Healthier people - richer community. What kind of health costs will pay off? Tallinn 30 th of april 2015 Daniel Müller Project leader, STAD
STAD Stockholm prevents alcohol and drug problems
About STAD Stockholm prevents alcohol and drug problems Research and development unit within Stockholm County Council, CPF (Centre for Psychiatric Research and Evaluation) and KI (Karolinska Medical Institute) Founded in 1995 Centre of knowledge for prevention focusing on alcohol and other drugs Unique position - researchers and practitioners work in close collaboration with the general mission to identify, develop, and evaluate promising methods for prevention of alcohol and drug related problems Most of our interventions utilize a community-based strategy, theoretically based on an environmental approach to prevention
Projects and activities: Community-based interventions RBS at licensed premises Clubs against drugs RBS at high school student parties RBS at univ. student pubs Gyms against steroid use Prevention of violence at sporting events Other interventions and evaluations Internal evaluations of STAD-interventions Primary health care Web-based interv. for CoA Support group for adult CoA and significant others External evaluations - Housing first - Parent training and school programs
Responsible Beverage Service
Background Public health concerns (e.g. alcoholconsumtion, violence) Number of licensed premises increase and gets extended opening hours Weakening of the Swedish alcohol monopoly 6
Overall goal Responsible Beverage Service Reduce violent crimes in the nightlife setting Specific goals Decrease problems related to alcohol service at licensed premises by Reducing alcohol service to intoxicated guests Reducing service to underage guests
Action group The Municipality - Licensing Board (Chair) The County Council The Police Authority The County Administration Visita the swedish hospitality industry The Union for licensed premises staff The National Institute of Public Health Crucial: All together worked out a written agreement
Prevention strategies Community mobilization Training in Responsible Beverage Service Efficient enforcement and sanctions
Results Refusal rates to intoxicated guests
Results Refusal rates to underaged guests 100 % som nekades 92 91 % 80 60 40 55 59 68 20 0 1996 1998 2001 2007 2013 Year
Reported violent Crimes Intervention group ( ) and control group ( ) Reduction of 29% in the intervention area 400 300 200 100 J UL Y 1 99 4 0 J AN 1 9 95 J UL Y 1 99 5 J AN 1 9 96 J UL Y 1 99 6 J AN 1 9 97 J UL Y 1 99 7 J AN 1 9 98 J UL Y 1 99 8 J AN 1 9 99 J UL Y 1 99 9 J AN 2 0 00 J UL Y 2 00 0
Results 29% reduction in police-reported violence in the project area A cost-effectiveness analysis showed that for every 1 euro spent 39 euros were saved 13
Conclusion STADs community-based interventions at licensed premises seem to have reduced alcohol related problems in the nightlife setting The most likely explanation is a combination of intervention components such as community mobilization, training and increased enforcement
Conclusion We have every reason to believe that money spent on this type of community based prevention strategies pay back many times the costs in terms of both euro and nevertheless, human suffering
Questions raised? 1. The different components of STAD - do they need each other and which is the most crucial? 2. How did we convince all the stakeholders to participate?
Questions raised? 3. What were the boosting and impeding factors of developing and implementing STAD? Boosting factors Steering group Signed and written agreement Long term funding Institutionalized Research and results Today self financed Impeding factors Lack of communication Cooperation and trust takes years to build and minutes to demolish
A few questions.. What would you do different? Involve ALL the stakeholders right from the start, especially the nightlife industry RCT (Randomized Clinical Trial)? Somehow more/better follow up of the enforcement strategies
Thank you for listening and Good Luck! daniel.muller@sll.se