This document discusses the risks of alcohol use in nightlife environments, especially for young people. It notes that alcohol is a major part of most nightlife cultures and is strongly linked to violence and injury, which are leading causes of death and disability for 15-24 year olds. The document then reviews studies on alcohol consumption and injuries in nightlife settings around the world. It evaluates different prevention strategies like responsible beverage service training, environmental design changes, enforcement of alcohol policies, and multi-component community interventions. The most effective approaches use multiple strategies like enforcement, training, and community engagement. Overall, the document emphasizes that preventing injuries requires reducing harmful underage drinking and controlling alcohol availability.

1. Young people:
Alcohol and Risks in Nightlife
Environments
Karen Hughes
Public Health Wales, UK

2. • Nightlife a major part of young people’s social
and working lives
• Alcohol key feature of most nightlife cultures
• Strongly linked to violence and unintentional
injury
• Leading risk factor for deaths and disability in 15-24
years olds
• Much alcohol use by young people occurs as
part of nightlife
• Key focus for prevention
Introduction
Mokdad et al, 2016

3. • Injury risk increases with amount of alcohol
consumed
• Effects of alcohol
– Depressant: slows down brain and body’s responses
– Disinhibitor: increases risk taking behaviour
• Nightlife environment
– Dark, crowded and noisy
– Glassware, special effects
– Fashion – e.g. high heeled shoes
– Promotion of alcohol use
Alcohol and Injury

4. Nightlife Alcohol Use
UK
(Liverpool)
Female
Male
Netherlands
(Utrecht)
Female
Male
Spain
(Palma)
Female
Male
Slovenia
(Ljubljana)
Female
Male
• Few studies - difficult to measure 1 standard drink, 10ml
• ~200 nightlife users per city
• Surveyed in nightlife areas
• 10pm to 5am, 2010
• Consumed + expected
alcohol consumption
Hughes et al, 2011

5. Nightlife Injuries
BRAZIL (Sanchez et al, 2015)
After leaving nightclub,
24% of patrons drove
under influence of alcohol
and 4% involved in fight
MEDITERREAN* (Calafat et al, 2011)
25% of nightlife users driven
when drunk in the past month
AUSTRALIA (Miller et al, 2015)
Alcohol-related injuries
accounted for 36% of all
ED attendances on
weekend nights
SOUTH AFRICA (Watt et al, 2015)
10% of female bar patrons
experienced forced sex in
last 4 months
*Greece, Italy, Portugal, Slovenia, Spain
UK (National statistics)
Alcohol involved in >80% of
violence and pedestrian
fatalities on weekend nights
Denmark (Tutenges et al, 2013; Søgaard et al, 2015)
58% of door supervisors and 17% of bar
servers physically assaulted at work
USA (Miller et al, 2015)
12% patrons exiting
nightclubs reported
physical/sexual aggression in
the club

6. • Two key approaches:
– Changing the nightlife environment to reduce harms from alcohol
– Reducing alcohol availability and preventing harmful drinking
• Focus on the former
– Creating ‘safe’ environments
• Shift to latter
– Need to address alcohol use rather than just manage its impacts
• Brief overview
– Staff training programmes
– Environmental design
– Enforcement activity
– Multi-component interventions
– Alcohol control measures
Preventing alcohol-related injury

7. Responsible beverage service
Ker & Chinnock, 2008;Johnsson & Berglund, 2009; Holder andWagenaar, 1994; Wagenaar et al, 2005
• Training bar servers:
o Effects of alcohol
o Licensing legislation
o Service refusal skills
• As standalone intervention:
o Can change bar server knowledge
o No clear evidence for ↑ responsible serving practice
o No clear evidence for ↓ alcohol consumption or injury
• Mandatory training in USA with server liability laws
o Reduced single vehicle crashes
• Part of multi-component programmes

8. Environmental Programmes
• Certain characteristics of bars linked to harm:
o Permissive atmosphere, crowding, lack of seating, dirtiness, loud noise…
• Certain areas of bars linked to harm, e.g. violence:
o Dance floor, bar areas, tables and areas of movement
• Modifiable through environmental design
o Risk assessment – limited evidence
• Safer drinking vessels
o E.g. polycarbonate glass to reduce glass-related injury
• Outside
o Street lighting, pedestrianisation, blocking access to dangerous areas
o Provision of safe nightlife transport
Hughes et al, 2012; Graham et al, 2012; Moore et al 2012, Anderson et al, 2009

9. Enforcement
• Drink driving
– Driver breath testing
• Reduces drink driving, traffic crashes
– Targeted at nightlife users
• ↓alcohol-related crashes in young people
• Policing
– Targeted policing
• Identification of high risk premises
• Enforcement visits
• Improve or close
• Can reduce violence in venues
Timmerman et al, 2003; Voas et al, 2002;; Wiggers et al, 2004

10. • Most effective interventions incorporate a range of
measures through multi-agency partnership
• STAD, Sweden
o Responsible server training
o Strict enforcement of licensing regulation
o Media and community engagement
o Informed by research
• Benefits:
o 29% decrease in violent crime
o ↓ sales of alcohol to drunks (95% to 30%)
o Saved €39 for every €1 invested
Community interventions
Wallin et al, 2003, 2005; Månsdotter 2007; Warpenius et al, 2010; Holmila and Warpenius, 2012

11. Density
• More alcohol outlets
– More alcohol-related injuries
– Focus on violence and road traffic crashes
• Little evidence for reducing density
– Very hard to reduce
• USA, Los Angeles riots
– Loss of 279 alcohol outlets, 100 permanently closed
– Reduced assaults up to five years later
Livingston et al, 2007; Yu et al, 2008, Morrison et al, 2016

12. Hours of Alcohol Sales
• Longer bar opening hours, higher alcohol-related injury
– Increased in several countries; hard to reduce
• Amsterdam: 1 hour increase in opening hours increased ambulance
call outs for alcohol-related injury by 34%
• Norway: Each 1 hour extension in opening hours associated with
16% increase in assaults
Rossow & Norstrom, 2011; Kypri et al, 2010, Miller et al, 2013, Fulde et al, 2015
• Australia – reduced opening hours
– Bars shut earlier, lockouts
– Reduced nightlife assaults
– Reduced hospital admissions
– Reduced ED attendance for serious
alcohol-related injury

13. Alcohol Pricing
• Lower alcohol prices:
• Higher alcohol consumption
• More alcohol-related injuries
• Can be increased through:
• Higher taxation
• Bans on cheap drink promotions
• Minimum alcohol prices
• Canada
• 10% increase in average minimum price of alcohol
• 9% decrease in acute alcohol-related hospital admissions
Stockwell et al, 2013

14. Summary
• Nightlife high risk environment for injury
– Key setting for prevention
• Most injuries linked to alcohol
– High consumption, increasing risk to self and others
• Co-ordinated, multi-agency approach to prevention
– Enforcement, training, environment and community engagement
• Preventing injuries in young people requires:
– Reducing or preventing harmful alcohol use
– Control of alcohol availability
• Increasing alcohol use in e.g. Sub Saharan Africa and Asia
major threat to injury prevention

15. Thank You
Karen Hughes
Public Health Wales
Karen.hughes18@wales.nhs.uk