Artigo Acesso aberto Revisado por pares

A critique of Fox's industry-funded report into the drivers of anti-social behaviour in the night-time economies of Australia and New Zealand

2016; Wiley; Volume: 111; Issue: 3 Linguagem: Inglês

10.1111/add.13149

ISSN

1360-0443

Autores

Nicki Jackson, Kypros Kypri,

Tópico(s)

Crime Patterns and Interventions

Resumo

It is, of course, justifiable to explore the effectiveness of small measures such as advertising restrictions, increases or decreases in price, relaxation or restriction of hours, but such things tinker at the margins of culture and it is doubtful that they will alter the culture of violence and anti-social behaviour in any meaningful way (Fox, 2015, p. 95). In 2012, alcohol producer Lion Pty Limited, commissioned an anthropological investigation into the drivers of aggression and violence in night-time economies of New Zealand and Australia. The report from the study makes the central claim that alcohol consumption is not responsible for night-time violence. We contend that Dr Fox's recommendations direct attention away from drinking to the cultural determinants of violence, with suggested strategies ranging from social norm campaigns, high school and parent education, and community empowerment. We argue that the conclusions of the report are unsound and that it fails to recognise important evidence that runs counter to its conclusions. During a period of 7 weeks in 2013, British anthropologist Dr Anne Fox conducted fieldwork in Australia and New Zealand to understand the drivers of violence in night-time economies (NTEs). Her investigation included methods such as observation in a range of drinking environments and occasions, formal and informal interviews and focus groups, with eavesdropping on conversations yielding ‘some valuable insights’ 1. The study was funded by a large manufacturer and distributor of alcohol, Lion Pty Limited [1, p.2]. The results of the fieldwork and literature review led Fox to conclude that ‘…it is the wider culture that determines the drinking behaviour, not the drinking. You can't change a culture by simply changing drinking’ (p. 95). Hence, the conclusions of the report and ensuing recommendations are that the dominant forces in violence are found in the wider culture and that attempting to address the availability and promotion of alcohol are doomed to fail unless the ‘culture of violence’ is changed. Fox disputes the notion that alcohol has a causal role in violence, asserting that strategies should be directed towards violent individuals, a violence-reinforcing culture and violent situations. This reflects a message that the alcohol industry has been promulgating for decades: that attention should be focused on social norm campaigns, individual responsibility, parent education, life-skills training and interventions targeting high-risk individuals. Fox states that ‘small measures such as advertising restrictions, increases or decreases in price, relaxation or restriction of hours… tinker at the margins of culture and it is doubtful that they will alter the culture of violence and anti-social behaviour in any meaningful way’ (p. 95). Despite failing to meet even basic standards of research the report cannot be ignored, because the findings are being used extensively by the alcohol industry 2, in mainstream media 3 and in submissions by government agencies on public policy 4. We provide a critique, addressing key claims with reference to the scientific evidence 5. One concern is the apparent lack of ethics committee approval for the study. Scientific journals normally require that research they publish involving human participants has received approval from an ethics committee or, in some cases, confirmation that the relevant ethics committee has deemed that the study does not require it 6. In e-mail correspondence with K.K. (6 May 2015), Fox explained: ‘we saw no need to seek approval from any external body. All focus groups mentioned in the report were convened by third parties (market research companies). We made sure, however, to review their procedures to ensure that they complied with our own exacting standards (participant information and consent forms, etc.)’. She made no mention of ethical approval for other components of the study. Ethical review also includes consideration of the proposed methods because poor-quality research is considered unethical 7. In fact, what would be considered to be standard elements of ethnographic research are missing in the report, including sampling and recruitment procedures, data collection methods and a rationale for the analytical approach 8. While the naturalistic observation approach used offers a valid method for the study of aggression 9, Fox does not test competing explanations for what she observed 10. Only one-third of the 205 references cited in the report were published in the last 10 years, yet there has been substantial growth in empirical research on alcohol and violence in recent times 11. We do not attempt to provide a systematic synthesis of the empirical evidence, but rather a critique of the most problematic recommendations in the report that, if heeded, would in our view set back severely efforts to reduce violence. We judged recommendations concerning conflict resolution strategies, family support and rehabilitation of violent offenders beyond the scope of this critique, because they are already identified as priorities in violence prevention strategies. It is well understood that violence is a complex phenomenon arising from the interaction of biological, social, cultural, economic and political factors 12. Alcohol intoxication is one of many factors playing a contributory causal role 13, 14, with epidemiological studies suggesting that 22% of the violence burden is attributable to this exposure 15. Variation observed in alcohol-attributable violence reflects the range of individual and contextual factors combining to produce violent events 16, 17. Numerous studies have documented cognitive and neurobiological mechanisms linking alcohol to aggression, outlining alterations to key neurotransmitter systems from alcohol consumption which result in dysregulation of the limbic system (the emotion centre of the brain) and impaired control of the prefrontal cortex, i.e. where reasoning occurs 18. Variation between individuals in alcohol-associated aggression is thought to be mediated partly by differences in serotonergic function and gene–environment interactions 18. Fox disputes the agency of alcohol in aggression, asserting that the behaviour is ‘more able to be controlled than we would like to believe’ (p. 13). She argues that if the disinhibiting effect of alcohol were valid an increase in other behaviours, including pick-pocketing, would be observed. This is a specious argument, given that alcohol consumption affects parts of the brain that react to threatening stimuli (fight and flight) 18, in contrast to the planned and technically demanding task of pick-pocketing. She cites an unpublished (and unavailable) study purporting to show that 0.11% of nights out in Australia result in alcohol-related violence. While the veracity of this estimate cannot be determined, recent peer-reviewed research suggests that the proportion of bar patrons experiencing violence is substantially greater, with at least one in 10 having experienced violence in the preceding 3 months 19 and one in seven having been involved in a fight in the preceding year 19. Apparently alcohol makes the amygdala less effective as a threat detector. Alcohol also activates dopaminergic neurons, creating a feeling of well-being. These combined effects are thought to trigger an increase in ‘approach’ behaviour. In the majority of individuals, this will merely increase sociability and lessen the anxiety associated with social interaction (p. 48). Fox appears to have been selective in her paraphrasing of the authors’ statements. She concentrates on the anxiolytic effects, yet the authors note that because alcohol reduces differences in activation between threatening and non-threatening stimuli it may also encourage risky decision-making during intoxication 20, 21. The relevance of the above studies is unclear given the laboratory settings, whose generalisability to the highly charged setting of the NTE is dubious, and the finding that, at midnight, more than one-quarter of patrons in an Australian city have breath alcohol levels consistent with BACs > 0.10 g/dl 22, i.e. levels consistent with significant cognitive and behavioural impairment 23. Oddly absent from the report, given the stated aims, were the wealth of population-based studies demonstrating the links between alcohol consumption and alcohol-related exposures to violence over time. Studies have shown that high levels of alcohol consumption in populations are associated with higher levels of violence 24-26, across a broad range of cultural contexts 27. Longitudinal spatial models also find that increases in bar density are associated with increased levels of violence, particularly in densely populated and deprived areas 28, 29. In addition, population-based studies have shown that the price of alcohol is related significantly to violence and crime 30, 31. Fox considers trading-hour restrictions to be small measures that are unlikely to reduce violence substantially. Absent from Fox's report is an appraisal of recent quasi-experimental research. In Norway, for example, where 18 municipalities changed their trading hours, 1-hour extensions were associated with a 16% increase in violent crime and 1-hour restrictions were associated with a 20% decrease in violence 32. In Newcastle, Australia, where pubs were required to close 1.5 hours earlier, assaults decreased by 37% in the following 18 months compared with the within-city control area of Hamilton 33. Evidence that this regulatory intervention changed the culture of drinking and violence is that assault rates remained a third lower during the following 3.5 years 34. One reason for this may be that Newcastle police reported to me that they employed another strategy—one that has not been widely noted in scientific evaluations of the measures—a dramatic increase in bail compliance checks (p. 53). Paradoxically, 24-hour opening, in many cities around the world, has resulted in a net reduction of violence and vandalism. Many city areas in the US, for example, have been transformed from ‘hell spots’, ‘combat zones’, and ‘no go areas’ at night into lucrative and far safer entertainment districts (p. 53). She cites a book by Hannigan (1998) which discusses urban regeneration in the United States in the 1980s and 1990s, where the closure of many industries led cities to develop new entertainment districts, with themed restaurants, nightclubs and open-air sports grounds. The book relates to a specific case and contains no formal estimate that we could find of the reduction in violence and vandalism attributable to the changes in alcohol availability. Restrictions in trading hours in New Zealand have been hotly contested, with new legislation permitting local governments to specify maximum trading hours, supported by high-quality, consistent scientific evidence 35, 36. This has resulted in several judicial appeals being lodged in the past year, mainly by industry representatives. The risk to industry from this evidence-based approach has been highlighted by the largest supermarket chain in New Zealand employing a prestigious Queens Counsel to represent it at the hearing 37. Had Fox reviewed the intervention literature systematically, the precariousness of her recommendation to stop focusing on alcohol-fuelled violence would have been clear. The focus on changing expectancies of intoxication could not be justified in the light of meta-analyses demonstrating the tiny, short-term effects of resource-intensive expectancy challenge interventions 38, 39. In contrast, evidence points toward regulatory approaches, such as those implemented between 2008 and 2012 in New South Wales, Australia. Comprehensive changes included reduced trading hours, new powers to impose licence conditions, curtailment of liquor promotions and placing special conditions on the 100 premises with the highest assault counts. Their staggered implementation permitted time–series analyses to investigate effectiveness, showing that the reforms were associated with a 30% reduction in assaults 40, so it is clear that restricting the role of alcohol as a facilitator of violence 41 can result in substantial public health gains. Recommendation 2 in Fox's report suggests that empowering the community, through the use of accords, may help to reduce violence. Liquor accords are mainly voluntary partnerships between enforcement agencies, licensees and sometimes communities, and are common in New Zealand and Australia. Popular accord strategies include banned patron lists, the use of ID scanners, improved communication between licensees, security and the police and alcohol awareness campaigns. There is little evidence that these voluntary approaches are effective in reducing alcohol-related harms 42, 43. Furthermore, there is no consistent evidence that comprehensive community action interventions reduce alcohol consumption 44, let alone violence. This may be due to difficulties in sustaining funding and the effort required to implement such programmes 45. Arguably, for communities to take effective action, they have to possess social capital 46 and the ability to realise their common values and maintain effective social control 47. In view of the concentration of alcohol outlets 48 and lower levels of social control 49 in poorer areas this is likely to present an unrealistic challenge to vulnerable communities, and accordingly there is a risk that such strategies could increase already steep socio-economic gradients in alcohol-related harm 50, 51. The heading in Fox's report pertaining to the importance of education strategies is ‘How to drink effectively’ (p. 88). Life-skills training and parent education are recommended, together with the need to identify ‘…the best way to prepare [children] to be part of a society in which drinking and nightlife is prevalent’ (p. 98). School-based programmes, including life-skills training, continue to be popular despite the volume of research failing to find an effect in reducing risky drinking 52, 53. Some studies show small beneficial effects 54-57, but results are not maintained and do not appear to generalise. Contrary to Fox's recommendation, these findings suggest that school-based approaches are delivering little in terms of preventing alcohol-related harm. Regarding parenting practices, Australian studies have found that parental supply of alcohol for consumption without supervision is associated with risky drinking 58, and high alcohol outlet density is associated with parental alcohol supply 59. Despite numerous parenting factors associated with adolescent alcohol use 60, 61, it has been found that parenting interventions that focus specifically on drinking are less effective than programmes focusing on family interaction, effective discipline and communication 62. Furthermore, studies show that when adolescents initiate early alcohol use parent–child communication declines 63. Evidence-based strategies, including increases in the price of alcohol and the minimum purchasing age, reductions in outlet density and the promotion of alcohol 64, continue to be critical to address adolescent alcohol use. The recommendation for educational approaches includes the use of culture change campaigns. Social marketing has been employed extensively in both countries, despite evidence of lack of effectiveness 44. Fox acknowledges the past failures of campaigns but suggests that, with innovation, they can be effective. There is some evidence to suggest that social marketing can be effective if it is underpinned by strong regulation 65. If there is a role for social marketing in the prevention of alcohol-related violence, it may be to raise awareness and increase the acceptability of evidence-based strategies to reduce alcohol harm. Lessons from drink-driving prevention 66 suggest that social marketing may be effective in deterring alcohol-related violence if used to highlight the risk of apprehension and seriousness of legal consequences, as long as police surveillance in entertainment precincts is sufficient and the criminal justice system responds efficiently. Fox's interviews with parents apparently revealed one social marketing campaign in Australia perceived as having extensive reach. The ‘Kids Absorb Your Drinking’ campaign was funded predominantly by Drinkwise, an organisation funded by the alcohol industry, including Lion Pty Limited. Drinkwise's campaigns have not been without their critics 67. More recently, Drinkwise has embarked on a marketing campaign to show young people how to ‘drink properly’. The ambiguity of this message and its appeal to young people 68 must be evaluated for possible adverse consequences across the drinking population. Changes in the law have been instrumental in changing an entrenched culture of smoking, with bans on smoking in indoor public areas and bans on tobacco advertising contributing to a widespread sense that smoking is non-normative 65. The evidence on smoking is consistent with the view expressed by Room 69, that cultures are not changed by exhortation alone. This seems likely to also apply to violence, for which the availability and promotion of alcohol, aspects of the commercial system underpinning the population's drinking are modifiable determinants 41. We believe that Fox's report, commissioned by the alcohol industry, deserves careful critique because of its potential to undermine evidence-based countermeasures to alcohol-related harm. In our view, the report lacks credibility as a piece of independent academic research, failing to present a balanced appraisal of the relevant literature. Dr Fox overstates the effectiveness of liquor accords, social marketing and alcohol education and underplays the causal role of alcohol in violence. In fact, policymakers have a strong evidence base to guide action, including restrictions in the density and trading hours of alcohol outlets, increasing taxes on alcohol and restricting alcohol advertising and promotion. None.

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