B3399 - Integrating longitudinal and cross-national evaluations of increased community alcohol availability and the health and economic - 08/11/2019

B number: 
B3399
Principal applicant name: 
Frank de Vocht | Population Health Sciences, University of Bristol (United Kingdom)
Co-applicants: 
Dr Bosco Rowland, Professor John Toumbourou, Dr Jon Heron, Professor Peter Miller, Dr Michael Livingston, Professor Matt Hickman, Dr Cheryl McQuire, Dr Inês Henriques-Cadeby, Mr Colin Angus, Dr John Holmes
Title of project: 
Integrating longitudinal and cross-national evaluations of increased community alcohol availability and the health and economic
Proposal summary: 

While the detrimental impact of alcohol use is well understood, in England and Australia, many adolescents consume, purchase, or are provided alcohol. In the short term, alcohol is linked to increased risk of injury and fatalities; in the long term it is associated with increased risk of cancers and diseases. Adolescent alcohol use is of particular concern as it is associated with poor mental health, brain damage, and increased risk of dependence in adulthood. Despite strong evidence that reducing the supply of alcohol in the built environment can be used to prevent or reduce consumption at a population level, in England and Australia, the prevalence of environments where alcohol is readily available is increasing yearly, often in low socio-economic urban areas.
The number of alcohol outlets in the built environment is one indicator of supply and availability. For adults, evidence consistently demonstrates an association between the number of outlets in a given area and alcohol-related behaviour. The evidence of increased availability on the health and well-being of adolescents is less clear and under examined. Most research is cross-sectional and USA-focused. The proposed project will address this important evidence gap. Our team will undertake a comprehensive longitudinal cross-national analysis of the links between alcohol availability and child and adolescent alcohol uptake with consumption, health and well-being over the adolescent and young adult years. It will use, high quality longitudinal studies of English and Australian participants followed over 17years (2002 to 2018) to examine links between changes in alcohol availability and alcohol-related behaviour and health from the school years (10-17 years) into early adulthood (27-31 years).
English data will be drawn from the Avon Longitudinal Study of Parents and Children (ALSPAC) and Australian data will be drawn from the International Youth Development study (IYDS). Data will be merged with retail outlet data. Changes in the density of outlets in a participant’s local area and its link with the age of initiation and consumption will be examined. Limitations of previous study designs will be addressed by employing novel cross-lagged panel analysis techniques, which mimic an RCT and can be used to develop causal evidence with longitudinal data. Multi-level growth, elasticity, and latent class modelling will be used to investigate issues neglected in the international literature relating to development and policy. The core research questions will be: Does density exposure at early ages have a sustained effect on child and adolescent behaviour? How does density exposure affect the severity and breadth of alcohol-related problems of young people? Are there maximum and minimum availability levels associated with adolescent alcohol-related behaviour and health? Cross-national comparisons will be made and socioeconomic sub-group analyses will be undertaken. An economic evaluation of the impact of adolescent consumption on health and services will be completed. To assist with translation and impact an analysis of policy and legal barriers and facilitators associated with opening or opposing of new alcohol outlets will also be undertaken.
The hypotheses guiding this research proposal are:
1. Exposure to higher density of alcohol sales outlets will predict an earlier age of uptake (initiation of use) of alcohol by adolescents (10-17 years of age) and increases the risk and rate of progressing to greater alcohol use across adolescence and early adulthood.
2. Over time, changes in alcohol sales outlets will be associated with changes in the extent to which adolescents report illegally purchasing alcohol, and changes in the extent to which they report parents supply alcohol to them.
3. Increased costs (health and broader societal), lower productivity and poorer health (including mental health) are expected in adolescents who are exposed to higher alcohol outlet densities.

Impact of research: 
The detrimental and causal impact of alcohol on non-communicable disease is well understood as are the links between alcohol availability, alcohol consumption and alcohol-related harms in adults. It is much less clear how increasing alcohol availability in local, and especially urban, built environments is causally linked to the uptake and frequency of consumption by children and adolescents, and the extent to which this may impact on health and well-being and consumption later in life. Thus, for this project, the academic impact of publishing high-quality, definitive evidence identifying these links is critical to the societal and policy impact of the proposed research. Using cross-national, longitudinal datasets and novel analyses, we will generate the best available evidence on how increasing alcohol outlets in cities is affecting children and adolescents’ alcohol use, their health and futures and the costs to local and national governments of trends in alcohol consumption among young people. The planned analyses will also identify what factors facilitate or impede the regulation of alcohol outlets in the community. From the first year we will interview stakeholders and policy makers (as part of WP6) to identify key questions that guide current licencing policy and ensure that our analyses addresses these issues. We will use qualitative analyses of interview data, observations of the history of licencing objections and analyses of local legalisation and practices to map out the processes by which policy is translated into licencing practice in Bristol and Melbourne. To maximise the impact of the project we are in the process of establishing an Expert Study Advocacy and Advisory Group (SAAG), for which we already have support from Public Health England, Public Health Association of Australia, the Institute of Alcohol Studies and from academia (Letters of Support included), and we aim to include further representation from stakeholders and the general public. The SAAG will be established to help identify how to best facilitate and promote findings. We anticipate that, we will write a series of brief policy and community information sheets targeting policy makers and community leaders. These will outline the main findings and recommendations arising from our research, including recommendations for policy and legislative change. We will also provide a “managing the process” community resource pack. It is easy to find “what-to-do” guidelines if you want to get a new alcohol licence (e.g., https://impos.com.au/blog/alcohol-licence-guide-australia/) and, for example, the VCGLR, sets out clearly how to object to new licences (https://www.vcglr.vic.gov.au/community-services/objecting-liquor-licence-application). However, it is less clear how community representatives can manage extant processes and advocate for policy and practice change. We will provide evidence-based guidelines to managing these processes that link directly to local policy frameworks. In addition, towards the end of the project we will we will run three workshops, one for community leaders in Melbourne and one for legislators in Canberra, while in the UK one workshop will be organised (location to be decided) for policy makers, local councils, NGOs, other stakeholders and the general public. These workshops will allow us to present not only the results of our data analyses but also our recommendations for policy and practice change that are compatible with a harm minimisation approach to the marketing of alcohol products. These workshops will highlight our findings in terms of the health, community and economic impact of current policies. We will present alternative legislative and policy futures and map out their likely health, community and economic consequences, based on our results. We will also identify road maps to harm minimisation policy development.
Date proposal received: 
Tuesday, 29 October, 2019
Date proposal approved: 
Thursday, 31 October, 2019
Keywords: 
Social Science, Addiction - e.g. alcohol, illicit drugs, smoking, gambling, etc., Behaviour - e.g. antisocial behaviour, risk behaviour, etc., Mental health, Qualitative study, Statistical methods, Cohort studies - attrition, bias, participant engagement, ethics, Childhood - childcare, childhood adversity, Cognition - cognitive function, Social science, Statistical methods