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All-Wales Licensed Premises Intervention (AWLPI): a randomised controlled trial of an intervention to reduce alcohol-related violence

Simon C Moore, Mohammed Fasihul Alam, David Cohen, Kerenza Hood, Chao Huang, Simon Murphy, Rebecca Playle, Laurence Moore, Jonathan Shepherd, Vaseekaran Sivarajasingam, Irena Spasic, Helen Stanton, Anne Williams, Fasihul Alam

Public Health Research, Volume: 3, Issue: 10, Pages: 1 - 152

Swansea University Author: Fasihul Alam

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DOI (Published version): 10.3310/phr03100

Abstract

Background:Violence in and around premises licensed for the on-site sale and consumption of alcohol continues to burden the NHS with assault-related injuries.Trial design:A randomised controlled trial with licensed premises as the unit of allocation, with additional process and cost-effectiveness ev...

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Published in: Public Health Research
Published: 2015
URI: https://cronfa.swan.ac.uk/Record/cronfa29233
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2016-07-18T11:43:26.8036246</datestamp><bib-version>v2</bib-version><id>29233</id><entry>2016-07-18</entry><title>All-Wales Licensed Premises Intervention (AWLPI): a randomised controlled trial of an intervention to reduce alcohol-related violence</title><swanseaauthors><author><sid>642c9290a11352cb60741fc2b1004f6d</sid><ORCID/><firstname>Fasihul</firstname><surname>Alam</surname><name>Fasihul Alam</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2016-07-18</date><deptcode>HHE</deptcode><abstract>Background:Violence in and around premises licensed for the on-site sale and consumption of alcohol continues to burden the NHS with assault-related injuries.Trial design:A randomised controlled trial with licensed premises as the unit of allocation, with additional process and cost-effectiveness evaluations.Methods:Premises were eligible (n&#x2009;=&#x2009;837) if they were licensed for on-site sale and consumption of alcohol, were within 1 of the 22 local authorities (LAs) in Wales and had previously experienced violence. Data were analysed using Andersen&#x2013;Gill recurrent event models in an intention-to-treat analysis. An embedded process evaluation examined intervention implementation, reach, fidelity, dose and receipt. An economic evaluation compared costs of the intervention with benefits.Intervention:Premises were randomised to receive a violence-reduction intervention, Safety Management in Licensed Environments (SMILE), which was delivered by an environmental health practitioner (EHP; the agent). SMILE consisted of an initial risk audit to identify known risks of violence, a follow-up audit scheduled to enforce change for premises in which serious risks had been identified, structured advice from EHPs on how risks could be addressed in premises and online materials that provided educational videos and related material.Objective:To develop intervention materials that are acceptable and consistent with EHPs&#x2019; statutory remit; to determine the effectiveness of the SMILE intervention in reducing violence; to determine reach, fidelity, dose and receipt of the intervention; and to consider intervention cost-effectiveness.Outcome:Difference in police-recorded violence between intervention and control premises over a 455-day follow-up period.Randomisation:A minimum sample size of 274 licensed premises per arm was required, rounded up to 300 and randomly selected from the eligible population. Licensed premises were randomly assigned by computer to intervention and control arms in a 1&#x2009;:&#x2009;1 ratio. Optimal allocation was used, stratified by LA. Premises opening hours, volume of previous violence and LA EHP capacity were used to balance the randomisation. Premises were dropped from the study if they were closed at the time of audit.Results:SMILE was delivered with high levels of reach and fidelity but similar levels of dose to all premises, regardless of risk level. Intervention premises (n&#x2009;=&#x2009;208) showed an increase in police-recorded violence compared with control premises (n&#x2009;=&#x2009;245), although results are underpowered. An initial risk audit was less effective than normal practice (hazard ratio&#x2009;=&#x2009;1.34, 95% confidence interval 1.20 to 1.51) and not cost-effective. Almost all eligible intervention premises (98.6%) received the initial risk audit; nearly 40% of intervention practices should have received follow-up visits but fewer than 10% received one. The intervention was acceptable to EHPs and to some premises staff, but less so for smaller independent premises.Conclusions:SMILE was associated with an increase in police-recorded violence in intervention premises, compared with control premises. A lack of follow-up enforcement visits suggests implementation failure for what was seen as a key mechanism of action. There are also concerns as to the robustness of police data for targeting and assessing outcome effectiveness, while intervention premises may have received greater attention from statutory agencies and, therefore, the identification of more violence than control premises. Although SMILE had high reach and was feasible and acceptable to EHPs, it was found to be ineffective and associated with increased levels of violence, compared with normal practice and it requires additional work to promote the implementation of follow-up enforcement visits. Future work will aim to better understand the role of intervention dose on outcomes and seek more objective measures of violence for use in similar trials.</abstract><type>Journal Article</type><journal>Public Health Research</journal><volume>3</volume><journalNumber>10</journalNumber><paginationStart>1</paginationStart><paginationEnd>152</paginationEnd><publisher/><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic/><keywords/><publishedDay>30</publishedDay><publishedMonth>9</publishedMonth><publishedYear>2015</publishedYear><publishedDate>2015-09-30</publishedDate><doi>10.3310/phr03100</doi><url/><notes/><college>COLLEGE NANME</college><department>Swansea Centre for Health Economics</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HHE</DepartmentCode><institution>Swansea University</institution><apcterm/><lastEdited>2016-07-18T11:43:26.8036246</lastEdited><Created>2016-07-18T11:43:26.8036246</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">School of Health and Social Care</level></path><authors><author><firstname>Simon C</firstname><surname>Moore</surname><order>1</order></author><author><firstname>Mohammed Fasihul</firstname><surname>Alam</surname><order>2</order></author><author><firstname>David</firstname><surname>Cohen</surname><order>3</order></author><author><firstname>Kerenza</firstname><surname>Hood</surname><order>4</order></author><author><firstname>Chao</firstname><surname>Huang</surname><order>5</order></author><author><firstname>Simon</firstname><surname>Murphy</surname><order>6</order></author><author><firstname>Rebecca</firstname><surname>Playle</surname><order>7</order></author><author><firstname>Laurence</firstname><surname>Moore</surname><order>8</order></author><author><firstname>Jonathan</firstname><surname>Shepherd</surname><order>9</order></author><author><firstname>Vaseekaran</firstname><surname>Sivarajasingam</surname><order>10</order></author><author><firstname>Irena</firstname><surname>Spasic</surname><order>11</order></author><author><firstname>Helen</firstname><surname>Stanton</surname><order>12</order></author><author><firstname>Anne</firstname><surname>Williams</surname><order>13</order></author><author><firstname>Fasihul</firstname><surname>Alam</surname><orcid/><order>14</order></author></authors><documents/><OutputDurs/></rfc1807>
spelling 2016-07-18T11:43:26.8036246 v2 29233 2016-07-18 All-Wales Licensed Premises Intervention (AWLPI): a randomised controlled trial of an intervention to reduce alcohol-related violence 642c9290a11352cb60741fc2b1004f6d Fasihul Alam Fasihul Alam true false 2016-07-18 HHE Background:Violence in and around premises licensed for the on-site sale and consumption of alcohol continues to burden the NHS with assault-related injuries.Trial design:A randomised controlled trial with licensed premises as the unit of allocation, with additional process and cost-effectiveness evaluations.Methods:Premises were eligible (n = 837) if they were licensed for on-site sale and consumption of alcohol, were within 1 of the 22 local authorities (LAs) in Wales and had previously experienced violence. Data were analysed using Andersen–Gill recurrent event models in an intention-to-treat analysis. An embedded process evaluation examined intervention implementation, reach, fidelity, dose and receipt. An economic evaluation compared costs of the intervention with benefits.Intervention:Premises were randomised to receive a violence-reduction intervention, Safety Management in Licensed Environments (SMILE), which was delivered by an environmental health practitioner (EHP; the agent). SMILE consisted of an initial risk audit to identify known risks of violence, a follow-up audit scheduled to enforce change for premises in which serious risks had been identified, structured advice from EHPs on how risks could be addressed in premises and online materials that provided educational videos and related material.Objective:To develop intervention materials that are acceptable and consistent with EHPs’ statutory remit; to determine the effectiveness of the SMILE intervention in reducing violence; to determine reach, fidelity, dose and receipt of the intervention; and to consider intervention cost-effectiveness.Outcome:Difference in police-recorded violence between intervention and control premises over a 455-day follow-up period.Randomisation:A minimum sample size of 274 licensed premises per arm was required, rounded up to 300 and randomly selected from the eligible population. Licensed premises were randomly assigned by computer to intervention and control arms in a 1 : 1 ratio. Optimal allocation was used, stratified by LA. Premises opening hours, volume of previous violence and LA EHP capacity were used to balance the randomisation. Premises were dropped from the study if they were closed at the time of audit.Results:SMILE was delivered with high levels of reach and fidelity but similar levels of dose to all premises, regardless of risk level. Intervention premises (n = 208) showed an increase in police-recorded violence compared with control premises (n = 245), although results are underpowered. An initial risk audit was less effective than normal practice (hazard ratio = 1.34, 95% confidence interval 1.20 to 1.51) and not cost-effective. Almost all eligible intervention premises (98.6%) received the initial risk audit; nearly 40% of intervention practices should have received follow-up visits but fewer than 10% received one. The intervention was acceptable to EHPs and to some premises staff, but less so for smaller independent premises.Conclusions:SMILE was associated with an increase in police-recorded violence in intervention premises, compared with control premises. A lack of follow-up enforcement visits suggests implementation failure for what was seen as a key mechanism of action. There are also concerns as to the robustness of police data for targeting and assessing outcome effectiveness, while intervention premises may have received greater attention from statutory agencies and, therefore, the identification of more violence than control premises. Although SMILE had high reach and was feasible and acceptable to EHPs, it was found to be ineffective and associated with increased levels of violence, compared with normal practice and it requires additional work to promote the implementation of follow-up enforcement visits. Future work will aim to better understand the role of intervention dose on outcomes and seek more objective measures of violence for use in similar trials. Journal Article Public Health Research 3 10 1 152 30 9 2015 2015-09-30 10.3310/phr03100 COLLEGE NANME Swansea Centre for Health Economics COLLEGE CODE HHE Swansea University 2016-07-18T11:43:26.8036246 2016-07-18T11:43:26.8036246 Faculty of Medicine, Health and Life Sciences School of Health and Social Care Simon C Moore 1 Mohammed Fasihul Alam 2 David Cohen 3 Kerenza Hood 4 Chao Huang 5 Simon Murphy 6 Rebecca Playle 7 Laurence Moore 8 Jonathan Shepherd 9 Vaseekaran Sivarajasingam 10 Irena Spasic 11 Helen Stanton 12 Anne Williams 13 Fasihul Alam 14
title All-Wales Licensed Premises Intervention (AWLPI): a randomised controlled trial of an intervention to reduce alcohol-related violence
spellingShingle All-Wales Licensed Premises Intervention (AWLPI): a randomised controlled trial of an intervention to reduce alcohol-related violence
Fasihul Alam
title_short All-Wales Licensed Premises Intervention (AWLPI): a randomised controlled trial of an intervention to reduce alcohol-related violence
title_full All-Wales Licensed Premises Intervention (AWLPI): a randomised controlled trial of an intervention to reduce alcohol-related violence
title_fullStr All-Wales Licensed Premises Intervention (AWLPI): a randomised controlled trial of an intervention to reduce alcohol-related violence
title_full_unstemmed All-Wales Licensed Premises Intervention (AWLPI): a randomised controlled trial of an intervention to reduce alcohol-related violence
title_sort All-Wales Licensed Premises Intervention (AWLPI): a randomised controlled trial of an intervention to reduce alcohol-related violence
author_id_str_mv 642c9290a11352cb60741fc2b1004f6d
author_id_fullname_str_mv 642c9290a11352cb60741fc2b1004f6d_***_Fasihul Alam
author Fasihul Alam
author2 Simon C Moore
Mohammed Fasihul Alam
David Cohen
Kerenza Hood
Chao Huang
Simon Murphy
Rebecca Playle
Laurence Moore
Jonathan Shepherd
Vaseekaran Sivarajasingam
Irena Spasic
Helen Stanton
Anne Williams
Fasihul Alam
format Journal article
container_title Public Health Research
container_volume 3
container_issue 10
container_start_page 1
publishDate 2015
institution Swansea University
doi_str_mv 10.3310/phr03100
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care
document_store_str 0
active_str 0
description Background:Violence in and around premises licensed for the on-site sale and consumption of alcohol continues to burden the NHS with assault-related injuries.Trial design:A randomised controlled trial with licensed premises as the unit of allocation, with additional process and cost-effectiveness evaluations.Methods:Premises were eligible (n = 837) if they were licensed for on-site sale and consumption of alcohol, were within 1 of the 22 local authorities (LAs) in Wales and had previously experienced violence. Data were analysed using Andersen–Gill recurrent event models in an intention-to-treat analysis. An embedded process evaluation examined intervention implementation, reach, fidelity, dose and receipt. An economic evaluation compared costs of the intervention with benefits.Intervention:Premises were randomised to receive a violence-reduction intervention, Safety Management in Licensed Environments (SMILE), which was delivered by an environmental health practitioner (EHP; the agent). SMILE consisted of an initial risk audit to identify known risks of violence, a follow-up audit scheduled to enforce change for premises in which serious risks had been identified, structured advice from EHPs on how risks could be addressed in premises and online materials that provided educational videos and related material.Objective:To develop intervention materials that are acceptable and consistent with EHPs’ statutory remit; to determine the effectiveness of the SMILE intervention in reducing violence; to determine reach, fidelity, dose and receipt of the intervention; and to consider intervention cost-effectiveness.Outcome:Difference in police-recorded violence between intervention and control premises over a 455-day follow-up period.Randomisation:A minimum sample size of 274 licensed premises per arm was required, rounded up to 300 and randomly selected from the eligible population. Licensed premises were randomly assigned by computer to intervention and control arms in a 1 : 1 ratio. Optimal allocation was used, stratified by LA. Premises opening hours, volume of previous violence and LA EHP capacity were used to balance the randomisation. Premises were dropped from the study if they were closed at the time of audit.Results:SMILE was delivered with high levels of reach and fidelity but similar levels of dose to all premises, regardless of risk level. Intervention premises (n = 208) showed an increase in police-recorded violence compared with control premises (n = 245), although results are underpowered. An initial risk audit was less effective than normal practice (hazard ratio = 1.34, 95% confidence interval 1.20 to 1.51) and not cost-effective. Almost all eligible intervention premises (98.6%) received the initial risk audit; nearly 40% of intervention practices should have received follow-up visits but fewer than 10% received one. The intervention was acceptable to EHPs and to some premises staff, but less so for smaller independent premises.Conclusions:SMILE was associated with an increase in police-recorded violence in intervention premises, compared with control premises. A lack of follow-up enforcement visits suggests implementation failure for what was seen as a key mechanism of action. There are also concerns as to the robustness of police data for targeting and assessing outcome effectiveness, while intervention premises may have received greater attention from statutory agencies and, therefore, the identification of more violence than control premises. Although SMILE had high reach and was feasible and acceptable to EHPs, it was found to be ineffective and associated with increased levels of violence, compared with normal practice and it requires additional work to promote the implementation of follow-up enforcement visits. Future work will aim to better understand the role of intervention dose on outcomes and seek more objective measures of violence for use in similar trials.
published_date 2015-09-30T03:35:37Z
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