LAUNCH OF WHO REPORT ON VIOLENCE AND HEALTH

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Health Challenge Wales alcohol misuse
Preventing Alcohol Related Violence
Jonathan Shepherd FMedSci Professor of Oral
Maxillofacial SurgeryDirector, Violence Research
Group
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SITE AND TYPE OF INJURY IN CONSECUTIVE ASSAULT
VICTIMS
Face Other head/neck Thorax Abdomen Lower
limb Upper limb
Number of Patients (n530)
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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)

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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
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VIOLENCE IN ODENSE MUNICIPALITY1403 (100)
victims
869 (62) victims
327 (23) victims
207 (15) victims
ODENSE UNIVERSITY HOSPITAL
POLICE
(Faergemann 2006)
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Police recording not related statistically to
Injury Severity Scores 13 of firearm violence
recorded in Atlanta EDs not recorded by police
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EFFECT OF CCTV ON POLICE VIOLENCE DETECTION
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CCTV towns
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8
6
Control towns
Percentage change
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2
0
-2
Before CCTV
After CCTV
-4
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EFFECT OF CCTV ON AE ASSAULT ATTENDANCE
Control towns
Percentage change
CCTV towns
After CCTV
Before CCTV
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Trends in Violence in England and Wales
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Community Safety Partnership CARDIFFVIOLENCE
PREVENTIONGROUP
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OBJECTIVES
Violence prevention Integrated victim services
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CRIME AND DISORDER ACT 1998334 partnerships
Persons/bodies with statutory obligations
include Health Authorities National Health
Trusts
POLICE REFORM ACT 2002
Local Health Boards Primary Care Trusts
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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 2004UK
Treasury Adviser
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National/Regional measurement ED data Local
surveillance/prevention
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INDEPENDENT NATIONAL CORRELATES WITH ASSAULT
INJURY (ED measure)

• Unemployment/Deprivation
• Ethnic minority population
• Alcohol expenditure
• Lager price
• Season

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VIOLENCE HOTSPOTS IN 21st CENTURY CARDIFF
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CHOLERA HOTSPOTS IN VICTORIAN LONDON
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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

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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 (OR0.6. 95 CI
  0.37-0.97)
• Marked increase in street assault in main
  entertainment thoroughfare
• Licensed premises capacity predicted street
  assaults

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Monthly Assault Attendances Cardiff ED
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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

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Primary Preventionglass injury
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Non-toughened glass
Toughened glass
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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 CI1.1-2.3). 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.

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Secondary PreventionRCT OF A BRIEF ALCOHOL
(motivational interviewing) INTERVENTION Victims

• Maxillofacial clinics
• Men aged 16-35 with facial injury
• 7 units in 6 hours pre-injury

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ABSTINENT DAYS
65
60
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Control Group Intervention Group
Abstinent Days ( Standard Error)
50
45
40
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Baseline 3 months 12 months
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MAGISTRATES COURT RCT Offenders
Re-offending at 12 months
95CI -0.11, 0.14
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Injury at 12 months
95CI -0.23, -0.009
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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

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Tertiary Preventionpost traumatic stress
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RCT FOUR SESSION COGNITIVE BEHAVIOURAL THERAPY
Bisson, Shepherd, Joy, Probert Newcombe (2004)
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PREVENTING COMMUNITY VIOLENCE Combining care
with prevention

• Physical injury treated
• Core assault data recorded and anonymised
• Victim advised on police reporting

Primary Prevention
Secondary Prevention alcohol
misuse intervention
Victim contacted to identify
Tertiary Prevention cognitive behavioural
therapy

• Mental health needs

• Circumstances of assault