Introduction: Late-night alcohol trading hours are generally associated with increased alcohol-related harm. Since 2018, two Scottish cities have allowed extensions in late-night alcohol trading hours with the aim of revitalising the night-time economy. This is the first study to directly observe whether and how bars and nightclubs use these extensions, and collect rich qualitative data about venue environment and staff behaviour. Methods: Trained, paired fieldworkers, behaving as customers, completed semi-structured observation schedules on mobile devices during repeated visits to 15 purposively sampled venues in 2023-24 (5 venues in Glasgow and 10 in Aberdeen: total of 313 h of observation). In-depth qualitative fieldnotes were completed within 48 h of visits. Results: Half of the venues closed early on at least one fieldworker visit without using all of their later trading hours. Venues using their extended hours were observed to be at low occupancy on at least one visit. Fieldworkers observed bar staff serving alcohol to intoxicated customers in every venue. In half of the venues, 'shot girls' were observed persistently approaching customers, including those who appeared intoxicated. Conclusions: Extensions in late-night alcohol trading hours granted in two Scottish cities were not used consistently by venues due to lack of demand by customers. The late-night sale of alcohol to intoxicated customers was routine. Our findings challenge the assumption that later trading hours benefit the night-time economy and highlight the likelihood of associated alcohol-related harms.

Introduction:Routinely-collected data are increasingly used to study outcomes among marginalised communities, including people who use drugs, because they capture groups often under-represented in traditional research. However, little is known about how this population feels about researchers using their data, particularly given the stigma they frequently encounter. Objectives:This public involvement and engagement study explored the views of people who use(d) drugs on the use of their routinely-collected data in research, with the aim of informing future work in this field. Methods:Participants were recruited through a recovery organisation in Southeast Scotland, UK. Two deliberative focus groups were conducted (n=11 and n=12). Each session began with a short introduction to routinely-collected data and its research uses, followed by discussion guided by a topic schedule and a creative participatory activity. Thematic analysis was carried out using NVivo v15. Results:Five overarching themes were identified. Participants expressed very low awareness that their data were being used in research and highlighted the need for clearer and more accessible transparency about data processes. Concerns about consent and personal control were common, with many wanting greater involvement or choice in how their information is used. Participants strongly supported data use when it served a clear and meaningful public benefit and when researchers were held accountable for how findings were used. Discussions also reflected worries about the accuracy, completeness, and fairness of the data held about them, particularly where misunderstandings or assumptions might be recorded. Underpinning all themes was a pervasive sense of fear and mistrust toward services that collect data, which participants felt could limit honest disclosure and ultimately affect data quality. Conclusions:People who use drugs were broadly supportive of their routinely-collected data being used in research with clear social value and transparency. However, pervasive mistrust of data-collecting services may affect data quality and should be carefully considered by researchers.

INTRODUCTION:Between 2017 and 2019, different policy processes in two large Scottish cities led to local authorities granting licences for later on-premises alcohol trading hours. As a part of a wider mixed methods study, we examine news media reporting of these licencing changes to understand the content and progression of arguments at the time they were being discussed through to, and after, implementation. METHODS:Forty-four news articles were identified through online searches (published 01/01/2015-01/01/2023) supplemented with hand searches of local publications. A qualitative thematic analysis was then conducted using NVivo. RESULTS:Trade and local government actors were foregrounded in the media. Sectors within the alcohol retail trade responded differently, depending on their business interests. In Aberdeen, stakeholders stated that the changes were primarily intended to support businesses and in response to consumer trends. In Glasgow, stakeholders stated that the changes were needed to boost the economy and compete with other European cities. A diverse range of stakeholders framed their arguments in health terms, expressing concerns that increased hours would lead to increased consumption and harm. DISCUSSION AND CONCLUSIONS:In media reports of extended late-night trading hours, stakeholders who were both for and against the changes put forward arguments about business and health impacts. There appeared to be little consensus about the value of extended trading hours amongst trade stakeholders who responded in line with their specific business interests, sometimes drawing on health arguments to do so. This counters the assumption of unity in trade views on liberalisation of opening hours.

Introduction 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 and 3 h up to 3am, and 10 nightclubs in Glasgow had a 1-h 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 May 2015 to March 2020. 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 11.4% (effect size=4.643; 95% CI 0.292 to 8.994; p=0.036) in alcohol-related ambulance call-outs, and 8.5% (effect size=3.442; 95% CI 0.239 to 6.645; p=0.035) in reported crimes, at weekend night-times compared with 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 and reported crimes 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.

Background: Late-night opening of alcohol venues is associated with increased intoxication, social disorder and burden on public services. From 2017, two Scottish cities—Aberdeen and Glasgow—extended venue trading hours, to 3am and 4am, respectively. This study aimed to explore (i) public perceptions of harms and benefits of later trading hours, and (ii) how related public health evidence is assessed and used by the public. Methods: Eight groups of residents and venue-goers (n = 42) participated in two deliberative focus groups over a two-week period. Evidence on the pros and cons of later hours was presented and discussed. Reflexive thematic analysis was used to analyze data. Results: Participants associated later hours with increased alcohol consumption and increased harms such as violence, antisocial behavior, crime and public disturbance. Harms were discussed more frequently than benefits. Venue-goers highlighted cultural and social benefits and suggested staggered closing times might reduce harms. Following consideration of public health evidence, participants’ focus shifted from individual to societal impacts, such as increased burden on police, ambulance, and hospital services. Conclusion: Exposing lay participants to public health evidence fostered more reflection on societal impacts of later trading hours, potentially providing policy-makers with strategies to increase public support for alcohol policies.

Background:Evidence suggests that controls on the physical and temporal availability of alcohol can reduce alcohol-related harms. Public health teams in England and Scotland have in recent years been given a statutory role in licensing systems through which premises are granted permits to sell alcohol. The Exploring the Impact of alcohol premises Licensing in England and Scotland study examined public health team efforts to engage in alcohol licensing from 2012 to 2019. Objective:We aimed to describe the range of public health team practice in engaging with alcohol licensing across England and Scotland, with a particular focus on unusual or innovative practices. Methods:Two sets of interviews were conducted with 20 public health teams in England and Scotland who were actively engaged in alcohol premises licensing. Firstly, representatives of each public health team with experience of licensing activity took part in structured face-to-face or telephone interviews (n = 41) and provided documentation to identify how and when their team engaged with alcohol premises licensing. Secondly, members of public health teams took part in in-depth one-to-one interviews (n = 28) which focused on individual roles and responsibilities. Relevant public health team activity was analysed quantitatively within 19 activities in 6 categories using the 'Public Health engagement In Alcohol Licensing' measure, as well as qualitatively using NVivo (QSR International, Melbourne, Australia). Innovative practices were identified using the highest Public Health engagement In Alcohol Licensing scores for specific activity types across single or multiple 6-month periods. Findings:Within each of the six activity categories, a range of practices were observed. More unusual practices included having a dedicated post to work full-time on alcohol licensing; developing a standardised reviewer tool allowing the team to respond to applications and provide the most relevant evidence in a consistent and systematic way; committing to additional scrutiny of occasional licences or temporary event notices; maintaining a detailed database recording applications made, whether the public health team decided to object and the outcome of the licensing board's decision; engaging with applicants prior to them submitting an application; visiting proposed/current licensed premises to gather bespoke data; leading the writing of local licensing policy; and working closely with licensing standards officers. Conclusions:Across six categories of public health team activity relating to the local alcohol premises licensing system, public health team practices varied, and some public health teams stood out as engaging in more innovative or intensive activities. The identified examples will be of value in informing public health team practice in what remains a relatively new area of work for many, despite limitations in the system. The inclusion of examples from both England and Scotland and from many public health teams will facilitate cross-fertilisation of ideas and practice across public health teams. Funding:This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number 15/129/11.

PurposeScotland faces a crisis of drug-related deaths, disproportionately affecting people living in the most deprived areas. The purpose of this paper is to explore patient and service provider perceptions of engagement within shared care treatment systems, acknowledged as a critical factor in preventing drug-related harms and deaths.Design/methodology/approachA qualitative case study approach was adopted, focusing on two primary care practices in highly deprived urban areas. Thematic analysis was used to investigate the interplay of individual, organisational and structural factors acting as facilitators and barriers to service engagement. Data were collected through 34 semi-structured interviews with 6 people who use drugs, 4 family members, 20 health-care practitioners and 4 policymakers.FindingsEngagement challenges were multifaceted, encompassing relational aspects (e.g. trust and stigma) and systemic issues, including poor collaboration across professional groups, fragmented services, inadequate communication and resource constraints. Participants emphasised the cumulative impact of socioeconomic deprivation and structural inequalities, which shaped the environments in which drug use occurred and constrained effective care delivery. Practitioners used various strategies, including harm reduction approaches and personalised support, to enhance engagement.Originality/valueThis paper provides new insights into the challenges faced by practitioners, people who use drugs and families in navigating the shared care system. The findings of this study highlight the need for policy action to strengthen service provision as well as reinforcing the importance of tackling cumulative health and social inequalities, seen as a key factor in drug-related deaths.

BACKGROUND:There are recognised barriers to engagement with mainstream alcohol services for certain groups within populations. Alcohol assertive outreach is an approach that uses repeated, persistent and flexible methods to engage with patients with alcohol problems from these groups. There are few qualitative studies that explore how alcohol assertive outreach services are experienced by stakeholders. This study focuses on a unique service, The Primary Care Alcohol Nurse Outreach Service (PCANOS), that operated in Glasgow, Scotland and which involved Alcohol Nurses working closely with general practices. METHODS:Twenty-three semi-structured qualitative interviews were used to explore staff and patient views and experiences of PCANOS. Interviews were conducted with 18 staff (nine general practice staff, five alcohol nurses, and four strategic staff) and seven patients from across six Deep End general practices. RESULTS:Findings from this study suggest that PCANOS has the potential to engage patients who may have difficulties engaging with mainstream alcohol treatment services. Through PCANOS, the Alcohol Nurses, in collaboration with General Practitioners and other practice staff, were able to engage patients and deliver a flexible, person-centred care service that impacted positively on patients' drinking behaviour and general health and wellbeing. CONCLUSIONS:PCANOS was a unique alcohol assertive outreach service that had the potential to engage with people from the most deprived communities in Glasgow, who were not engaging with the mainstream services. Further research could examine the potential benefits of services like PCANOS, including patient outcomes, the economic impact on the wider healthcare system, and its transferability to other settings such as rural areas.

Background Greater availability of alcohol is associated with higher consumption and harms. The legal systems, by which premises are licensed to sell alcohol in England and Scotland, differ in several ways. The ‘Exploring the impact of alcohol licensing in England and Scotland’ study measured public health team activity regarding alcohol licensing from 2012 to 2019 and identified seven differences between England and Scotland in the timing and type of activities undertaken. Objectives To qualitatively describe the seven previously identified differences between Scotland and England in public health approaches to alcohol licensing, and to examine, from the perspective of public health professionals, what factors may explain these differences. Methods Ninety-four interviews were conducted with 52 professionals from 14 English and 6 Scottish public health teams selected for diversity who had been actively engaging with alcohol licensing. Interviews focused primarily on the nature of their engagement (n = 66) and their rationale for the approaches taken (n = 28). Interview data were analysed thematically using NVivo. Findings were constructed by discussion across the research team, to describe and explain the differences in practice found. Findings Diverse legal, practical and other factors appeared to explain the seven differences. (1) Earlier engagement in licensing by Scottish public health teams in 2012–3 may have arisen from differences in the timing of legislative changes giving public health a statutory role and support from Alcohol Focus Scotland. (2) Public Health England provided significant support from 2014 in England, contributing to an increase in activity from that point. (3) Renewals of statements of licensing policy were required more frequently in Scotland and at the same time for all Licensing Boards, probably explaining greater focus on policy in Scotland. (4) Organisational structures in Scotland, with public health stakeholders spread across several organisations, likely explained greater involvement of senior leaders there. (5) Without a public health objective for licensing, English public health teams felt less confident about making objections to licence applications without other stakeholders such as the police, and instead commonly negotiated conditions on licences with applicants. In contrast, Scottish public health teams felt any direct contact with applicants was inappropriate due to conflicts of interest. (6) With the public health objective in Scotland, public health teams there were more active in making independent objections to licence applications. Further in Scotland, licensing committee meetings are held to consider all new applications regardless of whether objections have been submitted; unlike in England where there was a greater incentive to resolve objections, because then a meeting was not required. (7) Finally, Scottish public health teams involved the public more in licensing process, partly because of statutory licensing forums there. Conclusions The alcohol premises licensing systems in England and Scotland differ in important ways including and beyond the lack of a public health objective for licensing in England. These and other differences, including support of national and local bodies, have shaped opportunities for, and the nature of, public health engagement. Further research could examine the relative success of the approaches taken by public health teams and how temporary increases in availability are handled in the two licensing systems. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Reseacrh programme as award number 15/129/11.

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; 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) review-ing 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 Eng-land, 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. (J. Stud. Alcohol Drugs, 84, 318-329, 2023)

ObjectivesAdministrative data research requires trust that data will be used sensitively and wisely. People who use drugs are frequently stigmatised, and trust may be a particular barrier. This project aims to understand the perceptions of people who use drugs around the use of their administrative health data for research purposes. MethodsThis project will work with Restoration Fife, a third-sector organisation based in Fife, Scotland, that supports people who use drugs. We are conducting focus groups exploring how administrative health data are used in research from the perspectives of people who use drugs, including discussion around different types/sources of data. Data will be analysed using the Framework approach. We will also work with an artist and members of Restoration Fife, to co-produce a short, animated film about how administrative data are used in research around drug use, in order to educate the wider population about how their data are used. Results*This presentation will discuss findings from the focus groups on the perceptions of usage of administrative data for different types of research. It will also discuss the use of administrative data in the context of findings from previous studies involving general populations and populations with other vulnerabilities, such as care-experienced populations and people with mental health difficulties. We will also provide a viewing of the film within this paper session. *This project is funded by Research Data Scotland and runs from April to September 2023: all results will therefore be available by the time of the ADR conference in November 2023. ConclusionsEvidence suggests low levels of public awareness of how and why data are used. We know little about perceptions of people who use drugs, for whom trust of services may be a particular issue. This study uses innovative methods to provide a platform for voices rarely heard in this context.

This video was co-produced with people on their drug use recovery journey to explore the perceptions of administrative data use for research and to share this information with the wider community. This work was led by members of the Substance Use Research Group (SURG), School of Health Sciences, University of Dundee. This project was funded by Research Data Scotland (RDS), https://www.researchdata.scot/ A film by: Craig Glencross, David Hood, Jade Renton, Maxine Thomson, Ryan Westwood, Stewart Bernard, Sarah Hulin, Robert Doig, Ashley McMaihin and everyone at Restoration Fife who shared their views and experiences. Research team and collaborators: Camila Biazus Dalcin (Co-PI) and Louise Marryat (Co-PI) Sarah Gray (Co-I) Andrea Mohan (Co-I) Senga Robertson-Albertyn (Co-I) Sreekanth Thekkumkara (Co-I) Hazel Booth (Co-I) Calum Hoggitt (Mental Health Nursing Student) Kay McMahon (Receptionist Fife Campus) Graham Ogilvie (Conference in pictures – Ogilvie Design) Andrew Low (Artist) We appreciate the collaboration and support provided by all Restoration Fife staff involved in this project. Special thanks to Jade Whyte and Vanessa Hamilton.

Background: In England and Scotland, local governments regulate the sale of alcohol by awarding licences to premises to permit the sale of alcohol for consumption on or off the premises, under certain conditions; without such a licence, alcohol cannot be legally sold. In recent years, many local public health teams have become proactive in engaging with alcohol licensing, encouraging licensing authorities to act in ways intended to improve population health. Objective: This research aimed to explore and understand the approaches and activities of public health stakeholders (i.e. NHS staff and other public health professionals) in seeking to influence local alcohol licensing policy and decisions, and the views of licensing stakeholders (i.e. licensing officers/managers, police staff with a licensing remit, elected members and licensing lawyers/clerks) on the acceptability and effectiveness of these approaches. Participants: Local public health teams in England and Scotland were directly informed about this multisite study. Scoping calls were conducted with interested teams to explore their level of activity in alcohol licensing from 2012 across several categories. Twenty local authority areas with public health teams active in licensing matters were recruited purposively in England (n = 14) and Scotland (n = 6) to vary by region and rurality. Fifty-three in-depth telephone interviews (28 with public health stakeholders and 25 with licensing stakeholders outside health, such as local authority licensing teams/lawyers or police) were conducted. Interview transcripts were analysed thematically in NVivo 12 (QSR International, Warrington, UK) using inductive and deductive approaches. Results: Public health stakeholders’ approaches to engagement varied, falling into three main (and sometimes overlapping) types. (1) Many public health stakeholders in England and all public health stakeholders in Scotland took a ‘challenging’ approach to influencing licensing decisions and policies. Reducing health harms was felt to necessitate a focus on reducing availability and generating longer-term culture change, citing international evidence on the links between availability and alcohol-related harms. Some of these stakeholders viewed this as being a narrow, ‘nanny state’ approach, whereas others welcomed public health expertise and its evidence-based approach and input. (2) Some public health stakeholders favoured a more passive, ‘supportive’ approach, with some reporting that reducing availability was unachievable. They reported that, within the constraints of current licensing systems, alcohol availability may be contained (at least in theory) but cannot be reduced, because existing businesses cannot be closed on availability grounds. In this ‘supportive’ approach, public health stakeholders supplied licensing teams with data on request or waited for guidance from licensing teams on when and how to get involved. Therefore, public health action supported the licensing team in their aim of promoting ‘safe’ and ‘responsible’ retailing of alcohol and/or focused on short-term outcomes other than health, such as crime. (3) Some public health stakeholders favoured a ‘collaborative’ approach in which they worked in close partnership with licensing teams; this could include a focus on containing availability or responsible retail of alcohol, or both. Conclusions: In engaging with alcohol licensing, public health stakeholders adapted their approaches, sometimes resulting in a diminished focus on public health goals. Sampling did not include lower-activity areas, in which experiences might differ. The extent to which current licensing systems enable achievement of public health goals is questionable and the effectiveness of public health efforts merits quantitative evaluation. Study registration: The study is registered with the Research Registry as researchregistry6162. Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in Public Health Research. See the NIHR Journals Library website for further project information.

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. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.

Purpose Prisoners have an increased risk of cardiovascular disease (CVD) compared to the general population. Knowledge and risk perception of CVD can influence engagement in preventative behaviours that lower an individual's CVD risk. This paper aims to explore prisoners' knowledge of CVD, and prisoners and staff's perceptions of prisoners' CVD risk. Design/methodology/approach This was a qualitative study in which semi-structured interviews were conducted with 16 prisoners and 11 prison and National Health Services staff in a Scottish prison. Data were analysed thematically using the framework method. Findings Most prisoners had limited knowledge of CVD as they could not describe it or could only identify one or two risk factors or cardiovascular events. Both prisoners and staff viewed prisoners' CVD risk as either pertaining to one individual, or pertaining to the general prisoner population. Unhealthy behaviours that were believed to increase CVD risk were linked to three perceived consequences of imprisonment: mental health problems, boredom and powerlessness. Originality/value To the best of the authors' knowledge, this is the first study to explore the CVD knowledge of prisoners, and perceptions of CVD risk from the perspectives of prisoners and prison staff. Findings from this study indicate that CVD education needs to be a priority for prisoners, addressing knowledge of CVD, its risk and risk perceptions. Additionally, the findings indicate that individual and socio-environmental factors linked to prisoners' CVD risk need to be targeted to reduce this risk. Future research should focus on socio-environmental interventions that can lead to reducing the CVD risk of prisoners.

BackgroundPublic health teams (PHTs) in England and Scotland engage to varying degrees with local alcohol licensing processes to try to reduce harm to individuals and communities. Evidence is scarce on whether this engagement is effective. We aimed to quantify the effects of PHT engagement in alcohol licensing on selected health and crime outcomes.MethodsWe matched 20 higher activity PHTs and 19 lower activity PHTs, defined on the basis of initial discussions with local authorities, in England and Scotland using propensity score methods. We developed a semi-quantitative metric based on structured interviews, documentary analyses, and expert consultation to provide an estimate for the intensity of each PHT's engagement between April, 2012, and March, 2019. Public health outcomes were ambulance call outs, accident and emergency attendances, alcohol-related hospital admissions, alcohol-related and alcohol-specific mortality. Crime outcomes were violent and sexual crimes and public order offences. Data were analysed using negative binomial mixed-effects models, adjusted for area-level deprivation, age, season, country, time trend, population density, and local alcohol action area. Correlations were assessed between each outcome and PHT scores (range 0–35 points) and cumulative scores (range 0–364) for unlagged and 6-month lagged periods.FindingsThere was no evidence of associations between the primary exposure metric of 18-month average PHT engagement scores and public health or crime outcomes. However, lagged and unlagged cumulative PHT engagement was correlated with accident and emergency admissions for alcohol (–0·001 [95% CI –0·01 to –0·000] per unit exposure). Using the point estimates, had all areas had maximum PHT engagement across the whole period, 318 500 (unlagged) or 227 620 (lagged) accident and emergency admissions for alcohol (equivalent to 14–13%) might have been averted.InterpretationAn important limitation of this analysis is that it is not based on a randomised controlled trial, nor does it use an exposure change (ie a natural experiment), which restricts the strength of causal inferences. However, we report what, to our knowledge, is the first evidence of an association between PHT engagement in alcohol licensing and subsequent effects on public health in England and Scotland. Our findings provide evidence that PHT engagement in licensing might have a measurable positive effect, suggesting allocation of PHT resources to alcohol licensing could be beneficial.FundingNIHR Public Health Research Programme.

BackgroundIn England and Scotland, local governments regulate the sale of alcohol through premises licensing. In the past 10 years, some public health practitioner teams have become proactive in engaging with alcohol licensing to encourage actions regarded as likely to improve population health. These public health teams are largely based in the National Health Service in Scotland, and within local authorities in England. This research explored ways in which public health actors believe their activities make a difference to alcohol licensing decisions, policies, and systems, and the acceptability of their involvement from licensing stakeholder perspectives.MethodsAll public health practitioner teams were directly informed about this multicentre study. Scoping calls were conducted with interested teams to explore their level of activity in alcohol licensing in 2012–19 across several pre-defined categories. Recruited local authority areas purposively varied by region and rurality. 53 in-depth telephone interviews (28 with public health actors and 25 with licensing stakeholders) were done in 20 local authority areas in England (n=14) and Scotland (n=6). Interview transcripts were analysed thematically with NVivo 12 using inductive and deductive approaches.FindingsMost public health actors felt that they could make a difference by broadening licensing decision makers' understanding of alcohol-related health harms. For many, a key motivation was to reduce harms through containing alcohol availability at current levels and, ultimately, long-term culture change. Others adapted their approach to fit with the aims of licensing staff, focusing on promoting responsible sale of alcohol, so-called responsible drinking, or both. In both cases, public health actors and licensing stakeholders viewed partnership working as key to effectiveness. Although most licensing staff valued public health involvement, a minority were sceptical about public health involvement focused on containing availability, considering this approach as too narrow in focus. Some public health actors felt unable to secure public health improvements within the constraints of current licensing systems, which have potential to prevent increases in alcohol availability but are unable to reduce alcohol availability.InterpretationPublic health actors take different approaches to engagement with alcohol licensing, including disruptive or collaborative approaches. Collaborative approaches were seen as more acceptable by some licensing stakeholders, but focus mainly on short-term outcomes other than health (eg, crime). The effectiveness of public health involvement, including through these different approaches, merits quantitative evaluation. Sampling did not include lower activity areas wherein experiences might differ.FundingThe ExILEnS study was funded by the National Institute for Health Research (project number 15/129/11). The views expressed in this work are those of the authors and do not necessarily reflect those of the National Health Service, the National Institute for Health Research, or the UK Government's Department of Health and Social Care.

People who use drugs (PWUD) experience many social and health harms and are considered at greater risk of acquiring COVID-19. Little research has examined the impact of coronaviruses either on PWUD, or on services targeted to PWUD. We report the findings of a systematic review of empirical evidence from studies which have examined the impact of coronaviruses (Severe Acute Respiratory Syndrome (SARS-CoV-1) and Middle Eastern Respiratory Syndrome (MERS-CoV) and COVID-19) on PWUD or on service responses to them. Five databases were searched (MEDLINE, PsycINFO, CINAHL, ASSIA and EMBASE) as well as COVID-19 specific databases. Inclusion criteria were studies reporting any impact of SARS, MERS or COVID-19 or any service responses to those, published between January 2000 and October 2020. Weight of Evidence judgements and quality assessment were undertaken. In total, 27 primary studies were included and grouped by seven main themes: treatment/recovery services; emergency medical settings; low-threshold services; prison setting, PWUD/substance use disorder (SUD) diagnosis; people with SUD and HIV; 'Sexual minority' men. Overall, research in the area was scant, and of average/poor quality. More robust research is required to inform on-going and future responses to coronavirus epidemics for PWUD.