Professor of Behavioural Epidemiology
areas of expertise
The impact of adverse childhood experiences on health service use across the life course using a retrospective cohort study.
Mark Bellis, Professor Karen Hughes, Katie Hardcastle, Kat Ford, Dr Zara Quigg, Alisha Davies
JOURNAL OF HEALTH SERVICES RESEARCH & POLICY, 22(3), 168-177. doi:10.1177/1355819617706720, 2017.
Abstract: The lifelong health impacts of adverse childhood experiences are increasingly being identified, including earlier and more frequent development of non-communicable disease. Our aim was to examine whether adverse childhood experiences are related to increased use of primary, emergency and in-patient care and at what ages such impact is apparent.
Does continuous trusted adult support in childhood impart life-course resilience against adverse childhood experiences – a retrospective study on adult health-harming behaviours and mental well-being.
BMC PSYCHIATRY, 17, 12 pages. doi:10.1186/s12888-017-1260-z, 2017.
Abstract: Adverse childhood experiences (ACEs) including child abuse and household problems (e.g. domestic violence) increase risks of poor health and mental well-being in adulthood. Factors such as having access to a trusted adult as a child may impart resilience against developing such negative outcomes. How much childhood adversity is mitigated by such resilience is poorly quantified. Here we test if access to a trusted adult in childhood is associated with reduced impacts of ACEs on adoption of health-harming behaviours and lower mental well-being in adults.
Violence-related ambulance call-outs in the North West of England: a cross-sectional analysis of nature, extent and relationships to temporal, celebratory and sporting events.
Dr Zara Quigg, Dr Ciara McGee, Professor Karen Hughes, Simon Russell, Mark Bellis
EMERGENCY MEDICINE JOURNAL, 34(6), 364-369. doi:10.1136/emermed-206081, 2017.
Abstract: To explore the potential of ambulance call-out data in understanding violence to inform prevention activity.
INJURY PREVENTION Vol. 22 (pp. A104). BMJ PUBLISHING GROUP. doi:10.1136/injurypre-042156.284, 2016.
Abstract: An emergent body of research is underlining the long-term impacts that adverse childhood experiences (ACEs) have in determining the health and social prospects of individuals. ACEs are now considered one of the strongest predictors of poor health and social outcomes in adults. Individuals with higher numbers of ACEs are found to have higher risks of anti-social behaviour, crime, and violence, and are at increased risk of developing a range of health conditions and ultimately premature mortality.
Relationships between adverse childhood experiences and adult mental well-being: results from an English national household survey
Professor Karen Hughes, Helen Lowey, Dr Zara Quigg, Professor Mark Bellis
BMC Public Health 16:222, 2016.
Abstract: Background: Individuals’ childhood experiences can strongly influence their future health and well-being. Adverse childhood experiences (ACEs) such as abuse and dysfunctional home environments show strong cumulative relationships with physical and mental illness yet less is known about their effects on mental well-being in the general population. Methods: A nationally representative household survey of English adults (n = 3,885) measuring current mental well-being (Short Edinburgh-Warwick Mental Well-being Scale SWEMWBS) and life satisfaction and retrospective exposure to nine ACEs. Results: Almost half of participants (46.4 %) had suffered at least one ACE and 8.3 % had suffered four or more. Adjusted odds ratios (AORs) for low life satisfaction and low mental well-being increased with the number of ACEs. AORs for low ratings of all individual SWEMWBS components also increased with ACE count, particularly never or rarely feeling close to others. Of individual ACEs, growing up in a household affected by mental illness and suffering sexual abuse had the most relationships with markers of mental well-being. Conclusions: Childhood adversity has a strong cumulative relationship with adult mental well-being. Comprehensive mental health strategies should incorporate interventions to prevent ACEs and moderate their impacts from the very earliest stages of life.
Simon Russell, Professor Karen Hughes, Professor Mark Bellis
BMJ Open, 2016.
Abstract: Objectives: To examine the relative contribution of childhood experience, measured by childhood violence and childhood happiness, and adult well-being on adult eating preferences and behaviours, independent of proximal factors such as current deprivation. Design: A cross-sectional, stratified, randomised sample survey using retrospective measures of childhood violence and happiness and self-reported measures of current well-being. Setting: The North West Region of England between September 2012 and March 2013. Participants: Individuals aged 18–95-year-olds from randomly selected households ( participation was successful for 90% of eligible households and 78% of the total visited addresses; n=11 243). Outcomes: Dichotomised measures for preference of healthy foods or ‘feel good’ foods and low or high daily fruit and vegetable consumption. Results: After correcting for demographics, combined categories for childhood experience and dichotomised measures of adult well-being were found to be significantly related to adult food preferences and eating behaviours. Participants with unhappy and violent childhoods compared to those with happy and non-violent childhoods had adjusted ORs (95% CI, significance) of 2.67 (2.15 to 3.06, p<0.001) of having low daily fruit and vegetable intake (two or less portions) and 1.53 (1.29 to 1.81, p<0.001) of choosing ‘feel good’ foods over foods which were good for their long term health. Conclusions: Daily intake of fruit and vegetables, linked to non-communicable diseases, and preference for ‘feel good’ foods, linked to obesity, are affected by childhood experience and adult well-being independent of demographic factors. Preventative interventions which support parent–child relationships and improve childhood experience are likely to reduce the development of poor dietary and other health-risk behaviours.
Holidays, celebrations, and commiserations: measuring drinking during feasting and fasting to improve national and individual estimates of alcohol consumption
BMC Medicine, 13:113, 2015.
Abstract: Background: Accurate measures of alcohol consumption are critical in assessing health harms caused by alcohol. In many countries, there are large discrepancies between survey-based measures of consumption and those based on alcohol sales. In England, surveys measuring typical alcohol consumption account for only around 60% of alcohol sold. Here, using a national survey, we measure both typical drinking and atypical/special occasion drinking (i.e., feasting and fasting) in order to develop more complete measures of alcohol consumption. Methods: A national random probability telephone survey was implemented (May 2013 to April 2014). Inclusion criteria were resident in England and aged 16 years or over. Respondents (n = 6,085) provided information on typical drinking (amounts per day, drinking frequency) and changes in consumption associated with routine atypical days (e.g., Friday nights) and special dinking periods (e.g., holidays) and events (e.g., weddings). Generalized linear modelling was used to identify additional alcohol consumption associated with atypical/special occasion drinking by age, sex, and typical drinking level. Results: Accounting for atypical/special occasion drinking added more than 120 million UK units of alcohol/week (~12 million bottles of wine) to population alcohol consumption in England. The greatest impact was seen among 25- to 34-year-olds with the highest typical consumption, where atypical/special occasions added approximately 18 units/week (144 g) for both sexes. Those reporting the lowest typical consumption (≤1 unit/week) showed large relative increases in consumption (209.3%) with most drinking associated with special occasions. In some demographics, adjusting for special occasions resulted in overall reductions in annual consumption (e.g., females, 65 to 74 years in the highest typical drinking category). Conclusions: Typical drinking alone can be a poor proxy for actual alcohol consumption. Accounting for atypical/special occasion drinking fills 41.6% of the gap between surveyed consumption and national sales in England. These additional units are inevitably linked to increases in lifetime risk of alcohol-related disease and injury, particularly as special occasions often constitute heavy drinking episodes. Better population measures of celebratory, festival, and holiday drinking are required in national surveys in order to adequately measure both alcohol consumption and the health harms associated with special occasion drinking.
Professor Karen Hughes, Professor Mark Bellis, Katie Hardcastle, Dr Phil McHale, Andrew Bennett, Robin Ireland, Kate Pike
BMC Public Health 15:244, 2015.
Abstract: Background: Public health concerns regarding e-cigarettes and debate on appropriate regulatory responses are focusing on the need to prevent child access to these devices. However, little is currently known about the characteristics of those young people that are accessing e-cigarettes. Methods: Using a cross-sectional survey of 14-17 year old school students in North West England (n = 16,193) we examined associations between e-cigarette access and demographics, conventional smoking behaviours, alcohol consumption, and methods of accessing cigarettes and alcohol. Access to e-cigarettes was identified through a question asking students if they had ever tried or purchased e-cigarettes. Results: One in five participants reported having accessed e-cigarettes (19.2%). Prevalence was highest among smokers (rising to 75.8% in those smoking >5 per day), although 15.8% of teenagers that had accessed e-cigarettes had never smoked conventional cigarettes (v.13.6% being ex-smokers). E-cigarette access was independently associated with male gender, having parents/guardians that smoke and students’ alcohol use. Compared with non-drinkers, teenagers that drank alcohol at least weekly and binge drank were more likely to have accessed e-cigarettes (adjusted odds ratio [AOR] 1.89, P < 0.001), with this association particularly strong among never-smokers (AOR 4.59, P < 0.001). Among drinkers, e-cigarette access was related to: drinking to get drunk, alcohol-related violence, consumption of spirits; self-purchase of alcohol from shops or supermarkets; and accessing alcohol by recruiting adult proxy purchasers outside shops. Conclusions: There is an urgent need for controls on the promotion and sale of e-cigarettes to children. Findings suggest that e-cigarettes are being accessed by teenagers more for experimentation than smoking cessation. Those most likely to access e-cigarettes may already be familiar with illicit methods of accessing age-restricted substances.
Global development and diffusion of outcome evaluation research for interpersonal and self-directed violence prevention from 2007 to 2013: A systematic review
Professor Karen Hughes, Professor Mark Bellis, Katie Hardcastle, Alexander Butchart, Linda Dahlberg, James Mercy, Christopher Mikton
Aggression and Violent Behavior, Early online, In press, 2014.
Abstract: Through a global review, we identified gaps in the geographical distribution of violence prevention evidence outcome evaluation studies and the types of violence addressed. Systematic literature searches identified 355 articles published between 2007 and 2013 that evaluated programs to prevent interpersonal or self-directed violence; focused on universal or selected populations; and reported outcomes measuring violence or closely related risk factors. The number of studies identified increased annually from 2008 (n = 37), reaching 64 in 2013. Over half (n = 203) of all studies focused on youth violence yet only one on elder maltreatment. Study characteristics varied by year and violence type. Only 9.3% of all studies had been conducted in LMICs. These studies were less likely than those in high income countries (HICs) to have tested established interventions yet more likely to involve international collaboration. Evaluation studies successfully established in LMIC had often capitalized on other major regional priorities (e.g. HIV). Relationships between violence and social determinants, communicable and non-communicable diseases, and even economic prosperity should be explored as mechanisms to increase the global reach of violence prevention research. Results should inform future research strategies and provide a baseline for measuring progress in developing the violence prevention evidence-base, especially in LMICs.
Work Hard, Party Harder: Drug Use and Sexual Behaviour in Young British Casual Workers in Ibiza, Spain
, Professor Karen Hughes, Professor Mark Bellis
Int. J. Environ. Res. Public Health, 11(10), 10051-10061, 2014.
Abstract: Background: Every summer, young people flock to nightlife-focused holiday resorts around the world to find casual work. Despite being exposed to hedonistic environments, often for several months, little is known about their substance use, sexual activity and health service needs over this extended amount of time abroad. Methods: A short anonymous questionnaire examining alcohol and drug use, sexual behaviour and use of health services was administered to young British casual workers aged 16–35 in San Antonio, Ibiza (n = 171). Results: 97.7% of casual workers used alcohol in Ibiza, and the majority (85.3%) used drugs. Almost half (43.5%) of all participants used a drug in Ibiza that they had never used in the UK. Most casual workers arrived in Ibiza without a partner or spouse (86.5%). Of these, 86.9% had sex during their stay and 50.0% had unprotected sex; often while under the influence of alcohol. Only 14.3% of those having unprotected sex with a new partner sought a sexual health check-up in Ibiza, although 84.1% intended to do this on their return to the UK. Conclusion: Substance use and sexual risk taking is widespread among young British casual workers in Ibiza. Such international nightlife resorts represent key settings for substance-related health and social problems, and for the international spread of sexually transmitted infections. Addressing the health needs of casual workers and the environments that permit and promote their excessive behaviour requires collaboration between authorities in home and destination countries and the tourism industry.
Incidents of harm in European drinking environments and relationships with venue and customer characteristics
Dr Zara Quigg, Professor Karen Hughes, Professor Mark Bellis, Ninette van Hasselt, Amador Calafat, Matej Kosir, Mariangels Duch, Montse Juan, Lotte Voorham, Ferry Goossens
The International Journal Of Alcohol And Drug Research, August 2014.
Abstract: Aim: Research shows there are associations between bar environments and alcohol-related harms. However, few European studies have examined such links. Our study investigates the type of harms experienced by patrons in European bars, and their relationships with individual, social and environmental factors. Design: Unobtrusive one-hour observational visits. Characteristics of the bar environment, staff and patrons, and harms observed were recorded on structured schedules. Setting: Bars in four cities in the Netherlands, Slovenia, Spain and the United Kingdom (U.K.). Participants: 238 observations across 60 bars. Measures: Analyses utilized chi-squared, analyses of variance and logistic regression. Findings: 114 incidents of harm were observed; in one-fifth of visits, at least one incident was recorded. People falling over, arguing or being so severely intoxicated that they required assistance to walk were the most common incidents observed. Bivariate analyses showed associations between a range of staffing, customer and environmental characteristics, and incidents of harm. Controlling for city and venue, only a permissive environment remained significant in multivariate analyses. Conclusions: Harms occurring in nightlife venues are typically minor. However, such incidents have the potential to escalate into more serious harms; thus, prevention is crucial. Prevention should focus on improving venue management practice and on the behavioral standards expected of customers.
Adverse childhood experiences and associations with health-harming behaviours in young adults: surveys in the European Region
Professor Mark Bellis, Professor Karen Hughes, Nicola Leckenby, Lisa Jones, Adriana Baban, Margarita Kachaeva, Robertas Povilaitis, Iveta Pudule, Gentiana Qirjako, Betul Ulukol, Marija Raleva, Natasa Terzic
Bulletin of the World Health Organization, Online first format, 2014.
Abstract: Objective To evaluate the association between adverse childhood experiences – e.g. abuse, neglect, domestic violence and parental separation, substance use, mental illness or incarceration – and the health of young adults in the eastern European Region. Methods: Between 2010 and 2013, adverse childhood experience surveys were undertaken in Albania, Latvia, Lithuania, Montenegro, Romania, the Russian Federation, The former Yugoslav Republic of Macedonia and Turkey. There were 10’696 respondents – 59.7% female – aged 18–25 years. Multivariate modelling was used to investigate the relationships between adverse childhood experiences and health-harming behaviours in early adulthood including substance use, physical inactivity and attempted suicide. Findings: Over half of the respondents reported at least one adverse childhood experience. Having one adverse childhood experience increased the probability of having other adverse childhood experiences. The number of adverse childhood experiences was positively correlated with subsequent reports of harming behaviours. Compared with those who reported no adverse experiences, respondents who reported at least four adverse childhood experiences were at significantly increased risk of many health-harming behaviours, with odds ratios varying from 1.68 (95% confidence interval (CI): 1.32–2.15) – for physical inactivity – to 48.53 (95% CI: 31.98–76.65) – for attempted suicide. Modelling indicated that prevention of adverse childhood experiences would substantially reduce the occurrence of many health-harming behaviours within the study population. Conclusion: Our results indicate that individuals who do not develop health-harming behaviours are more likely to have experienced safe, nurturing childhoods. Evidence-based programmes to improve parenting and support child development need large-scale deployment in the eastern European Region.
Does legislation to prevent alcohol sales to drunk individuals work? Measuring the propensity for night-time sales to drunks in a UK city
Professor Karen Hughes, Professor Mark Bellis, Nicola Leckenby, Dr Zara Quigg, Katie Hardcastle, Olivia Sharples, David J Llewellyn
J Epidemiol Community Health, doi:10.1136/jech-2013-203287, 2014.
Abstract: Background: By measuring alcohol retailers’ propensity to illegally sell alcohol to young people who appear highly intoxicated, we examine whether UK legislation is effective at preventing health harms resulting from drunk individuals continuing to access alcohol. Methods: 73 randomly selected pubs, bars and nightclubs in a city in North West England were subjected to an alcohol purchase test by pseudo-drunk actors. Observers recorded venue characteristics to identify poorly managed and problematic (PMP) bars. Results: 83.6% of purchase attempts resulted in a sale of alcohol to a pseudo-intoxicated actor. Alcohol sales increased with the number of PMP markers bars had, yet even in those with no markers, 66.7% of purchase attempts resulted in a sale. Bar servers often recognised signs of drunkenness in actors, but still served them. In 18% of alcohol sales, servers attempted to up-sell by suggesting actors purchase double rather than single vodkas. Conclusions: UK law preventing sales of alcohol to drunks is routinely broken in nightlife environments, yet prosecutions are rare. Nightlife drunkenness places enormous burdens on health and health services. Preventing alcohol sales to drunks should be a public health priority, while policy failures on issues, such as alcohol pricing, are revisited.
Harms from other people’s drinking: an international survey of their occurrence, impacts on feeling safe and legislation relating to their control
Professor Mark Bellis, Dr Zara Quigg, Professor Karen Hughes, Kathryn Ashton, Jason Ferris, Adam Winstock
BMJ Open 2015;5:e010112, 2015.
Abstract: Objective To examine factors associated with suffering harm from another person's alcohol consumption and explore how suffering such harms relate to feelings of safety in nightlife. Design Cross-sectional opportunistic survey (Global Drug Survey) using an online anonymous questionnaire in 11 languages promoted through newspapers, magazines and social media. Subjects Individuals (participating November 2014–January 2015) aged 18–34 years, reporting alcohol consumption in the past 12 months and resident in a country providing ≥250 respondents (n=21 countries; 63 725 respondents). Main outcome measures Harms suffered due to others’ drinking in the past 12 months, feelings of safety on nights out (on the way out, in bars/pubs, in nightclubs and when travelling home) and knowledge of over-serving laws and their implementation. Results In the past 12 months, >40% of respondents suffered at least one aggressive (physical, verbal or sexual assault) harm and 59.5% any harm caused by someone drunk. Suffering each category of harm was higher in younger respondents and those with more harmful alcohol consumption patterns. Men were more likely than women to have suffered physical assault (9.2% vs 4.7; p<0.001), with women much more likely to suffer sexual assault or harassment (15.3% vs 2.5%; p<0.001). Women were more likely to feel unsafe in all nightlife settings, with 40.8% typically feeling unsafe on the way home. In all settings, feeling unsafe increased with experiencing more categories of aggressive harm by a drunk person. Only 25.7% of respondents resident in countries with restrictions on selling alcohol to drunks knew about such laws and 75.8% believed that drunks usually get served alcohol. Conclusions Harms from others’ drinking are a threat to people's health and well-being. Public health bodies must ensure that such harms are reflected in measures of the societal costs of alcohol, and must advocate for the enforcement of legislation designed to reduce such harms.
Student drinking patterns and blood alcohol concentration on commercially organised pub crawls in the UK
Dr Zara Quigg, Professor Karen Hughes, Professor Mark Bellis
Addictive Behaviors, Volume 38, Issue 12, pp 2924–2929, 2013.
Abstract: Background: Commercial student pub crawls are associated with high levels of alcohol consumption, and are of growing concern amongst public health and student bodies. However, little is currently known about drinking behaviours whilst participating in these events. Methods: A questionnaire was implemented amongst 227 students attending commercial pub crawls across three UK events. Questions established alcohol consumption patterns up to the point of interview and throughout the remaining night out, and pub crawl experience. Breathalyser tests were used to measure breath alcohol concentration (converted to blood alcohol concentration [BAC]) at interview. Analyses used chi squared, Mann–Whitney U, Kruskal–Wallis and logistic regression. Results: 94.3% of participants had consumed alcohol, 90.9% of whom reported preloading. Drinkers reported consuming a median of 10.0 alcohol units (80 g of pure alcohol) up to the point of interview (range one—40.6), with estimated total consumption over the evening exceeding 16 units (range three—70.6). Median BAC of drinkers at the time of interview was 0.10%BAC (range 0.00–0.27). High BAC (> 0.08%; at interview) was associated with having not eaten food in the four hours prior (AOR 4.8, p < 0.01), time spent drinking (AOR 1.4, p < 0.01) and number of units drank per hour (AOR 1.2, p < 0.01). Conclusions: Measures to prevent high levels of alcohol consumption before and during commercial pub crawls should aim to alter drinking behaviours such as preloading and rapid and excessive drinking. Organisers, local authorities, universities and students should all be involved in ensuring the effective management of pub crawls, including implementation of harm prevention measures.
Prevalence and risk of violence against adults with disabilities: a systematic review and meta-analysis of observational studies.
The Lancet, 379, 1621-1629, 2012, doi:10.1016/S0410-6736(11)61851-5..
Abstract: Background: About 15% of adults worldwide have a disability. These individuals are frequently reported to be at increased risk of violence, yet quantitative syntheses of studies of this issue are scarce. We aimed to quantify violence against adults with disabilities. Methods: In this systematic review and meta-analysis, we searched 12 electronic databases to identify primary research studies published between Jan 1, 1990, and Aug 17, 2010, reporting prevalence estimates of violence against adults (aged mainly ≥18 years) with disabilities, or their risk of violence compared with non-disabled adults. We included only studies reporting violence occurring within the 12 months before the study. We assessed studies with six core quality criteria, and pooled data for analysis. Findings: Of 10 663 references initially identified, 26 were eligible for inclusion, with data for 21 557 individuals with disabilities. 21 studies provided data suitable for meta-analysis of prevalence of violence, and ten for meta-analysis of risks of violence. Pooled prevalence of any (physical, sexual, or intimate partner) recent violence was 24·3% (95% CI 18·3—31·0) in people with mental illnesses, 6·1% (2·5—11·1) in those with intellectual impairments, and 3·2% (2·5—4·1) in those with non-specific impairments. We identified substantial heterogeneity in most prevalence estimates (I2 >75%). We noted large uncertainty around pooled risk estimates. Pooled crude odds ratios for the risk of violence in disabled compared with non-disabled individuals were 1·50 (95% CI 1·09—2·05) for all studies combined, 1·31 (0·93—1·84) for people with non-specific impairments, 1·60 (1·05—2·45) for people with intellectual impairments, and 3·86 (0·91—16·43) for those with mental illnesses. Interpretation: Adults with disabilities are at a higher risk of violence than are non-disabled adults, and those with mental illnesses could be particularly vulnerable. However, available studies have methodological weaknesses and gaps exist in the types of disability and violence they address. Robust studies are absent for most regions of the world, particularly low-income and middle-income countries. Funding: WHO Department of Violence and Injury Prevention and Disability.
Drunk and disorganised: relationships between bar characteristics and customer intoxication in European drinking environments
Professor Karen Hughes, Dr Zara Quigg, Professor Mark Bellis, Amador Calafat, Ninette van Hasselt, Matej Kosir, Lotte Voorham, Ferry Goossens, Mariangels Duch
International Journal of Environmental Research and Public Health. 9(11), pp 4068-4082, 2012.
Abstract: Preventing alcohol-related harm in drinking environments is a growing international priority. Factors relating to the physical, social and staffing environments in bars can contribute to increased alcohol consumption and harm. Understanding the relationships between such factors and intoxication in European drinking environments is critical to developing appropriate interventions. We undertook a quantitative observational study in 60 bars in four European cities, in The Netherlands, Slovenia, Spain and the UK (n = 237 observational visits). Using a structured observational schedule, researchers recorded characteristics of the bar environment and rated customer intoxication levels. All physical bar characteristics showed associations with intoxication before interactions between them were controlled for. Hierarchical modelling found significant independent associations between intoxication and use of plastic glassware, promotion of non-alcoholic drinks (often energy drinks), permissive environments, poor washroom facilities, the presence of a dance floor, customer sexual activity/competitiveness and later observational time. Findings suggest that prevention efforts should focus on raising and enforcing managerial standards in bars. While harm reduction measures such as plastic glassware are often promoted for high risk bars, such measures are inadequate to address public health concerns and insufficient to demonstrate social responsibility.
Data sharing for prevention: a case study in the development of a comprehensive emergency department injury surveillance system and its use in preventing violence and alcohol-related harms
Dr Zara Quigg, Professor Karen Hughes, Professor Mark Bellis
Injury Prevention: Journal of the International Society for Child and Adolescent Injury Prevention 18(5), 315-20, 2012.
Abstract: Objective: To examine emergency department (ED) data sharing via a local injury surveillance system and assess its contribution to the prevention of violence and alcohol-related harms. Methods: 6-year (2004-2010) exploratory study analysing injury attendances to one ED in the North West of England using descriptive and trend analyses. Results: Over the 6-year period, there were 242,796 ED injury attendances, including 21,683 for intentional injuries. Compared with unintentional injury patients, intentional injury patients were more likely to be men, aged 18-34 years, live in the most deprived communities, have attended the ED at night/weekends, have been injured in a public place and have consumed alcohol prior to the injury. Detailed data collected on alcohol and violence-related ED attendances were shared with local partners to monitor local trends and inform prevention activity including targeted policing and licensing enforcement. Over the 6-year period, intentional ED injury attendances decreased by 35.6% and alcohol-related assault attendances decreased by 30.3%. CONCLUSIONS: The collection of additional ED data on assault details and alcohol use prior to injury, and its integration into multi-agency policy and practice, played an important role in driving local violence prevention activity. Further research is needed to assess the direct contribution ED data sharing makes to reductions in violence.
Nighttime assaults: using a national emergency department monitoring system to predict occurrence, target prevention and plan services
Professor Mark Bellis, Nicola Leckenby, Professor Karen Hughes, Chris Luke, Sacha Wyke, Dr Zara Quigg
BMC Public Health 12, 746, 2012.
Abstract: Background: Emergency department (ED) data have the potential to provide critical intelligence on when violence is most likely to occur and the characteristics of those who suffer the greatest health impacts. We use a national experimental ED monitoring system to examine how it could target violence prevention interventions towards at risk communities and optimise acute responses to calendar, holiday and other celebration-related changes in nighttime assaults. Methods: A cross-sectional examination of nighttime assault presentations (6.01 pm to 6.00 am; n = 330,172) over a three-year period (31st March 2008 to 30th March 2011) to English EDs analysing changes by weekday, month, holidays, major sporting events, and demographics of those presenting. Results: Males are at greater risk of assault presentation (adjusted odds ratio [AOR] 3.14, 95% confidence intervals [CIs] 3.11-3.16; P < 0.001); with male:female ratios increasing on more violent nights. Risks peak at age 18 years. Deprived individuals have greater risks of presenting across all ages (AOR 3.87, 95% CIs 3.82-3.92; P < 0.001). Proportions of assaults from deprived communities increase midweek. Female presentations in affluent areas peak aged 20 years. By age 13, females from deprived communities exceed this peak. Presentations peak on Friday and Saturday nights and the eves of public holidays; the largest peak is on New Year’s Eve. Assaults increase over summer with a nadir in January. Impacts of annual celebrations without holidays vary. Some (Halloween, Guy Fawkes and St Patrick’s nights) see increased assaults while others (St George’s and Valentine’s Day nights) do not. Home nation World Cup football matches are associated with nearly a three times increase in midweek assault presentation. Other football and rugby events examined show no impact. The 2008 Olympics saw assaults fall. The overall calendar model strongly predicts observed presentations (R2 = 0.918; P < 0.001). Conclusions: To date, the role of ED data has focused on helping target nightlife police activity. Its utility is much greater; capable of targeting and evaluating multi-agency life course approaches to violence prevention and optimising frontline resources. National ED data are critical for fully engaging health services in the prevention of violence.
Prevalence and risk of violence against children with disabilities: a systematic review and meta-analysis of observational studies
Lancet, 380, 899-907, 2012.
Abstract: Background: Globally, at least 93 million children have moderate or severe disability. Children with disabilities are thought to have a substantially greater risk of being victims of violence than are their non-disabled peers. Establishment of reliable estimates of the scale of the problem is an essential first step in the development of effective prevention programmes. We therefore undertook a systematic review and meta-analysis to synthesise evidence for the prevalence and risk of violence against children with disabilities. Methods: For this systematic review and meta-analysis, we searched 12 electronic databases to identify cross-sectional, case-control, or cohort studies reported between Jan 1, 1990, and Aug 17, 2010, with estimates of prevalence of violence against children (aged ≤18 years) with disabilities or their risk of being victims of violence compared with children without disabilities. Findings: 17 studies were selected from 10 663 references. Reports of 16 studies provided data suitable for meta-analysis of prevalence and 11 for risk. Pooled prevalence estimates were 26·7% (95% CI 13·8—42·1) for combined violence measures, 20·4% (13·4—28·5) for physical violence, and 13·7% (9·2—18·9) for sexual violence. Odds ratios for pooled risk estimates were 3·68 (2·56—5·29) for combined violence measures, 3·56 (2·80—4·52) for physical violence, and 2·88 (2·24—3·69) for sexual violence. Huge heterogeneity was identified across most estimates (I2>75%). Variations were not consistently explained with meta-regression analysis of the characteristics of the studies. Interpretation: The results of this systematic review confirm that children with disabilities are more likely to be victims of violence than are their peers who are not disabled. However, the continued scarcity of robust evidence, due to a lack of well designed research studies, poor standards of measurement of disability and violence, and insufficient assessment of whether violence precedes the development of disability, leaves gaps in knowledge that need to be addressed. Funding: WHO Department of Violence and Injury Prevention and Disability.
- Published 6 February 2015
- Tagged Violence and unintentional injury