Prevention in nightlife. Amador Calafat IREFREA

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1 Prevention in nightlife Amador Calafat IREFREA

2 Nightlife and use of drugs Research studies targeted at young people in the EU who attend dance music events consistently report much higher prevalence of drug use than that found in surveys of the general population. This appears to be the case in all of the countries where such surveys have been conducted Annual report 2006, EMCDDA

3 PROBLEM AREAS IDENTIFIED IN RECREATIONAL SETTINGS Health problems (injuries, hearing damage, mental disorders, heat stroke, drunkenness, ) Violence Unsafe and involuntary sex Transport (e.g. drink/drug driving) Social nuisance (noise, street drinking, vandalism, ) Underage drinking Crime or law offences

4 Glass injury A study on the risk of occupational glass injury in bar staff revealed that 41% of bar workers in South Wales have sustained bar glass injury. Fifteen per cent of these had sustained five or more separate sharp injuries from broken glassware. Shepherd JP, Brickley MR, Gallagher D, et al. Risk of occupational glass injury in bar staff. Injury 1994;25:

5 Crystal Clear Raise awareness of Bottle and Glass related injury Encourage leaving glasses and bottles in clubs Reduce glass related injuries

6 Some Interventions for Noise Outside Clubs Police handing out of Lollipops Inside Clubs Luminous Clubbers Ear Plugs

7 EDUCATION OF PATRONS

8 Harm reduction messages A national survey of clubbers found high level of awareness of many key harm reduction messages, but much more variable implementation of them. Although clubbers were eager for up-todate information, their attempts at harm reduction were found to be irregular at the best. Winstock, A. Griffiths P (Unpublished). High risk behaviours and harm reduction implementation amongst drug users associated with the dance music scene in the UK.

9 INTERVENTIONS Venues Bar staff and management training programs. House policies Code of practice and other agreements Opening hours. Venues density. Physical and contextual Pill testing Community interventions Education (patrons education, in school, peer education, ) Emergency rooms, first aid provision assistance, Licensing, Law enforcement and Underage control. Environments, neighbourhood (transport, lighting, ) Drink and Driving programs Policing, collaboration with the industry Alternatives programs. Cultural approaches Campaigns

10 Safer Nightlife Guidelines England Denmark New Zealand New South Wales Spain

11 Transport (Calafat et al, 2009) Venue environmental factors that can be addressed Permissive atmosphere is a very important factor (Homel, 1994, Graham et al 2006) overcrowding and bumping (Macintyre and Homel, 1997) smokiness (Homel and Clark, 1994) bad and loud music (Home and Clark, 1994) activities such dancing or pool games (Graham et al 1980; Quigley et al 2003). overt sexual activity (Homel et al, 2004; Graham et al,2006)

Prevention of overcrowding Air conditioning and ventilation Availability of drinking water Further measures to combat overheating e.g. chill out areas, DJ choice of music Other environmental factors e.

12 Prevention of overcrowding Air conditioning and ventilation Availability of drinking water Further measures to combat overheating e.g. chill out areas, DJ choice of music Other environmental factors e.g. secure fixtures, glass collectors, regular checking of electrical systems, safe noise levels Door supervisor registration General security measures e.g. searching at entry, safe storage of seized drugs and weapons, CCTV, washroom attendants Staff training Medical and first aid provision Drugs information and advice Additional measures for large events Independent research and monitoring

13 Responsible Beverage Service (RBS) Typical objectives are: Learn to identify and refuse service to obviously intoxicated persons Learn to identify and refuse service to underage Contribute to a harm reduction strategy related to alcohol: cleanliness and maintenance of premises Removal of potentially harmful objects sufficient but subtle lighting and moderate noise level; availability of seating; crowd control, availability of food and non-alcoholic beverage choices; limiting specials, such as happy hours, two-fers, events. etc

14 Minimum requirements for RBS training Cover all basic information with servers Actives techniques (e.g. role playing) should be used, Focus on both managers and servers. Managers should be targeted because they are responsibles of supervising the servers, so they should be familiarised with the techniques. Include policy development for managers. Managers should develop written house policies. This increases the chances to implement RBS at the establishment. the minimum length for the most effective RBS is a minimum of four hours. Mosher JF, Toomey TL, Good C, Harwood E, Wagenaar AC. (2002) State laws mandating or promoting training programs for alcohol servers and establishment managers: an assessment of statutory and administrative procedures. J Public Health Policy. 23(1):90-113

15 Evaluation of RBS Mixed results. It is possible to reduce alcohol related problems by RBS (Gliksman, McKenzie, Single et al,1993) There is no effect or limited effects according a review (Graham, 2000) Results do not support that the RBS training alone has produced effects on alcohol. Clearly enforcement was better. But it was probably effective in the reduction of violence (Wallin, Andréasson, 2005).

16 Responsible Beverage Service Cochrane review 20 researches covering a range of interventions involving server training, health promotion initiatives, a drink driving service, a policy intervention and interventions that targeted the server setting environment. There is no reliable evidence that interventions in the alcohol server setting are effective in preventing injuries. The effectiveness of the interventions on patron alcohol consumption was found to be inconclusive. There is some indication of improved server behaviour but it is difficult to predict what effect this might have on actual injury risk. Lack of compliance (low paid, high turnover of staff, stressful work, ) with interventions seems to be a particular problem; hence mandated interventions or those with associated incentives for compliance, may be more likely to show an effect Ker. K and Chinnock. P (2008) Interventions in the alcohol server setting for preventing injuries, The Cochrane Collaboration

17 Community or multi component approach Integral or multi component approach will probably be more effective than the implementation of separate interventions. The most effective community model would combine education, coordination and enforcement (Homel) (Holder. HD, Gruenewald. P.J, Ponicki. W.R, Treno, A.J., GRube, J.B., Saltz, R.F., et al (2000) Effect of community-based interventions on High Risk drinking and alcohol-related injuries, JAMA 284: ; Wagenaar. A.C, Murray. D.M and Toomey. T.L (2000) Communities mobilizing for change on alcohol (CMCA): effects of a randomized trial on arrests and traffic crashes, Addiction 95:

18 An integral or multi component prevention approach combines some or all of the following interventions: Community awareness and community mobilization (involvement and cooperation with important stakeholders like municipalities, pubs and clubs, party-organisers, health/addiction services, and police) Training -RBS, preventing violence,..- bar staff (from doormen to managers) and other stakeholders House policies Improving the safety and the health of the Nightlife areas and venues (healthy settings) Education for nightlife visitors about decreasing the risks of drug and alcohol use Law enforcement

19 Stockholm Prevents Alcohol and Drug Problems. STAD The community alcohol prevention program related to alcohol consumption at licensed premises starts in 1996 in the northern part of central Stockholm and a control area in the south. Main intervention included community mobilization, training of servers in RBS and stricter enforcement of existing alcohol laws. Wallin, E., Andréasson, S. (2005). Effects of a community action program on problems related to alcohol consumption at licensed premises. In Stockwell, T., Gruenewald, P.J., Toumbourou, J.W., Loxley, W. (Eds), Preventing Harmful Substance Use: the Evidence Base for Policy and Practice. West Sussex: John Wiley & Sons

20 STAD Results a decrease in alcohol related problems at licensed premises increase of licensed premises that refused alcohol to intoxicated patrons (from 5% in 1996 to 47% in 1999 and 70% in 2001) increased refusal to serve minors (from 55% in 1996 to 59% in 1999 and 68% in 2001) During the project period the assaults decreased the 29% in the project area and slight increase in the control area

21 EXTENDED LIQUOR TRADING HOURS A small number of licensed premises responsible for most disorder and assaults (Briscoe & Donnelly, 2001, 2003; Jochelson, 1997) More evidence that drink driving incidents and traffic accidents coincide with extended liquor trading (ELT) and around closing times* Other research suggests ELT has little impact on positive BAC traffic fatalities** Chikritzhs et al., 1997; Palk & Davey, 2005; Smith,1988; Newton, 2007 ** Vingilis et al., 2005

22 Law enforcement Uniformed police officers visit pubs 2 to 3 times a week at an english seaside resort. 20% of reduction in recorded public disorders offences in intervention area. No reduction in control area. (Jeffs, B.W., Saunders, W.M. (1983). Tackling Alcohol Related Street Crime TASC in Cardiff a broad and multifaceted intervention implemented largely by the police (Maguire et al, 2003), produced reductions in violence at the relevant premises.

23 Some of these programmes are turnkey, or ready to implement, and have been measured and evaluated. They can be easily adapted to national cultures and contexts EUROPEAN FORUM for RESPONSIBLE DRINKING

24 Industry Activities

25 Venues European Standards Club Health // Irefrea project

26 Health and Safety Standards in nightlife. A review Project Overview 2: Assessment of the standards 1. Key informants were selected and contacted: 1.1. Industry representatives (80%) Representatives of industry umbrella organizations Managers of clubs and discos Promoters 1.2. Other key stakeholders (20%) Policy makers working in the field Public health representatives Police representatives working in the field Other key informants: health service representatives, prevention representatives Assessment among key informants carried out in: 25 European cities 14 European countries

27 Health and Safety Standards in nightlife. A review Standards Evaluation Data from final assessment Organized around 6 main standards: No selling of alcohol to those under the legal age Staff training and management factors Involvement of key stakeholders and collaboration with police Create a safe physical environment Promote a safe social environment Regulation of alcohol sale and promotions Data from industry representatives: Representatives of umbrella organizations Managers of clubs and discos Promoters

28 Health and Safety Standards in nightlife. A review Standards Evaluation As a summary In general, industry representatives: Are aware of the risk and protective factors shown by literature Show a high compliance at operational level on most of the key health and safety components (enforced or not) Use key components as an added value (to stand out from competition) Apply them discretionally according to their interests/needs Express doubts on further regulation (paperwork/costs)

29 Recommendations (1) 1. To concentrate more efforts in risky alcohol use because it generates most of the problems 2. Greater accountability for law enforcement. - needs political and social support - easiest to implement when there are local awareness of problems (vandalism, ) 3. Community approaches tend to produce the largest and most significant effects. - more expensive - need political support - problem with sustainability

30 Recommendations (2) 4. Intervention in venues - many possibilities - not very evaluated - more effective when non compliance can be sanctioned. 5. Classical measures like taxation, random breath testing of drivers, enforcement of purchase age laws are evidence based and effective. 6. Education to patrons not useful specially alone. 7. Codes of practice and other coordination efforts of industry are promising but there is no evidence. - The problem is the compliance and sustainability.

31 IREFREA

Drinking Environments

Drinking Environments Karen Hughes Centre for Public Health, Liverpool John Moores University WHO Collaborating Centre for Violence Prevention Ninette van Hasselt & Lotte Voorham Trimbos Institut, Netherlands