding

This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number 15/129/11.

Public health involvement in alcohol licensing decisions in the UK: a systematic review of qualitative studies

Introduction

One approach to reducing alcohol consumption and related harm is to limit physical availability. However, a recent review found alcohol licensing decisions are not consistently associated with improved local health outcomes in the UK, despite public health teams (PHTs) having a statutory role in licensing. This may be explained by limitations in regulatory powers, or because PHTs have been unable to sufficiently influence the use of regulation. This review aims to synthesise qualitative evidence to understand the nature, barriers and enablers, and value of PHT involvement in alcohol licensing decisions in the UK.

Methods

A systematic review of qualitative evidence was conducted. Five electronic databases were searched, supplemented by web searches for grey literature and author, reference and citation searches for included studies. Data was extracted and quality assessed using the Critical Appraisal Skills Programme (CASP) checklist. Data was synthesised using thematic synthesis, and confidence in the findings was judged using the Confidence in Evidence from Reviews of Qualitative research (CERQual) approach.

Results

10 reports, relating to four separate studies, met the eligibility criteria. Thematic synthesis generated seven analytical themes. We found variation in how PHTs' role in licensing is understood and enacted, with shared barriers and enablers. PHTs are often not regarded as a key consultee, though some teams found success in pursuing a more strategic approach. While the public health licensing objective in Scotland is considered an asset, it does not guarantee influence. Regardless of its presence, there is variation in the perceived value of PHTs' involvement in licensing.

Conclusions

A more strategic focus may be of value to PHTs and help strengthen their impact on licensing. However, given the limited potential for public health benefits through influencing regulatory decision-making, PHTs may want to consider if it is the most effective use of limited resource in tackling alcohol-related harms.

PROSPERO registration number

CRD42023452508.

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.

Evaluating the impact of local alcohol licensing decisions on outcomes for the community: a systematic review

Background

International evidence reviews suggest that reducing the availability of alcohol positively impacts both levels of alcohol consumption and associated harms. To understand the impact of recent changes to alcohol licensing and public health in the UK, this review aimed to identify and synthesise quantitative research evidence on the impact of local alcohol licensing decisions on the health and well-being of the community.

Methods

We searched peer-reviewed articles and grey literature for UK studies. We extracted and tabulated key data from the included papers and appraised study quality. We included topic expert and public consultation to confirm the scope of the evidence synthesis and suggest evidence for inclusion. We synthesised narratively and made recommendations based on our findings.

Results

We identified a small volume (seven papers) of evidence regarding the health (and related) impacts of local alcohol licensing decision undertaken in the UK local authorities. The evidence we identified did not demonstrate a consistent or sustained association between local interventions and health or crime outcomes downstream. This was despite relatively sophisticated study designs using a range of available data sources and some longer-term analysis.

Conclusion

Given that the impacts of local licensing decisions are currently limited, greater regulatory powers are needed if local licensing interventions are to be an effective public health interventions to reduce alcohol-related harms.

Process evaluation of the Belgian one-month-without alcohol campaign 'Tournée Minérale': a mixed method approach

BACKGROUND

The Tournée Minérale campaign [TMC] is a mass media prevention campaign challenging Belgian adults to refrain from alcohol during one month. A process evaluation may help us better understand the effect of TMC and to formulate recommendations for future editions. The current study aimed to examine reach, experiences, perceived effectiveness and maintenance of TMC.

METHODS

A mixed method design was used to assess the process, using pre- and post-questionnaires (n = 49.022, 44.5 ± 13.1 years old, 37.0% men) and focus groups (n = 31, 47.3 ± 14.3 years old, 33.3% men).

RESULTS

Most campaign materials were considered useful and/or motivating. Facilitators for taking part in TMC were connectedness with other participants, stimulus control (e.g. removing alcohol at home) and a supportive social environment. Most difficulties were encountered with abstaining during social occasions as participants had to change a habit or find alternative non-alcoholic beverages. Participants reported both beneficial (e.g. sleeping better) and adverse effects (e.g. drinking more soft drinks).

CONCLUSIONS

Future editions of TMC should try to decrease perceived adverse effects (e.g. by providing attractive non-alcoholic beverages) and can benefit from having a forum where people can share experiences.

Factors influencing public health engagement in alcohol licensing in England and Scotland including legal and structural differences: comparative interview analysis

Background

Greater availability of alcohol is associated with higher consumption and harms. The legal systems, by which premises are licensed to sell alcohol in England and Scotland, differ in several ways. The 'Exploring the impact of alcohol licensing in England and Scotland' study measured public health team activity regarding alcohol licensing from 2012 to 2019 and identified seven differences between England and Scotland in the timing and type of activities undertaken.

Objectives

To qualitatively describe the seven previously identified differences between Scotland and England in public health approaches to alcohol licensing, and to examine, from the perspective of public health professionals, what factors may explain these differences.

Methods

Ninety-four interviews were conducted with 52 professionals from 14 English and 6 Scottish public health teams selected for diversity who had been actively engaging with alcohol licensing. Interviews focused primarily on the nature of their engagement (n = 66) and their rationale for the approaches taken (n = 28). Interview data were analysed thematically using NVivo. Findings were constructed by discussion across the research team, to describe and explain the differences in practice found.

Findings

Diverse legal, practical and other factors appeared to explain the seven differences. (1) Earlier engagement in licensing by Scottish public health teams in 2012-3 may have arisen from differences in the timing of legislative changes giving public health a statutory role and support from Alcohol Focus Scotland. (2) Public Health England provided significant support from 2014 in England, contributing to an increase in activity from that point. (3) Renewals of statements of licensing policy were required more frequently in Scotland and at the same time for all Licensing Boards, probably explaining greater focus on policy in Scotland. (4) Organisational structures in Scotland, with public health stakeholders spread across several organisations, likely explained greater involvement of senior leaders there. (5) Without a public health objective for licensing, English public health teams felt less confident about making objections to licence applications without other stakeholders such as the police, and instead commonly negotiated conditions on licences with applicants. In contrast, Scottish public health teams felt any direct contact with applicants was inappropriate due to conflicts of interest. (6) With the public health objective in Scotland, public health teams there were more active in making independent objections to licence applications. Further in Scotland, licensing committee meetings are held to consider all new applications regardless of whether objections have been submitted; unlike in England where there was a greater incentive to resolve objections, because then a meeting was not required. (7) Finally, Scottish public health teams involved the public more in licensing process, partly because of statutory licensing forums there.

Conclusions

The alcohol premises licensing systems in England and Scotland differ in important ways including and beyond the lack of a public health objective for licensing in England. These and other differences, including support of national and local bodies, have shaped opportunities for, and the nature of, public health engagement. Further research could examine the relative success of the approaches taken by public health teams and how temporary increases in availability are handled in the two licensing systems.

Funding

This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Reseacrh programme as award number 15/129/11.

Public health engagement in alcohol licensing in England and Scotland: the ExILEnS mixed-method, natural experiment evaluation

Background

International systematic reviews suggest an association between alcohol availability and increased alcohol-related harms. Alcohol availability is regulated through separate locally administered licensing systems in England and Scotland, in which local public health teams have a statutory role. The system in Scotland includes a public health objective for licensing. Public health teams engage to varying degrees in licensing matters but no previous study has sought to objectively characterise and measure their activity, examine their effectiveness, or compare practices between Scotland and England.

Aim

To critically assess the impact and mechanisms of impact of public health team engagement in alcohol premises licensing on alcohol-related harms in England and Scotland.

Methods

We recruited 39 diverse public health teams in England (n = 27) and Scotland (n = 12). Public health teams more active in licensing were recruited first and then matched to lower-activity public health teams. Using structured interviews (n = 66), documentation analysis, and expert consultation, we developed and applied the Public Health Engagement In Alcohol Licensing (PHIAL) measure to quantify six-monthly activity levels from 2012 to 2019. Time series of PHIAL scores, and health and crime outcomes for each area, were analysed using multivariable negative binomial mixed-effects models to assess correlations between outcome and exposure, with 18-month average PHIAL score as the primary exposure metric. In-depth interviews (n = 53) and a workshop (n = 10) explored public health team approaches and potential mechanisms of impact of alcohol availability interventions with public health team members and licensing stakeholders (local authority licensing officers, managers and lawyers/clerks, police staff with a licensing remit, local elected representatives).

Findings

Nineteen public health team activity types were assessed in six categories: (1) staffing; (2) reviewing and (3) responding to licence applications; (4) data usage; (5) influencing licensing stakeholders/policy; and (6) public involvement. Usage and intensity of activities and overall approaches varied within and between areas over time, including between Scotland and England. The latter variation could be explained by legal, structural and philosophical differences, including Scotland's public health objective. This objective was felt to legitimise public health considerations and the use of public health data within licensing. Quantitative analysis showed no clear evidence of association between level of public health team activity and the health or crime outcomes examined, using the primary exposure or other metrics (neither change in, nor cumulative, PHIAL scores). Qualitative data suggested that public health team input was valued by many licensing stakeholders, and that alcohol availability may lead to harms by affecting the accessibility, visibility and norms of alcohol consumption, but that the licensing systems have limited power to act in the interests of public health.

Conclusions

This study provides no evidence that public health team engagement in local licensing matters was associated with measurable downstream reductions in crime or health harms, in the short term, or over a 7-year follow-up period. The extensive qualitative data suggest that public health team engagement is valued and appears to be slowly reorienting the licensing system to better address health (and other) harms, especially in Scotland, but this will take time. A rise in home drinking, alcohol deliveries, and the inherent inability of the licensing system to reduce - or in the case of online sales, to contain - availability, may explain the null findings and will continue to limit the potential of these licensing systems to address alcohol-related harms.

Future work

Further analysis could consider the relative success of different public health team approaches in terms of changing alcohol availability and retailing. A key gap relates to the nature and impact of online availability on alcohol consumption, harms and inequalities, alongside development and study of relevant policy options. A national approach to licensing data and oversight would greatly facilitate future studies and public health input to licensing.

Limitations

Our interview data and therefore PHIAL scores may be limited by recall bias where documentary evidence of public health activity was not available, and by possible variability in grading of such activity, though steps were taken to minimise both. The analyses would have benefited from additional data on licensing policies and environmental changes that might have affected availability or harms in the study areas.

Study registration

The study was registered with the Research Registry (researchregistry6162) on 26 October 2020. The study protocol was published in BMC Medical Research Methodology on 6 November 2018.

Funding

This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number 15/129/11.

"Availability is the poor cousin of marketing and pricing": qualitative study of stakeholders' views on policy priorities around tobacco and alcohol availability

Background

Reducing alcohol and tobacco availability is one potential way to reduce harm from these unhealthy commodities. This study explores key stakeholders' views in relation to policy priorities and considerations for both alcohol and tobacco availability.

Methods

We conducted semi-structured interviews with 14 stakeholders from alcohol and/or tobacco third sector organizations, government, public health and licensing in Scotland. Interviews explored their views on alcohol/tobacco availability, including its place in the policy landscape and experiences in gaining support for policies. Data were analyzed using thematic analysis.

Results

Stakeholders believed that alcohol and tobacco availability have not received as much policy attention as pricing and marketing. Stakeholders highlighted the importance of public support and having sufficient evidence to inform policy. Key considerations for future policies include: drawing on lessons from tobacco control policies to address alcohol availability, considering different aspects of availability (especially online availability), ensuring policies reflect their local context, considering the impact of policies on children, and managing retailers' involvement in the policy process.

Conclusion

This study highlights key considerations for policies to address alcohol and tobacco availability. There is a need for more research to consider retailers' views and provide greater detail on specific policy suggestions.

Alcohol outlet density and marketing in Abeokuta, Nigeria

AIM

The physical availability of alcohol is a modifiable determinant of alcohol consumption and related harm. However, Nigeria currently does not have national regulations restricting the physical availability of alcohol. The study measured alcohol outlet density and marketing in Abeokuta, Nigeria.

METHODS

A descriptive community design was employed. Seven wards in Abeokuta South local government were surveyed street by street for functional alcohol outlets and nearby public institutions (schools and worship centres). Outlet characteristics were documented, and the location of outlets and public institutions was geocoded using a global positioning system app. The density and proximity of outlets and public institutions were analysed using QGIS 3.22.

RESULTS

Four hundred and seventy-six alcohol outlets and 194 public institutions (82 schools, 87 churches, and 25 mosques) were sampled across the 7 wards. The most common type of alcohol premises and outlets was on/off-premises and liquor/non-alcoholic drinks stores. Alcohol banners on liquor store lintels were the most prevalent marketing item. Alcohol outlet density ranged from 8.06 to 200 per km2. The smallest average distance between alcohol outlets was 28 m in Sodeke, while Ago Egun/Ijesa had the highest number of outlets and on/off premises. The shortest distance from an outlet to a school was 18.77 m in Ijaiye and 44 (14.7%) schools were located within ≤100 m of an outlet.

CONCLUSIONS

Findings indicate high alcohol density, resulting in short distances between alcohol outlets and public institutions in Abeokuta South local government area. These results underscore the importance of implementing evidence-based alcohol availability policies in Nigeria.

Research evidence use in local government-led public health interventions: a systematic review

BACKGROUND

Local governments play an important role in improving public health outcomes globally, critical to this work is applying the best-available research evidence. Despite considerable exploration of research use in knowledge translation literature, how research is practically applied by local governments remains poorly understood. This systematic review examined research evidence use in local government-led public health interventions. It focused on how research was used and the type of intervention being actioned.

METHODS

Quantitative and qualitative literature published between 2000 and 2020 was searched for studies that described research evidence use by local governments in public health interventions. Studies reporting interventions developed outside of local government, including knowledge translation interventions, were excluded. Studies were categorised by intervention type and their level of description of research evidence use (where 'level 1' was the highest and 'level 3' was the lowest level of detail).

FINDINGS

The search identified 5922 articles for screening. A final 34 studies across ten countries were included. Experiences of research use varied across different types of interventions. However, common themes emerged including the demand for localised research evidence, the legitimising role of research in framing public health issues, and the need for integration of different evidence sources.

CONCLUSIONS

Differences in how research was used were observed across different local government public health interventions. Knowledge translation interventions aiming to increase research use in local government settings should consider known barriers and facilitators and consider contextual factors associated with different localities and interventions.

'Give us the real tools to do our jobs': views of UK stakeholders on the role of a public health objective for alcohol licensing

OBJECTIVES

This study ascertains the views of UK stakeholders on the actual, and possible, impact of a public health licensing objective in their day-to-day work.

STUDY DESIGN AND METHODS

Twenty-eight interviews were conducted with members of public health teams who were actively engaged in alcohol licensing in their local area between 2017 and 2019. Six teams were based in Scotland (where there is a public health licensing objective) and 14 in England (where there is no similar objective).

RESULTS

Scottish participants reported that while challenges remained in applying the public health licensing objective, progress had been made and the objective was beneficial to their work. Participants in England felt that an objective would increase the legitimacy, value and impact of their contributions. In both Scotland and England, constructive relationships between PHTs, licensing authorities and other key stakeholders were developing suggesting that PHTs could have a sustainable and positive role in licensing.

CONCLUSIONS

In many Scottish areas, the alcohol licensing system is evolving to take constructive account of its public health objective. In England, PHTs that have invested resources in engaging in this area have demonstrated an ability to work effectively within licensing systems. Strong support for the adoption of a public health licensing objective among these PHTs adds weights to calls for the UK Government to reconsider its previous decision not to introduce such an objective.

Impact of public health team engagement in alcohol licensing on health and crime outcomes in England and Scotland: A comparative timeseries study between 2012 and 2019

Background

Public health teams (PHTs) in England and Scotland engage to varying degrees in local alcohol licensing systems to try to reduce alcohol-related harms. No previous quantitative evidence is available on the effectiveness of this engagement. We aimed to quantify the effects of PHT engagement in alcohol licensing on selected health and crime outcomes.

Methods

39 PHTs in England (n = 27) and Scotland (n = 12) were recruited (of 40 contacted) for diversity in licensing engagement level and region, with higher activity areas matched to lower activity areas. Each PHT's engagement in licensing for each 6 month period from April 2012 to March 2019 was quantified using a new measure (PHIAL) developed using structured interviews, documentary analyses, and expert consultation. Outcomes examined were ambulance callouts, alcohol-related hospital admissions, alcohol-related and alcohol-specific mortality and violent, sexual and public order offences. Timeseries were analysed using multivariable negative binomial mixed-effects models. Correlations were assessed between each outcome and 18-month average PHIAL score (primary metric), cumulative PHIAL scores and change in PHIAL scores. Additionally, 6-month lagged correlations were also assessed.

Findings

There was no clear evidence of any associations between the primary exposure metric and the public health or crime outcomes examined, nor between cumulative PHIAL scores or change in PHIAL score and any outcomes. There were no significant associations in England or Scotland when analysed separately or between outcomes and lagged exposure metrics.

Interpretation

There is no clear evidence that allocating PHT resources to engaging in alcohol licensing is associated with downstream reductions in alcohol-related health harms or crimes, in the short term or over a seven year follow-up period. Such engagement likely has benefits in shaping the licensing system to take account of health issues longer term, but as current systems cannot reduce alcohol availability or contain online sales, their potential benefits are somewhat constrained.

Funding

The ExILEnS project is funded by the NIHR Public Health Research Programme (project number 15/129/11). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

How public health teams navigate their different roles in alcohol premises licensing: ExILEnS multistakeholder interview findings

Background

In England and Scotland, local governments regulate the sale of alcohol by awarding licences to premises to permit the sale of alcohol for consumption on or off the premises, under certain conditions; without such a licence, alcohol cannot be legally sold. In recent years, many local public health teams have become proactive in engaging with alcohol licensing, encouraging licensing authorities to act in ways intended to improve population health.

Objective

This research aimed to explore and understand the approaches and activities of public health stakeholders (i.e. NHS staff and other public health professionals) in seeking to influence local alcohol licensing policy and decisions, and the views of licensing stakeholders (i.e. licensing officers/managers, police staff with a licensing remit, elected members and licensing lawyers/clerks) on the acceptability and effectiveness of these approaches.

Participants

Local public health teams in England and Scotland were directly informed about this multisite study. Scoping calls were conducted with interested teams to explore their level of activity in alcohol licensing from 2012 across several categories. Twenty local authority areas with public health teams active in licensing matters were recruited purposively in England (n = 14) and Scotland (n = 6) to vary by region and rurality. Fifty-three in-depth telephone interviews (28 with public health stakeholders and 25 with licensing stakeholders outside health, such as local authority licensing teams/lawyers or police) were conducted. Interview transcripts were analysed thematically in NVivo 12 (QSR International, Warrington, UK) using inductive and deductive approaches.

Results

Public health stakeholders’ approaches to engagement varied, falling into three main (and sometimes overlapping) types. (1) Many public health stakeholders in England and all public health stakeholders in Scotland took a ‘challenging’ approach to influencing licensing decisions and policies. Reducing health harms was felt to necessitate a focus on reducing availability and generating longer-term culture change, citing international evidence on the links between availability and alcohol-related harms. Some of these stakeholders viewed this as being a narrow, ‘nanny state’ approach, whereas others welcomed public health expertise and its evidence-based approach and input. (2) Some public health stakeholders favoured a more passive, ‘supportive’ approach, with some reporting that reducing availability was unachievable. They reported that, within the constraints of current licensing systems, alcohol availability may be contained (at least in theory) but cannot be reduced, because existing businesses cannot be closed on availability grounds. In this ‘supportive’ approach, public health stakeholders supplied licensing teams with data on request or waited for guidance from licensing teams on when and how to get involved. Therefore, public health action supported the licensing team in their aim of promoting ‘safe’ and ‘responsible’ retailing of alcohol and/or focused on short-term outcomes other than health, such as crime. (3) Some public health stakeholders favoured a ‘collaborative’ approach in which they worked in close partnership with licensing teams; this could include a focus on containing availability or responsible retail of alcohol, or both.

Conclusions

In engaging with alcohol licensing, public health stakeholders adapted their approaches, sometimes resulting in a diminished focus on public health goals. Sampling did not include lower-activity areas, in which experiences might differ. The extent to which current licensing systems enable achievement of public health goals is questionable and the effectiveness of public health efforts merits quantitative evaluation.

Study registration

The study is registered with the Research Registry as researchregistry6162.

Funding

This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in Public Health Research. See the NIHR Journals Library website for further project information.

Observational study of the association between diverse licensed premises types and alcohol-related violence in an inner-London borough

BACKGROUND

An ecological correlation has been observed between licensed premises and alcohol-related violence (ARV). In the UK to date, no evidence directly connects alcohol-related harm to a single premises type. Recent policies have called for a diversified alcohol offer, yet quantitative evidence in support remains sparse. This study aims to inform policy by determining whether diversification of the alcohol economy is desirable and to inform the licensing process and submission of public health evidence.

METHODS

Using 11 years of local licensing data from the London Borough of Southwark, alcohol availability over time was approximated by the number of extant alcohol licences, categorised by outlet type: drinking establishments, eateries, takeaways, off-sales and 'other'. Harm was quantified drawing on law enforcement intelligence that recorded ARV. A linked data set was analysed using negative binomial regression, contrasting cumulative impact zones (CIZ)-a common alcohol control policy-with non-CIZ geographies.

RESULTS

Each licensed drinking establishment was associated with a 1.6% (95% CI 0.7% to 2.6%; p=0.001) increase in ARV, respectively. 'Other' outlets had a protective effect and were associated with a 1.8% (95% CI 1.0% to 2.5%; p<0.001) decrease in ARV.

CONCLUSION

This study provides direct evidence for an association between alcohol-related harm and licensed premises. The varying associations between outlet type and ARV provide local public health stakeholders with an evidence base upon which to advocate for licensing policies that diversify alcohol availability.