Marja Holmila

Community prevention of alcohol problems

List of Tables - List of Illustrations - Foreword - Acknowledgements -Notes on the Contributors - Introduction M.Holmila - PART 1: LOCAL PREVENTION IN CONTEXT - Alcohol Policy, the State and the Local Community J.Simpura & P.Sulkunen - Constructing Alcohol Problems in the Locality J.Simpura - Alcohol and the Imperative of Health in Mass Society: Images of Alcohol Policy Among the Local Elites P.Sulkunen - PART 2: REFLEXIVE INTERVENTION - The Educational Activities M.Holmila - Brief Intervention in Primary Health Care P.Sillanaukee - Responsible Service and Drinking Environments M.Holmila & K.Haavisto - The Young and Alcohol M.Holmila & K.Haavisto - Family and Other Close Persons M.Holmila - PART 3: ASSESSING THE UTILITY - Process Evaluation M.Holmila - Outcome Evaluation M.Holmila & J.Simpura - PART 3: CONCLUSIONS: LOCAL COMMUNITY IN PREVENTIVE ACTION M.Holmila - Appendices - References - Index

Effects of a community intervention to reduce the serving of alcohol to intoxicated patrons

AIMS To assess the effects of an alcohol prevention programme to reduce the serving of alcoholic beverages to intoxicated clients on licensed premises. RESEARCH DESIGN A controlled pre- (2004) and post-intervention study (2006) design. INTERVENTION A community-based programme combining law enforcement, responsible beverage service training, information campaigns and policy initiatives in one Finnish town (Jyväskylä). PARTICIPANTS AND MEASUREMENTS A male actor pretended to be clearly under the influence of alcohol and tried to buy a pint of beer at licensed premises. For the baseline measurement, every bar and nightclub was visited in the intervention and the control areas (94 licensed premises in total). Post-intervention data were gathered with the same principles (100 licensed premises in total). A researcher observed every visit and documented the results. RESULTS In the post-intervention study there was a statistically significant increase in refusals to serve denials alcohol to the actor in the intervention area (from 23% to 42% of the licensed premises) compared to refusals in the control area (from 36% to 27% of the licensed premises). CONCLUSION Previous research has documented that multi-component community-based interventions can have a significant impact on over-serving of alcohol when training and house policies are combined with effective law enforcement. The present findings also demonstrate that comprehensive Responsible Beverage Service (RBS) interventions applied at a local community level can be effective in decreasing service to intoxicated clients in a Nordic context.

The role of the spouse in regulating one's drinking

This article examines the relationship between experiences of external influence from spouses and partners to influence ones drinking and ones own concern over drinking; whether spouses control attempts and concern over ones own drinking are in congruence; how the level of drinking and the frequency of drinking to intoxication and the estimate of the spouses level of drinking are related, for women and men belonging to different sociodemographic groups. Using data from the 2000 Finnish Drinking Habit Survey (n = 1337), our results show that (1) drinking habits – especially drinking large quantities on a single occasion – are strongly related to both external control from the spouse and ones own concern about drinking and (2) there are significant differences between genders in the level of control from the spouse and concern over ones own drinking habit. These results are important when planning treatment and prevention for drinkers and their families.

Introduction: Community Action Research and the Prevention of Alcohol Problems at the Local Level

Many community action projects from around the world exist to reduce alcohol problems at the local level. The role of research within this international movement is discussed within this introduction for the entire special issue on community action research in alcohol problem prevention. Previous community prevention programs have utilized a variety of prevention strategies: (a) an educational approach which focuses on changing behavior through changes in knowledge, attitudes, and information; and (b) an environmental approach which focuses on changing behavior through changes in the social and economic systems within a community. Many projects have used both approaches. This special issue provides a current overview of many types of community action projects from different countries and summarizes what has been learned to date from these experiences.

Invisible victims or competent agents: Opinions and ways of coping among children aged 12-18 years with problem drinking parents

Aims: The article describes the lives of children with problem drinking parents from childrens own perspective, emphasizing their experiences, agency and coping. Methods: The qualitative data were collected with a web-based questionnaire advertised on two childrens and adolescents’ help pages. The final sample consisted of 70 volunteers between the ages 12 and 18 years, mostly girls (17% were boys). Findings: Children with problem drinking parents are a hidden population and neglected by services, which they need. Children have, however, developed their own ways of trying to cope. They also have various practical suggestions and opinions concerning services and the type of help they would find useful. Conclusions: Harms inflicted to children are an important reason for preventing substance misuse. It is also important that children are heard by professionals and authorities dealing with family problems, and that one understands, supports and respects childrens own agency and ways of coping. Childrens ways of coping can differ from those of the adults. Further studies on children living with problem drinking parents are needed. The study shows that internet can be one way of collecting research data from this otherwise hard-to-reach group.

A study on effectiveness of local alcohol policy: Challenges and solutions in the PAKKA project

To an increasing degree, alcohol policy and prevention in the Nordic countries is expected to be carried out on the local level as the free-trade agreements and international harmonization of alcohol taxes and regulations are limiting the scope of traditional national alcohol policies. In recent reviews on the effectiveness of alcohol political interventions the recommended strategy for local communities is to combine community mobilization with various types of environmental strategies focused on the supply of alcoholic beverages. The PAKKA project continues the international tradition of research on community-based prevention of alcohol-related harms. In this paper we discuss the challenges and solutions of evaluating community-based prevention projects, using the recently started ‘PAKKA’ (Local Alcohol Policy) project as a concrete example. The PAKKA project relies on a mixed-intervention strategy attempting to change the local social, economic and physical environment related to risky and under-age drinking. In measuring the projects effectiveness a quasi-experimental research design is used. In our research design we have had to tackle three interconnected problems: the problems of causality in a multi-component population level study, the problem of generalizability and the complex role of the researcher.

Controlling teenagers' drinking: Effects of a community-based prevention project

Aims: The study presents the evaluation results of the age-limit component of a community-based prevention project called PAKKA. The project aimed to reduce alcohol availability among those under 18, which is the legal age for purchasing alcohol. The interventions consisted of law enforcement, community coalitions and community mobilization. Data and methods: The effects of the interventions were measured in a quasi-experimental research-setting with a matched control area before (2004) and after (2006/7) the interventions. The data included under-age purchase trials, a population survey and a school-based survey. Results: According to the purchase trials, the age limit control in the shops improved between the measuring points, and the young people reported in surveys that it had become more difficult to obtain alcohol. However, changes in the intervention and the control areas were similar. This can partly be explained by increased surveillance in addition to spill-over effects of PAKKA-interventions into the control areas. Conclusions: Local coalitions can be important tools in reducing alcohol availability among minors. The quasi-experimental research-setting has its methodological limitations in assessing the interventions impact given the overlap in local and national processes seen in the case of the PAKKA project.

Drinking in the presence of underage children: Attitudes and behaviour

The ambivalent characteristic of the Finnish drinking culture is particularly evident in the context of family life. While drinking to intoxication in the home environment is widely tolerated, attitudes towards drinking in the presence of children appear negative, and there is broad political concern about harms to children. This study aims to both illuminate the attitudes towards drinking and the actual drinking behaviour of parents living with their children. We use data on 19–59-year old Finns from a general population survey (n = 2046). Respondents were asked about their drinking habits, recent drinking occasions and attitudes to drinking. Men under 40 years of age without underage children at home drank significantly more and more often to intoxication than those who had underage children. In a similar manner, women in all age groups without children at home drank significantly more often to intoxication than those who had children at home. Drinking to intoxication while children are present was almost unanimously considered inappropriate. Yet almost 40% of respondents considered it acceptable to drink to intoxication in the childs company if someone else is looking after the child. There was a significant relationship between these attitudes and actual behaviour among women. The drinking culture in Finland is very permissive, with intoxication often considered suitable for childrens eyes as long as their safety is guaranteed. Prevention efforts should continue to target these attitudes and behaviour.

Mothers who abuse alcohol and drugs: Health and social harms among substance-abusing mothers of small children in three child cohorts

AIMS – The study looks at the prevalence and register-based indicators of substance abuse-related harms among mothers of small children. We examined the living conditions, various health and social harms and the differences between the users of different kinds of substances (alcohol only vs. drugs only vs. alcohol and other drugs). DATA & METHODS – Population-level register data was collected of all biological mothers of three Finnish birth cohorts (1991, 1997, 2002) describing the womens social problems, health and use of services during the period when the child was under seven years old. RESULTS – The substance-abusing mothers of small children had a higher rate of mortality and psychological disorders and increased risk of using hospital services than the comparison group. Their children had been taken into custody dramatically more often than the children of the comparison group. Also, mothers with substance abuse problems had lower education and income level, and their purchases of prescribed psychopharmacological medications were manifold compared to other mothers. Mixed use of both alcohol and illegal drugs coincided with the highest prevalence of health and social problems. CONCLUSIONS – Substance-abusing mothers of small children are in a serious risk of health and social problems ranging from poverty to poor mental health and high mortality. The study shows also that the social and health care professionals have a potentially important role in giving support to the mothers and their children, as the substance-abusing mothers have had several contacts with them. Prevention of harms to children of substance-abusing mothers should perhaps focus more on the possibilities offered by these contacts in different health and social services.

Roles for researchers in community action projects to prevent alcohol and other drug problems: Methodological choices

Aims: To discuss three alternative roles and associated challenges for researchers as participants in community action projects for prevention of alcohol and other drug problems. Methods: To undertake a case study of alternative roles for researchers in community action projects in three Nordic countries. Findings: There are three alternatives roles for researchers in community prevention projects, each with scientific advantages and disadvantages. The researcher role in practice depends on key features of the intervention as well as the focus and overall aim of the evaluation study. The choice of the researcher role has important implications for the entire research methodology and responsibility and ethics of research. Conclusions: There is a need to assess the stage of local preventive work in a given country when planning evaluation of community action projects. The first stage of development of a solid scientific foundation for local substance prevention requires pilot and early demonstration projects. In the early developmental phases, researchers often choose to be active participants and partners with the communities. Without the researcher or other professional involvement, the risk of lack of any effect is increased. If the pilot projects and their efficacy trials are successful, it is mandatory to move on to the next (more natural) test phase. Effectiveness trials with researchers, who act as unobtrusive observers, will then be useful.