Richard Purves

Background: Young people’s engagement in gambling can be linked to gambling-related harm. There is a lack of independently funded and evidence-based school-based interventions that seek to prevent and reduce the harms associated with gambling. Objectives: To conduct a pilot cluster randomised controlled trial of a gambling prevention intervention (Preventing Gambling Related Harm in Adolescents) among young people aged 13–15 years to determine the utility of conducting a phase III randomised controlled trial assessing effectiveness and cost-effectiveness. Design and methods: Two-arm, pilot cluster randomised controlled trial with an embedded process evaluation, health economic scoping study and social network analysis. Setting: Six state schools across Scotland: four intervention and two control. Participants: Students aged 13–15 years (baseline: intervention N = 762 students, control N = 352 students. Follow-up: intervention N = 598 students, control N = 295 students). Intervention: Preventing Gambling Related Harm in Adolescents is a peer-led, social network intervention to prevent adolescent gambling and reduce gambling-related harm. Students, nominated by peers in their year group, attended a 2-day training workshop outside of school, which was delivered by trained youth workers. After completing the 2-day training workshop, students were then assigned the role of ‘peer supporters’. Peer supporters then attended three in-school follow-up sessions, with the same youth workers, to refresh the learning they had received during the workshop. After the workshop and during the follow-up sessions, peer supporters were encouraged to have conversations about their learning on the topic of gambling and gambling-related harm with their friends and family. Social network maps were created by peer supporters to: (1) help them identify people to speak to and (2) record to who they spoke to about gambling and gambling-related harm. Main outcome measures: Progression to a full-scale Phase III cluster randomised control trial, using pre-set progression criteria. Progression criteria were: (1) successful recruitment of six schools; (2) five schools remain in the pilot study; (3) the intervention being delivered with 80% fidelity to the manual; (4) the process evaluation indicates the intervention is acceptable to students and staff and (5) 70% of students complete the student questionnaire at baseline and follow-up. Results: All five progression criteria were met. All schools were recruited and retained in the study and there were low levels of missing data on outcomes. The process evaluation indicated that Preventing Gambling Related Harm in Adolescents was acceptable to all stakeholders and was delivered with fidelity to the delivery manual. Some minor refinements to the intervention and trial methods would aid student perception of the real-world effects of gambling. Indicative costs to deliver two cycles of Preventing Gambling Related Harm in Adolescents in one school were £8313.00, with a mean cost per student of £28.08. Limitations: A limitation is student self-reported gambling behaviour. This relied on their interpretation of what gambling is, which varied. Conclusions: Delivery of the Preventing Gambling Related Harm in Adolescents intervention was both feasible and acceptable, indicating that the study could progress to a full-scale Phase III randomised controlled trial, with minor amendments to the intervention and trial processes. Future work: Preventing Gambling Related Harm in Adolescents should progress to a full-scale randomised controlled trial. Funding: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR150838.

Aim: To conduct a pilot cluster randomised controlled trial (cRCT) of a gambling prevention intervention (PRoGRAM‐A) among young people aged 13–15 to determine the utility of conducting a Phase III RCT assessing effectiveness and cost‐effectiveness. Design: Two‐arm, pilot cluster randomised controlled trial with an embedded process evaluation, health economic scoping study and social network analysis. Six schools were identified based on Scottish Index of Multiple Deprivation and school roll size. Schools were randomised to either intervention ( n = 4) or control ( n = 2). The trial was delivered between October 2023 and November 2024. Setting: Six state funded secondary schools in Scotland (four intervention, two control). Participants: Students (intervention n = 762, and control n = 352) in secondary school year 3 (aged 13–15 years old). Intervention and comparator: PRoGRAM‐A (Preventing Gambling Related Harm in Adolescents), a peer‐led social network intervention to protect young people, their friends and family members from gambling related harm (GRH). Control schools delivered their standard Personal, Social, Health and Education (PSHE) curriculum, which did not include any form of gambling education. Measurements: The primary outcome of this study was whether progression to a full‐scale Phase III cRCT was warranted, using pre‐set progression criteria. These criteria sought to address uncertainties in the intervention and cRCT design with thresholds set according to a traffic light system. Findings: All five progression criteria were met. All schools were recruited and retained in the study with minimal missing outcome data. The process evaluation indicated that PRoGRAM‐A was acceptable to multiple stakeholders and delivered with fidelity to the delivery manual. The proposed primary outcome for a future Phase III cRCT was self‐reported gambling participation (measured by asking about types of gambling participation ‘in the last 4 weeks’ and ‘in the last 12 months'). This pilot study found no statictically significant differences between the control and intervention groups at follow‐up. Conclusions: The school‐based gambling prevention intervention PRoGRAM‐A appears to be an acceptable intervention which can be delivered with high fidelity. The trial methods were acceptable with all settings recruited and retained. Progression to a larger randomised controlled trial to test effectiveness and costs effectiveness is warranted.

Young people’s engagement in gambling can be linked to gambling-related harm. This can cause stress, anxiety, relationship issues, debt, and lost opportunities. There is a lack of independently funded, and evidence-based school-based interventions that seek to prevent and reduce the harms associated with gambling. PRoGRAM-A is one of the first independently research funded interventions to prevent gambling related harm in adolescents. This paper presents findings from an embedded process evaluation of the pilot cluster randomised control trial of PRoGRAM-A, with a specific focus on intervention fidelity, feasibility and acceptability. Multi-modal study design comprised of qualitative focus groups with students (N = 42); and individual interviews with teachers (N = 7), PRoGRAM-A trainers (N = 5), student friends and family (N = 2) and stakeholders (N = 8). Structured Observations of the full cycle of PRoGRAM-A across two intervention schools were also undertaken. PRoGRAM-A was delivered with a high degree of fidelity (95%) to the training manual. It was also found to be both feasible and acceptable to students, staff and parents. It was appealing to schools as it allowed teachers to address the topic of gambling, which had already been flagged as an issue for some of the schools, but they lacked the skill and capacity to take action. Peer Supporters enjoyed the interactive nature of the training workshop. Parents and carers were supportive of the intervention and stakeholders recognised the growing need for a non-industry funded school-based intervention to raise awareness among students of gambling and gambling-related harm (GRH). Suggested intervention refinements include embedding examples of lived experience to aid students’ engagement with the topic of gambling and GRH. Increasing social skills activities to ensure students are comfortable and confident when initiating conversations and making follow-up sessions more interactive (in-line with the two-day workshop). This study demonstrated that it is feasible and acceptable to deliver the PRoGRAM-A gambling harm reduction intervention within secondary schools with a high degree of fidelity. Addressing the topic of gambling and GRH within the school curriculum was deemed to be acceptable by all sample groups, including students. Research Registry researchregistry8699.

This article consists of a citation of a published article describing research funded by the Public Health Research programme under project number 15/129/11, and is provided as as part of the complete record of research outputs for this project. The original publication is available at: https://doi.org/10.15288/jsad.22-00020 Objective: In the United Kingdom, some public health teams (PHTs) routinely engage with local alcohol premises licensing systems, through which licenses to sell alcohol are granted. We aimed to categorize PHT efforts and to develop and apply a measure of their efforts over time. Method: Preliminary categories of PHT activity were developed based on prior literature and were used to guide data collection with PHTs in 39 local government areas (27 in England; 12 in Scotland), sampled purposively. Relevant activity from April 2012 to March 2019 was identified through structured interviews (N = 62), documentation analysis, and follow-up checks, and a grading system was developed. The measure was refined based on expert consultation and used to grade relevant PHT activity for the 39 areas in 6-month periods. Results: The Public Health engagement In Alcohol Licensing (PHIAL) Measure includes 19 activities in six categories: (a) staffing; (b) reviewing license applications; (c) responding to license applications; (d) data usage; (e) influencing licensing stakeholders or policy; and (f) public involvement. PHIAL scores for each area demonstrate fluctuation in type and level of activity between and within areas over time. Participating PHTs in Scotland were more active on average, particularly on senior leadership, policy development, and working with the public. In England, activity to influence license applications before decision was more common, and a clear increase in activity is apparent from 2014 onward. Conclusions: The novel PHIAL Measure successfully assessed diverse and fluctuating PHT engagement in alcohol licensing systems over time and will have practice, policy, and research applications. Funding: This publication was funded by the Public Health Research programme as a part of award number 15/129/11. This article reports on one component of the research award EXILENS EXploring the Impact of alcohol Licensing in ENgland and Scotland: a mixed-method, natural experiment evaluation of public health engagement in alcohol premises licensing and impact on alcohol-related harms. For more information about this research please view the award page [https://fundingawards.nihr.ac.uk/award/15/129/11] DOI: https://doi.org/10.15288/jsad.22-00020

This article consists of a citation of a published article describing research funded by the Public Health Research programme under project number 15/129/11, and is provided as as part of the complete record of research outputs for this project. The original publication is available at: https://doi.org/10.1016/j.lanepe.2022.100450 Summary: Background: Public health teams (PHTs) in England and Scotland engage to varying degrees in local alcohol licensing systems to try to reduce alcohol-related harms. No previous quantitative evidence is available on the effectiveness of this engagement. We aimed to quantify the effects of PHT engagement in alcohol licensing on selected health and crime outcomes. Methods: 39 PHTs in England (n = 27) and Scotland (n = 12) were recruited (of 40 contacted) for diversity in licensing engagement level and region, with higher activity areas matched to lower activity areas. Each PHT's engagement in licensing for each 6 month period from April 2012 to March 2019 was quantified using a new measure (PHIAL) developed using structured interviews, documentary analyses, and expert consultation. Outcomes examined were ambulance callouts, alcohol-related hospital admissions, alcohol-related and alcohol-specific mortality and violent, sexual and public order offences. Timeseries were analysed using multivariable negative binomial mixed-effects models. Correlations were assessed between each outcome and 18-month average PHIAL score (primary metric), cumulative PHIAL scores and change in PHIAL scores. Additionally, 6-month lagged correlations were also assessed. Findings: There was no clear evidence of any associations between the primary exposure metric and the public health or crime outcomes examined, nor between cumulative PHIAL scores or change in PHIAL score and any outcomes. There were no significant associations in England or Scotland when analysed separately or between outcomes and lagged exposure metrics. Interpretation: There is no clear evidence that allocating PHT resources to engaging in alcohol licensing is associated with downstream reductions in alcohol-related health harms or crimes, in the short term or over a seven year follow-up period. Such engagement likely has benefits in shaping the licensing system to take account of health issues longer term, but as current systems cannot reduce alcohol availability or contain online sales, their potential benefits are somewhat constrained. Funding: The ExILEnS project is funded by the NIHR Public Health Research Programme (project number 15/129/11). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Funding: This publication was funded by the Public Health Research programme as a part of award number 15/129/11. This article reports on one component of the research award EXILENS EXploring the Impact of alcohol Licensing in ENgland and Scotland: a mixed-method, natural experiment evaluation of public health engagement in alcohol premises licensing and impact on alcohol-related harms. For more information about this research please view the award page [https://fundingawards.nihr.ac.uk/award/15/129/11] DOI: https://doi.org/10.1016/j.lanepe.2022.100450

This article consists of a citation of a published article describing research funded by the Public Health Research programme under project number 15/129/11, and is provided as as part of the complete record of research outputs for this project. The original publication is available at: https://doi.org/10.1111/dar.13413 Introduction: The COVID-19 pandemic necessitated unprecedented changes in alcohol availability, including closures, curfews and restrictions. We draw on new data from three UK studies exploring these issues to identify implications for premises licensing and wider policy. Methods: (i) Semi-structured interviews (n = 17) with licensing stakeholders in Scotland and England reporting how COVID-19 has reshaped local licensing and alcohol-related harms; (ii) semi-structured interviews (n = 15) with ambulance clinicians reporting experiences with alcohol during the pandemic; and (iii) descriptive and time series analyses of alcohol-related ambulance callouts in Scotland before and during the first UK lockdown (1 January 2019 to 30 June 2020). Results: COVID-19 restrictions (closures, curfews) affected on-trade premises only and licensing stakeholders highlighted the relaxation of some laws (e.g. on takeaway alcohol) and a rise in home drinking as having long-term risks for public health. Ambulance clinicians described a welcome break from pre-pandemic mass public intoxication and huge reductions in alcohol-related callouts at night-time. They also highlighted potential long-term risks of increased home drinking. The national lockdown was associated with an absolute fall of 2.14 percentage points [95% confidence interval (CI) 3.54, 0.74; P = 0.003] in alcohol-related callouts as a percentage of total callouts, followed by a daily increase of +0.03% (95% CI 0.010, 0.05; P = 0.004). Discussion and Conclusions: COVID-19 gave rise to both restrictions on premises and relaxations of licensing, with initial reductions in alcohol-related ambulance callouts, a rise in home drinking and diverse impacts on businesses. Policies which may protect on-trade businesses, while reshaping the night-time economy away from alcohol-related harms, could offer a ‘win–win’ for policymakers and health advocates. Funding: This publication was funded by the Public Health Research programme as a part of award number 15/129/11. This article reports on one component of the research award EXILENS EXploring the Impact of alcohol Licensing in ENgland and Scotland: a mixed-method, natural experiment evaluation of public health engagement in alcohol premises licensing and impact on alcohol-related harms. For more information about this research please view the award page [https://fundingawards.nihr.ac.uk/award/15/129/11] DOI: https://doi.org/10.1111/dar.13413

This article consists of a citation of a published article describing research funded by the Public Health Research programme under project number 15/129/11, and is provided as as part of the complete record of research outputs for this project. The original publication is available at: https://doi.org/10.1080/09687637.2023.2205991 Aims: Interventions restricting temporal and spatial availability of alcohol are associated with reduced harm, but the pathways by which specific interventions have impact are poorly understood. We examined mechanisms of impact from the perspective of diverse licensing stakeholders. Methods: Fifty-three in-depth interviews were conducted with licensing stakeholders (from public health teams [PHTs], police, local authority licensing teams and lawyers, and alcohol premises licensing committees) from 20 local government areas. Interviewees were recruited as part of the Exploring the impact of alcohol licensing in England and Scotland (ExILEnS) study. Data were analyzed thematically and preliminary themes/subthemes were discussed during online groups with a different sample of public health and licensing professionals (n = 10). Findings: Most interviewees struggled to articulate how availability interventions might lead to changes in alcohol consumption or harms. Five overarching mechanisms were identified: access, visibility, premises and area-level norms, affordability, and management of the night-time economy, with specific pathways identified for certain subgroups/premises types. The mechanisms by which alcohol availability interventions may impact on alcohol consumption and harms are diverse, but were poorly understood. Conclusions: These findings will inform licensing and availability policy and advocacy, highlighting the need for further scrutiny of the evidence underpinning identified mechanisms, and primary research to address knowledge gaps. Funding: This publication was funded by the Public Health Research programme as a part of award number 15/129/11. This article reports on one component of the research award EXILENS EXploring the Impact of alcohol Licensing in ENgland and Scotland: a mixed-method, natural experiment evaluation of public health engagement in alcohol premises licensing and impact on alcohol-related harms. For more information about this research please view the award page [https://fundingawards.nihr.ac.uk/award/15/129/11] DOI: https://doi.org/10.1080/09687637.2023.2205991

This article consists of a citation of a published article describing research funded by the Public Health Research programme under project number 15/129/11, and is provided as as part of the complete record of research outputs for this project. The original publication is available at: https://doi.org/10.1016/j.puhe.2022.07.006 Objectives: This study ascertains the views of UK stakeholders on the actual, and possible, impact of a public health licensing objective in their day-to-day work. Study design and methods: Twenty-eight interviews were conducted with members of public health teams who were actively engaged in alcohol licensing in their local area between 2017 and 2019. Six teams were based in Scotland (where there is a public health licensing objective) and 14 in England (where there is no similar objective). Results: Scottish participants reported that while challenges remained in applying the public health licensing objective, progress had been made and the objective was beneficial to their work. Participants in England felt that an objective would increase the legitimacy, value and impact of their contributions. In both Scotland and England, constructive relationships between PHTs, licensing authorities and other key stakeholders were developing suggesting that PHTs could have a sustainable and positive role in licensing. Conclusions: In many Scottish areas, the alcohol licensing system is evolving to take constructive account of its public health objective. In England, PHTs that have invested resources in engaging in this area have demonstrated an ability to work effectively within licensing systems. Strong support for the adoption of a public health licensing objective among these PHTs adds weights to calls for the UK Government to reconsider its previous decision not to introduce such an objective. Funding: This publication was funded by the Public Health Research programme as a part of award number 15/129/11. This article reports on one component of the research award EXILENS EXploring the Impact of alcohol Licensing in ENgland and Scotland: a mixed-method, natural experiment evaluation of public health engagement in alcohol premises licensing and impact on alcohol-related harms. For more information about this research please view the award page [https://fundingawards.nihr.ac.uk/award/15/129/11] DOI: https://doi.org/10.1016/j.puhe.2022.07.006

Aims: This study aimed to explore the nature and extent of alcohol sports sponsorship in Uganda and the activities involved. Methods: Utilising an exploratory case study methodology to document examples of alcohol industry activity related to sports sponsorship in Uganda. This study employed desk-based reviews of publicly available examples of sponsorship activities from websites and social media sites as well as visits to sporting venues to observe alcohol sponsorship practices. Results: Sports sponsorship by alcohol companies was found to be a common practice in Uganda. Across the sample of data included in this study, we observed multiple sponsorship deals within a range of professional sports, including football, basketball and golf. Across these sponsorship arrangements, several activities explicitly promoted products or subtly blended them amongst other stimulating content. This included: a presence on social media channels; limited edition products; alcohol brand logos on match strips; advertising and promotion at various locations inside and outside the sporting venues; and alcohol industry representatives featuring in news reports. Conclusion: Alcohol sports sponsorship in Uganda is widespread and multi-faceted. The types of sponsorship activities observed in this study mirror those used around the world. The transnational companies involved use sports sponsorship to position themselves as central to Ugandan economy, culture, heritage and the sustainability of sports across the country. Understanding how sports sponsorship is used to promote alcohol brands across Uganda is important to inform future policy decisions regarding alcohol marketing.