Tuakana-teina peer education programme to help Maori elders enhance wellbeing and social connectedness.

BACKGROUND: There are significant inequities between Maori (Indigenous people) and non-Maori in ageing outcomes. This study used a strengths-based approach based on the key cultural concept of mana motuhake (autonomy and self-actualisation) to develop a tuakana-teina (literally older sibling-younger sibling) peer education programme to assist kaumatua (elders) in addressing health and social needs. The purpose of this study was to test the impact on those receiving the programme. Three aims identify the impact on outcomes, resources received and the cost effectiveness of the programme. METHODS: Five Kaupapa Maori (research and services guided by Maori worldviews) iwi (tribe) and community providers implemented the project using a partnership approach. Tuakana (peer educators) had up to six conversations each with up to six teina (peer learners) and shared information related to social and health services. A pre- and post-test, clustered staggered design was the research design. Participants completed a baseline and post-programme assessment of health and mana motuhake measures consistent with Maori worldviews. Open-ended questions on the assessments, five focus groups, and four individual interviews were used for qualitative evaluation. FINDINGS: A total of 113 kaumatua were recruited, and 86 completed the programme. The analysis revealed improvements in health-related quality of life, needing more help with daily tasks, life satisfaction, paying bills and housing problems. Qualitative results supported impacts of the programme on mana motuhake and hauora (holistic health) through providing intangible and tangible resources. Cost-effectiveness analysis showed that the intervention is cost effective, with a cost per QALY of less than the conventional threshold of three times GDP per capita. CONCLUSIONS: A culturally-resonant, strengths-based programme developed through a participatory approach can significantly improve health and social outcomes in a cost-effective way. TRIAL REGISTRY: Clinical trial registry: Trial registration: (ACTRN12620000316909). Prospectively registered 06/03/2020, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379302&isClinicalTrial=False .

Enhancing health outcomes for Maori elders through an intergenerational cultural exchange and physical activity programme: a cross-sectional baseline study.

Background: The study offers baseline data for a strengths-based approach emphasizing intergenerational cultural knowledge exchange and physical activity developed through a partnership with kaumatua (Maori elders) and kaumatua service providers. The study aims to identify the baseline characteristics, along with correlates of five key outcomes. Methods: The study design is a cross-sectional survey. A total of 75 kaumatua from six providers completed two physical functioning tests and a survey that included dependent variables based in a holistic model of health: health-related quality of life (HRQOL), self-rated health, spirituality, life satisfaction, and loneliness. Results: The findings indicate that there was good reliability and moderate scores on most variables. Specific correlates included the following: (a) HRQOL: emotional support (ß = 0.31), and frequent interaction with a co-participant (ß = 0.25); (b) self-rated health: frequency of moderate exercise (ß = 0.32) and sense of purpose (ß = 0.27); (c) spirituality: sense of purpose (ß = 0.46), not needing additional help with daily tasks (ß = 0.28), and level of confidence with cultural practices (ß = 0.20); (d) life satisfaction: sense of purpose (ß = 0.57), frequency of interaction with a co-participant (ß = -0.30), emotional support (ß = 0.25), and quality of relationship with a co-participant (ß = 0.16); and (e) lower loneliness: emotional support (ß = 0.27), enjoyment interacting with a co-participant (ß = 0.25), sense of purpose (ß = 0.24), not needing additional help with daily tasks (ß = 0.28), and frequency of moderate exercise (ß = 0.18). Conclusion: This study provides the baseline scores and correlates of important social and health outcomes for the He Huarahi Tautoko (Avenue of Support) programme, a strengths-based approach for enhancing cultural connection and physical activity.

A mixed-methods evaluation of the one-way door and CitySafe patrol policies in Whangarei, New Zealand.

In this paper, we evaluate the impacts of one-way door and CitySafe patrol policies in Whangarei, New Zealand, using a mixed-methods approach. In the quantitative analyses, we apply interrupted time series analysis and difference-in-differences analysis to data on antisocial behaviour derived from CCTV footage, and to police calls-for-service data. In the qualitative analysis, we apply thematic analysis to data from semi-structured interviews with 33 local stakeholders. We find a statistically significant increase in observed antisocial behaviour, but statistically significant decreases in violence and drug and alcohol offences, except when other small cities are used as a control group. In the qualitative analysis, a large majority of interviewees thought that the policy had reduced alcohol-related harm and increased safety, although a number of possible unintended consequences were also noted, including a reallocation of police resources, a redistribution of night-time drinking towards the suburbs, and a change in the demand for taxi companies. Overall, there is evidence only that the policies have reduced perceived alcohol-related harm, rather than reducing measures of harm.

The relationship between alcohol outlets and crime is not an artefact of retail geography.

BACKGROUND AND AIMS: In previous research, the spatial distribution of alcohol outlets has been shown to be related to the spatial distribution of crime. However, the spatial distribution of alcohol outlets is also related to the spatial distribution of other retail (and non-retail) activities. We measured whether a residual relationship between alcohol outlets and crime remains statistically significant after controlling for retail density. DESIGN AND SETTING: A cross-sectional analysis of area unit data for Hamilton, New Zealand. MEASUREMENTS: We constructed index measures of retail density using principal component analysis, based on counts of retail outlets (non-alcohol outlets alone and all outlets in total). We estimated the relationship between outlets and police calls-for-service using negative binomial regression, controlling for social deprivation, population and demographics. In our primary analysis, we employed a two-stage process that first accounted for the correlation between calls-for-service and retail density in a negative binomial regression model, then tested for correlation between alcohol outlet counts and the first-stage residuals. FINDINGS: The spatial distributions of retail outlets of all types were highly correlated with each other, and all types of retail outlets (alcohol and non-alcohol) were correlated with crime, after controlling for social deprivation, population and demographics. After controlling for index measures of retail density and other controls, statistically significant semipartial correlations remained with counts of alcohol outlets of all types. For example, in our preferred specification, which controlled for non-alcohol retail density in the first stage, an additional off-licence alcohol outlet was associated with 97.34 (95% confidence interval = 36.66-158.0) additional police calls-for service. CONCLUSIONS: There is a positive relationship between the spatial distribution of alcohol outlets and the spatial distribution of crime that appears to persist even after controlling for non-alcohol retail density. The relationship between alcohol outlets and crime is not simply an artefact of retail geography.

Pre-drinking behaviour of people in the night-time economy: Evidence from a street-intercept survey in New Zealand.

INTRODUCTION: Pre-drinking behaviour has grown in prevalence and generates harm for pre-drinkers and others. In this article, we answer three research questions: (i) Where and when do pre-drinkers obtain their alcohol?; (ii) What is the difference in the level of intoxication of pre-drinkers versus non-pre-drinkers, and how does this difference vary over the course of a night?; and (iii) Is the level of intoxication of pre-drinkers related to where and when they obtain their alcohol? METHODS: We obtained data from 469 respondents using a street-intercept survey conducted in Hamilton, New Zealand in 2019. Data were analysed by cross-tabulation, linear regression and plotting the average intoxication level in the night-time economy over time. RESULTS: The majority of pre-drinkers purchase their alcohol for pre-drinking on the day of consumption. Half of the same-day purchasers purchase before 6 pm. The average level of intoxication increases over the course of the night, and is unambiguously higher for pre-drinkers than non-pre-drinkers. The level of intoxication does not differ based on the source or timing of pre-drinking purchases. The main motivation for pre-drinking was price, especially among women. DISCUSSION AND CONCLUSIONS: Pre-drinking is a contributor to intoxication in the night-time economy, but most drinkers purchase their alcohol for pre-drinking before 7 pm. Further research is required to understand whether trading hours restrictions for off-premises alcohol suppliers will affect the most harmful drinking patterns. Price interventions to reduce the price differential between on-licenced and off-licence alcohol outlets offer the greatest potential to reduce pre-drinking and associated harm.

Side-loading prevalence and intoxication in the night-time economy.

Although pre-drinking has attracted considerable research interest, side-loading (any drinking occurring outside of licensed premises during a night out, and excluding drinking at home) is comparatively under-studied. In this paper, we investigate the prevalence of side-loading behaviour and intoxication in the night-time economy of Hamilton, New Zealand's fourth-largest city. Using a street-intercept survey conducted over six nights (n = 469) in March and April 2019, we found that 17.5% of research participants (82/469), and 19.9% of drinkers (82/413), had engaged in side-loading. Of those engaging in side-loading, the majority did so in a car (61.0%), with smaller proportions engaging in side-loading in the street (17.1%), a carpark (12.2%), or somewhere else (13.4%). Men were significantly more likely than women to engage in side-loading behaviour (p = 0.001). In linear models controlling for time of the night, day of the week, and demographic variables, side-loading was not statistically significantly associated with breath alcohol content. This contrasts with pre-drinking, which was associated with statistically significantly higher breath alcohol content. Our results suggest that side-loading might not be used as a method for drinkers to enhance intoxication, but instead as a means of sustaining a target level of intoxication during an evening.

Breast cancer costs in New Zealand's public health system.

AIM: This study aims to estimate the mean costs of breast cancer in New Zealand's public health system. METHOD: This study included women diagnosed with invasive breast cancer between 1 July 2010 and 30 June 2018 who received services in public hospitals. These patients were identified from the National Breast Cancer Register or the New Zealand Cancer Registry and linked with the Pharmaceutical Collection, National Minimum Dataset, National Non-Admitted Patient Collection and Mortality Collection. RESULTS: 22,948 breast cancer patients were included. The mean public health cost of breast cancer was NZ$44,954 per patient for the period of three months preceding and five years following cancer diagnosis, with the treatment phase accounting for 70% of the cost and the follow-up phase accounting for the remaining 30%. During the treatment phase, surgery costs accounted for the biggest proportion (35%) of the total cost, followed by immunotherapy costs (18%), radiotherapy costs (17%) and costs of diagnostic test, scan and biopsy (16%). The costs decreased substantially with age, from $69,121 for women younger than 45 years old to $23,805 for those aged 80 or over. CONCLUSIONS: The costs of breast cancer in New Zealand's public health system are substantial and have been increasing. However, outcomes of breast cancer have been improving. The results of this study can be used as a baseline of actual costs for comparing the costs of introducing new diagnosis and treatment modalities in the future.

Interventions to mitigate indoor air pollution: A cost-benefit analysis.

Globally, around three billion people depend upon solid fuels such as firewood, dry animal dung, crop residues, or coal, and use traditional stoves for cooking and heating purposes. This solid fuel combustion causes indoor air pollution (IAP) and severely impairs health and the environment, especially in developing countries like Pakistan. A number of alternative household energy strategies can be adopted to mitigate IAP, such as using liquefied petroleum gas (LPG), natural gas, biogas, electric stoves, or improved cook stoves (ICS). In this study, we estimate the benefit-cost ratios and net present value of these interventions over a ten-year period in Pakistan. Annual costs include both fixed and operating costs, whereas benefits cover health, productivity gains, time savings, and fuel savings. We find that LPG has the highest benefit-cost ratio, followed by natural gas, while ICS has the lowest benefit-cost ratio. Electric stoves and biogas have moderate benefit-cost ratios that nevertheless exceed one. To maximize the return on cleaner burning technology, the government of Pakistan should consider encouraging the adoption of LPG, piped natural gas, and electric stoves as means to reduce IAP and adopt clean technologies.

Kaumatua Mana Motuhake Poi: a study protocol for enhancing wellbeing, social connectedness and cultural identity for Maori elders.

BACKGROUND: The Aotearoa New Zealand population is ageing accompanied by health and social challenges including significant inequities that exist between Maori and non-Maori around poor ageing and health. Although historically kaumatua (elder Maori) faced a dominant society that failed to realise their full potential as they age, Maori culture has remained steadfast in upholding elders as cultural/community anchors. Yet, many of today's kaumatua have experienced 'cultural dissonance' as the result of a hegemonic dominant culture subjugating an Indigenous culture, leading to generations of Indigenous peoples compelled or forced to dissociate with their culture. The present research project, Kaumatua Mana Motuhake Poi (KMMP) comprises two interrelated projects that foreground dimensions of wellbeing within a holistic Te Ao Maori (Maori epistemology) view of wellbeing. Project 1 involves a tuakana-teina/peer educator model approach focused on increasing service access and utilisation to support kaumatua with the greatest health and social needs. Project 2 focuses on physical activity and cultural knowledge exchange (including te reo Maori--Maori language) through intergenerational models of learning. METHODS: Both projects have a consistent research design and common set of methods that coalesce around the emphasis on kaupapa kaumatua; research projects led by kaumatua and kaumatua providers that advance better life outcomes for kaumatua and their communities. The research design for each project is a mixed-methods, pre-test and two post-test, staggered design with 2-3 providers receiving the approach first and then 2-3 receiving it on a delayed basis. A pre-test (baseline) of all participants will be completed. The approach will then be implemented with the first providers. There will then be a follow-up data collection for all participants (post-test 1). The second providers will then implement the approach, which will be followed by a final data collection for all participants (post-test 2). DISCUSSION: Two specific outcomes are anticipated from this research; firstly, it is hoped that the research methodology provides a framework for how government agencies, researchers and relevant sector stakeholders can work with Maori communities. Secondly, the two individual projects will each produce a tangible approach that, it is anticipated, will be cost effective in enhancing kaumatua hauora and mana motuhake. TRIAL REGISTRATION: Australia New Zealand Clinical Trial Registry ( ACTRN12620000316909 ). Registered 6 March 2020.

Kaumatua Mana Motuhake: peer education intervention to help Maori elders during later-stage life transitions.

BACKGROUND: Aotearoa/New Zealand has a population that is ageing and there are challenges to health and social outcomes related to related to key life transitions (e.g., retirement, change in health conditions, loss of spouse). Further, there are significant inequities between Maori (Indigenous people) and non-Maori in ageing outcomes. The purpose of this study was to test the impacts and cost effectiveness of a tuakana/teina (peer education) intervention on kaumatua (elders) receiving the intervention. This study was framed by a strengths-based approach based on the key cultural concept of mana motuhake (autonomy and self-actualisation). METHODS: This study was grounded in principles of Kaupapa Maori and community-based participatory research to bring together a diverse group of stakeholders to co-develop and co-evaluate the intervention. The intervention had tuakana (peer educators) having conversations with up to six teina (recipients) and providing information related to health and social services. The research design was a pre- and post-test, clustered staggered design. Participants completed a baseline assessment of health and mana motuhake measures consistent with Maori worldviews along with two follow-up assessments (one after the first intervention group completed its activities and a second after the second intervention group completed its activities). Additionally, five focus groups and open-ended questions on the assessments were used to provide qualitative evaluation. FINDINGS: A total of 180 kaumatua were recruited to the intervention with 121 completing it. The analysis revealed improvements over time in the expected direction on most of the variables. However, only three of the variables had statistically significant intervention effects: received support, tribal identity, and trouble paying bills. Qualitative results supported impacts of the intervention on mana motuhake, social connectedness, and tangible/information support related to services. Cost-effectiveness analysis showed that the intervention is cost effective, with a cost per QALY of less than the conventional threshold of three times gross domestic product per capita. CONCLUSIONS: The findings support the relevancy and importance of kaumatua knowledge to create a strengths-based approach to improve health and social outcomes. This study demonstrates that a contextually based and culturally safe age-friendly environments can facilitate engagement and participation by kaumatua for kaumatua. TRIAL REGISTRY: Australia New Zealand Clinical Trial Registry (ACTRN12617001396314); Date Registered: 3 October 2017 (retrospectively registered); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373733&isClinicalTrial=False.

Correlates of Health-Related Quality of Life for Maori Elders Involved in a Peer Education Intervention.

The purpose of this study was to identify social determinant and communication correlates of health-related quality of life for kaumatua (Maori elders) in New Zealand. A total of 209 kaumatua completed a self-report survey of self-rated health, physical/mental quality of life, spirituality, and a series of questions about social determinants (e.g., factors related to income) and communication variables (e.g., loneliness, social support, cultural identity, and perceived burden/benefit). The survey was baseline data for a peer education intervention to help kaumatua work through life transitions in older age. The main findings of this study were that social determinants, particularly difficulty paying bills, accounted for a small amount of variance in physical/mental quality of life and self-rated health. Further, the communication correlates of loneliness, perceived burden, and desired support accounted for about three times as much variance in these two outcomes all with negative associations. Strength of tribal identity, importance of whanau (extended family), and knowledge of tikanga (customs and protocols) accounted for a moderate amount variance in spirituality with positive associations. These findings have important theoretical and practical implications for positive aging.

Kaumatua Mana Motuhake: A study protocol for a peer education intervention to help Maori elders work through later-stage life transitions.

BACKGROUND: The Aotearoa/New Zealand population is ageing and numerous studies demonstrate with this phenomenon comes increases in non-communicable diseases, injuries and healthcare costs among other issues. Further, significant inequities exist between Maori (Indigenous peoples of Aotearoa/New Zealand) and non-Maori around poor ageing and health. Most research addressing these issues is deficit oriented; however, the current research project takes a strengths-based approach that highlights the potential of kaumatua (elders) by asserting mana motuhake (autonomy, identity and self-actualisation). We believe that the esteem of elders in Maori culture signals transformative potential. Specifically, this project utilises a 'tuakana-teina' (older sibling/younger sibling) peer-educator model, where kaumatua work with other kaumatua in relation to health and wellbeing. The objectives of the project are (a) to develop the capacity of kaumatua as peer educators, whilst having positive impacts on their sense of purpose, health and wellbeing; and (b) to enhance the social and health outcomes for kaumatua receiving the intervention. METHODS: The research is grounded in principles of Kaupapa Maori and community-based participatory research, and brings together an Indigenous community of kaumatua, community health researchers, and academic researchers working with two advisory boards. The project intervention involves an orientation programme for tuakana peer educators for other kaumatua (teina). The research design is a pre- and post-test, clustered staggered design. All participants will complete a baseline assessment of health and wellbeing consistent with Maori worldviews (i.e., holistic model). The tuakana and teina participants will be divided into two groups with the first group completing the intervention during the first half of the project and the second group during the second half of the project. All participants will complete post-test assessments following both interventions allowing comparison of the two groups along with repeated measures over time. DISCUSSION: The findings will provide an evidence base for the importance and relevancy of kaumatua knowledge to create contextually based and culturally safe age-friendly environments that facilitate engagement and participation by kaumatua for kaumatua. If the model is effective, we will seek to facilitate the dissemination and scalability of the intervention. TRIAL REGISTRATION: Australia New Zealand Clinical Trial Registry ( ACTRN12617001396314 ); Date Registered: 3 October 2017 (retrospectively registered).

Pre-Drinking and the Temporal Gradient of Intoxication in a New Zealand Nightlife Environment.

OBJECTIVE: We measured changes in the average level of intoxication over time in the nighttime economy and identified the factors associated with intoxication, including pre-drinking. METHOD: A random intercept sample of 320 pedestrians (105 women; 215 men) was interviewed and received breath alcohol analysis in the nighttime economy of Hamilton, New Zealand. Data were collected over a five-night period, between 7 P.M. and 2:30 A.M. Data were analyzed by plotting the moving average breath alcohol concentration (BrAC) over time and using linear regression models to identify the factors associated with BrAC. RESULTS: Mean BrAC was 241.5 mcg/L for the full sample; 179.7 for women and 271.7 for men, which is a statistically significant difference. Mean BrAC was also significantly higher among those who engaged in pre-drinking than those who did not. In the regression models, time of night and pre-drinking were significantly associated with higher BrAC. The effect of pre-drinking on BrAC was larger for women than for men. CONCLUSIONS: The average level of intoxication increases throughout the night. However, this masks a potentially important gender difference, in that women's intoxication levels stop increasing after midnight, whereas men's increase continuously through the night. Similarly, intoxication of pre-drinkers stops increasing from 11 P.M., although remaining higher than non-pre-drinkers throughout the night. Analysis of BrAC provides a more nuanced understanding of intoxication levels in the nighttime economy.

Acceptability and Preferences for Hypothetical Rectal Microbicides among a Community Sample of Young Men Who Have Sex with Men and Transgender Women in Thailand: A Discrete Choice Experiment.

Rectal microbicides (RMs) may offer substantial benefits in expanding HIV prevention options for key populations. From April to August 2013, we conducted Tablet-Assisted Survey Interviewing, including a discrete choice experiment, with participants recruited from gay entertainment venues and community-based organizations in Chiang Mai and Pattaya, Thailand. Among 408 participants, 74.5 % were young men who have sex with men, 25.5 % transgender women, with mean age = 24.3 years. One-third (35.5 %) had ≤9th grade education; 63.4 % engaged in sex work. Overall, 83.4 % reported they would definitely use a RM, with more than 2-fold higher odds of choice of a RM with 99 versus 50 % efficacy, and significantly higher odds of choosing gel versus suppository, intermittent versus daily dosing, and prescription versus over-the-counter. Sex workers were significantly more likely to use a RM immediately upon availability, with greater tolerance for moderate efficacy and daily dosing. Engaging key populations in assessing RM preferences may support biomedical research and evidence-informed interventions to optimize the effectiveness of RMs in HIV prevention.

Alcohol outlet density and violence: A geographically weighted regression approach.

INTRODUCTION AND AIMS: We investigate the relationship between outlet density (of different types) and violence (as measured by police activity) across the North Island of New Zealand, specifically looking at whether the relationships vary spatially. DESIGN AND METHODS: We use New Zealand data at the census area unit (approximately suburb) level, on police-attended violent incidents and outlet density (by type of outlet), controlling for population density and local social deprivation. We employed geographically weighted regression to obtain both global average and locally specific estimates of the relationships between alcohol outlet density and violence. RESULT: We find that bar and night club density, and licensed club density (e.g. sports clubs) have statistically significant and positive relationships with violence, with an additional bar or night club is associated with nearly 5.3 additional violent events per year, and an additional licensed club associated with 0.8 additional violent events per year. These relationships do not show significant spatial variation. In contrast, the effects of off-licence density and restaurant/café density do exhibit significant spatial variation. However, the non-varying effects of bar and night club density are larger than the locally specific effects of other outlet types. DISCUSSION AND CONCLUSION: The relationships between outlet density and violence vary significantly across space for off-licences and restaurants/cafés. These results suggest that in order to minimise alcohol-related harms, such as violence, locally specific policy interventions are likely to be necessary. [Cameron MP, Cochrane W, Gordon C, Livingston M. Alcohol outlet density and violence: A geographically weighted regression approach. Drug Alcohol Rev 2016;35:280-288].

The marginal willingness-to-pay for attributes of a hypothetical HIV vaccine.

This paper estimates the marginal willingness-to-pay for attributes of a hypothetical HIV vaccine using discrete choice modeling. We use primary data from 326 respondents from Bangkok and Chiang Mai, Thailand, in 2008-2009, selected using purposive, venue-based sampling across two strata. Participants completed a structured questionnaire and full rank discrete choice modeling task administered using computer-assisted personal interviewing. The choice experiment was used to rank eight hypothetical HIV vaccine scenarios, with each scenario comprising seven attributes (including cost) each of which had two levels. The data were analyzed in two alternative specifications: (1) best-worst; and (2) full-rank, using logit likelihood functions estimated with custom routines in Gauss matrix programming language. In the full-rank specification, all vaccine attributes are significant predictors of probability of vaccine choice. The biomedical attributes of the hypothetical HIV vaccine (efficacy, absence of VISP, absence of side effects, and duration of effect) are the most important attributes for HIV vaccine choice. On average respondents are more than twice as likely to accept a vaccine with 99% efficacy, than a vaccine with 50% efficacy. This translates to a willingness to pay US$383 more for a high efficacy vaccine compared with the low efficacy vaccine. Knowledge of the relative importance of determinants of HIV vaccine acceptability is important to ensure the success of future vaccination programs. Future acceptability studies of hypothetical HIV vaccines should use more finely grained biomedical attributes, and could also improve the external validity of results by including more levels of the cost attribute.

Alcohol outlet density is related to police events and motor vehicle accidents in Manukau City, New Zealand.

OBJECTIVES: To explore the cross-sectional association between alcohol outlet density and police events in Manukau City, New Zealand. METHODS: Using data for the Census Area Unit (suburb) level, per-capita measures of alcohol outlet density for January 2009 were calculated for off-licence outlets, clubs and bars, and restaurants and cafés. Data on police events and motor vehicle accidents were obtained for the period 1 July 2008 to 30 June 2009, and also converted into per capita measures. A spatial seemingly unrelated regression model was developed, which simultaneously assessed the relationship between densities and all nine categories of police events, and motor vehicle accidents, while controlling for relevant covariates. RESULTS: All three outlet density measures were significantly associated with a range of police events, but only off-licence density was significantly associated with motor vehicle accidents. An additional off-licence outlet in a given area was associated with 85.4 additional police events and 10.3 additional motor vehicle accidents; an additional club or bar was associated with 34.7 additional police events and 0.5 additional motor vehicle accidents; and an additional restaurant or cafe was associated with 13.2 additional police events and 2.1 additional motor vehicle accidents. CONCLUSIONS: The results do not imply causality. However, they are broadly consistent with availability theory, and imply that local alcohol policy should account for the effects of additional outlets when new licences are granted. While the methodological approach described here is easily transferable to investigate the relationships elsewhere, we suggest some areas for improvement of future studies.