Björn Trolldal

Effects of a multi-component responsible beverage service program on violent assaults in Sweden

AIM A multi-component Responsible Beverage Service (RBS) programme has been disseminated in Swedish municipalities. The aim of the programme is to reduce violence associated with consumption of alcohol at on-licensed premises. This study aimed to analyse the effect of the programme on police-recorded assaults after the dissemination of the programme in Swedish municipalities, 1996-2009. DESIGN This study is a natural experiment that uses variation in the level of implementation of the RBS programme to predict change in the rate of police-recorded assaults. SETTING Swedish municipalities. PARTICIPANTS The municipalities included in the study initiated the RBS programme no later than 2008. On-licensed premises open during the evenings must exist. Of 290 municipalities, 237 fulfilled these requirements. MEASUREMENT Programme fidelity was studied by means of several surveys. Yearly data on police-recorded assaults, per 100,000 inhabitants aged 15 and above, committed on weekend nights, were used as dependent variable. A fixed-effects panel data regression model was used to examine the effect of the programme. FINDINGS Each extension of the programme, by one component, was associated with a significant 3.1% reduction in assaults. However, this effect was seen mainly in smaller municipalities. Of the different components of the programme, the presence of a community coalition steering group had a significant effect on assaults. No significant effect was found regarding RBS training or supervision of on-licensed premises. CONCLUSION Multi-component Responsible Beverage Service programmes can have a significant effect on police-recorded assaults even when implemented on a large scale in many communities.

Was the STAD programme really that successful

Aim A community intervention programme STAD was launched in Stockholm in January 1998, which included training in responsible beverage service and stricter enforcement of existing alcohol laws. An evaluation suggested that during the first 33 months of the programme, the level of police-recorded violence dropped by a striking 29%. We propose to probe the robustness of this estimate, which is often cited as evidence of the effectiveness of these kinds of intervention. In this paper, we reanalyse the underlying data by applying alternative model specifications. Data and Methods We reanalysed the original data on police-recorded violence from January 1994 to September 2000 by autoregressive integrated moving average (ARIMA) modelling. We estimated models based on raw data and seasonally differenced data; we also varied the definition of control area and applied the statistical technique of difference-in-differences modelling. Results The estimated intervention effects from these model specifications were all strongly significant statistically, ranging between 21% and 32%. Conclusion Estimates based on a variety of model specifications were generally somewhat lower than those previously reported. However, the new estimates were all strongly statistically significant and fairly uniform with regard to effect size, which suggests that the findings of a substantial impact of the STAD programme are indeed quite robust.

Factors associated with implementation of a multicomponent responsible beverage service program – results from two surveys in 290 Swedish municipalities

BackgroundThe purpose of this study was to investigate which factors affected the implementation of a multicomponent Responsible Beverage Service (RBS) program in 290 Swedish municipalities and whether the amount of such factors influenced the level of implementation of the program.MethodsThis study used variation in the presence of implementation-promoting factors to predict the level of implementation of the RBS program in municipalities throughout Sweden. The presence of such factors and the level of implementation of the program were studied by means of two surveys in all Swedish municipalities (N=290). Logistic regression and Spearman’s correlation analyses were used to analyze the relationship between implementation-promoting factors and the level of implementation of the RBS program.ResultsThe response rates of the two surveys were 96% and 98%, respectively. One main finding was that program fidelity was low. Only 13% of the municipalities surveyed had implemented the RBS program as a whole, as stated in the specification of requirements. In municipalities reporting a higher amount of implementation-promoting factors, a significantly higher level of implementation of the program was shown. Evaluation and feedback was the only factor that correlated significantly with the level of implementation of the RBS program as a whole.ConclusionEvaluation and feedback constitutes an important implementation-promoting factor also in complex programs like the RBS program. Program fidelity is significant for the outcome of an intervention and must be a major focus of the implementation processes.

Norwegian-Swedish cross-border trade in alcohol beverages

In order to reduce the total alcohol consumption, and thereby also the level of individual and social alcohol-related damages, Norwegian alcohol control policy is based on a system in which high alcohol excise taxes constitute a key element. The excise taxes on alcoholic beverages therefore serve other purposes than representing sources of revenue to the state coffers, and must in consequence be viewed from a public health and social policy perspective. However, this policy may also have other effects that do not appear in the official alcohol sales statistics. These effects, which may include legal and illegal home production, legal tourist import in compliance with the existing rules and quota regulations, and illegal import in the form of smuggling, may contribute to undercut the effect of high alcohol excise taxes as a public health and social policy strategy to limit alcohol-related damages. If the legal and illegal home production and import reach a certain level, the legitimacy of the Norwegian alcohol control policy may be weakened. In this paper, the extent to which Norwegians purchase alcoholic beverages in Sweden will be regarded as an indirect effect of the high excise tax level in Norway. The continuing debate around this theme has intensified during the 1990s, mainly as a result of the fact that Norwegian prices on alcoholic beverages during this period have risen compared with the Swedish prices. The aim of this paper is to analyse how the cross-border trade with alcoholic beverages between Norway and Sweden has been affected by the changes in prices, taxes, and exchange rates during the 1990s. This issue will be addressed by analysing the changes in cross-border trade in different subperiods. In addition, the overall volume of cross-border trade with alcoholic beverages between the two countries will be estimated.

Implementation of a Multicomponent Responsible Beverage Service Programme in Sweden - a Qualitative Study of Promoting and Hindering Factors

Aims The objective of this study was to identify factors that either promote or hinder implementation of a multicomponent Responsible Beverage Service programme in Swedish municipalities. Design Forty semi-structured interviews were conducted in six municipalities and directed content analysis, guided by the Consolidated Framework for Implementation Research (CFIR), was performed. Results The CFIR framework was useful as an underlying theoretical model in this study. Importance of the following factors, described in the five domains of CFIR, was empirically supported in this study: local needs, evidence strength and advantages of the intervention, costs and available resources, clear goals, evaluation and feedback, access to knowledge and information, clear role definitions and cooperation, and enthusiastic key persons with high confidence in the effectiveness of the intervention. Hindering factors listed by the informants were lack of enthusiasm and opportunities to specialise, low degree of self-efficacy, unengaged decision-makers, complexities of the programme, and a top-down approach. Conclusions This study indicates that previously identified factors shown to promote and hinder implementation processes are also valid in the context of multicomponent community action programmes like RBS. Suggestions on how to elude some of the hindering factors are proposed, e.g. to develop long-time financial plans, to provide better information about the RBS program in full, and to stress the importance of collaboration between representatives from the municipalities, police authorities and owners of on-licenced premises.