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An Observational Study to Examine How Cumulative Impact Zones Influence Alcohol Availability from Different Types of Licensed Outlets in an Inner London Borough

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An Observational Study to Examine How Cumulative Impact Zones Influence Alcohol Availability from Different Types of Licensed Outlets in an Inner London Borough Open access Original research BMJ Open: first published as 10.1136/bmjopen-2018-027320 on 24 September 2019. Downloaded from An observational study to examine how cumulative impact zones influence alcohol availability from different types of licensed outlets in an inner London Borough Carolyn A Sharpe, 1,2 Alan Poots,3 Hilary Watt,1 Chris Williamson,4 David Franklin,5 Richard J Pinder 1,2 To cite: Sharpe CA, Poots A, ABSTRACT Strengths and limitations of this study Watt H, et al. An observational Objectives Cumulative impact zones (CIZs) are a study to examine how widely implemented local policy intended to restrict cumulative impact zones ► This study provides the first quantitative evaluation influence alcohol availability alcohol availability in areas proliferated with licensed of cumulative impact zones that disaggregates out- from different types of outlets. Limited previous research has questioned their let type into five discrete categories. licensed outlets in an inner effectiveness and suggested they may play a more ► This research provides deeper insight into the na- London Borough. BMJ Open nuanced role in shaping local alcohol environments. ture of alcohol exposure in different locations within 2019;9:e027320. doi:10.1136/ This study evaluates the association between CIZ an urban centre and therefore provides an evidence bmjopen-2018-027320 implementation and the number of licence applications base from which local policy can be developed to ► Prepublication history and made, and the number issued, relative to a control support local licensing goals which may include di- additional material for this region. versification of the night-time economy. paper are available online. To Design A quantitative observational study. ► This study shows that descriptive analyses of alco- view these files, please visit Setting The inner London Borough of Southwark, which hol control policies (using absolute numbers) are in- the journal online (http:// dx. doi. currently enforces three CIZs. sufficient, and provides a robust statistical approach org/ 10. 1136/ bmjopen- 2018- that can be employed in other urban settings. 027320). Population Licence applications received by Southwark Although substantial steps were taken to assure Council’s Licensing Authority between 1 April 2006 and 31 ► the reproducibility of the results, the categorisation Received 16 October 2018 March 2017 (n=1254). http://bmjopen.bmj.com/ of outlet type into five discrete categories involved Revised 19 July 2019 Interventions CIZ implementation. Accepted 30 August 2019 qualitative assessment and there remains a risk of Primary outcome measures Five outlet types were subjectivity. categorised and evaluated: drinking establishments, ► Necessary stratification of the dataset rendered eateries, takeaways, off sales and other outlets. some strata with very few (or in some cases zero) Primary outcome measures were the number of counts, thereby constraining statistical power. © Author(s) (or their applications received and the number of licences employer(s)) 2019. Re-use permitted under CC BY. issued. These were analysed using Poisson regression Published by BMJ. of counts over time. INTRODUCTION on October 4, 2021 by guest. Protected copyright. 1Department of Primary Care Results Across all CIZs, implementation was associated Alcohol harm and opportunities to control and Public Health, School of with greater increases in the number of eateries in availability Public Health, Imperial College CIZ regions (incidence rate ratio (IRR)=1.58, 95% CI: Alcohol occupies a prominent role in London, London, UK 1.02–2.45, p=0.04) and number of takeaway venues 2 modern society. It is a commodity used by Public Health Directorate, (IRR=3.89, 95% CI: 1.32–11.49, p=0.01), relative to the Southwark Council, London, UK many, across social strata, as a relaxant and a 1 3NIHR CLARHC Northwest control area. No discernible association was found for the means of enjoyment. The misuse of alcohol London, Imperial College remaining outlet types. Disaggregating by area indicated leads to increased morbidity and mortality. London, London, UK a 10-fold relative increase in the number of new eateries In England in 2016, it was estimated that 4Public Health Division, Place in Peckham CIZ (IRR=10.38, 95% CI: 1.39–77.66, p=0.02) and Wellbeing Department, almost 13 million adults drank at levels that and a fourfold relative increase in the number of newly increased their risk of harm.2 Among those Southwark Council, London, UK licensed takeaways in Bankside CIZ (IRR=4.38, 95% CI: 5Licensing, Southwark Council, aged 15–49, alcohol has become the leading 1.20–15.91, p=0.03). London, UK risk factor for ill-health, early mortality and Conclusions CIZs may be useful as policy levers to shape disability.3 Correspondence to local alcohol environments to support the licensing goals Outlet spatial density is positively associ- Carolyn A Sharpe; of specific geographical areas and diversify the night-time ated with consumption.4 5 Policies to restrict carolyn. sharpe15@ imperial. economy. ac. uk the physical availability of alcohol are well Sharpe CA, et al. BMJ Open 2019;9:e027320. doi:10.1136/bmjopen-2018-027320 1 Open access BMJ Open: first published as 10.1136/bmjopen-2018-027320 on 24 September 2019. Downloaded from supported in the literature.6 However, such evidence is when compared with a control region. On analysing based on aggregate studies that consider all alcohol-outlet one CIZ area in isolation, establishment was associated types as equal. At best, outlets have been categorised as with a statistically significant 133% increase in successful either on-sales or off-sales. On-sales of alcohol refer to applications.12 venues such as pubs, nightclubs and restaurants where Qualitative research, conducted in 2016, investigating alcohol is purchased to be consumed on the premises. the drivers behind CIZ implementation has suggested Off-sales of alcohol refer to premises such as off-licences them to be more nuanced than simply restricting outlet and supermarkets from which alcohol is purchased to be density.16 Participants described how CIZs have evolved to consumed away from the retailer’s premises.7 Although encourage local regeneration goals. CIZs tended not to be greater association has been found between off-sales and established to cap the number of licensed outlets, rather alcohol-related hospitalisations and deaths than with they are viewed as a tool to control the temporal avail- on-sales,8 both on-licences and off-licences cover a broad ability of alcohol and even to encourage a certain type of range of establishments. Such aggregate studies remain application for example, from arts, food and coffee led a crude way to evaluate alcohol availability9 and debate establishments as opposed to ‘vertical drinking’ bars. remains around when to use aggregated and disaggre- Plans to diversify night-time economies and offer alter- gated analyses.10 natives to alcohol-led activities are emerging. In April A full description of the licensing process in England 2017, the Mayor of London published guidance for and Wales, as defined by the Licensing Act 2003,11 is culture and the night-time economy in the capital and outlined in our previous paper.12 In summary, revised identified diversification and inclusiveness as key areas of guidance issued under section 182 of the Licensing Act focus. Through encouraging leisure and cultural venues, 2003 enables local licensing authorities (LAs) to address for example, late-night markets, museums, shops, cafes, the cumulative impact of a concentration of licensed theatres and fairs, urban centres hope to attract a wider premises.13 Cumulative impact is defined as ‘the poten- clientele. Examples of which include non-drinkers, older tial impact on the promotion of the licensing objectives people, families and those with a disability.17 Despite of a significant number of licensed premises concen- these plans, an evidence base in support of diversifying trated in one area’.13 The licensing objectives, in England the night-time economy is lacking. and Wales, as defined by the Licensing Act 2003 are: the prevention of crime and disorder, public safety, the Gaps in the literature prevention of public nuisance and the protection of chil- A key research gap exists around the assumption that all dren from harm.11 on-licensed and off-licensed outlets are treated as equal.9 A cumulative impact zone (CIZ) may therefore be Although aggregate studies may show an association established, if a LA can evidentially justify that the between outlet density and harm, they are of limited use to licensing objectives are not being upheld in a particular policy makers. Interventions need to be targeted towards location. This evidence must be published in a LA’s state- outlets that cause the most harm. Therefore, through http://bmjopen.bmj.com/ ment of licensing policy (SOLP).13The Licensing Act stratifying by outlet type, we aim to understand how CIZ 2003 requires all LAs to develop and publish a SOLP at establishment is associated with the number of licence least every 5 years.11 Evidence to establish a CIZ relates to applications and issued licences for different outlet types. the licensing objectives. Local crime, disorder and antiso- Qualitative evidence indicates that CIZs can facilitate the cial behaviour statistics can be evaluated alongside acute proliferation of certain types of premises, thereby diversi- health data, such as alcohol-related ambulance atten- fying local night-time economies.16 We therefore propose dances and hospital admissions. Environmental health a quantitative methodology to test for this. complaints, particularly in relation to litter and noise, can on October 4, 2021 by guest. Protected copyright. also be included.13 Southwark’s three CIZs Southwark is an inner London borough with an estimated Current evidence relating to CIZs population of 311 655.18 Southwark is home to approx- In 2016 there were 215 CIZs established across 106 LAs.14 imately 1400 licensed premises which make a signifi- Despite their widespread establishment, there is a scar- cant contribution to its culture and economy.
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