1 Alcohol and drug prevention - national policies and possibilities in communities Zaza Tsereteli, MD, MPH International Technical Advisor Alcohol and Substance Abuse Expert Group (ASA EG) NDPHS
2 Recorded alcohol consumption in the EU including Croatia, Norway and Switzerland, (in litres pure alcohol per capita 15+).
3 Central-Western and Western Country Group Central-Eastern and Eastern Country Group Nordic Countries Southern Europe Source: WHO 2013
4 Country differences Source: WHO 2013
5 High exposure, high burden of mortality and disease For men between ages of 15 and 64, 1 in 7 deaths were caused by alcohol (clearly premature deaths given the life expectancy in Europe) For women of the same age category, 1 in 13 deaths were caused by alcohol
7 Men vs. women in burden of disease Tobacco: men #1, women #4 Alcohol: men #3, women #12 Illegal drugs #20, women not in top #20 Huge differences between high- and low/middle income countries Alcohol consumption varies with emancipation: the more emancipated, the higher the alcohol- attributable burden of disease! Source: GBD 2010
8 Alcohol attributable SDRs for injury per people
9 Globally For tobacco there are 6.30 million deaths in 2010, for alcohol 2.74 million deaths, and for drugs 0.16 million deaths In total in 2010, there were million deaths. Thus tobacco is causing more than 10% of all deaths (11.9%), and alcohol for about 5.2% and illegal drugs for 0.3%
10 Changes in alcohol policy areas over the five years (N=30)
11 Restrictions on alcohol consumption in public places (number of countries)
12 Alcohol use during the past 30 days, boys (2011) Source: WHO 2011
13 Alcohol use during the past 30 days, girls (2011)
14 European action plan to reduce the harmful use of alcohol (EAAP) action areas Leadership, awareness and commitment, as sustainable intersectoral action requires strong leadership and a solid base of awareness and political will Health services response, as these services are central to tackling health conditions in individuals caused by harmful alcohol use Community action, as governments and other stakeholders can support and empower communities in adopting effective approaches to prevent and reduce harmful alcohol use Policies and countermeasures on drink driving, as it is extremely dangerous to drivers, passengers and other people using the roads Availability of alcohol, as public health policies to regulate commercial or public availability have proved to be very effective in reducing the general level of harmful use and drinking among minors
15 EAAP action areas Marketing of alcoholic beverages, as systems are needed to protect people, particularly children and young people, from advanced advertising and promotion techniques Pricing policies, as most consumers, particularly heavy drinkers and young people, are sensitive to changes in the prices of alcohol products Reducing the negative consequences of drinking and alcohol intoxication, in order to minimize violence, intoxication and harm to intoxicated people Reducing the public health impact of illicit and informally produced alcohol, as its consumption could have additional negative health consequences due to its higher ethanol content and potential contamination with toxic substances Monitoring and surveillance, as relevant data create the basis for the appropriate delivery and success of responses
16 Best buys package population-based approaches Smoke-free environments Warning about the dangers of tobacco use Bans on tobacco advertising Raising taxes on tobacco Raising taxes on alcohol Restricting access to retail alcohol Bans on alcohol advertising Reducing salt intake and salt content of food Replacing trans-fat in food with polyunsaturated fat Promoting public awareness about diet and physical activity
17 Polydrug use among young adults Among young adults (aged 15 to 34), frequent or heavy alcohol users were, in general, between two and six times more likely to report the use of cannabis compared to the general population and between two and nine times more likely to use cocaine.
18 Types of adolescent polydrug user Table Source: ESPAD 2003
20 Examples of Prevention Programs
21 % Substance abuse decrease amongst year old adolescents in Iceland Drunk last 30 days Daily smoking Hashish once or more
22 How has this been achieved? Used research as a basis for policy and actions on local and national level Prevention work has been focused on few simple factors related to risk and protective behavior of youth Managed to keep a constant dialogue between stakeholders in the close community prevention work
23 The practical role of research 1. Population data collection on substance use every year (no samples, always population). 2. Practical descriptive reports within 4 months of each data collection to the municipalities 3. School reports to the schools 4. Local information INTO all levels of prevention work is a key issue
24 Importance of frequent measuring Every school, every parent, every prevention worker can see the current situation in their close community and can act accordingly. Not 2-3 years later but almost immediately
25 Childrens rights 1. Children have the right to have a say about what the want, what they do and how they feel. 2. We have the obligation to make good use of what they tell us, react and constantly try to make their lives better.
26 The four main risk and protective factors Family factors Extracurricular activities, sports Peer group effect General well being Source: ICSRA
27 And analyzing deeper Organized activities vs. unorganized Extracurricular activities Family factors Time spent with parents Support Monitoring Control Peer group Positive and negative effects. How we as parents approach the peer group General well being Inside and outside of school, at home, bullying e.t.c. Source: ICSRA
28 Percentage of students in 9th and 10th grade who have become drunk in the last 30 days depending on how much time they spend with parents % ,1 Almost never Seldom Sometimes Often Almost always 22,6 42,0 27,8 15,3 17,6 10,5 12,0 8,0 10,4 Boys who have become drunk last 30 days Girls who have become drunk last 30 days Source: ICSRA
29 Percentage of students in 9th and 10th grade who have become drunk in the last 30 days depending on if their friends become drunk once pr. month. % None or few A few Many Almost all 68,2 66,8 53,1 49,3 23,3 23,4 4,6 3,7 Boys Girls Source: ICSRA
30 Percentage of students in 9th and 10th grade who smoke daily depending on if they practice sports Almost never Up to 3 times pr. week 4 times or more often 30 % ,5 24,9 10,4 9,9 4,0 3,5 0 Boys who smoke daily Girls who smoke daily Source: ICSRA
31 1998 Drug free Iceland Based on these findings a research based action plan was initiated by the government with the aim to try out a totally new methodology in substance abuse prevention
32 Local actions Research as a basis in all decision making Strengthen parent organizations and cooperation Support extra curricular activities / sports Support active NGOs Support Young people at risk inside schools Form co-operative work groups against drugs Anti smoking/drinking campains Strengthen social capital
33 National actions Legal age of adulthood raised from 16 to 18 years Outside hours for adolecents,,youth curfew Age limits to buy tobacco and alcohol (18 and 20) Strict regulations for sellers of tobacco A total advertising ban of tobacco and alcohol Restricted access to buying alcohol and tobacco Total visibility ban of tobacco and alcohol in the country
34 Local information fuels dialogue Dialogue between key stakeholders Politicians, municipalities and local authorities Parental groups and family planners School authorities and school workers Health educators, health and social services Leisure time workers, prevention workers Sports and youth institutions
35 The Reykjavik City Leisure Card The Leisure Card initiative is to guarantee that all children up to the age of 18 have the opportunity to engage in leisure activities outside school The City of Reykjavik allocates approximately EUR , yearly to the Leisure Card
36 Percentage of students in 9th grade that participate in sports in a sports club four times pr week or more (whole country) Increased organized sports participation
37 Percentage of students in 9 th and 10 th grade who spend time (often/almost always) with their parents during weekdays Time spent with parents Source: ICSRA
38 Proportion of students in 9 th and 10 th grade who have been out after 10 pm (3 times or more) in the past week Source: ICSRA
39 And substance use is going down % Drunk last 30 days Daily smoking Hashish once or more
40 Denmark Health Packages
41 The work with the health promotion packages arose from the reform of local government in 2007 in which Denmark s municipalities were delegated the responsibility of creating healthy settings and establishing disease prevention and health promotion services for their citizens in accordance with the Health Act of Denmark has 98 municipalities, which span from small island communities of only a few thousand inhabitants to the City of Copenhagen, with more than 500,000 in- habitants. The average municipality has a population of about 55,000.
42 Purpose of the Health Packages The Health Packages comprise an evidence- informed tool to assist municipal decision makers and health planners to: Setting priorities Planning and organizing local health promotion and disease prevention initiatives
43 The range of Health promotion Packages Alcohol Physical activities Sexual health Indoor climate in schools Healthy food and meals Tobacco Mental Health Sun protection Hygiene Obesity Drug abuse
44 The Structure of the Publication The Recommendations Plans and policies Early detection Health promotion services Information and Education
45 The Structure of the Publication Implementation Competences Monitoring and Indicators Dimensions of the recommended initiatives
46 Municipal policy on alcohol Plans and policies Alcohol is part of the municipal health policy, with own measurable targets. The policy on alcohol covers prevention, early detection, counseling and treatment and integrate the alcohol-related tasks across administrative sectors. The policy on alcohol should be accompanied by action plans for implementing the policy s targets.
47 Plans and policies Alcohol policies in the municipality s workplaces and institutions The municipality adopts alcohol policies for the municipality s workplaces and institutions i.e. schools, job centers, nursing homes, sport facilities The focus is on alcohol consumption and detection of alcohol problems among both employees and people who use the institutions
48 Plans and policies Dialogue between upper-secondary educational institutions The municipality facilitates dialogue between the uppersecondary educational institutions to ensure uniform policies on alcohol.
49 Plans and policies Responsible serving of alcohol The municipality manages alcohol licensing based on the principle of responsible alcohol serving. The municipality establishes a permanent forum for collaboration between i.e. the police, the holder of the alcohol licence (restaurant owners, etc.)agreements are made to promote a safe nightlife environment. The need for courses for personnel serving alcohol is evaluated and formalized. The key perspective in the overall plan for catering is reducing alcohol availability.
50 Early detection Systematic early detection by frontline personnel The municipal frontline personnel who meet people in the settings of social services, job centres, health services, can ensure that people with excessive alcohol use or alcohol problems and families with alcohol problems are detected early through a brief discussion. Action plans The municipality prepares action plans for frontline personnel, emphasizing recommended questions for the brief conversation focusing on early detection of alcohol problems and referring people to counseling and treatment.
51 Early detection Alcohol counselling at the end of lower secondary school The municipal health services systematically provide counseling about general health, including alcohol consumption, as part of the health interviews and examinations when students finish lowersecondary school (at 15 or 16 years old). Collaboration on pregnant women and families with children Together with the regional health services, the municipality focuses on alcohol problems among pregnant women and families with children. All pregnant women should be asked about their alcohol consumption and should be referred to the regional outpatient family health centre if needed.
52 Health promotion services Brief counselling for people with excessive or harmful alcohol use and their families, including children The municipality offers a brief high-quality counselling session to people with excessive or harmful alcohol use and to their families, including children. The services are adjusted and located according to the needs of the target group, such as: health centres as a service provided on site for students as a service for older people.
53 Health promotion services Differentiated alcohol treatment services The municipality qualifies its alcohol treatment services to match the treatment needs of people with alcohol problems according to the degree of severity and based on the available evidence. The target groups are: people with alcohol dependence and people with severely harmful use; family-specific treatment services for families, partners, children and other relatives; dual diagnosis services for people with alcohol dependence or harmful alcohol use and with a personality disorder or another mental disorder offered in collaboration with the regional health services, including psychiatry; pregnant women, in collaboration with the regional outpatient family health centre; and
54 Health promotion services Cooperation between alcohol treatment, social services and family therapy The municipality ensures integration between alcohol treatment and the municipal social services to ensure social support for the family in following up treatment. The goal is to ensure the necessary integration and sharing of competencies between alcohol treatment centers and family therapy centers. Both institutions work with families that may have both alcohol problems and family problems and are socially disadvantaged and vulnerable.
55 Information and education National information campaigns Frontline employees provide information about the municipal services Information for retailers Parents meetings and involving parents Teaching in primary and lower-secondary schools
56 Implementation The municipality integrates alcohol into its municipal health policy, defining its own measurable targets. policy on alcohol cover prevention, early detection, counselling and treatment and integrate the alcohol-related tasks across administrative sectors. The policy on alcohol is accompanied by action plans for implementing the policy s targets.
57 What is the commitment?
58 The ADPY Project To inventory and analyse the alcohol and drug situation amongst young people, as well as the structures and methods for alcohol and drug-related prevention efforts in selected municipalities. The participating municipalities are Nyna shamn (Sweden), Drammen (Norway), Klaipeda (Lithuania), as well as Sovjetsk and Bagrationovsk (Russia).
59 To develop and distribute manuals for target groups, such as public health specialists, public officials, social educators and school nurses. To increase the capacity of the local alcohol and drug-related prevention infra- structure, and to induce the municipalities to agree to work with this issue in a sustainable manner.
61 Ranking of most needed strategy in the community, % Youth life/social skills training programs Enforcement of community laws and policies 9.2 Recovery support activities (AA and other 12-step groups, outpatient treatment centers) Parent education programs/parenting skills training 7.5 Media advocacy - 6.7
62 Informant ratings of perceived barriers to substance abuse activities
63 Informant ratings of community Readiness for substance abuse planning activities
64 Perceived barriers to data collection for substance abuse prevention
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