Evaluating the impact of alcohol minimum unit pricing on deaths and hospitalisations in Scotland: a controlled interrupted time series study.

BACKGROUND: Since May 1, 2018, every alcoholic drink sold in Scotland has had minimum unit pricing (MUP) of £0·50 per unit. Previous studies have indicated that the introduction of this policy reduced alcohol sales by 3%. We aimed to assess whether this has led to reductions in alcohol-attributable deaths and hospitalisations. METHODS: Study outcomes, wholly attributable to alcohol consumption, were defined using routinely collected data on deaths and hospitalisations. Controlled interrupted time series regression was used to assess the legislation's impact in Scotland, and any effect modification across demographic and socioeconomic deprivation groups. The pre-intervention time series ran from Jan 1, 2012, to April 30, 2018, and for 32 months after the policy was implemented (until Dec 31, 2020). Data from England, a part of the UK where the intervention was not implemented, were used to form a control group. FINDINGS: MUP in Scotland was associated with a significant 13·4% reduction (95% CI -18·4 to -8·3; p=0·0004) in deaths wholly attributable to alcohol consumption. Hospitalisations wholly attributable to alcohol consumption decreased by 4·1% (-8·3 to 0·3; p=0·064). Effects were driven by significant improvements in chronic outcomes, particularly alcoholic liver disease. Furthermore, MUP legislation was associated with a reduction in deaths and hospitalisations wholly attributable to alcohol consumption in the four most socioeconomically deprived deciles in Scotland. INTERPRETATION: The implementation of MUP legislation was associated with significant reductions in deaths, and reductions in hospitalisations, wholly attributable to alcohol consumption. The greatest improvements were in the four most socioeconomically deprived deciles, indicating that the policy is positively tackling deprivation-based inequalities in alcohol-attributable health harm. FUNDING: Scottish Government.

Lockdown and licensed premises: COVID-19 lessons for alcohol policy.

INTRODUCTION: The COVID-19 pandemic necessitated unprecedented changes in alcohol availability, including closures, curfews and restrictions. We draw on new data from three UK studies exploring these issues to identify implications for premises licensing and wider policy. METHODS: (i) Semi-structured interviews (n = 17) with licensing stakeholders in Scotland and England reporting how COVID-19 has reshaped local licensing and alcohol-related harms; (ii) semi-structured interviews (n = 15) with ambulance clinicians reporting experiences with alcohol during the pandemic; and (iii) descriptive and time series analyses of alcohol-related ambulance callouts in Scotland before and during the first UK lockdown (1 January 2019 to 30 June 2020). RESULTS: COVID-19 restrictions (closures, curfews) affected on-trade premises only and licensing stakeholders highlighted the relaxation of some laws (e.g. on takeaway alcohol) and a rise in home drinking as having long-term risks for public health. Ambulance clinicians described a welcome break from pre-pandemic mass public intoxication and huge reductions in alcohol-related callouts at night-time. They also highlighted potential long-term risks of increased home drinking. The national lockdown was associated with an absolute fall of 2.14 percentage points [95% confidence interval (CI) -3.54, -0.74; P = 0.003] in alcohol-related callouts as a percentage of total callouts, followed by a daily increase of +0.03% (95% CI 0.010, 0.05; P = 0.004). DISCUSSION AND CONCLUSIONS: COVID-19 gave rise to both restrictions on premises and relaxations of licensing, with initial reductions in alcohol-related ambulance callouts, a rise in home drinking and diverse impacts on businesses. Policies which may protect on-trade businesses, while reshaping the night-time economy away from alcohol-related harms, could offer a 'win-win' for policymakers and health advocates.

Managing COVID-19 Transmission Risks in Bars: An Interview and Observation Study

Objective: Licensed premises face particular challenges to operating safely within COVID-19 restrictions. Following a U.K. national lockdown from March 20, 2020, we studied business practices and behaviors in licensed premises to inform COVID-19 policies. To our knowledge, no previous study worldwide has examined these issues. Method: Before premises reopened in Scotland, we conducted in-depth telephone interviews (May–June 2020) with participants from hospitality trade associations, licensed premises, or in related roles (n = 18). Interviews focused on anticipated business practices and challenges relevant to minimizing COVID-19 transmission. Following reopening (July–August 2020), we conducted observations of relevant practices and behaviors in 29 bars purposively sampled for diversity, using a structured schedule. Interviews and observation reports were analyzedthematically. Results: Interviewees generally sought clarity, flexibility, and balance in government guidance on reopening, and they cited commercial and practical challenges to doing so safely. Alcohol consumption was perceived as an additional but potentially manageable challenge. Most observed premises had made physical and operational modifications;however, practices were variable. Observed incidents of concern included close physical interaction between customers and with staff, frequently featuring alcohol intoxication and rarely effectively stopped by staff. Conclusions: Despite the efforts of bar operators and guidance from government, potentially significant risks of COVID-19 transmission persisted in a substantial minority of observed bars, especially when customers were intoxicated.