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The challenge of prevention in recreational settings. Evidence, approaches and recommendations from EU projects.

by Giovanni Viganò

[Networks n.1 - 2012]

The results of the project Prevention of poly-drugs addiction and reduction of drug-related harms programs for young people in recreational settings here presented set out the key outcomes of the transnational investigations concerning the interventions in recreational settings and the resulting recommendations to inform best practice for future programme developers.
The interviewed programme developers for recreational interventions identified the staff involved in the intervention as a key aspect in setting up a prevention intervention in recreational settings. They underlined the importance of including a range of personnel from different organizations to reflect the different employment roles and job responsibilities. There are also different institutional roles to take into account. These will include municipalities, local health authorities, police departments, volunteers, peers, responsible of the nightclubs, other professionals who work in night contexts. The latter for example are fundamental to convey positive messages and to facilitate the setting up of the interventions within the venues like chill out rooms, info points, first aid points.
The synergy among professionals that have different cultural approaches and different backgrounds, i.e. more educative and addressed to harm reduction for what regards the Local Health Authorities or more “repressive” for the Police, gives the opportunity to build prevention projects that seem to be more complete, coordinated and generally to be more effective. At the same time, having an heterogeneous working group implies some difficulties in the overall management of the project and in the definition of the project plan due to the different approaches used (sociological research vs epidemiological research).
In the partnership building process another relevant aspect is the active involvement of the users, in this instance individuals patronizing recreational settings, both in groups and as individuals. User-involvement was evidenced in two distinct modes: as active organizers or in the needs-assessment process. The involvement of organized groups and youth associations can play an important role in supporting the planning of the interventions using a participative approach. Alternatively, user engagement during the design phase e.g. in focus group sessions can establish a better understanding of the populations needs in terms of recreational consumption patterns or drug used behaviours thus enhancing the knowledge-base available to services or policy makers.
In terms of barriers to health promotion programmes targeted in recreational settings the most commonly reported compounding factor was duration of the project. The projects described in the case studies typically ran over a duration of 6-12 months financial constraints were often cited as the parameter preventing extension of the programme. The limited duration of the project was often determined to be, too short in order to establish a long term impact from the interventions implemented.
At national and local level, the financial resources addressed to prevention interventions or prevention projects are generally scarce. The lack of resources disposable for prevention interventions in recreational contexts minimizes the opportunities to have long lasting projects. The lack of funding, in addition to the length of the project, influences its potential impact.
Taking into account the elements derived from the case study analysis and summarized above, according to the partnership the European Commission and the other supra-national organizations could intervene on the theme of drug prevention at two different levels: politically and economically.
From a political point of view, in many Countries among social and health policies the area of prevention of drug and alcohol abuse has not the same “dignity” of other prevention areas where funding and visibility are much more consistent. Many occasions, even within local health services, the departments that specifically work in night-time and recreational contexts do not receive the same attention and resources.
Therefore, the European Commission could encourage Member States to recognize equal dignity to drug reduction intervention in night contexts and stimulate national and local authorities to invest politically, economically and socially in this direction.
Another point of weakness observed is the lack of significant evidence-based studies on impact evaluation of drug reduction interventions in recreational settings. In contrast to other contexts, like educational contexts where during the last years many research projects have been conducted and analysed. The effects of interventions in recreational contexts however are few and therefore a new important and innovative area of study. The traditional epidemiological approaches used for the project impact evaluation are only applicable with great difficulty in recreational contexts due to the change of the sample over the duration of the project.
Finally, it is of the utmost importance to encourage and support the international exchange of good practices on this theme: transnational projects, such as this one guarantee the transferability and sharing at European level of skills and knowledge among professionals involved in the drug prevention field. In this perspective an important synergy of exchange of experiences and results was established with the international initiative Healthy Nightlife Toolbox (HNT), namely an organisation composed by a transnational group of partners. The operating working group involves the Trimbos Institute (ND), the Centre for Public Health at the Liverpool John Moores University (UK), the National Institute for Drug Prevention in Budapest (HU), The VAD association for alcohol and other drug problems (BE) and IREFREA from Palma de Mallorca (SP).
In addition to the above considerations, an important strategy of the HNT is the use of interventions within an integral approach. Still according to HNT, scientific research indicates that such an approach, which is based on a community approach, could probably be more effective than the implementation of separate interventions.
In an integral prevention approach of risky substance use attention is given to:
  • •    problem analysis;
  • •    cooperation with important stakeholders like municipalities, pubs and clubs, party-organisers, health/addiction services, and police, creation of specific platform for managing all these initiative;
  • •    a variety of prevention interventions;
  • •    creating safe nightlife areas, and venues (healthy settings): clear house rules, good door policy, good ventilation and chill-out rooms;
  • •    rules and enforcement;
  • •    training bar staff (from doormen to managers) and other stakeholders;
  • •    education for nightlife visitors about decreasing the risks of drug and alcohol use.
Similarly to what stated with the project carried out by the ASL Bergamo, the HNT planning for creating healthy and safe nightlife settings put the accent on the key aspect of actively involving several parties such as local authorities, pub and club owners, clubbers, police, transport department, and prevention professionals. The inner idea is that fostering healthy settings approach demands cooperation between these parties and this starts with creating commitment and gaining knowledge about the different tasks and interests of the parties.
Finally, in describing the organisation of a specific project plan, HNT notice how the adaptability of specific interventions or types of interventions significantly depends on laws, policies and the economical situation in a country, as well as on the available resources. Assuming this, the importance of having a constantly updated source where to look for examples of other interventions that, according to the aims and the budget, could be suitable for the case at stake is key provides users with an important helping tool. Thus, making adaptations to existing interventions, seeking for alternatives or finding support when developing his/her own intervention turn to be somehow facilitated.

This article is a summary of the paper downloadable here below. It presents the main results of the EU funded project Prevention of poly-drugs addiction and reduction of drug-related harms programs for young people in recreational settings financed by the Drug Prevention and Information Programme 2007-2013 of the European Commission proposed and developed by the ASL Bergamo in partnership with Synergia (IT), the University of St. Andrews (UK), the National Board of Health - MidWest Region (DK), the Eotovos Lorand University (HU) and Regione Lombardia (IT). In this short summary and in the downloadable paper the valuable experience of the similar international initiative Healthy Nightlife Toolbox (HNT) is presented.

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