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  1. Prioritization - a study of alcohol and drug prevention i Västra Götaland County, Western Sweden, 2002-2004 Fredrik Spak, Per Blanck MD, PhD, ass. prof. at Social medicine, Sahlgren Academy, Göteborg University Department of Public Health, Västra Götalandsregionen Prevention activities: alcohol, drugs, program evaluation, secondary prevention in primary health care och working life, education

  2. National Action Plan for Alcohol and Drug Prevention, areas that concern local municipalities, 2001 • Support to risk groups and individuals with risk behaviours • Support treatment • Restrict accessibility of alcohol beverages • Competence enhancement • Monitoring trends • Influence public opinion

  3. 49 municipalities 1.5 million inh. Municipal size: 475 000 – 5 000 61 % < 20 000 Interview at base-line and 2 year follow-up 4 municipalities studied in more detail Method, Västra Götaland

  4. Method • Interviews x 2 in 49 municipalities + 4 townships • Interviews x 2 in 4 municipalities (deeper studies) • Survey study: contact persons • Document, plans, webb sites • Participating observation

  5. RESULTS (So far only available in a Swedish– two articles to appear in J Subst. Use and Abuse)

  6. Alcohol and other drugs • Gradually the task changed from implementation of the alcohol problem prevention plan to implementation of the alcohol- och drug prevention plans

  7. Concordance with the national alcohol prevention plan The plan has target 6 areas. 30 % of the municipalities had activities in at least 4 areas >50 % of the municipalities had activities in at least 3 areas The most common activies: • Opinion making • Competence enhancement • Work with risk groups

  8. Activities: Substance abuse prevention groups • Develop and strenghten networks in and inbetween municipalities • Meetings with substance abuse coordinators • Meetings för exchanging ideas • Education • Study trips (Denmark, Norway, Stockholm)

  9. Policy programs • 39 municipalities • But 27 of these ”outdated” • policy never accepted • policy not known • old

  10. Substance coordinators • In 40 of 49 municipalities,else public health officers • Common tasks • Monitor substance use • Develop or enforce policy programs • Promote preventive efforts • Unclear expectations, low sustainability

  11. First interview: Freedom Many interested Small resources Second interview: Mandate unclear Mandate not respected Activities ceased Small, but increased resources Economy och mandate

  12. Almost all municipalities: Youth or Children and youth Few municipalities: Adults Young adults Target groups

  13. All municipalities: School Parents Fewer municipalities: (Leisure time) associations Work life Primary health care Traffic Arenas

  14. Education • Efforts in all municipalities • wide variety • usually grade 7-9 • Often a part of ”Health promoting schools” • undocumented • No well documented programs

  15. Information to teenage parents • Lecture series • Study circles • few But: lacks sustainability and large impact

  16. Sales restrictions • Controlling (low alcohol) beer sales • regulation adherence = 50% • Restuarant and bar license increase (per 10.000 inh.) 1998: 9.8 2003: 12.4

  17. Secondary prevention in health care/primary health care • New parents (Mother and child care) Yes • Early secondary intervention No

  18. Activities in the traffic area • Swedish police very active, activities increasing • No community cooperation

  19. Conclusions • Network building: rather successful • Municipalities adhere to the national alcohol and drug action plans to some extent • Low sustainability • Too many activities in relation to resource avialability • Do stakeholders agree on the benefit of the activities? (different rational fields –Seedhouse)

  20. Recommendations • More realistic och evaluable programs • Prioritization among the many different activities • Clearer mandates – allocate resources • More focus on adults as a target group • More focus on structures than on individuals • Sustainability requires political cooperation • Invite implementation specialists

  21. Recommendations • Increase activities aming at reducing availability – not in the least concerning sales of alcohol purchased abroad • Promote secondary prevention in primary health care (mainly concerning alcohol), (family practice, maternity care and child care) • Support substance prevention in work life • Support well functioning parent programs • General improvement of the school ”milieu”

  22. Alcohol policy in the regions of Europe – factors to be considered • What is the LEAST we can do to set off an effective program? • SURPLUS VALUE NEEDED - All resources allocated to alcohol prevention could have been used for some other purpose • SMALL EFFECT TO BE EXPECTED - Even if a municipality does everything correct in working to reduce demand – this will have less effect than working with alcohol availability. • Why are so MANY TIRED today?