Hospital-based violence prevention programmes in South Wales Emergency Departments: A process evaluation protocol.

BACKGROUND: Addressing violence related harm is a global public health priority. While violence is primarily managed in the criminal justice system, healthcare supports and manages those injured by violence. Emergency Departments (EDs), the primary destination for those seriously injured, have emerged as a candidate location for violence prevention initiatives. There is limited evaluation of ED-based violence prevention, and a lack of guidance for the implementation and delivery of them. Nurse-led Violence Prevention Teams (VPTs) have been developed and implemented in two EDs in Wales, UK. This protocol describes methods used in the process evaluation of these VPTs. AIM: To understand how VPTs function, how they were implemented, and mechanisms of impact, as well as the exploration of wider contextual factors influencing their function. METHODS: Adopting a critical realist approach and informed by the Medical Research Council (MRC) guidance for process evaluations, the process evaluation will employ qualitative methods to collect and analyse data: a scoping review of evidence of effectiveness that considers the causal mechanisms underpinning violence; a documentary analysis to determine operational considerations concerning the development, implementation and delivery of the VPTs; a descriptive analysis of routine ED data to characterise the prevalence of violence-related attendances in each ED; interviews with professional stakeholders (N = 60) from the violence prevention ecologies in which the VPTs are embedded. DISCUSSION: This protocol outlines a process evaluation of a novel, nurse led violence prevention intervention. Findings will be used to inform policy makers' decision making on whether and how VPTs should be used in practice in other EDs across the UK, and the extent that a single operational model should be adjusted to address the local characteristic of violence. To the authors knowledge, this is the first process evaluation of a UK-based, nurse led Emergency Department Violence Prevention Team. TRIAL REGISTRATION: Protocol registration ISRCTN: 15286575. Registered 13th March, 2023.

An Exploration of the Multiplicative Effect of "Other People" and Other Environmental Effects on Violence in the Night-Time Environment.

BACKGROUND: The characteristics of night-time environments (NTEs) in which alcohol is consumed and that contribute to violence are poorly described. We explore competing explanations for violence in the NTE, with a particular focus on the number of patrons and its association with assault-related visits to a hospital emergency department. Other environmental features including the weather and notable events were also considered. The primary aim was to stimulate debate around the causal mechanisms responsible for violence. METHODS: Assault-related ED visits occurring between 8 pm and 4 am were recorded at the University Hospital of Wales, the single Emergency Department (ED) serving Cardiff, Wales, United Kingdom. Footfall was derived from the total number of unique MAC addresses recorded per hour collected from ten wireless fidelity monitoring tools located in the city centre. A narrative review of the literature concerning alcohol and violence informed exploratory analyses into the association between night-time footfall, sporting events, the weather, and other potential predictors of assault-related visits to the ED. We developed analytic methods from formal accounts of queueing. RESULTS: International rugby matches at home, the weather (temperature), national holidays, the day of the week, and number of patrons in the NTE predicted assault-related injury (R2 = 0.70), with footfall yielding a positive non-linear exponential association consistent with predictions derived from mathematical models of queueing. DISCUSSION: Assault-related visits to the ED have a non-linear association with the number of people socialising in the night-time environment and are further influenced by the weather and notable events. Opportunities for further research that might inform policy and interventions aimed at better managing NTEs are discussed.

Alcohol affordability: implications for alcohol price policies. A cross-sectional analysis in middle and older adults from UK Biobank.

BACKGROUND: Increasing the price of alcohol reduces alcohol consumption and harm. The role of food complementarity, transaction costs and inflation on alcohol demand are determined and discussed in relation to alcohol price policies. METHODS: UK Biobank (N = 502,628) was linked by region to retail price quotes for the years 2007 to 2010. The log residual food and alcohol prices, and alcohol availability were regressed onto log daily alcohol consumption. Model standard errors were adjusted for clustering by region. RESULTS: Associations with alcohol consumption were found for alcohol price (ß = -0.56, 95% CI, -0.92 to -0.20) and availability (ß = 0.06, 95% CI, 0.04 to 0.07). Introducing, food price reduced the alcohol price consumption association (ß = -0.26, 95% CI, -0.50 to -0.03). Alcohol (B = 0.001, 95% CI, 0.0004 to 0.001) and food (B = 0.001, 95% CI, 0.0005 to 0.0006) price increased with time and were associated (ρ = 0.57, P < 0.001). CONCLUSION: Alcohol and food are complements, and the price elasticity of alcohol reduces when the effect of food price is accounted for. Transaction costs did not affect the alcohol price consumption relationship. Fixed alcohol price policies are susceptible to inflation.

The health behaviours of European study abroad students sampled from forty-two countries: Data from a three-wave longitudinal study.

Research on travelling populations indicates that geographic mobility is associated with changes in health behaviours. However, there is currently little longitudinal data recording study abroad students' health behaviours other than alcohol use [1], [2], and that includes a variety of risk and protective factors related to students' demographics and their experiences abroad. The present dataset contains the original longitudinal data from a study of European study abroad students' and includes information on participants health-related behaviour: including physical exercise, diet, alcohol and drug use, and unprotected casual sex. Self-reported data were collected across three waves: on arrival in the host country, to assess pre-departure behaviour (T1), four months through the period abroad (T2), and four months after returning home (T3). Data on factors related to participants' demographics and their abroad experience, including motivations to study abroad, acculturation orientation and adjustment to the host environment, and perceptions regarding different referent peers' drinking behaviour were also collected. Data were collected in the 2015-2016 academic year. At T1 students in 200 cities from more than 40 European countries were approached by representatives from an international student association. Participants who completed at least two surveys were included (N = 908). The T1 survey was completed by 899 students (nine students provided an e-mail address but did not complete the survey at T1), 785 (86.5%) completed T2 survey, and 438 (48.2%) the T3 survey. The data article presents tables charting variables measured by survey wave and participants' socio-demographic and study abroad experience characteristics. With an acceptable drop-out across the three waves, these data may be of interest to researchers who wish to understand factors related to changes in health behaviours in this population and develop targeted health promotion interventions. Other stakeholders such as policy makers, international offices, health professionals in counselling service, student associations may also use these data to develop communication campaigns and intervene with reference to relevant risk and protective factors.

Visualisation and optimisation of alcohol-related hospital admissions ICD-10 codes in Welsh e-cohort data.

INTRODUCTION: The excessive consumption of alcohol is detrimental to long term health and increases the likelihood of hospital admission. However, definitions of alcohol-related hospital admission vary, giving rise to uncertainty in the effect of alcohol on alcohol-related health care utilization. OBJECTIVES: To compare diagnostic codes on hospital admission and discharge and to determine the ideal combination of codes necessary for an accurate determination of alcohol-related hospital admission. METHODS: Routine population-linked e-cohort data were extracted from the Secure Anonymised Information Linkage (SAIL) Databank containing all alcohol-related hospital admissions (n,= 92,553) from 2006 to 2011 in Wales, United Kingdom. The distributions of the diagnostic codes recorded at admission and discharge were compared. By calculating a misclassification rate (sensitivity-like measure) the appropriate number of coding fields to examine for alcohol-codes was established. RESULTS: There was agreement between admission and discharge codes. When more than ten coding fields were used the misclassification rate was less than 1%. CONCLUSION: With the data at present and alcohol-related codes used, codes recorded at admission and discharge can be used equivalently to identify alcohol-related admissions. The appropriate number of coding fields to examine was established: fewer than ten is likely to lead to under-reporting of alcohol-related admissions. The methods developed here can be applied to other medical conditions that can be described using a certain set of diagnostic codes, each of which can be a known sole cause of the condition and recorded in multiple positions in e-cohort data.

Association of violence with urban points of interest.

The association between alcohol outlets and violence has long been recognised, and is commonly used to inform policing and licensing policies (such as staggered closing times and zoning). Less investigated, however, is the association between violent crime and other urban points of interest, which while associated with the city centre alcohol consumption economy, are not explicitly alcohol outlets. Here, machine learning (specifically, LASSO regression) is used to model the distribution of violent crime for the central 9 km2 of ten large UK cities. Densities of 620 different Point of Interest types (sourced from Ordnance Survey) are used as predictors, with the 10 most explanatory variables being automatically selected for each city. Cross validation is used to test generalisability of each model. Results show that the inclusion of additional point of interest types produces a more accurate model, with significant increases in performance over a baseline univariate alcohol-outlet only model. Analysis of chosen variables for city-specific models shows potential candidates for new strategies on a per-city basis, with combined-model variables showing the general trend in POI/violence association across the UK. Although alcohol outlets remain the best individual predictor of violence, other points of interest should also be considered when modelling the distribution of violence in city centres. The presented method could be used to develop targeted, city-specific initiatives that go beyond alcohol outlets and also consider other locations.

A Latent Class Analysis of Parental Alcohol and Drug Use: Findings from the Avon Longitudinal Study of Parents and Children.

Previous measures of parental substance use have often paid limited attention to the co-occurrence of alcohol and drugs, or to the between-parent dynamics in the use of substances. These shortcomings may have important implications for our understandings of the relationship between parental substance use and child wellbeing. Using data from the Avon Longitudinal Study of Parents and Children, a UK community-based cohort study from 1990 onwards (n = 9,451), we identified groups of parental substance use using latent class analysis. The 4-class solution offered the best fit, balancing statistical criteria and theoretical judgement. The results show distinct classes across the range of parental substance use, including very low users, low users, moderate users and heavy users. These classes suggest that substance use patterns among mothers are somewhat mirrored by those of their partners, while heavy use of alcohol by mothers and their partners is related to increased mothers drug use. We suggest that studies that investigate the effects of parental substance use on child wellbeing should pay greater attention to the dynamics of substance use by parental figures.

The Enduring Effects of Parental Alcohol, Tobacco, and Drug Use on Child Well-being: A Multilevel Meta-Analysis.

The effects of psychoactive substance abuse are not limited to the user, but extend to the entire family system, with children of substance abusers being particularly at risk. This meta-analysis attempted to quantify the longitudinal relationship between parental alcohol, tobacco, and drug use and child well-being, investigating variation across a range of substance and well-being indices and other potential moderators. We performed a literature search of peer-reviewed, English language, longitudinal observational studies that reported outcomes for children aged 0 to 18 years. In total, 56 studies, yielding 220 dependent effect sizes, met inclusion criteria. A multilevel random-effects model revealed a statistically significant, small detriment to child well-being for parental substance abuse over time (r = .15). Moderator analyses demonstrated that the effect was more pronounced for parental drug use (r = .25), compared with alcohol use (r = .13), tobacco use (r = .13), and alcohol use disorder (r = .14). Results highlight a need for future studies that better capture the effect of parental psychoactive substance abuse on the full breadth of childhood well-being outcomes and to integrate substance abuse into models that specify the precise conditions under which parental behavior determines child well-being.Registration: PROSPERO CRD42017076088.

The acceptability of alcohol intoxication management services to users: A mixed methods study.

INTRODUCTION AND AIMS: Alcohol Intoxication Management Services (AIMS) provide basic care for intoxication and minor injuries, have been increasingly implemented in urban areas characterised by a large number of premises licensed for the sale and on-site consumption of alcohol, with the goal of reducing alcohol's burden on emergency services, including referrals into hospital emergency departments. The acceptability of new health services to users is a key effectiveness outcome. The aim was to describe patient experiences when attending an AIMS and document the acceptability of AIMS to users. DESIGN AND METHODS: A sequential mixed methods study was undertaken involving semi-structured interviews with participants from four AIMS followed by a survey of users recruited from six AIMS. RESULTS: Interviewees (N = 19) were positive about the care they received in AIMS and appreciated the friendly, non-judgemental atmosphere. Survey respondents rated their experience in AIMS positively (on a 0 to 10 Likert scale, mean = 9.34, SD = 1.38, n = 188). Frequently given reasons for attendance included drinking alcohol (57%) and minor injury (42%); 24% said they would have attended the emergency department had the AIMS not been available and 6% said they would have preferred to go to the emergency department; 31% indicated they would have felt unsafe without the AIMS. DISCUSSION AND CONCLUSIONS: AIMS are acceptable to users. AIMS are likely to address previously unmet demand for a safe space within the night-time environment.

A Longitudinal Study of European Students' Alcohol Use and Related Behaviors as They Travel Abroad to Study.

BACKGROUND: Travelling away from home can be associated with fewer limits on behavior, particularly for students who participate in exchange programs. AIMS: To examine the effects of eight moderators on change in alcohol use and related negative outcomes, drug use and unprotected sexual behavior in European study abroad students before, during, and after their time abroad. METHODS: A three wave (before departure, while abroad, and after their return) longitudinal design collecting data on the frequency and volume of alcohol consumed, heavy episodic drinking, alcohol-related outcomes, drug use, and unprotected casual sex. RESULTS: The baseline survey was completed by 1145 students participating in one or two semester exchange programs (67.5% spent up to a semester abroad), of which 906 participated in two or more waves, representing 42 and 33 countries of origin and destination, respectively. Mean age was 22.2 years (SD = 2.28) and 72.7% were female. Students increased the amount of alcohol consumed by 35% (B = 0.32; 95% CI 0.287-0.349) and experienced more alcohol-related consequences (B = 0.15; 95% CI 0.089-0.219) during the study abroad experience, though levels fell below pre-departure levels when they returned home. Factors related to greater alcohol use while abroad include pre-departure expectations about alcohol use during the study abroad experience, psychological adjustment to the host country, academic involvement, and host country living costs. No statistically meaningful change in drug use and unprotected sexual behavior was observed. CONCLUSIONS: Studying abroad exposes European students to additional time-limited alcohol-related health risks.

The costs of negative affect attributable to alcohol consumption in later life: A within-between random longitudinal econometric model using UK Biobank.

AIMS: Research demonstrates a negative relationship between alcohol use and affect, but the value of deprecation is unknown and thus cannot be included in estimates of the cost of alcohol to society. This paper aims to examine this relationship and develop econometric techniques to value the loss in affect attributable to alcohol consumption. METHODS: Cross-sectional (n = 129,437) and longitudinal (n = 11,352) analyses of alcohol consumers in UK Biobank data were undertaken, with depression and neuroticism as proxies of negative affect. The cross-sectional relationship between household income, negative affect and alcohol consumption were analysed using regression models, controlling for confounding variables, and using within-between random models that are robust to unobserved heterogeneity. The differential in household income required to offset alcohol's detriment to affect was derived. RESULTS: A consistent relationship between depression and alcohol consumption (ß = 0.001, z = 7.64) and neuroticism and alcohol consumption (ß = 0.001, z = 9.24) was observed in cross-sectional analyses, replicated in within-between models (depression ß = 0.001, z = 2.32; neuroticism ß = 0.001, z = 2.33). Significant associations were found between household income and depression (cross sectional ß = -0.157, z = -23.86, within-between ß = -0.146, z = -9.51) and household income and neuroticism (cross sectional ß = -0.166, z = -32.02, within-between ß = -0.158, z = -7.44). The value of reducing alcohol consumption by one gram/day was pooled and estimated to be £209.06 (95% CI £171.84 to £246.27). CONCLUSIONS: There was a robust relationship between alcohol consumption and negative affect. Econometric methods can value the intangible effects of alcohol use and may, therefore, facilitate the fiscal determination of benefit.

The effect of parental drinking on alcohol use in young adults: the mediating role of parental monitoring and peer deviance.

BACKGROUND AND AIMS: Evidence demonstrating an association between parental alcohol use and offspring alcohol use from robust prospective studies is lacking. We tested the direct and indirect associations between parental and young adult alcohol use via early alcohol initiation, parental monitoring and associating with deviant peers. DESIGN: Prospective birth cohort study. Path analysis was used to assess the possible association between parental alcohol use (assessed at 12 years) and alcohol use in young adults (assessed at 18 years) via potential mediators (assessed at 14 and 15.5 years, respectively). SETTING: South West England. PARTICIPANTS: Data were available on 3785 adolescents and their parents from the Avon Longitudinal Study of Parents and Children. MEASUREMENTS: The continuous Alcohol Use Disorders Identification Test (AUDIT) score was used as the primary outcome measure. Maternal alcohol use was defined as light (< 4 units on any day), moderate (≥ 4 units on 1-3 days) and high-risk (≥ 4 units on ≥ 4 days in 1 week). Partner alcohol use was also defined as light, moderate and high risk. Socio-economic variables were included as covariates. FINDINGS: There was strong evidence of a total effect from maternal alcohol use to young adult alcohol use [moderate: b = 1.07, 95% confidence interval (CI) = 0.64, 1.49, P < 0.001; high risk: b = 1.71, 95% CI = 1.07, 2.35, P < 0.001]. The majority of this association was explained through early alcohol initiation (moderate: b = 0.14, 95% CI = 0.04, 0.25, P = 0.01; high risk: b = 0.24, 95% CI = 0.07, 0.40, P < 0.01) and early alcohol initiation/associating with deviant peers (moderate: b = 0.06, 95% CI = 0.02, 0.10, P < 0.01; high risk: b = 0.10, 95% CI = 0.03, 0.16, P < 0.01). There was strong evidence of a remaining direct effect (moderate: b = 0.81, 95% CI = 0.39, 1.22, P < 0.001; high risk: b = 1.28, 95% CI = 0.65, 1.91, P < 0.001). A similar pattern of results was evident for partner alcohol use. CONCLUSIONS: Young adults whose parents have moderate or high-risk alcohol consumption are more likely to consume alcohol than those with parents with lower alcohol consumption. This association appears to be partly accounted for by earlier alcohol use initiation and higher prevalence of association with deviant peers.

The feasibility of characterising the effects of dental post-operative discomfort and sensitivity over time.

OBJECTIVES: To assess the feasibility of using short message service text messages to solicit dental patients' experiences of post-operative dental discomfort and sensitivity (PODDS) and whether responses characterise change in PODDS over time. METHODS: Patients were recruited from clinics following routine dental procedures, such as simple restorations or root surface debridement. They completed a short questionnaire collecting information on socio-economic circumstances, their recent experience of PODDS, the acceptability of receiving text message questions and their telephone number. Participants received a short question by text to their telephone for five consecutive days that asked them to respond with an indication (on a 1 to 10 scale) of their experience of PODDS at that time. RESULTS: Questionnaires were completed by 34 participants, of whom text message responses were received from an average of 23.4 participants (min 20, max 26) across the five follow-up days. Regression analyses indicated that PODDS decreased over time (ß = -0.24, 95% CI -0.36 to -0.12). CONCLUSIONS: Text messaging to solicit PODDS is feasible and can potentially be used to assess the efficacy of treatments designed to minimise or reduce PODDS.

The relationship between alcohol use and long-term cognitive decline in middle and late life: a longitudinal analysis using UK Biobank.

Background: Using UK Biobank data, this study sought to explain the causal relationship between alcohol intake and cognitive decline in middle and older aged populations. Methods: Data from 13 342 men and women, aged between 40 and 73 years were used in regression analysis that tested the functional relationship and impact of alcohol on cognitive performance. Performance was measured using mean reaction time (RT) and intra-individual variation (IIV) in RT, collected in response to a perceptual matching task. Covariates included body mass index, physical activity, tobacco use, socioeconomic status, education and baseline cognitive function. Results: A restricted cubic spline regression with three knots showed how the linear (ß1 = -0.048, 95% CI: -0.105 to -0.030) and non-linear effects (ß2 = 0.035, 95% CI: 0.007-0.059) of alcohol use on mean RT and IIV in RT (ß1 = -0.055, 95% CI: -0.125 to -0.034; ß2 = 0.034, 95% CI: 0.002-0.064) were significant adjusting for covariates. Cognitive function declined as alcohol use increased beyond 10 g/day. Decline was more apparent as age increased. Conclusions: The relationship between alcohol use and cognitive function is non-linear. Consuming more than one UK standard unit of alcohol per day is detrimental to cognitive performance and is more pronounced in older populations.

Managing alcohol-related attendances in emergency care: can diversion to bespoke services lessen the burden?

Acute alcohol intoxication (AAI) has a long history of burdening emergency care services. Healthcare systems around the world have explored a variety of different services that divert AAI away from EDs to better manage their condition. Little formal evaluation has been undertaken, particularly in the UK where alcohol misuse is one of the highest in the world. In this article, we outline a brief history of diversionary services, introduce the concept of Alcohol Intoxication Management Services (AIMS) and describe examples of AIMS in the UK. We then describe Evaluating the Diversion of Alcohol-Related Attendances, a natural experiment including six cities with AIMS compared with six cities without, that involves an ethnographic study, records patient experiences in both AIMS and EDs, assesses impact on key performance indicators in healthcare and evaluates the cost-effectiveness of AIMS.

I am going to make the most out of it! Italian university Credit Mobility Students' social representations of alcohol use during study abroad experiences.

The aim was to explore shared representations of alcohol use in students who were to travel abroad to study. Focus group data from Italian students ( N = 69) were collected. Analyses used Grounded Theory Methodology and were informed by the four key components of Social Representation Theory (cognition, emotion, attitude and behavioural intentions). The study abroad experience was described as one that would involve an increase in alcohol consumption compared to pre-departure levels. Reasons given included greater social and leisure opportunities involving alcohol, reduced social control and features of the host country environment. Opportunities to intervene and address risky alcohol use in this group are discussed.

Parental alcohol use and risk of behavioral and emotional problems in offspring.

OBJECTIVE: The majority of studies that have examined parental alcohol use and offspring outcomes have either focused on exposure in the antenatal period or from clinical populations. This study sought to examine proximal and distal associations between parental alcohol use and offspring conduct problems and depressive symptoms in a population birth cohort. METHODS: We used prospective data from a large UK based population cohort (ALSPAC) to investigate the association between parental alcohol use, measured in units, (assessed at ages 4 and 12 years) with childhood conduct trajectories, (assessed on six occasions from 4 to 13.5 years, n = 6,927), and adolescent depressive symptoms (assessed on four occasions from ~13 to ~18 years, n = 5,539). Heavy drinking was defined as ≥21 units per week in mothers and partners who drank 4+ units daily. RESULTS: We found little evidence to support a dose response association between parental alcohol use and offspring outcomes. For example, we found insufficient evidence to support an association between maternal alcohol use at age 4 years and childhood conduct problems (childhood limited: OR = 1.00, 95% CI = .99, 1.01; adolescent onset: OR = 0.99, 95% CI = .98, 1.00; and early-onset persistent: OR = 0.99, 95% CI = .98, 1.00) per 1-unit change in maternal alcohol use compared to those with low levels of conduct problems. We also found insufficient evidence to support an association between maternal alcohol use at age 4 years and adolescent depressive symptoms (intercept: b = .001, 95% CI = -.01, .01, and slope: b = .003, 95% CI = -.03, .03) per 1-unit change in maternal alcohol use. Results remained consistent across amount of alcohol consumed (i.e., number of alcohol units or heavy alcohol use), parent (maternal self-reports or maternal reports of partner's alcohol use), and timing of alcohol use (assessed at age 4 or age 12 years). CONCLUSIONS: There is no support for an association between parental alcohol use during childhood and conduct and emotional problems during childhood or adolescence.

The effectiveness of an intervention to reduce alcohol-related violence in premises licensed for the sale and on-site consumption of alcohol: a randomized controlled trial.

BACKGROUND AND AIMS: Premises licensed for the sale and consumption of alcohol can contribute to levels of assault-related injury through poor operational practices that, if addressed, could reduce violence. We tested the real-world effectiveness of an intervention designed to change premises operation, whether any intervention effect changed over time, and the effect of intervention dose. DESIGN: A parallel randomized controlled trial with the unit of allocation and outcomes measured at the level of individual premises. SETTING: All premises (public houses, nightclubs or hotels with a public bar) in Wales, UK. PARTICIPANTS: A randomly selected subsample (n = 600) of eligible premises (that had one or more violent incidents recorded in police-recorded crime data; n = 837) were randomized into control and intervention groups. INTERVENTION AND COMPARATOR: Intervention premises were audited by Environmental Health Practitioners who identified risks for violence and provided feedback by varying dose (informal, through written advice, follow-up visits) on how risks could be addressed. Control premises received usual practice. MEASUREMENTS: Police data were used to derive a binary variable describing whether, on each day premises were open, one or more violent incidents were evident over a 455-day period following randomization. FINDINGS: Due to premises being unavailable at the time of intervention delivery 208 received the intervention and 245 were subject to usual practice in an intention-to-treat analysis. The intervention was associated with an increase in police recorded violence compared to normal practice (hazard ratio = 1.34, 95% confidence interval = 1.20-1.51). Exploratory analyses suggested that reduced violence was associated with greater intervention dose (follow-up visits). CONCLUSION: An Environmental Health Practitioner-led intervention in premises licensed for the sale and on-site consumption of alcohol resulted in an increase in police recorded violence.