The impact of alcohol in Liverpool:

Transcription

1 The impact of alcohol in Liverpool: quarterly report July 28 Carly Lightowlers, Michela Morleo and Penny A Cook Centre for Public Health, Liverpool John Moores University

2 Contents 1 Introduction Consumption Health related impacts of alcohol Crime Other alcohol impacts Examples of initiatives to tackle excessive alcohol consumption Thematic focus: 18 to 25 year old binge drinkers References Appendices

3 1 Introduction Liverpool Alcohol Strategy Group is committed to improving information and data collection on alcohol and related harms in Liverpool (Liverpool PCT 27). As such, in 26, the group commissioned the Centre for Public Health (CPH) at Liverpool John Moores University to identify available alcohol intelligence and to produce quarterly reports to inform the Group on the alcohol situation in Liverpool. This is the fifth quarterly report for the Group and relates to data published between January and March 28. This report provides data including: Details of latest reports on the impact of alcohol consumption on the workplace, and consumption in young people; The number of people presenting to the Royal Liverpool accident and emergency department for assault; Local alcohol-related crime estimates and details of offenders in contact with the probation service; The number of workplaces with whom awareness has been raised regarding alcohol; and Local initiatives to address alcohol-related harm. For each report, a thematic focus is discussed, as determined by the Alcohol Strategy Group. The previous report (January 28) focused on young people and the thematic focus of this report is year old binge drinkers (see section 7). The Centre for Public Health endeavours to contact as many organisations as possible to obtain data for inclusion in this series of reports. We would like to encourage all agencies with relevant data to contact Carly Lightowlers on (or c.l.lightowlers@ljmu.ac.uk) to contribute to future editions. Acknowledgements We would like to thank all those who provided data to inform this quarterly report, including: Centre for Public Health, Liverpool John Moores University; Children s Services; Citysafe; Health at Work; North West Public Health Observatory (NWPHO); Liverpool Primary Care Trust (PCT); Probation Service; and Trauma and Injury Intelligence Group (TIIG). 2

4 2 Consumption 2.1 Alcohol consumption surrounding the workplace Nationally, alcohol costs the economy 6.4 billion each year through factors such as sickness, reduced productivity, accidents and inability to work (Strategy Unit 23). commissioned the Centre for Public Health to investigate the impact of alcohol on workplaces in Liverpool. Researchers surveyed 32 local businesses, interviewed 1 company representatives and surveyed 62 employees (Harkins et al. 28). Findings highlight that: Employers believe overall consumption of alcohol amongst staff to be low, but are aware of occasions when consumption is likely to increase, such as during football matches. Nearly half (47%) of businesses provide alcohol to staff at least once a year (for example, at Christmas), although some do moderate consumption (for example, through a maximum quantity purchased). More than half (54%; see figure 2.1.1) think that alcohol contributes at least a little to staff absence. Nearly a third (31%) believe they are negatively affected by alcohol consumed by staff outside working hours. A fifth of employees (19%) had arrived in work with a hangover in the last two weeks and 12% would like to reduce their consumption. Two thirds (67%) of companies have an alcohol policy and 62.3% provide at least one form of support for alcohol-related issues (such as advice). Such companies are more likely to be large and well-established. Figure Percentage of businesses where alcohol affects sickness absence Percentage of businesses None A little Half A lot Don't know Proportion of absence Source: Harkins et al. (28) To tackle alcohol-related harm in the workplace, researchers recommended raising awareness amongst employers, especially smaller employers, on how alcohol can affect business, the importance of implementing suitable alcohol policies and the benefits of implementing initiatives. Further, researchers recommended developing initiatives that can be implemented by employers when consumption is likely to be elevated (such as during football matches) and identifying alternative Christmas party plans that do not include alcohol. 3

5 2.2 Alcohol consumption amongst young people In 26, the Centre for Public Health published a study on alcohol consumption and related risky behaviour amongst 15 and 16 year olds in the North West following a survey by Trading Standards (Bellis et al. 27). This survey was re-run in 27 and local findings specific to Liverpool were reported in the last quarterly report (Lightowlers et al. 27; Box 1). As in 26, the Centre for Public Health has further investigated the data to examine in more detail the relationships between consumption and related harm across the North West overall (no further examination was performed for local areas). The report was published in March 28 and key findings show (Hughes et al. 28): The majority (84%) of year olds in the North West drink alcohol. This is a decrease since 27 (88%); Two thirds (66%) drink at least monthly and 3% binge drink 1 weekly; Binge drinking was reported in all socio-economic groups but was more common amongst those from deprived areas; A third (34%) bought their own alcohol (a decrease from 4% in 27); and High levels of alcohol consumption were associated with greater risk of being involved in alcohol-related violence, having regretted sex and smoking. Box 1: Key findings for Liverpool from the 27 Trading Standards survey Over 4 questionnaires were returned from Liverpool (4%). Given the small number, results should be treated with caution. A larger proportion of year olds in Liverpool never drink (21%), compared with the North West overall (17%). Fewer drink frequently and fewer binge drink in Liverpool (18% regularly binge compared with 29% for the North West). In Liverpool, a higher proportion buy their own alcohol than the North West: 34% and 28% respectively, although both have fallen since 25. Those who had a hobby or were involved in sports were 1.59 times less likely to binge drink than those who did not, and those who were provided alcohol by their parents were 1.64 times less likely to binge drink. Researchers highlighted the importance of preventing underage sales, providing better health information to parents and delivering consistent messages on alcohol and related harms through education settings which can counteract alcohol advertising. 1 Binge drinking is defined here as drinking more than 5 or more drinks in one session. 4

6 3 Health related impacts of alcohol 3.1 Hospital attendances Accident and emergency presentations for assaults The Trauma and Injury Intelligence Group (TIIG) was set up to collect information on injuries across Merseyside and Cheshire from local accident and emergency (A&E) departments. Between 26 and 27, the overall number of assault attendances at the Royal Liverpool A&E decreased by 8%. The number of assaults does fluctuate over the course of the year. However, when comparing each month individually, ten months of the year saw a decrease in 27 when compared with 26 (Figure 3.1.1; Appendix 1 for figures). For January, this decrease has continued into 28. Figure 3.1.1: Number of assault attendances at the Royal Liverpool accident and emergency department* Number of assault attendances Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month * Please see Appendix 1 for a breakdown of the figures. Source: Anderson (26); Hungerford and Anderson (27); Anderson and Hungerford (28). Further information on assault attendances at the Royal Liverpool A&E department is collected through a questionnaire. This was completed by 18% (n=69) of the attendances between February 27 and January 28 (Hungerford and Anderson 28) 2. Latest data on assault attendances for February 27 to January 28 show that, where known: Over half (54%) of assaults occurred on the street. When looking at trend data, the number of assaults on the street decreased between 26 and 27 in most months. However, peaks can be seen in the summer for both 26 and 27. Conversely, assaults in pubs, bars and clubs tend to peak during the winter (please see Appendix 2). On average 69% of victims had been assaulted by a stranger. Whilst this annual average figure has remained consistent, on a month by month basis 2 Please note that during this period completion rates varied between 9 and 27%. 5

7 there have fluctuated dramatically (ranging from 42% to 86% between December 25 and March 28). The majority (87%) of attackers, where known, were male. The percentage of male attackers has remained fairly consistent, with an average of 84% for between December 25 and March 28 (ranging between 71% and 92%; see Appendix 2). In total, 56% had consumed alcohol in the three hour period prior to their assault. Whilst there are monthly fluctuations in the number of cases in which alcohol was consumed (ranging from 3% to 73% over this period; see Appendix 2), the overall average for December 25 to March 28 is also 56% Hospital admissions for young people The North West Public Health Observatory has recently published a report providing intelligence on young people s health for local authorities across the region (Deacon et al. 28). This report published details on a range of different topics, including hospital admissions for under 18s. Data on hospital admissions have previously been published under the Local Alcohol Profiles for England and reported in an earlier quarterly report (NWPHO 28; Lightowlers et al. 28), but the new report provides the information by gender. Estimates show that levels of alcohol-specific hospital admission in Liverpool are higher for girls than boys, consistent with the North West overall. For males, rates of such hospital admission are notably lower than the North West average but are slightly higher for females (figure 3.1.2). Figure 3.1.2: Rate of alcohol-specific hospital admission for under 18s from 23/4 to 25/6 for Liverpool and the North West Rate per 1, Liverpool North West Males Females Total Gender Source: Deacon et al. (28); NWPHO (28). 3.2 Other health-related impacts for young people The North West Public Health Observatory s report (Deacon et al. 28; see Section 3.1.2) went on to discuss a number of other topics which may also be strongly related to alcohol consumption. Levels of teenage conceptions and road traffic accidents will be discussed in this section Teenage conceptions The rate of teenage conceptions is linked with alcohol consumption as, for example: 6

8 Among sexually active 13 and 14 year olds, 4% say they were drunk or stoned at first intercourse (Wright et al. 1998). The effects of alcohol can reduce a young person s ability to assess risks, making them more likely to engage in unprotected sex (Alcohol Concern 22). Six per cent of year olds in the UK report having engaged in unprotected sex after drinking (Hibell et al. 24). Rates of teenage conception are very similar in Liverpool compared with the North West overall (figure 3.2.1) Figure 3.2.1: Rate of conception amongst year olds in 25 per 1, population in Liverpool and the North West Rate per 1, Liverpool North West Area Source: Deacon et al. (28) Road traffic accidents Alcohol is related to road accidents amongst young people both as passengers of the vehicle and as cyclists and pedestrians. Rates of young people killed or seriously injured in road traffic accidents in Liverpool are significantly higher than in the North West overall (figure 3.2.2), and in fact are the second highest in the region. However, it is not possible to say how many of these are attributable to alcohol. Figure 3.2.2: Rate of road traffic accidents where those aged under 16 were killed or seriously injured in 25 in Liverpool and the North West 2. Rate per 1, Liverpool North West Area Source: Deacon et al. (28) 7

9 4 Crime 4.1 Crime in Liverpool CitySafe has provided the Alcohol Strategy Group with data on alcohol-related crime in Liverpool since April 28. In the first three quarters of 27/8, the number of alcohol-related violent offences decreased, whilst figures have fluctuated for other crime types (see Box 2 for the associated explanation; Figure 4.1.1). These fluctuations may be due to seasonal trends. When all crimes are combined, a 2% reduction was seen between April to June 27 and January to March 28 (see Appendix 2 for a breakdown of figures). Box 2: Alcohol related crime The Strategy Unit has estimated the proportion of crimes that are related to alcohol, by crime type, based on the proportion of positive urine tests in arrestees (Table 4.1; Strategy Unit 23). These proportions have been applied to crime data collected locally by Citysafe. These are the latest and most reliable figures available but caution should be used when interpreting the data. Table 4.1: Percentage of crimes estimated to be related to alcohol in England Crime type Percentage related to alcohol Criminal damage 47% Violence against the person 37% Other offences 26% Drug offences 19% Burglary 17% Fraud and forgery 16% Sexual offences 13% Theft and handling of stolen goods 13% Robbery 12% Source: Strategy Unit 23 8

10 Figure 4.1.1: Number of offences related to alcohol in Liverpool, April 27 to March 28* April - June 27 Number of offences July - September 27 October - December 27 January - March Criminal Damage Violence against the person Theft and handling of stolen goods Burglary Domestic Drug Offences Fraud and Forgery Robbery Other Offences Crime type * Please see Appendix 2 for figures. Source: Citysafe recorded crime data. 4.2 Probation service The Probation Service assesses offenders who are placed on community orders 3 for their level of alcohol need. Need is then scored from one to nine, with a score of higher than four indicating a serious criminogenic alcohol need. This is where alcohol consumption is directly related to the criminal behaviour, and the offender will be more likely to re-offend unless the need is tackled. Key figures from the Probation Service show: Between January and March 28, 53% (n=744) of the offenders on community orders had a criminogenic alcohol need; This need was more prevalent in male offenders compared with female (49% compared with 55%); and Violence was the most common offence type for those offenders with an alcohol need (3% or 222 of all offenders with an alcohol need). Previous data from the Probation Service have been submitted, but because they were provided in a different format, no trend data are yet available for comparison. 3 A community order is a bespoke community-based sentence supervised by a probation officer and can include curfews, compulsory unpaid work and attending drug and / or alcohol treatment. 9

11 5 Other alcohol impacts The North West Public Health Observatory s report (Deacon et al. 28; see section 3.1.2) went on to discuss a number of other topics which may also be strongly related to alcohol consumption. Potential impacts on education will be discussed here. 5.1 Impacts on education Educational attainment Research has shown an association between poor school performance and risky drinking patterns. In a study of Norwegian school students, alcohol intoxication was associated with fewer hours spent on homework and poorer school grades (Wichstrom 1998). Educational attainment at GCSE level is slightly lower in Liverpool than in the North West overall (figure 5.1.1). However, it is not possible to say what proportion of this is attributable to alcohol. Figure 5.1.1: Percentage of pupils achieving five or more A*-C grades at GSCE (or equivalent) in 25/6 in Liverpool and the North West Percentage Liverpool North West Source: Deacon et al. (28) Area School absence Alcohol is associated with school absence: among year olds in London, more than two-thirds of frequent excessive drinkers reported having been repeatedly truant from school (Best et al. 26). Levels of absence in schools are higher in Liverpool than in the North West overall (figure 5.1.2). Again, it is not possible to say what proportion of this is attributable to alcohol. Figure 5.1.2: Absence in schools as a percentage of pupil half days missed in 25/6 in Liverpool and the North West 12 Percentage Liverpool North West Absence in primary schools Absence in secondary schools Unauthorised absence Absence from school Source: Deacon et al. (28) 1

12 5.1.3 School exclusions School exclusions are also associated with alcohol: in England and Wales, between 13 and 15% of suspensions from school were for drinking alcohol on site (Youth Justice Board 22). Figure 5.1.3: Percentage of pupils excluded in 25/6 in Liverpool and the North West Percentage Source: Deacon et al. (28) Fixed period Permanent School exclusions Liverpool North West Local data from Children s Services show that in the financial year 27/8 there were 26 exclusions due to drugs or alcohol. Nineteen were fixed term exclusions and seven were permanent exclusions (see Box 3). There are fluctuations over the year (see figure 5.1.4); with low levels in July to September due to the school holidays. Box 3: School exclusions data School exclusions are defined as those students temporarily excluded or excluded for a fixed term from primary, secondary or specialist schools in Liverpool, including permanent exclusions. Figure 5.1.4: Number of school exclusions due to drugs and alcohol by quarter for 27/8 Number of exclusions Apr to Jun 7 Jul to Sept 7 Oct to Dec 7 Jan to Mar 8 Quarter Source: Children s Services. 11

13 6 Examples of initiatives to tackle excessive alcohol consumption This section gives an overview of some of the current or recent initiatives in Liverpool aiming to tackle alcohol-related harm. 6.1 Marketing campaign Liverpool Primary Care Trust s (PCT) alcohol social marketing campaign, PSSST!, promotes work and initiatives surrounding alcohol in Liverpool. Although no press releases have been issued since January 28, six were issued from October to December 27 covering a range of different topics 4. Section 7.5 discusses the developments from one of these press releases in more detail. 6.2 Best Bar None The Best Bar None initiative and annual awards are designed to reward and promote a responsible licensed trade. Liverpool John Moores University's Student Union was awarded Best Independent Premises at the most recent awards for the second year running. It was praised for both promoting safe drinking and for staff training. 6.3 Health@Work Liverpool is a major centre for economic activity in the North West and hosts over 13, businesses (Liverpool City Council 26). In January to March 28 Health@Work (see Box 4) worked with 12 businesses in Liverpool to raise alcohol awareness and 9 of these businesses produced alcohol policies with the assistance of Health@Work. The Clarity alcohol campaign was ran during November and December 27. During this campaign, Health@Work visited 1526 businesses, distributed 1527 information packs and 669 alcohol policy guidebooks, as all the remaining businesses had alcohol policies in place. Figure 6.3.1: Health@Work activities with local businesses Box 4: Health@Work Health at Work is a charity assisting organisations to address health related issues in the workplace, including alcohol-related problems or harm, such as absenteeism. Number of companies in Liverpool Jan- Mar 7 April- June July- Sept 7 Oct - Dec 7 Jan- Mar 8 Worked with to raise awareness Policies produced Quarter

14 6.4 Underage test purchasing There have been no underage alcohol test purchases in the last quarter (January to March 28) due to other operational priorities taking precedence. Previous reports have highlighted that both on and off-licensed premises have sold alcohol to young people in approximately 2% of underage test purchases (based on data since June 27 to December 27). Previous data is produced in table below to show trends and for convenient reference. Table 6.4.1: Underage alcohol test purchases in Liverpool Number of sales Number of refusals Total number targeted % resulting in a sale April-June July-September October-December January-March April-June July-September October-December 8 8 January-March April-June July-September October-December January-March April-June

15 7 Thematic focus: 18 to 25 year old binge drinkers The 18 to 25 year old population is strongly associated with involvement in binge drinking, alcohol-related violence and disorder in town and city centres (Krug et al. 22; McVeigh et al. 25). Such injury and harm brings with it associated public health and criminal justice costs as well as economic impacts such as lost productivity and loss of earnings. A minority of offenders within this age category (predominantly males) are considered to be responsible for a disproportionate volume of alcohol-related offences (Maguire and Brookman 25) and changes in licensing laws are accompanied with concerns about levels of violent assault and accident and emergency (A&E) admissions. 7.1 Consumption National surveys Weekly levels of alcohol consumption are highest amongst 16 to 24 year olds, and have been for a number of years (figure 7.1.1). Consumption is higher still amongst males but the gap in levels of consumption between young men and women is narrowing, with women s consumption increasing. The decrease in consumption between 22 and 25 may be due to survey changes, asking about units consumed rather than the number of glasses (which vary in size). Figure displays higher levels of binge drinking 5 amongst the younger age groups and males. Figure 7.1.1: Percentage of men and women exceeding maximum limits of weekly alcohol consumption* in Great Britain, Percentage exceeding weekly units * 21 units for males; 14 for females Source: Goddard Year Men Men aged Women Women aged Drinking eight or more units in one day for men and six or more units for women (DH 25). 14

16 Figure 7.1.2: Percentage of binge drinkers* on at least one day in the last week in Great Britain Percentage of respondents Age group Male Female * Drinking more than eight units for males; more than six units for females. Source: Goddard Local estimates of consumption Intelligence has been published that provide local estimates of consumption: The Local Alcohol Profiles for England (LAPE) online tool 6 provides data on various alcohol-related issues, including binge drinking 7. Binge drinking in Liverpool is estimated to be significantly worse than both the North West and England averages (Figure 7.1.3). Indeed Liverpool has the second highest level of binge drinking in the North West and the seventh highest in England. However, this tool does not provide estimates of consumption for specific age groups. Figure 7.1.3: Binge drinking estimates in Liverpool compared with the North West and England for 22 to 25 Percentage of population (synthetic estimate) Liverpool North West England Area Source: NWPHO 27 Elevated levels of consumption and related harm are found amongst young people in the night-time economy (Anderson et al. 27). To investigate this further in Liverpool, the Centre for Public Health was 6 The Local Alcohol Profiles for England can be found at 7 Drinking more than eight units for males; more than six units for females. 15

17 commissioned to run a survey of year olds in Liverpool who visit pubs, bars and clubs (n=38). It found that the majority (84%) of those accessing Liverpool s nightlife did so at least once a week and three quarters (77%) always drank on a night out in Liverpool. The survey established greater risk of increased consumption amongst those that drink at home or a friend s home prior to going out. There was a significant difference in the volume of alcohol consumed on a night out between those who drank prior to going and out and those who did not; those who drank prior to going out consumed greater quantities overall (Anderson et al. 27). A survey of Liverpool students (n=3) for the Pssst! marketing campaign evaluation highlighted that 77% of students drink alcohol at least weekly (Alchemy Research 28). Of those who drink, an average of 2 units a week was consumed and on average, students exceeded unit limits 1.3 times each week. They perceived alcohol s main benefit as increased sociability (49%). The most common precautions taken when planning a night out were: travelling home with friends (64%), eating before going out (52%) and making travel plans in advance (43%). 7.2 Alcohol-related violence Approximately half of violent assaults in the UK are related to alcohol (Nicholas et al. 27). To monitor assaults, a number of accident and emergency (A&E) departments in Merseyside such as the Royal Liverpool ask patients to complete a questionnaire providing further details of the incident. General details on the number of assaults presenting to the Royal are discussed in Section The most recent six monthly data from the Royal Liverpool A&E show that: Between August 27 and January 28, young people aged were the most common age group presenting to A&E due to an assault. Young people were also the most likely to have been drinking prior to their assault (Figure 7.4). Nearly two thirds (61%) of year old assault attendees had been drinking prior to their assault. Males are also more likely to be involved: 87% of perpetrators in assaults were male (Hungerford and Anderson 28). Figure 7.2.1: Percentage of assault attendances* to the Royal Liverpool accident and emergency department who had been drinking prior to their assault, by age group in August 27 to January 28. Percentage of assault attendances plus Age group * Data are only for attendees completing the assault survey Source: TIIG data. 16

18 Nightlife and related binge drinking are often associated with increased levels of violence. Nearly a fifth of assaults (18% 8 ) presenting to the Liverpool Royal A&E occur in bars and nightclubs. Further, over two thirds (69%) of those who had been drinking prior to their assault had purchased or consumed their last alcoholic beverage in a pub, bar or nightclub (Hungerford and Anderson 28) Local surveys A survey of year olds in Liverpool (Section 7.1.2) shows that (Anderson et al. 27): Nearly two thirds thought levels of violence in Liverpool at night were very or fairly low; Three quarters had witnessed a fight and one in ten had been involved in a fight in the last year; Participants who had been involved in a fight drank significantly more alcohol than those who had not (21.3 units compared to 17.7 units); Nearly two thirds of the reported fights were not attended by the police and were not reported to the police; and Those who drank prior to going out were more likely to have been involved in a fight in the last year. Further, a study of Liverpool students (Section 7.1.2) showed that a fifth (21%) had been involved in or knew a friend that had been involved in a fight in the last two to three months and 13% had required or knew a friend who had required medical help. 7.3 Alcohol-related mortality Although no local data exist, national intelligence shows levels of mortality due to liver cirrhosis 9 have increased dramatically in the last thirty years: between 1979 and 25, the number of year olds dying due to liver cirrhosis has increased sevenfold (Thomson et al. 28). This increase is thought to be related to the trend towards binge drinking and the associated increased risk amongst younger age groups (Morleo et al. 28). 8 This figure is calculated from the total number of patients that completed the assault patient questionnaire. Of all assault attendances 23% (n = 357) filled in this questionnaire between August 27 to January Approximately half of liver cirrhosis cases are thought to be related to alcohol (Strategy Unit 23). 17

19 7.4 Alcohol treatment In 25/6 1,691 of those living in Liverpool PCT were accessing alcohol treatment services and 5% of these are aged under 24 years (two thirds (66%) are aged between 3 and 54 years; see figure 7.4.1). It is possible that younger people are not being effectively reached by these services may be accessing treatment through drug services as poly-drug users rather than through alcohol-specific services. This is because the average age of alcohol misusers doing so is significantly lower than the average age for those accessing alcohol services (33 years in drugs services as opposed to 47 years respectively) (Morleo et al. 27). Figure 7.4.1: Percentage of those in contact with alcohol and drug treatment services for alcohol who are resident in Liverpool Primary Care Trust in 25/6 by age and gender 2 Percentage Female Male Under Age group Source: Alcohol Treatment Monitoring System and National Drug Treatment Monitoring System (27). 7.5 Initiatives Over winter, a Chill out cabin toured Liverpool city centre at night, encouraging students to take a break from drinking on a night out. Beneficiaries of the cabin had access to educational information on alcohol, health, personal safety and transport options to and from the city centre as well as complimentary alternative therapies, water and mocktails (cocktails that do not contain alcohol). The cabin was operational for 19 nights and received over 3, visitors. 18

20 8 References Alchemy Research Associates (ARA) (28). PSSST! Campaign evaluation research. ARA. Alcohol Concern (22). Alcohol and teenage pregnancy. London; Alcohol Concern. Anderson Z (26). Royal Liverpool accident and emergency department monthly bulletin: April 25 to March 26. Trauma and Injury Intelligence Group, Centre for Public Health, Liverpool John Moores University. Anderson Z, Hughes K, Bellis MA (27). Exploration of young people s experience and perceptions of violence in Liverpool s nightlife. Centre for Public Health, Liverpool John Moores University. Anderson Z, Hungerford D (28). The Royal accident and emergency department: assault and last drink location yearly report January 27 to February 28 and additional Trauma Injury and Intelligence (TIIG) analysis for this report. Trauma Injury and Intelligence Group, Centre for Public Health, Liverpool John Moores University. Bellis MA, Hughes K, Morleo M et al. (28). Patterns of risky alcohol consumption in North West teenagers and their implications for preventing alcohol-related harm. Centre for Public Health, Liverpool John Moores University. Best D, Manning V, Gossop M et al. (26). Excessive drinking and other problem behaviours among year old children. Addictive Behaviours. 31(8): CI Research (27). Trading Standards North West (TSNW) Alcohol survey of young people. TSNW. Deacon L, Harrison R, Jones A et al. (28). North West Children and Young People's Health Indicators. North West Public Health Observatory, Centre for Public Health, Liverpool John Moores University. Department of Health (DH) (25). Alcohol Needs Assessment Research Project (ANARP): the 24 national alcohol needs assessment for England. DH, London. Goddard E (28) Smoking and drinking among adults 26. Office for National Statistics, London. Hibell B, Andersson B, Bjarnasson T et al. (24). The 23 ESPAD report: alcohol and other drugs use among students in 35 European countries. Stockholm, Swedish Council for Information on Alcohol and Other Drugs. Hughes S, Bellis MA, Hughes K, Tocque K, et al. (28). Risky drinking in North West school children and its consequences: a study of fifteen and sixteen year olds. Centre for Public Health, Liverpool John Moores University. Hungerford D, Anderson Z (27). Royal Liverpool accident and emergency department monthly bulletin: January to December 27. Trauma Injury and Intelligence Group, Centre for Public Health, Liverpool John Moores University. Hungerford D, Anderson Z (28). Royal Liverpool accident and emergency department monthly bulletin: February 27 to January 28. Trauma Injury and Intelligence Group, Centre for Public Health, Liverpool John Moores University. Krug EG, Dahlberg LL, Mercy JA et al. (22) (eds). World report on violence and health. Geneva: World Health Organization. Lightowlers C, Morleo M, Cook PA (28). The impact of alcohol in Liverpool: quarterly report. Centre for Public Health, Liverpool John Moores University. Liverpool City Council (26). Key statistics bulletin. Issue 3: December 26. Liverpool City Council. McVeigh J, Morleo M Khundakar K et al. (26). Alcohol treatment in Cheshire and Merseyside 25/6. Centre for Public Health, Liverpool John Moores University. Maguire M, Brookman F (25). Violent and sexual crime: handbook of crime prevention and community safety. N. Tilley. Devon, Willan Publishing: McVeigh C, Hughes K, Bellis MA (25). Violent Britain: people, prevention and public health. Centre for public health, Liverpool John Moores University. Morleo M, Lushey C and Hughes K (27). The impact of alcohol in Liverpool: quarterly report February 27. Centre for Public Health, Liverpool John Moores University. 19

21 Morleo M, Phillips-Howard P, Cook PA et al. (28). Fact sheet 1: tolerance and perceptions of drinking. Centre for Public Health, Liverpool John Moores University. Nicholas S, Kershaw C, Walker A (27). Crime in England and Wales 26/7. Home Office Statistical Bulletin 11/7. Home Office, London. North West Public Health Observatory (NWPHO) (27). Local Alcohol Profiles for England (LAPE). Online tool. NWPHO. ( Phillips-Howard P, Morleo M, Cook PA et al. (28). Fact Sheet 2: Alcohol availability to underage drinkers. Centre for Public Health, Liverpool John Moores University. Strategy Unit (23). Alcohol misuse: how much does it cost? Cabinet Office, London. ( Wagenaar A, Toomey T (22). Effects of minimum drinking age laws: review and analyses of the literature from 196 to 2. Journal of Studies on Alcohol. Supplement 14: Wichstrom L (1998). Alcohol intoxication and school dropout. Drug and Alcohol Review. 17: Wright S, Moran L, Meyrick M et al. (1998). Intervention by an alcohol health worker in an Accident and Emergency Department. Alcohol and Alcoholism, 35: Youth Justice Board (22). Youth Survey 22. Research study conducted for the Youth Justice Board, January March 22. MORI Social Research, London. 2

22 9 Appendices Appendix 1: Number of assault attendances at the Royal Liverpool accident and emergency department by month, January 26 to January 28. Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Total , , Source: TIIG Appendix 2: Breakdown of assault attendances at the Royal Liverpool accident and emergency department for whom an assault patient questionnaire was completed for December 25 to March 28. Figure 8.2.1: Percentage of those assaults, where known, that occurred on the street.* Percentage Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month * Figures are available on request. Source: TIIG 21

23 Figure 8.2.2: Percentage of those assaults, where known, that occurred in pubs, bars or clubs.* Percentage Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month * Figures are available on request. Source: TIIG Figure 8.2.3: Percentage of those assaults, where known, in which the assailant was a stranger.* Percentage Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month * Figures are available on request. Source: TIIG 22

24 Figure 8.2.4: Percentage of those assaults, where known, in which the attendee had been drinking in the three hours prior to the assault.* 8 Percentage Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month * Figures are available on request. Source: TIIG Appendix 3: Total numbers of crimes attributable to alcohol in Liverpool by quarter and type, April 27 to March 25. April June 27 July September 27 October December 27 January March 28 Criminal Damage Violence against the person Theft and handling of stolen goods Burglary Domestic Drug Offences Fraud and Forgery Robbery Other Offences Sexual Offences Total* * Figures may not add up due to rounding. Please note that the total figure is a total of the listed offences and does not include other non-domestic burglaries for which there is no known attributable fraction. Source: Citysafe recorded crime figures. 23