Abstract
BackgroundAlcohol-related violence in and in the vicinity of licensed premises continues to place a considerable burden on the United Kingdom’s (UK) health services. Robust interventions targeted at licensed premises are therefore required to reduce the costs of alcohol-related harm. Previous evaluations of interventions in licensed premises have a number of methodological limitations and none have been conducted in the UK. The aim of the trial was to determine the effectiveness of the Safety Management in Licensed Environments intervention designed to reduce alcohol-related violence in licensed premises, delivered by Environmental Health Officers, under their statutory authority to intervene in cases of violence in the workplace.Methods/DesignA national randomised controlled trial, with licensed premises as the unit of allocation. Premises were identified from all 22 Local Authorities in Wales. Eligible premises were those with identifiable violent incidents on premises, using police recorded violence data. Premises were allocated to intervention or control by optimally balancing by Environmental Health Officer capacity in each Local Authority, number of violent incidents in the 12 months leading up to the start of the project and opening hours. The primary outcome measure is the difference in frequency of violence between intervention and control premises over a 12 month follow-up period, based on a recurrent event model. The trial incorporates an embedded process evaluation to assess intervention implementation, fidelity, reach and reception, and to interpret outcome effects, as well as investigate its economic impact.DiscussionThe results of the trial will be applicable to all statutory authorities directly involved with managing violence in the night time economy and will provide the first formal test of Health and Safety policy in this environment. If successful, opportunities for replication and generalisation will be considered.Trial registrationUKCRN 14077; ISRCTN78924818.
Highlights
Alcohol-related violence in and in the vicinity of licensed premises continues to place a considerable burden on the United Kingdom’s (UK) health services
Five randomised controlled trials (RCT) were identified and these were subject to a number of shortcomings including (i) considerable variation in and poorly defined outcome measures meaning studies could not be compared, (ii) follow-up periods were decided ad hoc and did not consider intervention sustainability, (iii) economic evaluations were not included, (iv) studies often relied on inappropriate control groups, (v) many failed to achieve random allocation, and (vi) participants or evaluators were not blind to study conditions
The theoretical basis of the intervention (SMILE: Safety Management In Licensed Environments) evaluated in the current trial is that reducing known risk factors [17] within premises and their immediate environment will either directly or indirectly reduce alcohol misuse and violence and that current legislation (2003 Licensing Act, Health and Safety at Work Act 1974) provides a framework for the delivery of a risk audit intervention
Summary
This protocol describes a RCT of an intervention (SMILE) designed to reduce alcohol-related violence in licensed premises in all LAs across Wales. This is the first RCT of a PL intervention in the UK and has been designed to overcome a number of methodological limitations of similar studies conducted elsewhere. If the potentially low cost implementation succeeds in reducing alcohol-related violence there will likely be substantial tangible (e.g. reducing costs to health services and the police) and intangible benefits (e.g. reducing fear of crime [29] and the psychological impact of victimisation). All authors read, contributed to and approved the final manuscript
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