Monday, 10 December 2018

When the biggest changes in alcohol legislation aren't implemented, you can't expect much to change

Back in October, the New Zealand Herald pointed to a new study published in the New Zealand Medical Journal:
New laws introduced to curb alcohol harm have failed to make a dent on ED admissions, new research has found.
The study, released today, showed that around one in 14 ED attendances presented immediately after alcohol consumption or as a short-term effect of drinking and that rate had remained the same over a four-year period.
Here's the relevant study (sorry I don't see an ungated version, but there is a presentation on the key results available here), by Kate Ford (University of Otago) and co-authors. They looked at emergency department admissions at Christchurch Hospital over three-week periods in November/December 2013 and in November/December 2017, and found that:
...[t]he proportion of ED attendances that occurred immediately after alcohol consumption or as a direct short-term result of alcohol did not change significantly from 2013 to 2017, and was about 1 in 14 ED attendances overall.
The key reason for doing this research was that the bulk of the changes resulting from the Sale and Supply of Alcohol Act 2012 had been implemented in between the two data collection periods. The authors note that:
...[a] key part of the Act was a provision to allow territorial authorities to develop their own Local Alcohol Policies (LAPs). The Act was implemented in stages from December 2012 onwards and subsequently, many local authorities attempted to introduce LAPs in their jurisdictions.
However, here's the kicker:
In many cases these efforts met legal obstacles, particularly from the owners of supermarket chains and liquor stores... For example, a provisional LAP in Christchurch was developed in 2013 but by late 2017 it still had not been introduced. 12 This provisional LAP was finally put on hold in 2018... Similar problems have been encountered in other regions... 
If you are trying to test whether local alcohol policies have had any effect on alcohol-related harm, it's pretty difficult to do so if you're looking at a place where a local alcohol policy hasn't been implemented. Quite aside from the fact that there is no control group in this evaluation, and that the impact of the earthquakes makes Christchurch a special case over the time period in question, it would have been better to look at ED admissions in an area where a local alcohol policy has actually been implemented (although, there have been too few local authorities that have been successful in this). To be fair though, the authors are well aware of these issues, and make note of the latter two in the paper.

However, coming back to the point at hand, whether legislation is implemented as intended is a big issue in evaluating the impact of the legislation. A 2010 article by David Humphreys and Manuel Eisner (both Cambridge), published in the journal Criminology and Public Policy (sorry I don't see an ungated version), makes the case that:
Policy interventions, such as increased sanctions for drunk-driving offenses... often are fixed in the nature in which they are applied and in the coverage of their application... To use epidemiological terminology, these interventions are equivalent to the entire population receiving the same treatment in the same dose...
However, in other areas of prevention research... the onset of a policy does not necessarily equate to the effective implementation of evidence-based prevention initiatives...
This variation underlines a critical issue in the evaluation of effects of the [U.K.'s Licensing Act 2003]...
In other words, if you want to know the effect of legislative change on some outcome (e.g. the effect of alcohol licensing law changes on emergency department visits), you need to take account of whether the legislation was fully implemented in all places.

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