Eva Wallin

Can I have a beer, please? A study of alcohol service to young adults on licensed premises in Stockholm.

This study evaluated the effects of a community alcohol prevention program on the frequency of alcohol service to young adults at licensed premises in Stockholm, Sweden. We used a pretest (1996)-posttests (1998 and 2001) design with intervention and control areas. The multicomponent intervention combines training of serving staff in responsible beverage service, policy initiatives, and enforcement of existing alcohol regulations. Adolescents 18 years old (the legal drinking age on licensed premises in Sweden), but younger looking according to an expert panel, visited licensed premises in pairs, where each adolescent ordered a beer. At baseline in 1996, the adolescents made 600 attempts to order. At follow-up in 1998, the number of attempts to order was 252, and at the second follow-up in 2001, the adolescents made 238 attempts. We found no statistically significant differences between the intervention and control areas. Overall, the frequency of alcohol service to adolescents on licensed premises in these areas of Stockholm decreased significantly over time, from 45 to 41 and to 32%, in 1996, 1998, and 2001, respectively. The decrease in alcohol service in 2001 was statistically significant compared to the baseline in 1996. One explanation for this improvement could be more effective enforcement of existing alcohol laws in both the intervention and control areas. We also found that licensed premises that used doormen to screen potential customers were less likely to sell to minors.

Institutionalization of a community action program targeting licensed premises in Stockholm, Sweden.

The objective of this article is to evaluate the level of institutionalization of a community action program targeting licensed premises in Stockholm. Five key factors were identified for institutionalization: adoption, sustainability, key leader support, structural changes, and compliance. A scale was developed to assess the strength of each factor. The results indicate a high degree of institutionalization (score 13 on a scale from 5 to 15). The authors conclude that the program activities have been sustained at a high level. A written agreement ensures that the participating organizations take responsibility for the continuing work.

Effects of a Community-Based Drug Use Prevention Program Targeting Licensed Premises

This study evaluated the effects of a community-based drug use prevention program on the frequency with which doormen at licensed premises intervene in cases of obviously drug use-impaired patrons. Doormen were trained in recognizing signs of drug use impairment to be able to stop drug use–impaired patrons to enter the premises. The study included 28 trendy nightclubs in Stockholm, Sweden, that used doormen to screen patrons. Two male actors were instructed to act as if they were obviously drug use–impaired (cocaine/amphetamines) while attempting to enter nightclubs. Data were collected at pretest when 40 entry attempts were made (2003) and posttest (2004) when 48 attempts were made. At follow-up, the doormen intervened in 27% of the attempts, a significant improvement compared to the intervention rate of 7.5% at baseline. The results indicate that the intervention has had effect on doormens behavior. However, in the majority of the attempted visits, the doormen still did not intervene. Limitations of the study were the lack of a control group and problems with identifying the training status for the individual doormen. Further research is necessary to explore the effectiveness of community-based drug use prevention programs targeting licensed premises.

Measuring substance use in the club setting: a feasibility study using biochemical markers

BackgroundDuring the last few decades the use of club drugs (e.g., cocaine, amphetamines) has been of increased concern in nightlife settings. Traditionally, surveys have been used to estimate the use of club drugs, however, they mostly rely on self-reports which may not be accurate. Recent advances have allowed for readily accessible drug testing methods such as oral fluid drug testing. Nevertheless, research using oral fluid sampling to measure the frequency of drug use in the club environment is scarce. The objective of this study is to evaluate the feasibility of measuring the frequency of alcohol and drug use among Swedish clubbers using breath alcohol and oral fluid drug testing.MethodThe setting was a 40 hour electronic music dance event (EMDE) on a cruise ship on the Baltic Sea, departing from Sweden, with 875 passengers. Groups of participants at the EMDE were randomly invited to participate. Data were collected with face-to-face and self-administered questionnaires. Further, oral fluid samples were collected to determine illicit drug use, and blood alcohol concentration (BAC) levels were measured using a breath analyzer.ResultsA total of 422 passengers were asked to participate in the study whereof 21 declined (5.0% refusal rate). Of the 401 study participants (accounting for 45.8% of all attendees), 5 declined oral fluid drug testing. Results show that there was a discrepancy between self-reported and actual drug use as 10.1% of the participants were positive on illicit drug use (amphetamines, ecstasy/MDMA, cannabis, cocaine), while only 3.7% of the participants reported drug use during the last 48 hours. The average BAC level was 0.10% and 23.7% had BAC levels ≥ 0.15%, while 5.9% had levels below the detection limit. The mean BAC levels for the illicit drug users were significantly higher (p = 0.004) than for non-drug users (0.13% vs. 0.10%). Self-reported AUDIT-C scores (using a threshold of ≥ 5 for men and ≥ 4 for women) revealed that 76.0% of the men and 80.7% of the women had risky alcohol consumption patterns.ConclusionThis study indicates that it is feasible to conduct breath alcohol and oral fluid drug testing in a Swedish club setting.

Dissemination of Prevention: Community Action Targeting Alcohol Use-Related Problems at Licensed Premises

In 2003, a community action program targeting alcohol use–related problems at licensed premises was disseminated to municipalities in Stockholm County. The intervention program includes local mobilization, training in responsible beverage service, and stricter enforcement of extant alcohol laws. This research studies the dissemination process, which was based on Diffusion of Innovations Theory. The communities followed a systematic model for dissemination: engaging a local coordinator, conducting interviews with owners of licensed premises, creating an action group, presenting results from studies to the local media, and initiating training in responsible beverage service. Evaluation of uptake is based on meeting minutes from local action groups and activity reports. Preliminary results indicate that the dissemination strategy has been fairly successful. Half of the communities (7 of 14) contacted are implementing the model program. Further research is needed to more fully explore the potential of the use of the Diffusion of Innovations Theory, taking into consideration different stages of community readiness.

Effects of a community action programme on responsible beverage service (RBS)

During the past decade the Swedish national alcohol policy has changed. Of the previous state-run alcohol monopolies for production, wholesale, and retail sales, only the retail monopoly remains intact. Furthermore, the number of licensed premises has increased markedly during the past 15 years. Research based on Swedish data has shown a clear association between beer/liquor consumption at licensed premises and the assault rate (Norström 1998). Parallel to this we have also seen increased alcohol consumption in the Swedish population (Leifman 2002). In 1996 the Stockholm County Council initiated a community alcohol prevention programme, entitled STAD, to prevent problems related to alcohol consumption at licensed premises. STAD is an abbreviation for Stockholm Prevents Alcohol and Drug Problems (Andréasson et al. 1999). The inner city of Stockholm was chosen as the intervention area. An action group was established consisting of representatives from the authorities and the hospitality industry. The main components in the community action programme have been community mobilization, a 2-day training course in responsible beverage service primarily for servers, and stricter enforcement of existing alcohol laws (Wallin et al. 2002a). The objective of our presentation at the KBSmeeting at Vuoranta, Helsinki, in March 2002 was to present the effects of the community alcohol prevention programme on problems related to alcohol consumption at licensed premises.