Preventing Alcohol Related Violence

Slide1 : Health Challenge Wales: alcohol misuse Preventing Alcohol Related Violence Jonathan Shepherd FMedSci Professor of Oral & Maxillofacial Surgery Director, Violence Research Group


SITE AND TYPE OF INJURY IN CONSECUTIVE ASSAULT VICTIMS : SITE AND TYPE OF INJURY IN CONSECUTIVE ASSAULT VICTIMS Number of Patients (n=530) Face Other head/neck Thorax Abdomen Lower limb Upper limb


INCIDENCE OF VIOLENCE/MAXILLOFACIAL INJURY : INCIDENCE OF VIOLENCE/MAXILLOFACIAL INJURY Death rate: 28.8/100,000 population worldwide 2000. (WHO 2003) Mean annual risk of assault injury in UK 1995-2000/10,000 population (Sivarajasingam et al 2004) 75: males 26: females 28: Southeast 100: Northwest 76,000 assault patients treated by UK Maxillofacial services in 1997. (BAOMS Face Injury Survey 1998). Antisocial lifestyles include offending and injury (Shepherd et al 2004)


RECORDING OF VIOLENT OFFENCES BY THE POLICE : RECORDING OF VIOLENT OFFENCES BY THE POLICE Crime Surveys in Sweden, UK and US demonstrate low recording rates Police recording varies by victim age and gender and violence location 23% of people injured in violence (hospital data) recorded by police


Slide7 : VIOLENCE IN ODENSE MUNICIPALITY 1403 (100%) victims 869 (62%) victims 327 (23%) victims 207 (15%) victims ODENSE UNIVERSITY HOSPITAL POLICE (Faergemann 2006)


Slide8 : Police recording not related statistically to Injury Severity Scores 13% of firearm violence recorded in Atlanta EDs not recorded by police


Slide10 : -4 -2 0 2 4 6 8 10 12 Before CCTV Control towns CCTV towns Percentage change After CCTV EFFECT OF CCTV ON POLICE VIOLENCE DETECTION


Slide11 : EFFECT OF CCTV ON A&E ASSAULT ATTENDANCE Control towns After CCTV Percentage change Before CCTV CCTV towns


Slide12 : Trends in Violence in England and Wales


Slide14 : Community Safety Partnership CARDIFF VIOLENCE PREVENTION GROUP


Slide15 : OBJECTIVES Violence prevention Integrated victim services


Slide16 : CRIME AND DISORDER ACT 1998 334 partnerships Persons/bodies with statutory obligations include: Health Authorities National Health Trusts POLICE REFORM ACT 2002 Local Health Boards Primary Care Trusts


Slide17 : “To improve understanding of prevalence of disease … much greater use needs to be made of primary care data. [Their] potential … to guide both national understanding and lead activity must be fully realised.” WANLESS 2004 UK Treasury Adviser


Slide19 : National/Regional measurement ED data Local surveillance/prevention


Slide20 : INDEPENDENT NATIONAL CORRELATES WITH ASSAULT INJURY (ED measure) Unemployment/Deprivation Ethnic minority population Alcohol expenditure Lager price Season


VIOLENCE HOTSPOTS IN 21st CENTURY CARDIFF : VIOLENCE HOTSPOTS IN 21st CENTURY CARDIFF


CHOLERA HOTSPOTS IN VICTORIAN LONDON : CHOLERA HOTSPOTS IN VICTORIAN LONDON


TARGETED POLICING : TARGETED POLICING Combined ED/Police intelligence High visibility/covert operations Patrols Day-time liaison with licensees Redeployment Door-staff regulation/enforcement Fast-food outlet relocation Traffic flow/car-park improvement


EVALUATION : EVALUATION Marked decreases in assault injury in target premises Significantly greater decrease in assault injury in premises targeted by police and ED compared with targeted policing alone (OR=0.6. 95% CI 0.37-0.97) Marked increase in street assault in main entertainment thoroughfare Licensed premises capacity predicted street assaults


Slide26 : Monthly Assault Attendances – Cardiff ED


VIOLENCE PREVENTION : VIOLENCE PREVENTION Primary prevention Community RCT of toughened glass Secondary prevention Court and Clinic RCTs of alcohol misuse motivational interview Tertiary prevention RCT of cognitive behavioural therapy to prevent post traumatic stress disorder


Slide29 : Primary Prevention: glass injury


Slide30 : Toughened glass Non-toughened glass


RCT OF TOUGHENED GLASSES : RCT OF TOUGHENED GLASSES 57 UK Bars randomised to toughened or non-toughened beer glasses. Injury data from 1,229 bar workers. Relative Risk: 1.5 (95% CI:1.1-2.3). Injury rate 60% higher in intervention group. But, impact resistance of toughened glasses significantly higher: double blind trial Conclusion: toughened glass resulted in lower injury risk.


Slide32 : Secondary Prevention RCT OF A BRIEF ALCOHOL (motivational interviewing) INTERVENTION: Victims Maxillofacial clinics Men aged 16-35 with facial injury 7 units in 6 hours pre-injury


Slide33 : ABSTINENT DAYS Abstinent Days (± Standard Error) Baseline 3 months 12 months Control Group Intervention Group 65 60 55 50 45 40 35


Slide34 : Re-offending at 12 months 95%CI= -0.11, +0.14 MAGISTRATES COURT RCT: Offenders


Slide35 : Injury at 12 months 95%CI= -0.23, -0.009*


Slide36 : MAGISTRATES COURT RCT: Offenders No effect on alcohol misuse No effect on offending Significant reduction in injury In sum, reducing alcohol misuse may reduce victim vulnerability more than the propensity to offend


Slide37 : Tertiary Prevention: post traumatic stress


RCT: FOUR SESSION COGNITIVE BEHAVIOURAL THERAPY : RCT: FOUR SESSION COGNITIVE BEHAVIOURAL THERAPY Bisson, Shepherd, Joy, Probert & Newcombe (2004)


Slide39 : PREVENTING COMMUNITY VIOLENCE Combining care with prevention Secondary Prevention: alcohol misuse intervention Victim contacted to identify: Physical injury treated Core assault data recorded and anonymised Victim advised on police reporting Mental health needs Circumstances of assault Primary Prevention Tertiary Prevention: cognitive behavioural therapy