Governments, policy experts, researchers and randomly selected members of communities all support the idea of greater co-ordination of efforts aimed at reducing alcohol-related harm. Despite this support, a rigorous evaluation of co-ordinated community-action has been missing, making it difficult to weigh its value relative to other strategies, such as legislative approaches (e.g. alcohol taxation policy), and individual public health and clinical interventions. The AARC project addresses this knowledge gap. It is the first evaluation of community-action for alcohol harm that uses a prospective Randomised Controlled Trial design, the most scientifically rigorous evaluation design available, and a Benefit-Cost Analysis, the most comprehensive method of economic evaluation appropriate for a community-action intervention.
Dr Alys Havard (NDARC conjoint)
Dr Dennis Petrie (University of Dundee)
Professor Chris Doran (University of Newcastle)
Professor Rob Sanson-Fisher (University of Newcastle)
Professor Catherine D’Este (University of Newcastle)
Elissa Harwood (formerly NDARC)
Dr Anton Clifford (University of Queensland)
Stuart Gilmour (formerly NDARC)
Dr Hector Navarro (formerly NDARC)
Dr Joshua Byrnes (formerly NDARC)
The World Health Organisation (WHO) advocates community-action to reduce risky alcohol consumption and harm, arguing that all members of a community are responsible for action because the burden of alcohol harm is spread across multiple settings, including health services, police, public spaces and workplaces. Community-action is also highly acceptable to members of communities. Nevertheless, there have been only four randomised trials of the effectiveness of alcohol community-action to date, all of which were US-based, focused on young people (the unit of randomisation in three trials was schools, rather than the community) and limited to self-report or alcohol purchase attempt outcomes. There is no rigorous evidence about whether the economic benefits of alcohol community-action outweigh its costs.
The Alcohol Action in Rural Communities (AARC) project aimed to quantifying the effectiveness of community-action in reducing risky alcohol consumption and harm, including the first benefit-cost analysis ever undertaken internationally.
A cluster RCT comprising 20 communities in NSW that had populations of 5,000-20,000,were at least 100km from an urban centre (population ≥ 100,000) and were not involved in another community alcohol project. Communities were pair-matched and one randomly allocated to the experimental group. The economic analysis was a benefit-cost analysis.
The project was completed in 2012 and the results officially launched by the Hon. Kevin Humphries, the NSW Minister of Mental Health, Western NSW and Health Lifestyles. Key outcomes were:
- Compared to the control communities, the active communities experienced a 20 per cent reduction in average alcohol consumption; 42 per cent reduction in residents’ experience of alcohol fuelled verbal abuse; 33 per cent reduction in alcohol-related street offences; and 30 per cent reduction in the number of residents who reported drinking at levels that placed them at high-risk of alcohol-related violence, accidents and injuries.
- The benefits of implementing community action outweigh the associated costs of such action. For every $1.00 invested in AARC, between $1.75 and $1.37 of benefits were returned to the community.
The AARC project successfully supported 5 PhD students, 2 Masters students, and produced in excess of 30 papers published in the international peer review literature.
Links to peer-reviewed publications are featured below under the 'Publications' heading.
Shakeshaft, A. Alcohol Action in Rural Communities. Centrelines, Issue 34, December 2012.
Shakeshaft, A. Alcohol Action in Rural Communities. ADCA News Issue 32, 2006.
Shakeshaft, A. Alcohol Action in Rural Communities. Centrelines, Issue 16, July 2005.
Presentations on the results of the project include:
Havard, A. National Drug and Alcohol Research Centre seminar series, Sydney, 9 August 2007.
Shakeshaft, A. Commonwealth Department of Health and Ageing, Canberra, 1 August 2007
Wood, E. National Drug and Alcohol Research Centre seminar series, Sydney, 12 July 2007.
Shakeshaft, A. Australian Professional Society on Alcohol and other Drugs, Cairns, 5-8 November 2006.
Sanson-Fisher, R. Alcohol Education and Rehabilitation Foundation National Conference, Sydney, 17-19 September 2006.
Shakeshaft, A. Social Policy Research Centre, Sydney, 15 August 2006.
Shakeshaft, A. National Drug and Alcohol Research Centre Annual Symposium, Sydney, 20 July 2006.
Shakeshaft, A. National Drug and Alcohol Research Centre seminar series, Sydney, 20 April 2006.
Shakeshaft, A. Australasian Liquor Regulators Conference, Darwin, 13-16 September 2005.
Shakeshaft, A. National Centre for Education and Training on Addictions, Adelaide, 20 July 2005.
Sanson-Fisher, R. NSW Cabinet Office, Premier’s Department, Sydney, 24 May 2004.
For the participating communities, AARC will have achieved significant reductions in their rates of problem drinking and alcohol-related harm. For communities more broadly, AARC has articulated a 5 step model for ongoing integration and evaluation of community action that they could implement to minimize their experience of alcohol-related harm. For policy makers, AARC will provide the best evidence available on the benefits and costs of community action, which can inform their future policy development for minimizing the burden of alcohol-related harm in Australia. For researchers, AARC has demonstrated the feasibility of conducting rigorous, real world research in public health, and has contributed to the evidence-base in multiple content areas (including health economics, complex intervention designs and measures, reliable and valid measures, and descriptive data). It has also contributed significantly to increasing national and international research capacity in the drug and alcohol filed: it supported four PhD students; 2 masters students; 2 research medical students; three early career-researchers; and numerous research officers.