A natural experiment combined with a novel statistical method to evaluate the impact of local alcohol licensing on health and crime

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Nora Murphy
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1 A natural experiment combined with a novel statistical method to evaluate the impact of local alcohol licensing on health and crime F. de Vocht 1,2, Kate Tilling 1,2, Triantafyllos Pliakas 1,3, Colin Angus 1,4, Matt Egan 1,3, Alan Brennan 1,4, Rona Campbell 1,2, Matthew Hickman 1,2 1 NIHR School for Public Health Research (SPHR). 2 School of Social and Community Medicine, University of Bristol, Bristol, UK 3 London School of Hygiene and Tropical Medicine, London, UK 4 ScHARR, School of Health and Related Research, University of Sheffield, Sheffield, UK

4 Background o Variation in local implementation of alcohol licensing policies, including CIZ, is associated with weak evidence of public health improvement o Limitation of observational studies is that they determine correlations rather than causations o However, this local and temporal variation enables the design of natural experiments o These can provide stronger evidence of a causal effect o...but how to do this? licensing-decisions-by-local-authorities-can-reduce-alcohol-related-hospitaladmissions /stricter-alcohol-licensing-policies-were-linked-to-declines-in-crime-rates

5 The Problem See if outcome changes after intervention Compare trend with that in other area with available data Compare trend with neighbouring area Compare trend with comparable area (but how do you know?)

8 Bayesian structural time series.combined with slab n spike priors.in 8 pictures

11 The impact of local alcohol licensing on health and crime o Home Office licensing data linked at LTLA-level to alcohol-related hospital admissions violent and sexual crimes rates anti-social behaviour rates o Intervention areas were local areas where a CIZ and increased licensing enforcement were introduced in 2011 (n=5) o Control areas were those where neither were present throughout (n=86)

12 Alcohol-related Hospital Admissions Slide removed

13 Alcohol-related Violent Crimes Slide removed

14 Meta-analytic Results Slide removed

15 Control analyses Slide removed

16 The impact of local alcohol licensing on health and crime o The introduction of a CIZ and simultaneous increase in licensing enforcement intensity was associated with: Alcohol-related hospital admissions: -6% (-13%, 0%) ar-violent crimes (esp. <2014): -5% (-11%, 1%) ar-sexual crimes (<2014): -8% (-21%, 5%) ar-anti-social behaviour: Insufficient evidence of effect

19 Conclusions o Moderate reductions in alcohol-related hospital admissions and violent and sexual crimes associated with introduction alcohol licensing policies o This novel methodology holds promise for use in other natural experiments in public health o.but relies upon stable trends prior to the intervention.

Future work o SPHR 2 new research proposal Important limitation to public health having significant impact in the licensing arena is lack of public health evidence around individual premises For

20 Future work o SPHR 2 new research proposal Important limitation to public health having significant impact in the licensing arena is lack of public health evidence around individual premises For example, evidence on the potential impact of a new nightclub opening in a specific area on crime rates or ambulance call-outs Beneficial if evaluation of impact could be done at very small geospatial level (i.e. street or single premises) Would supplement of case law and other sources of evidence (if available)

Funders: NIHR School for Public Health Research The views are those of the authors(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

21 Funders: NIHR School for Public Health Research The views are those of the authors(s) and not necessarily those of the NHS, the NIHR or the Department of Health. SPHR is a partnership between the Universities of Sheffield; Bristol; Cambridge; Exeter; UCL; The London School for Hygiene and Tropical Medicine; the LiLaC collaboration between the Universities of Liverpool and Lancaster and Fuse; The Centre for Translational Research in Public Health, a collaboration between Newcastle, Durham, Northumbria, Sunderland and Teesside Universities. For further details:

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