Implementing and Sustaining Effective Alcohol‐Related Policies at the Local Level: Evidence, Challenges, and Next Steps

Giesbrecht, Norman; Bosma, Linda M.; Juras, Jennifer; Quadri, Maria

doi:10.1002/wmh3.98

Cited by 18 publications

(11 citation statements)

References 77 publications

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“…Cities are a natural site for preventing alcohol-related harm 87 . Although not having the full jurisdictional responsibilities of national governments for all alcohol policy issues, they often have greater flexibility and are an important site for both media-based and social norms programmes, as well as environmental measures to manage and limit availability of alcohol 88 . Networks of cities are natural vehicles for exploitation of the results and deployment to full scale, more so with the trends of increasing urbanization in Latin America 89 , 90 .…”

Section: Protocolmentioning

confidence: 99%

Scaling-up primary health care-based prevention and management of heavy drinking at the municipal level in middle-income countries in Latin America: Background and protocol for a three-country quasi-experimental study

et al. 2017

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Background: While primary health care (PHC)-based prevention and management of heavy drinking is clinically effective and cost-effective, it remains poorly implemented in routine practice. Systematic reviews and multi-country studies have demonstrated the ability of training and support programmes to increase PHC-based screening and brief advice activity to reduce heavy drinking. However, gains have been only modest and short term at best. WHO studies have concluded that a more effective uptake could be achieved by embedding PHC activity within broader community and municipal support. Protocol: A quasi-experimental study will compare PHC-based prevention and management of heavy drinking in three intervention cities from Colombia, Mexico and Peru with three comparator cities from the same countries. In the implementation cities, primary health care units (PHCUs) will receive training embedded within ongoing supportive municipal action over an 18-month implementation period. In the comparator cities, practice as usual will continue at both municipal and PHCU levels. The primary outcome will be the proportion of consulting adult patients intervened with (screened and advice given to screen positives). The study is powered to detect a doubling of the outcome measure from an estimated 2.5/1,000 patients at baseline. Formal evaluation points will be at baseline, mid-point and end-point of the 18-month implementation period. We will present the ratio (plus 95% confidence interval) of the proportion of patients receiving intervention in the implementation cities with the proportions in the comparator cities. Full process evaluation will be undertaken, coupled with an analysis of potential contextual, financial and political-economy influencing factors. Discussion: This multi-country study will test the extent to which embedding PHC-based prevention and management of alcohol use disorder with supportive municipal action leads to improved scale-up of more patients with heavy drinking receiving appropriate advice and treatment. Study status: The four-year study will start on 1 st December 2017.

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Section: Protocolmentioning

confidence: 99%

Scaling-up primary health care-based prevention and management of heavy drinking at the municipal level in middle-income countries in Latin America: Background and protocol for a three-country quasi-experimental study

et al. 2017

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“…Altogether, five further international conferences on community action research on alcohol problems were held, in 1992 in San Diego, California, 17 in 1995 in Greve-in-Chianti, Italy, in 1997 in Malmö, Sweden, in 1998 in Russell, New Zealand, 18 and in 2002 in Helsinki, Finland. 19 Since the early 2000s, there have been some further studies in this tradition, 20 but the research tradition of community action projects appears to have lost some of its momentum.…”

Section: The Wave Of International Interest In Community Action Projementioning

confidence: 99%

3. Prevention of Alcohol-Related Problems in the Community Context

Room¹

2017

Preventing Alcohol-Related Problems: Evidence and Community-Based Initiatives

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Many problems from alcohol occur within the community, impinge on others in the community, and often are responded towhether informally or formally-by community members and institutions. 1 The community is thus a primary locus for policies, actions and efforts to prevent the problems occurring. The preventive effort may be an informal intervention by a family member or neighboure.g., taking the car keys out of the hand of an intoxicated personor by a social groupe.g., parents deciding against bringing alcohol for the picnic on a joint family outing. It may be an action by a community-based officer or agencya lecture by a teacher, a warning by a policewoman, or a planning decision on an application to open a bar. Or it may be adoption of a policy by the municipal council or other authoritye.g., a closing-time policy which reduces the number of drunk people in the streets at 3am. A century and more ago, much of the action in temperance movements grew out of and focused on the community level. Where temperance sentiment was strong, a local prohibition ordinance might pass, or the municipality might take over the alcohol retail trade and run it as a municipal monopoly. But in the course of the 20 th century, the power to make such decisions was increasingly focused at higher political levels than the communityat state, provincial or national levels. 2 In temperance culturesthat is, countries with a strong temperance movement history 3there are examples of the local government level still retaining decisive power over the fact and conditions of alcohol availability, but it is relatively uncommon. More commonly, there is little power at the community level to determine promotion, price levels and the general availability of alcohol, and only limited power to control the conditions of sale and consumption. Increasingly, free trade agreements are limiting the control powers even of national governments. 4,5 Meanwhile, spurred by cultural changes and generational reactions against temperance, alcohol availability and consumption increased substantially in the temperance cultures in the 1960s and 1970s, 6 with further increases in availability, under the impetus of neoliberal open-market and competition policies, in more recent decades (e.g., for Australia, Roche & Steenson; 7 for the UK, Measham 8). However, in counterpoint to these trends, there were increasing public concerns about alcohol as a source of social and health problems.

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“…Giesbrecht, Bosma, and Reisdorfer focus on the challenges faced in the implementation of alcohol policies and offer some approaches to be tried in response. This work expands upon an earlier investigation on the topic of “Implementing and Sustaining Effective Alcohol‐Related Policies at the Local Level” by Giebrecht, Bosma, Juras, and Quadri (). In the current issue, Ferraiolo turns her attention to “Messaging and Advocacy in U.S. Tobacco Control Policy, 2009–19” while in 2014 her focus was on “Morality Framing in U.S. Drug Control Policy” in the case of marijuana decriminalization (Ferraiolo, ).…”

mentioning

confidence: 52%