James Nicholls

The provision of supervised drug consumption facilities (SDCF) is a recent development in the United Kingdom (UK). The only currently operating facility opened in Glasgow in 2025. It has attracted extensive media and political scrutiny, often framed in moral terms. This experimental vignette study examined the role of moral judgements in UK debates on SDCF provision through the lens of Moral Foundations Theory (MFT). We undertook a cross-sectional online experimental study with a randomised factorial design. Participants ( N =1,506; 52% female; mean age 47±16 years) were randomly assigned one of seven short vignettes. Six made an argument in favour of SDCF provision, framed around one of the six moral foundations identified in the Moral Foundations Questionnaire, Version 2 (MFQ-2). One provided a neutral description of SDCFs. Participants then answered two questions on support for SDCF provision either (a) in the UK or (b) in their local area. Across all groups, support for SDCF provision somewhere in the UK was broadly positive. However, exposure to different message frames was not associated with differences in level of support. In contrast, only participants exposed to the care/harm framing vignette showed support for an SDCF in their own neighbourhood. Furthermore, MFQ-2 scores showed only limited associations with support: specifically, orientation towards the care/harm foundation predicted greater support for local provision. Our findings suggest that moral framing may have limited persuasive effect when policy proposals are hypothetical or abstract, but that some types of moral considerations may become more salient as interventions are concretised in local contexts. The findings raise questions about the extent to which MFQ scores predict opinions on specific drug policy issues and invite further research on the role of emotional salience in shaping public responses to drug policy proposals.

Background and aims: Permitting alcohol outlets to trade later at night is associated with increased intoxication, violence and burden on public services. Between 2017 and 2019 two processes led to later trading hours in 10 nightclubs in Glasgow (1-hour pilot extension, to 4am) and 38 bars in Aberdeen (1-3 hours extension, to 3am). We explored stakeholder views on the impact of these later hours against the backdrop of the Covid-19 pandemic and UK cost of living crisis. Methods: Semi-structured interviews conducted March 2022 to March 2023 with 39 stakeholders (10 public health/community/police; 14 frontline services; 9 licensing stakeholders (non-trade); and 6 venue owners/managers), analysed using framework analysis. Results: Participants across both cities reported mixed consumer demand for extended trading hours. Consequently, later hours were used irregularly and unpredictably by venues and economic benefits were at best smaller than anticipated. Low demand was attributed to the pandemic, cost of living crisis and changing drinking patterns. Frontline workers were more likely than those in other/more senior roles in policing, health and local government to report increased violence and disorder during the later hours. In Aberdeen, changes were perceived broadly negatively, due to greater demand from often vulnerable drinkers later at night, which outstripped the capacity of ambulance, policing, transport and voluntary services. In Glasgow, impact on services was more often described as mixed or neutral, although some transport and voluntary services were not available to cover the extra hour. Conclusions: Night-time economy stakeholders in Glasgow and Aberdeen perceived little or no economic benefits from the introduction of later trading hours, lower than anticipated consumer demand and increased demand for services, which often outstripped service capacity. Policymakers should treat with scepticism claims of benefits from later trading hours and consider other measures which address alcohol harms and pressure on services. KEY POINT SUMMARY: Demand for later hours was mixed in both cities; subsequently, use of the extensions by venues was unpredictable and reported economic benefits minimal. The after-effects of the Covid-19 pandemic, cost of living crisis and changing drinking patterns were described as factors influencing lower than expected demand. Frontline workers were more likely than those in strategic roles to describe increased violence and disorder during the later hours. Ambulance, policing, transport and voluntary services struggled to meet demand from often vulnerable drinkers during the later hours in Aberdeen, and some transport and voluntary organisations were unable to meet demand during the extra hour in Glasgow.

Background Alcohol-related harms are prevalent late at night, especially on weekends, when high levels of intoxication contribute to increased rates of injury and violence. Reducing or increasing alcohol trading hours late at night in bars and clubs is generally associated with reduced and increased harms, respectively. This study evaluates the impact of later alcohol trading hours in the Scottish cities of Aberdeen and Glasgow on alcohol-related ambulance call-outs and crimes. Under local policy changes, 38 bars in Aberdeen had trading hours extended between 1 to 3 hours up to 3am, and 10 nightclubs in Glasgow had a 1-hour extension to 4am. Methods Following a natural experiment evaluation framework, we used a controlled interrupted time series design to compare outcomes before and after policy changes, from 2015 to 2021. The primary outcome was a count of total weekend night-time alcohol-related ambulance call-outs. Secondary outcomes included weekend night-time crimes. Results In Aberdeen, the policy led to a significant relative increase of 17.4% (effect size=7.061; 95% CI=3.902 to 10.220; p<0.001) in alcohol-related ambulance call-outs, and 7.9% (effect size=3.187; 95% CI=0.564 to 5.810; p=0.017) in reported crimes (not robust across sensitivity analyses), at weekend night-times compared to Edinburgh (control). Findings were not significant and robust across analyses for Glasgow. Conclusion Later alcohol trading hours had a significant negative impact on alcohol-related ambulance call-outs in Aberdeen (where more premises had longer extensions) but not in Glasgow, suggesting the number, capacity and type of premises moderated outcomes. This is important for the design of future national and local licensing policies and regulations.

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