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Community Prevention of Alcohol Problems PDF

261 Pages·1997·23.828 MB·English
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COMMUNI1Y PREVENTION OF ALCOHOL PROBLEMS Conununity Prevention of Alcohol ProbleDls Edited by Matja Holmila Senior ResearcMr Social Research Institute of Alcohol Studies He15inki Finland Foreword by Sally Casswell Professor, Director of Alcohol and Public Health Research Unit University of A uckland Ncw Zealand Consultant Editor: Jo Campling in association with Palgrave Macmillan Editorial matter and selection © MaIja Holmila 1997 Text © Macmillan Press Ltd 1997 All rights reselVed. No reproduction, copy or transmission of this publication may be made without written permission. No paragraph of this publication may be reproduced, copied or transmitted save with written permission or in accordance with the provisions of the Copyright, Designs and Patents Act 1988, or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London WIP 9HE. Any person who does any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages. The authors have asserted their rights to be identified as the authors of this work in accordance with the Copyright, Designs and Patents Act 1988. First published 1997 by MACMILLAN PRESS LTD Houndmills, Basingstoke, Hampshire RG21 6XS and London Companies and representatives throughout the world ISBN 978-0-333-64840-7 ISBN 978-1-349-25854-3 (eBook) DOI 10.1007/978-1-349-25854-3 A catalogue record for this book is available from the British Library. This book is printed on paper suitable for recycling and made from fully managed and sustained forest sources. 10 9 8 7 6 5 4 3 2 1 06 05 04 03 02 01 00 99 98 97 The Ipswich Book Company LId Ipswich, Suffolk Contents List 0/ Tables ix List 0/ Figures x Acknowledgements xi Notes on the Contributors xiii Foreword xiv 1 Introduction 1 Ma7ja Holmila 1. Hann Prevention in Transient Communities 1 2. Preventing or Promoting? 4 3. The Surface Level and the Deep Structure of Community Life 7 4. Reflexive Problem Prevention 8 5. The Lahti Project 10 6. Research Methodologies 14 Part I Loca1 Prevention in Context 21 2 Alcohol Policy, the State and the Local Community 23 Pekka Sulkunen and Jussi Simpura 1. Introduction 23 2. Alcohol and Consumption Risks 24 3. Alcohol Policy and the Modem Trinity of Progress, Universalism and Nationalism 26 4. Modemity, Alcohol and the State in the Nordic Countries 29 5. Globalization and Localization: Bifurcation of Nation-State Politics 34 6. Alcohol-Related Issues in Globalization and Localization 37 7. Future Perspectives 39 3 Constructing Alcohol Problems in the Community 41 Jussi Simpura v vi Contents 1. Introduction 41 2. The Multiple Channels of Problem Construction 42 3. The Culture, Sodal Structure and Public Opinion 46 4. Local Media and Alcohol Issues 48 5. Alcohol-Related Issues in Local Administration and Politics 51 6. Local Civil Action and Alcohol Issues 53 7. Conclusion: Community Action as Problem Construction 54 4 Alcohol and the Imperative of Health in Mass Sodety: Images of Alcohol Policy among the Local Elites 56 Pekka Sulkunen 1. The Public Health Predicament 56 2. Positions and Values 58 3. Control and Transgression 60 4. Three Views on Aleohol Poliey 62 5. Defending the Public Good 65 6. Cultural Intermediaries 68 7. Moral Authority 73 8. Political Ideology versus Individual Choice 74 9. Conclusion: Endotactic versus Exotactic Value Systems 77 Appendix to Chapter 4: The Research and Intervention Methods 81 Jukka Törrönen and Pekka Sulkunen n Part Reflexive Intervention 93 5 The Educational Activities 95 Maria Holmila 1. Introduction 95 2. Major Happenings 97 3. Targeted Happenings 102 4. Produced Materials 103 5. Media Advocacy 104 6. The Content of the Education 106 7. Summary 106 Contents vii 6 Brief InteIVention in Primary Health Care 108 Pelika Sillanaukee 1. Introduction 108 2. The Goals and the Process 111 3. Educating the General Practitioners and the Nurses 113 4. Experiences from the Project 115 7 Responsible Service and Drinking Environments 123 Ma'lja Holmila and Kari Haavisto 1. The Market for Alcoholic Beverages in Lahti 123 2. Violence and Disorder 126 3. The Controversial Responsibility 129 4. SeIVer Training 132 5. Summary 134 8 The Young and Alcohol 136 Ma'lja Holmila and Kari Haavisto 1. SUITounded by Ambivalence 136 2. Playing with the Bottle: Young People's Drinking Habits 137 3. Taking Care: the Street Service Mono 141 4. Activities with the Adolescents 143 5. What Should the Big Ones Do? 150 6. Coordinating the Activities 152 7. Conclusions 152 9 Family and Other Close Persons 154 Ma'lja Holmila 1. The Painful Contradiction 154 2. Who are the Intimate Others? 155 3. The Experiences and Actions of Intimate Others 157 4. Printing Out the Experience 164 5. Group Consultations for Family Members 165 6. The Power of Naming 167 7. Conclusions 169 Partill Assessing the Utility of the Lahti Project 171 10 Process Evaluation 173 Ma'lja Holmila 1. The Evaluative Viewpoint 173 2. The Programme Theory 175 viii Contents 3. The Partidpants' Experience and Ratings: Prevention is Food, Love and Common Sense 176 4. Summarizing the Process 180 11 Outcome Evaluation 183 Marja Holmila and Jussi Simpura 1. Visibility of the Lahti Project in the Local Newspapers 183 2. Reaching the Audience 186 3. Changes in Perception of Alcohol as a Sodal Problem 188 4. Changes in Public Knowledge about Alcohol 190 5. Changes in Drinking Behaviour: Statistics on Alcohol Consumption and Alcohol-Related Harm 195 6. Changes in Drinking Habits: the Survey Data 200 7. Changes in Sodal Response to Alcohol Problems 203 8. Dissemination of the Project Experience 204 9. Conc1uding the Outcome Evaluation 204 Part IV Conclusions: Local Community in Preventive Action 207 Marja Holmila 1. The Community as the Focus of Prevention 207 2. Ideology and Opinions 208 3. Fleeting Communities and Transient Networks 210 4. The Neutral Language of Evaluation 211 5. The Relevant Surface Communities 212 6. Creative, Ritualistic and Emotional 215 Appendix 1 Unemployment Rates 217 Appendix 2 A Guidebook JOT Controlled Drinking 218 ~J"enc~ 225 Index 242 List of Tables 2.1 Centra1 features of the welfare state development and alcohol policy in Finland, 1930-95 31 5.1 The educational activities in the Lahti project 97 8.1 Frequency of drinking, 14-year-olds in Lahti 138 8.2 Frequency of drunkenness, 14-year-olds in Lahti 138 8.3 Number of adolescents arrested for drunkenness 144 8.4 List of youth work activities in Lahti project 144 9.1 Percentage of those who reported having one or more elose people drinking 'too much' 156 9.2 The effects of a elose person's drinking, respondents in Lahti 157 9.3 Harms caused by a elose person's drin king, interviewees in Lahti 159 11.1 The content of drug- and alcohol-related artieles in two local newspapers in Lahti, October 1993-April 1994 184 11.2 Incidence of various alcohol-related diseases in Lahti, 1990-94; in-patients treated in somatic hospitals 199 11.3 Selected alcohol-related hann indicators, Lahti and all of Finland 199 11.4 Abstainers and frequent drinkers in Lahti and three comparison sites, 1992 and 1995 201 11.5 Frequency of heavy drinking: proportion of those drinking six drinks or more per session, Lahti and three comparison sites, 1992· and 1995 201 11.6 Mean values of estimated annual alcohol consumption, Lahti and three comparison sites, 1992 and 1995 (el 100 per cent alcohol) 202 11.7 The proportion of respondents exceeding certain limits on the AUDIT scale, Lahti and three control sites, 1992 and 1995 202 ix List of Figures 1.1 Reflexive eommunity prevention 9 3.1 A sehematie presentation of the loeal and general fields of problem eonstruetion 45 4.1 Causal strueture of argumentation on aleohol policy 66 4.2 Aleohol policy views in Group 6 (Members of the City Council) 75 6.1 General design of the brief intervention study 112 11.1 Do you reeall having seen or heard about the following aetivities in the Lahti projeet? 187 11.2 Do you eonsider alcohol use to be a serious, rather serious or not at all serious problem in Lahti? 189 11.3 Aleohol eontent: one portion. Estimates by frequent drinkers 191 11.4 Harmful level of consumption. Estimates by men and women who drink frequently 193 11.5 Aggregate aleohol eonsumption, Lahti and three comparison sites, 1990-94 198 A.1 Unemployment rates in Lahti, three eomparison sites and all of Finland 217 x

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