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STAD –
Stockholm Prevents Alcohol and Drug Problems
Stockholm County Council and Karolinska Institutet
(Stockholm förebygger alkohol- och drogproblem)
Alcohol sales in Sweden 1861-2009(litres of pure alcohol per inh. 15+)
0
1
2
3
4
5
6
7
8
9
10
11
12
Sprit Starköl Öl, klass IIA
Öl, klass IIB Summa Öl Vin
Totalt registrerad Skattning av total alkoholanskaffning
Alcohol consumption (sales) divided by type of beverage 1996 - 2010
Alcohol consumption (sales) divided by ’purchase source’1996 - 2010
0,0
1,0
2,0
3,0
4,0
5,0
6,0
7,0
1996 1998 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
liter
alk
oh
ol (
100%
) p
er in
vån
are
15 å
r +
Systembolaget
Resandeinförsel
Restauranger
Livsmedelsbutiker
Hemtillverkning
Smuggling
Distribution of alcohol consumption in different percentiles 2004, 2007, 2008 och 2009 among men.
0
0,2
0,4
0,6
0,8
1
1,2
1,4
1,6
1,8
2
2,2
2,4
2,6
2,8
3
1 8 15 22 29 36 43 50 57 64 71 78 85 92 99
Lite
r re
n (1
00 %
) al
koho
l per
mån
ad (
förs
ta 9
mån
.)
Alcohol-2004 Alcohol-2007 Alcohol-2008 Alcohol-2009
Gräns för riskkonsumtion (> 14 standardglas i veckan = 92 cl ren alk i mån)
Distribution of alcohol consumption in different percentiles 2004, 2007, 2008 och 2009 among men
0
0,1
0,2
0,3
0,4
0,5
0,6
0,7
0,8
0,9
1
1,1
1,2
1,3
1,4
1,5
1 8 15 22 29 36 43 50 57 64 71 78 85 92 99
Alcohol-2004 Alcohol-2009 Alcohol-2007 Alcohol-2008
Gräns för riskkonsumtion (> 9 standardglas i veckan = 58 cl ren alk i mån)
Self-reported alcohol consumption in different age groups in the years 2004/05, 2006/07 and 2008/09,
among men
0
0,1
0,2
0,3
0,4
0,5
0,6
0,7
0,8
0,9
16-1
7
18-1
9
20-2
1
22-2
3
24-2
5
26-2
7
28-2
9
30-3
1
32-3
3
34-3
5
36-3
7
38-3
9
40-4
1
42-4
3
44-4
5
46-4
7
48-4
9
50-5
1
52-5
3
54-5
5
56-5
7
58-5
9
60-6
1
62-6
3
64-6
5
66-6
7
68-6
9
70-7
1
72-7
3
74-7
5
76-7
7
78-7
9
80-8
1
Lit
er r
en a
lko
ho
l per
mån
ad (
jan
-sep
t 20
04-j
an-s
ept
2005
Alkoholkonsumtion 2004-05 Alkoholkonsumtion 2008-09 Mediankonsumtion 2004-05
Mediankonsumtion 2008-09 Mediankonsumtion 2006-07 Alkoholkonsumtion 2006-07
Self-reported alcohol consumption in different age groups in the years 2004/05, 2006/07 and
2008/09, among women
0
0,05
0,1
0,15
0,2
0,25
0,3
0,35
0,4
0,45
1617
1819
2021
2223
2425
2627
2829
3031
3233
3435
3637
3839
4041
4243
4445
4647
4849
5051
5253
5455
5657
5859
6061
6263
6465
6667
6869
7071
7273
7475
7677
7879
8081
Lit
er r
en a
lko
ho
l per
mån
ad (
jan
-sep
t 20
04-j
an-s
ept
2005
Alkoholkonsumtion 2004-05 Alkoholkonsumtion 2008-09 Alkoholkonsumtion 2006-07
Mediankonsumtion 2004-05 Mediankonsumtion 2008-09 Mediankonsumtion 2006-07
Self-reported consumption among boys and girls grade nine (age 15-16) 1987-2009
27
3133 33
31 32
2830
32
39
42
53
48
41
38
41
35 36
3032 32
15
1816 15
17 18 1917
20
26 26
29 28
3129 30
32
28
22
25
21
0
10
20
30
40
50
60
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Gen
omsn
ittlig
sjä
lvra
ppor
tera
d to
tal å
rslk
onsu
mtio
n av
alk
ohol
(i d
ecili
ter r
en
alko
hol)
Pojkar Flickor Källa: CAN, 2006
Binge drinking among women, based on monthly survey data (Monitor project)
Binge drinking frequency
2002
2003
2004
2005
2006
2007
2008
2009
2010
All ages16-80 of age More than once a week 1,4 1,3 1,2 1,1 1,3 0,9 0,9 0,8 1,0 Once a week 2,4 2,5 2,5 2,4 2,2 2,0 1,8 1,5 1,7 2-3 times a month 17,7 16,6 14,8 15,1 15,7 13,7 13,0 14,0 13,8 Never 78,5 79,6 81,5 81,4 80,9 83,5 84,3 83,6 83,5
16-29 years of age
More than once a week 3,5 3,2 3,6 2,9 3,6 2,2 2,1 1,3 2,0 Once a week 5,2 6,1 6,2 6,4 4,9 4,6 4,5 3,7 3,7 2-3 times a month 34,0 31,6 26,3 28,0 28,1 25,9 23,3 24,7 22,2 Never 57,2 59,2 63,9 62,7 63,4 67,4 70,17 70,3 72,1
Binge drinking among men, based on monthly survey data (Monitor project)
Binge drinking frequency
2002
2003
2004
2005
2006
2007
2008
2009
2010
All ages16-80 of age More than once a week 4,5 5,0 5,0 4,3 4,8 4,5 4,3 4,0 3,4 Once a week 7,7 7,9 7,7 8,0 7,5 7,2 6,0 5,3 5,3 2-3 times a month 33,5 30,4 29,5 28,3 28,4 28,4 26,9 25,5 26,6 Never 54,3 56,7 57,8 59,3 59,4 59,9 62,8 65,2 64,7
16-29 years of age
More than once a week 7,8 9,2 8,9 8,3 8,1 8,0 5,7 6,0 5,8 Once a week 12,6 13,6 13,1 13,7 12,3 11,5 8,6 8,7 8,2 2-3 times a month 46,9 38,8 38,3 35,9 36,3 35,8 34,7 30,5 31,9 Never 32,7 38,5 39,7 42,2 43,3 44,7 51,0 54,7 54,1
Used cannabis among 15-24-year olds (Source: Eurobarometer, Young people and drugs, 2004)
Ever used Past month
EU-15 Sweden EU-15 Sweden
2002 29 % 17 % 11 % 4 %
2004 33 % 14 % 11 % 3 %
Culture acceptance
More culturally accepted -- Yes and no
More integrated in everyday life - wine, beer
Still restrictive attitudes – more positive towards high taxation and keeping the retail monopoly
More people abstain altogether from alcohol
Prop (%) women and men who agree completely or largely that wine should be sold in grocery stores, year
2002 and 2005-2010. 2002 2003 2004 2005* 2006* 2007 2008 2009 2010**
n=18018 n=9052 n=9007 n=18005 n=18012 n=18014 n=13474
Women 16-29 50.9 . . 41.1 39.0 33.0 31.2 29.7 20.4 30-49 59.0 . . 47.2 49.0 45.0 42.1 40.7 36.5 50-64 60.1 . . 47.4 44.0 46.4 41.3 38.1 32.6 65-80 48.9 . . 45.2 40.0 39.6 37.4 36.0 31.3 All 55.6 . . 45.6 43.6 41.3 39.4 36.7 31.0 Men 16-29 64.1 . . 48.8 46.0 45.0 40.5 39.6 31.3 30-49 73.5 . . 56.8 60.0 57.0 54.6 53.0 47.4 50-64 71.4 . . 57.2 55.0 54.0 49.5 47.0 42.2 65-80 60.9 . . 55.7 46.0 50.0 48.0 46.4 43.9
All 68.8 . . 54.8 53.4 52.5 49.7 47.3 41.7
Alcohol policyOn many levels, and today more than before
on local level
Have a written national alcohol policy – strategy, so also most municipalities
Still – low physical and econ. availability – corner pillars in the alc. policy – number of outlets, age limits, taxation, opening hours,
One major reason – affecting young people
Alcohol policy
Recent years – focus more on local level and on other ’new’ methods to compensate for the weakening of most important national alc. policy measures (i.a. due to closer European integration – cross border shopping, abolishment of all monopolies except on the retail side)
Local – regional organisation and coordination built up and resources spent on strengthening and developing methods, especially young people
Alcohol policyLocal level:- Limit availability incl. social availability constraints
(drinking context) - surveillance, enforcement, RBS- Illegal alcohol – ‘Kronoberg method’- Parental/family programs – strengthening parenthood
– some prg. focusing on alcohol – clear rules, caring parents etc.
- Students at high school and particularly univ. – RBS, brief intervention (Student health care org.)
- Some focus on schools and prg (but not explicit alc.)
During the intervention period (July 1998-July 2000), reported violent crimes during night time (between 22-06 hours) were reduced by 29 per cent in the intervention area compared to the trends in the control area
(Wallin, et al., 2003)
Alcohol policy
Local level:- More focus on mothers (parents) to be – in
prenatal care – AUDIT, brief intervention- In new strategy as from 2011 – much focus on
new born and children brought up in dysfunctional families, incl. alcohol and drug abuse: how to reach these children , cooperation between different actors – school, social services, health care, police etc.
Eval. alcohol policy- Main pillars in the alcohol policy – strong
scientific support, but the emphasise on local level
– no ‘real’ evaluation, but follow-ups.
We don’t know why young people drink less – does the local prevention and the increase in prev. matters? We must know better.
Therefore in the new strategy on alcohol, drugs, doping and tobacco (ANDT):
Swedish national strategy for alcohol, narcotics, doping and tobacco (ANDT) from 2011-2015.
- Overall goal – a drug and doping free society, less harm from alc. and tobacco
- Seven long-term goals (L-T G) targets – (1) lower availability, (2) protecting children (incl. unborn, new born child), (3) lower levels among young people (age on onset etc), (4) reduced risk cons., harmful use, dependence, (5) increased avail. to treatment, (6) reduced harm rates - morbidity and mortality, (7) Sweden – active work internationally
- Within each LT, several prioritised (policy) goals (PG)
– If possible, develop measurable indicators ( but difficult, e.g. indicator/s on ‘more effective crime prevention concerning illegal alcohol’, ‘more coordinated and effective
supervision of on-premise sales and sales at grocery stores’
For each level and goal – indicators should be suggested.
Structure for the ANDT-strategy
L-T G 1
L-T G 2
L-T G 3
L-T G 4
L-T G 5
L-T G 6
L-T G 7
Overall goal: a drug and doping free society and reduced medical and social harm from alcohol and tobacco use
P G 1P G2P G 3P G 3P G 4
etc
P G 1P G2P G 3P G 3P G 4
etc
P G 1P G2P G 3P G 3P G 4
etc
P G 1P G2P G 3P G 3P G 4
etc
P G 1P G2P G 3P G 3P G 4
etc
P G 1P G2P G 3P G 3P G 4
etc
P G 1P G2P G 3P G 3P G 4
etc
• Suggest measurable indicators – long term (goals) (outcomes: behaviour change – risk cons., heavy use, harm reduce etc.) and prioritised goals (policy, activities, processes)
• Not only give definition – but the whole chain from def. to concrete analyses: what data, which scale, how to analyse
• Core indicators: most important to follow – some should also be plugged into local studies (surveys) – bridge between national main surveys and local surveys
• Expanded indicators – complementing core indicators – focus on more detailed diff. aspects of the core indicators
• Additional/developmental indicators: open up new areas, need development before ready as indicators – cannot be used today
• Also – suggest a follow-up system, including who should and what should be collected and how the new “guidelines” of indicators and monitoring should be disseminated on national and to the local level
Indicators – what should be doneIndicators – what should be done
Indicators – Indicators – Why this? (1) Increases the possibilities to understand/explain
changes and (2) a driving force for more systematic work. Since local level important – also indicators on local level, when applicable
Policy/activitiesConsumption/
harmNational level:
Regional/local level:
Policy/activitiesConsumption/
harm