National Drug Research Institute Preventing Harmful Drug Use in Australia Violence in the night-time economy: availability and amenity Prof Tanya Chikritzhs & Dr Wenbin Liang

Background Research indicates strongly that as alcohol becomes more available through commercial or social sources, consumption and alcohol-related problems rise. Conversely, when availability is restricted, alcohol use and associated problems decrease. (Babor et al. 2010, p 5) There is strong evidence that substantial changes in the number of alcohol outlets result in significant changes to alcohol consumption and related harm. (p. 131)

Background: what is ‘outlet density’?  Number of hotels for every 1,000 residents in a region  Number of packaged liquor licenses for every hectare in a region  Number of restaurants per kilometre of roadway in a region OR  Amount (volume) of alcohol sold/supplied within a region

Changes in outlet density 2003 to 2005

Outlet density research from Victoria Livingston (2008a): increased outlets over time strongly related to increased violence in Victoria but varied by SES and licence type. Hotels problematic in inner-city entertainment precincts, off-premise outlets highly associated with violence in suburban areas. Livingston (2008b); explored non-linear relations between density and violence in Melbourne. Showed a ‘critical threshold’ for pubs, where bunching of venues risk of violence in and around surrounding increased from 12 to 40 assaults per/yr.

This study

AIM To investigate the effects of numbers of outlets, alcohol sales, and types of alcohol outlets on the risk of assault at different locations in Western Australia. Amenity? Availability? or both?

Sales data collections Sales data - volume of wholesale alcohol purchases made by retailers from wholesalers WA, NT, QLD only – see the National Alcohol Sales Data Project (NASDP)

Alcohol outlet density studies Measure these association between numbers of outlets and harm, e.g. violence, road crashes, hospitalisations, suicide, venereal disease Dominated by studies from the US Dominated by count- based studies

Design Ecological, cross-sectional Sales data - volume of wholesale alcohol purchases made by retailers from wholesalers Alcohol sales made by type of licensed outlet Police assault data by type of location (domestic, licensed, other) 140 local government areas About two and a half postcodes to every one LGA in 2000/01 70% outside of metropolitan area Controlled for range of demographic and socio-economic variables

Figure 1: Geographic distribution of total counts of licensed outlets, Local Government Areas, Western Australia, 2000/01

Profile: WA licensed outlets, numbers (N=2,576) and alcohol sales

Profile: police reported assaults (n= 18,223)

Profile: place of assault

Profile: residential vs on-site assaults, sex of victims and perpetrator

Analysis Numbers of violent assault offences formed the dependent variable in all analyses arising in individual models: i) total assaults; ii) assaults at on-site outlets; iii) assaults at residential premises iv) assaults at ‘other’ places. All models simultaneously included measures of alcohol sales volumes and numbers of both on-site and off-site outlets as well as the full compliment of potential demographic and socio-economic confounders.

Results: Incidence rate ratio for on- and off-site numbers of outlets and average alcohol sales (on-site 3,600 ltrs; off- site 12,000 ltrs) On-site (hotels, restaurants, social clubs, nightclubs) Off-site (liquor stores) Counts (per 1 outlet) Alcohol sales (per 10,000 ltrs) Counts (per 1 outlet) Alcohol sales (per 10,000 ltrs) Total assaults1.021* * On-site outlets1.048* * Residential * Other places1.027* *

% increase in reported assaults per one additional average outlet (on-site 3,600 ltrs; off-site 12,000 ltrs)

Summary In relation to violence, the amount of alcohol sold is the most important factor to consider for liquor stores/packaged liquor outlets (counting up liquor stores is of little predictive value) Alcohol sales by liquor stores/packaged liquor outlets predicts violence in the domestic settings and violence in the on-site licensed setting Neither alcohol sales nor counts of on-site outlets predicts violence in domestic settings Alcohol sales from liquor stores/packaged liquor outlets is a much stronger predictor of violence in and around the night time environment than numbers of on-site outlets

Implications Research Outlet density measures which essentially rely on ‘counts’ of licensed premises necessarily assume that all licensed premises of a certain type, are equivalent In reality, this is not the case, size and capacity to influence overall consumption in a community may differ markedly between premises, neighbourhoods and communities Off-site outlets largely influence harm via economic availability and its effect on behaviours such as pre-loading Counting off-site outlets does not adequately describe highly variable alcohol sales How to address this when sales data are not widely available? Counting on-site outlets may be a better measure than sales – probably because on- site outlets influence violence largely via amenity effects than availability effects How much of the ‘outlet density’ jigsaw puzzle are we missing without knowledge of alcohol sales? Relative absence of sales data in the literature may explain less robust findings for road crashes, other non-violent harms e.g. chronic morbidity, falls etc

For discussion Policy Efforts to reduce violence in the night-time economy should not ignore off- outlet sales and their influence on economic availability within communities. Scottish Executive noted the observation by health informants that “…perhaps front loading was playing a role in antisocial behaviour outside on-sales, as with the increase of individuals drinking before going out, there is an increase of people in one location who are already drunk and ‘topping’ up in on-sales which then spills out at the end of the night.” (2007,p. 38). Intervention needs to simultaneously reduce the affordability of alcohol overall and the disparity between on- and off-outlet beverage prices. Could minimum price per standard drink (price posting, floor price) be an effective strategy for reducing violence in the night-time economy?

Thankyou