Title: Evaluating later or expanded premises hours for alcohol in the night-time economy (ELEPHANT): A mixed-methods, natural experiment evaluation
Funder: Chief Scientist Office, Scotland

Abstract: When bars and nightclubs are allowed to open later at night, injuries and violence tend to increase. International studies show that even opening an hour later after midnight can lead to significantly more ambulance call-outs and assaults. Ambulance call-outs due to alcohol are estimated at more than 171,000 annually costing about £52 million._x000D_ _x000D_ In the UK, local councils control opening hours through the licensing system that permits bars/clubs etc. to sell alcohol. In Aberdeen from late 2018, about 30 premises that previously closed at 1am were allowed to close later, some up to 3am. In Glasgow, from May 2019, 10 nightclubs were allowed to change their closing time from 3am to 4am. Health professionals and police were unable to make the case against expanded opening hours, due to gaps in UK evidence, and their arguments ultimately failed. There are no UK studies of how opening hours affect ambulance call-outs, or of changes in business practices, policing, health services or economic costs that may occur alongside or due to later opening hours. This new study is needed to inform future decisions, policies and laws on bar/club opening hours in the UK and internationally._x000D_ _x000D_ The study AIM is to understand and assess the impact of these later opening hours on harms, services and costs in Glasgow and Aberdeen, including for specific groups, and the implications for other UK cities if similar changes were introduced._x000D_ _x000D_ The study has 5 work packages (WPs)._x000D_ • WP1 will focus on understanding why the changes came about, what effects were expected, and how public services/businesses were affected. We will search licensing meeting notes and media reports, and interview officials, managers and premises owners._x000D_ • WP2 will identify whether and when bars/clubs are using their extra hours and will explore what happens during the later opening period such as who is in the venue, alcohol and drug use, violence and how the venue operates. Researchers will attend venues to observe the later openings, and will interview venue staff and review venue’s social media feeds._x000D_ • WP3 will examine if changes in alcohol-related ambulance call-outs and assaults have resulted from later opening hours, working with Scottish Ambulance Service and Police Scotland data from before and after the changes. We will also look for impact on different groups (men/women, age-groups, richer/poorer) and changes in call-out locations._x000D_ • WP4 will evaluate any costs of the changes especially to services and businesses._x000D_ • WP5 will identify whether other UK local councils are considering similar changes, and model the likely impact of the changes on inequalities, long-term health and healthcare costs both for Glasgow and Aberdeen and selected other UK locations._x000D_ _x000D_ A wide range of stakeholders will sit on the advisory group for the study, and groups of local residents/customers of premises will be established in each city to inform the study. The findings will be useful to police and health services, local authority licensing teams and politicians and devolved and national governments, as well as communities and premises owners in the UK and internationally.

Lay abstract: This study will describe, understand and evaluate the introduction, operation and impact of later trading hours for licensed alcohol premises in two Scottish cities (Glasgow and Aberdeen). Late night alcohol sales are associated with increased rates of assaults, injuries & disorder. Alcohol is linked to ~ 50% of weekend ambulance call-outs and up to 70% of assaults presenting to A&E in Scotland. International systematic reviews find that extensions in late night opening of alcohol premises are linked to increased intoxication, assaults, injuries and use of services. Recent studies using robust methods found significant impacts on assaults (Norway, 16% increase with 1 hour extension; Australia 21% increase with each extra hour), and on alcohol-related ambulance call-outs (Amsterdam, 34% increase with 1 hour extension)._x000D_ _x000D_ Two different processes recently led to local decisions to permit later opening hours in 10 nightclubs in Glasgow (a 1 hour extension) and ~30 bars in Aberdeen (up to 2 hours extension), which form the basis of our proposed natural experiment. Our AIM is to understand and evaluate the contribution of changes in trading hours to harms, services and costs in the local night-time economy in the two cities, and implications for other major UK cities. Our study will be the most methodologically robust and in-depth study of additional late night alcohol availability in the UK to date, informed by systems thinking. In line with systems thinking, as well as considering the impact on harms and costs arising from the policy changes, we will examine the antecedents and implementation of the changes, their contribution to adaptations or changes in consumers, businesses and services, intended or unintended ancillary impacts or feedback effects, and emergence of new thinking, ways of working, or behaviour as a result of the changed opening hours. This systems approach will also allow for consideration of the impact and implications of Covid19, including relevant findings emerging from other studies. Our approach will be multidisciplinary and the study will be delivered via five interdependent work packages (WPs):_x000D_ _x000D_ - WP1: Understanding the Changes at System Level: will use documentary analysis and interviews to understand what led to the changes and explore their expected and actual impact [led by Prof. Niamh Fitzgerald, University of Stirling]._x000D_ - WP2: Understanding the Changes at Venue Level: will use venue observation, staff interviews and social media feeds to establish whether and when premises are opening later; and what happens during the later opening period [led by Prof. Carol Emslie, Glasgow Caledonian University]._x000D_ - WP3: Evaluating Impact on Harms: will use time series analysis (ARIMA) and Bayesian spatio-temporal models to evaluate if changes in alcohol-related ambulance call-outs and assaults have resulted from the later opening hours, including impact on different subgroups and changes in call-out locations [led by Prof. James Lewsey, University of Glasgow]._x000D_ - WP4: Evaluating Economic Impact: will evaluate any associated costs of the changes to NHS, police services and local businesses [led by Prof. Emma McIntosh, University of Glasgow]._x000D_ - WP5: Evaluating Impact on Inequalities, Long-Term NHS Costs and for other UK Local Authorities (LAs): will identify whether other UK LAs are considering similar changes, and model the likely impact of the changes on inequalities, long-term health and healthcare costs for the two cities and other UK LAs [led by Colin Angus, University of Sheffield]._x000D_ _x000D_ To our knowledge, no previous study in the UK has considered the impact of later trading hours on alcohol-related ambulance call-outs. The findings will inform future decisions and legislation on trading hours locally, nationally and internationally.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: GENERIC HEALTH RELEVANCE