The economic costs of alcohol-related harms at the local level in New South Wales.

INTRODUCTION: Alcohol is a harmful, toxic and addictive substance that causes many diseases and injuries. Alcohol use also incurs a financial cost to the health care system and wider economy. This project aimed to undertake a cost impact analysis of alcohol-related harms at the local level in New South Wales (NSW). The alcohol-related harms costing model is an interactive tool designed for use by local health districts, stakeholders such as Liquor and Gaming NSW, NSW Independent Liquor and Gaming Authority and community stakeholders. METHODS: Costs included in the analysis were alcohol-related hospitalisations, deaths, crimes, emergency department attendances, outpatient presentations and their impacts on productivity. Two local government areas (LGA) were used as case studies to demonstrate local impacts. RESULTS: In 2019-2020, the total cost of alcohol-related harms for NSW was estimated at $9 billion, at a rate of $120.3 million per 100,000 population. The total costs were comprised of alcohol-attributable premature mortality ($8.3 billion), non-fatal health care costs ($275 million) and crime costs ($457 million). A comparative analysis of two case study LGAs estimated that alcohol-related harms cost $195 million for the Northern Beaches LGA and $351 million for the Central Coast LGA. DISCUSSION AND CONCLUSIONS: This research has developed a 'proof-of-concept' model to estimate the cost of alcohol-related harms at the local level in Australia, empowering health agencies and local community stakeholders to use economic evidence in their submissions in response to new liquor licence applications and other policies that impact their local community. This economic evidence can be used to improve the quality of decisions on alcohol regulation and policies. There are a number of future research opportunities that would enhance the economic evidence available to liquor licensing decision-makers.

Online liquor gets audited: a review of regulatory controls and supply practices of online liquor retailers in NSW, Australia.

OBJECTIVES: In New South Wales (NSW), Australia, the number of 'online liquor licences' - packaged liquor licences with conditions restricting the sale of alcohol to online, phone or fax orders - increased from 101 in 2010 to 500 by May 2018. International and national evidence is emerging that this growth in online liquor licences has been accompanied by increased risk of supply to young and intoxicated people. This study aimed to determine the extent to which online liquor retailers in NSW have adopted safeguards to prevent people younger than 18 years purchasing alcohol online; and the supply of alcohol to intoxicated people. It also aimed to assess the regulatory framework in NSW for these licences. METHODS: We undertook an audit between May and November 2018 of regulatory controls for 213 online liquor retailers in NSW with publicly available websites at the time of auditing. A comparative analysis of the NSW Liquor Act 2007 and the NSW Liquor Regulation 2018 was conducted. RESULTS: Three gaps in the existing legal safeguards for online liquor retailers were identified: inconsistent application of the NSW Liquor Act 2007; the inability of the regulator to complete compliance auditing; and an absence of consistent mandatory signage. The study also identified inconsistencies between the regulation of physical and online liquor retailers. CONCLUSIONS: Study findings led to the formulation of recommendations for regulatory change, which were presented to the government oversight agency, Liquor & Gaming NSW, in April 2019 and followed up by written submissions from the research group on behalf of Northern Sydney Local Health District Health Promotion. Several key reforms were subsequently incorporated into the NSW Liquor Amendment (24-hour Economy) Bill 2020. Findings have informed an advocacy approach which has led to improved regulatory reform within NSW.

Ecological study of playground space and physical activity among primary school children.

OBJECTIVES: To examine the relationship between school playground size and total physical activity (PA), fitness and fundamental movement skills (FMS) of primary school students. DESIGN: Cross-sectional ecological analysis. SETTING: 43 primary schools in New South Wales, Australia. PARTICIPANTS: Data were from 5238 students, aged 5 to 12 years, participating in the Schools Physical Activity and Nutrition Survey. OUTCOME MEASURES: Self (for age ≥11 years) and parent (for age <11 years) report of PA (meeting PA recommendations and number of days meeting recommendations), objectively measured FMS and cardiorespiratory and muscular fitness. RESULTS: Associations between playground space and measures of PA and fitness were mostly non-linear and moderated by loose equipment. Students in schools with no loose equipment showed a weak association between space and meeting PA recommendations (self-report). In schools with equipment, students' predicted probability of meeting PA recommendations increased sharply between 15 m2 and 25 m2 per student from 0.04 (95% CI: 0.01 to 0.08) to 0.30 (95% CI: 0.14 to 0.46), but at 30 m2 returned to levels comparable to students in schools with no equipment (0.18, 95% CI: 0.07 to 0.28). For cardiorespiratory fitness, in schools with no loose equipment, probabilities for being in the healthy cardiovascular fitness zone varied between 0.66 and 0.77, showing no consistent trend. Students in schools with loose equipment had a predicted probability of being in the healthy fitness zone of 0.56 (95% CI: 0.41 to 0.71) at 15 m2 per student, which rose to 0.75 (95% CI: 0.63 to 0.86) at 20 m2 per student. There was no relationship between space and FMS. CONCLUSIONS: School space guidelines need to incorporate sufficient playground space for students. Our study provides evidence supporting better PA outcomes with increasing space up to 25 m2 per student, and access to loose equipment, however further research is required to determine precise thresholds for minimum space. Intersectoral planning and cooperation is required to meet the needs of growing school populations.

Closing the loop: short term impacts on physical activity of the completion of a loop trail in Sydney, Australia.

BACKGROUND: In Australia, an estimated 57% of the population do not meet physical activity recommendations for health. The built environment is important for active living, and recreational trails provide safe and pleasant settings for this purpose. However, evidence for positive impacts on physical activity from real world natural experiments is sparse. We describe the impact of transforming a recreational trail into a loop on usage by cyclists and pedestrians and users' physical activity levels. METHOD: We conducted time series analyses of pre and post-completion (November 2013-July 2015) counts taken from infrared electronic counters of pedestrians and cyclists on two established sections of the trail adjusted for underlying trend, trend change, weather, holidays and trail closures. Chi-square analyses of pre and post-completion visual counts examined change in the distribution of pedestrian/cyclist, adult/child, and male/female users. Descriptive and bivariate analyses of post-completion intercept survey data of 249 trail users were conducted to examine user characteristics and impact on physical activity. RESULTS: Pedestrian and cyclist counts on established trail sections increased by between 200 and 340% from pre to post-completion. Visual count data showed a significant 7% increase in children (vs adults) using the trail at one site pre to post (p = 0.008). Of previous users, 48% reported doing more physical activity at the trail and this was additional to (not replacing) physical activity done elsewhere. Those users not meeting physical activity recommendations were more likely to report increased total physical activity since the loop was created (55.5% vs 39.2%, p = 0.031). The connected loop nature of the trail and its length was perceived to encourage more and different forms of physical activity. CONCLUSION: Creating an accessible loop trail away from motorised traffic can lead to increased trail use and potentially total physical activity. The modification to the trail encouraged proportionate and real increases in usage among vulnerable populations such as children and perhaps greater total physical activity especially for people not meeting physical activity recommendations. The findings suggest that the benefits of environmental changes such as these can accrue to those most in need of support for being physically active.