STOP-sexual violence: evaluation of a community-based nightlife worker awareness raising bystander training programme.

BACKGROUND: Preventing sexual violence in nightlife environments is a pervasive issue across many countries. This study explored the associated impact of a nightlife worker sexual violence awareness raising/bystander training programme (STOP-SV) on trainees' sexual violence myth acceptance and readiness and confidence to intervene. METHODS: : Pre- and post-test (n = 118), and 3-month follow-up (n = 38) trainee surveys were implemented across three countries (Czech Republic, Portugal and Spain). Paired-sample tests examined changes across time-periods in participants' myth acceptance (e.g. unwanted sexual advances are a normal part of a night out), and readiness and confidence to intervene. Multi-nominal regression was used to examine the relationship between the change in pre-to-post-training scores and trainee characteristics. RESULTS: Compared to pre-training, post-training participants were significantly (P < 0.01) less likely to agree with sexual violence myths, and more likely to be ready and confident to intervene. In bi-variate and multi-variate analyses, we found no significant associations between the change in pre-to-post-training scores and trainee characteristics. Analyses of the small follow-up sub-sample illustrated some positive changes at the post-training and follow-up time-periods (i.e. reduction in sexual violence myth acceptance). CONCLUSION: This exploratory study suggests that the STOP-SV training programme was associated with a decrease in trainees' acceptance of sexual violence myths, and an increase in their readiness and confidence to intervene. Our findings support the case for further implementation and evaluation of awareness raising/bystander programmes for nightlife workers that aim to prevent and respond to sexual violence.

A family systems approach to genetic counseling: Development of narrative interventions.

To what extent are family systems approaches relevant in the genomics era? What difference does it make to remember the wider social context within which 'problems' associated with a genetic diagnosis reside? How does this influence the conversations we have with our patients? These questions will be considered in relation to systemic approaches to genetic counseling practice. Narrative therapy with an emphasis on people's strengths, wishes, and ways of resisting the effects of a problem may be a particularly useful framework for genetic counselors. Narrative practice views people as multi-storied and is concerned with the question of how we encourage people to tell their stories in ways that make them feel stronger. Increased uptake of genomic testing and the number of people seeking genetic counseling present opportunities to consider new ways of working, particularly around support following a new genetic diagnosis. One option is to realize the potential of group interventions. Family therapy and narrative practices have the potential to encourage communication and for families to learn from each other.

Evaluating a genetic counseling narrative group session for people who have tested positive for the Huntington's disease expansion: An interpretative phenomenological analysis.

Huntington's disease (HD) is an inherited neurodegenerative disorder characterized by motor problems, cognitive impairment, and mood disturbances. Given the emotional elements of both HD itself and the testing process for it, psychological interventions may be helpful for those families impacted by HD. A stand-alone genetic counseling narrative group has been offered by one regional genetics clinic in the north of England to support people's coping following predictive genetic testing for HD. Groups are held 4-5 times per year with patients attending a group on a single occasion. This study assessed participants' experiences of attending a group using the qualitative method interpretative phenomenological analysis (IPA). Telephone interviews were conducted with 12 people who had a mutation-positive HD predictive test result and who had taken part in a genetic counseling narrative group session between November 2017 and February 2018. Participants were asked about their experiences of the group and any impact it had had on their lives. Four themes emerged: 'The power of the group, 'Active elements of the narrative exercise', 'Subsequent impact of the session', and 'Another voice'. Participants described the positive impact of being able to meet and empathize with others in a similar situation, the group's positive impact on their mood and future outlook, and its beneficial impact on disclosure. While most participants were positive about the session, the final theme presented the voices of two participants for whom the groups were poorly timed. Given the sessions' generally positive impact, we recommend other centers consider offering people impacted by HD similar sessions.

Duration of Internet use and adverse psychosocial effects among European adolescents.

Despite the significant contributions from previous studies about the prevalence of problematic Internet use (PIU) among adolescents in Europe, important questions remain regarding adverse consequences of PIU. This study aims to assess the relation between duration of Internet use and adverse psychosocial effects among adolescents from six European countries. The final sample included 7,351 adolescents (50.8% male and 49.2% female; mean age: 14.6±1.90) recruited from randomly selected schools within the six study sites. Results showed that 12.9% of adolescents used Internet more than 20 hours per week. There was a significant relationship between duration of Internet use and frequency of alcohol, tobacco, cannabis and other illegal drug use. Duration of Internet use is also significantly associated with school problems, with use of slot machines and with other psychosocial problems. These findings highlight the need to strengthen preventive efforts for reducing PIU and related consequences among adolescents. Key Words: Internet, adolescents, psychosocial problems.

Blood alcohol level tests in nightlife recreational settings as a preventive tool.

BACKGROUND: Getting drunk is a common practice in the nightlife context and is related to risk behaviors. One potentially preventive strategy would be to conduct breathalyzer (blood alcohol content level-BAC) tests in situ, encouraging the young people to take responsibility. The aim of this study is to evaluate the efficacy of such a measure. METHOD: A sample of 555 young people were interviewed in the most popular nightlife recreational areas in three Spanish cities. After they answered to a brief questionnaire, the breathalyzer test was done and they were then informed of the results and also informed about the results, telling them what the maximum authorized rate of alcohol in expired air was for driving. After, they were asked about their drinking intentions for the rest of the night, and if they we going to be driving. RESULTS: Only 21.6% stated that they would stop drinking or drink less, while a similar percentage (21.5%) said they would drink even more than they had intended after finding out their BAC. The logistic regression indicated that the decision to drink more or less was influenced by the BAC level, the amount they had planned to drink prior to the test and high scores on "sensation seeking." Those who decided to drive had lower BAC levels and had planned to drink less prior to the interview. CONCLUSIONS: Prevention strategies involving attempts to change behavior through informing drinkers of their own BAC are controversial, since although for some it leads to their drinking less, in other cases the young people end up drinking more than they had planned.

Health and safety European standards for nightlife venues.

There is growing concern to understand those interventions which when effectively implemented may bring reduction in the harms associated with recreational nightlife venues. Management of drinking environments vary across Europe and we are faced with the need to set standards across European countries. The aim of this study is to present evidence highlighted by literature to a diverse sample of European recreational industry representatives and other key stakeholders (74 participants in 14 European countries), to ascertain their judgements on level of implementation, acceptance, effectiveness and regulation to propose a set of standards be implemented in European recreational nightlife settings. Results revealed that most industry representatives display high rates of agreement with those preventive interventions deemed most important by evidence, including those concerning venue management, underage checkouts, staff training and collaboration with the police. However, participants expressed doubts on further regulation fearing it would mean further obstacles such as added paperwork and costs. Indeed, in countries were night-time economy is not well developed or is already suffering the impact of the economic crisis, we found that nightlife industry is not keen to adopt measures they may perceive to lower their incomes; while in countries where these practices are widely implemented, industry representatives were reluctant for these practices to be regulated or enforced since it would require a higher level of compliance. Regulating and enforcing the standards highlighted both by literature and industry representatives should be a priority to ensure promotion of health and safety in nightlife premises.

[How does family disorganization influence children's drug use? A review]. / ¿Cómo influye la desorganización familiar en el consumo de drogas de los hijos? Una revisión.

It is well known that various aspects of family functioning can influence children's drug use, both by promoting resilience and by increasing the risk of use. This review examines studies published in the last 30 years about the influence of family disorganization on children's drug use. Based on the results, we consider that disorganised families (charactirezed by parents' mental illness, parents' substance use and/or non-intact families) are more likely to have children who are drug users, both legal and illegal. Finally, we stress the need to improve the conceptualization of family disorganization and its assessment, and point out other methodological limitations found in the empirical studies reviewed.

Drinking behaviours and blood alcohol concentration in four European drinking environments: a cross-sectional study.

BACKGROUND: Reducing harm in drinking environments is a growing priority for European alcohol policy yet few studies have explored nightlife drinking behaviours. This study examines alcohol consumption and blood alcohol concentration (BAC) in drinking environments in four European cities. METHODS: A short questionnaire was implemented among 838 drinkers aged 16-35 in drinking environments in four European cities, in the Netherlands, Slovenia, Spain and the UK. Questions included self-reported alcohol use before interview and expected consumption over the remainder of the night. Breathalyser tests were used to measured breath alcohol concentration (converted to BAC) at interview. RESULTS: Most participants in the Dutch (56.2%), Spanish (59.6%) and British (61.4%) samples had preloaded (cf Slovenia 34.8%). In those drinking < 3 h at interview, there were no differences in BAC by gender or nationality. In UK participants, BAC increased significantly in those who had been drinking longer, reaching 0.13% (median) in females and 0.17% in males drinking > 5 h. In other nationalities, BAC increases were less pronounced or absent. High BAC (> 0.08%) was associated with being male, aged > 19, British and having consumed spirits. In all cities most participants intended to drink enough alcohol to constitute binge drinking. CONCLUSIONS: Different models of drinking behaviour are seen in different nightlife settings. Here, the UK sample was typified by continued increases in inebriation compared with steady, more moderate intoxication elsewhere. With the former being associated with higher health risks, European alcohol policy must work to deter this form of nightlife.

Nightlife young risk behaviours in Mediterranean versus other European cities: are stereotypes true?

BACKGROUND: Mediterranean lifestyle has long been hailed as protective against certain risk behaviours and diseases. Mediterranean drinking patterns of moderate alcohol consumption as part of daily life have often been assumed to protect young people from harmful alcohol consumption, in contrast to Northern European drinking patterns. Nightlife environments are strong related to alcohol and drugs use, and other health risk behaviours but few cross-national studies have been undertaken amongst young Europeans frequenting bars and nightclubs. This study aims to understand differences in nightlife risk-taking behaviours between young nightlife users from Mediterranean and non-Mediterranean cultures, including alcohol and illicit drug use, unprotected sex, violence and driving under the influence of alcohol. METHODS: A total of 1363 regular nightlife users aged 16-35 years were surveyed in nine European cities by means of a self-reported questionnaire. Sample selection was done through respondent driven sampling techniques. RESULTS: after controlling for demographic variables, no differences among the Mediterranean and non-Mediterranean samples were found in current alcohol, tobacco, cannabis, or cocaine use, neither in violent behaviours, but Northern people were more likely to get drunk [adjusted odds ratio (AOR) = 0.53], while Mediterranean were more likely to have unprotected sex (AOR = 2.01) and to drive drunken (AOR = 5.86). CONCLUSION: Our data suggest that stereotypes are partially confirmed, and that Mediterranean lifestyle is protective for some risk behaviours (drunkenness, ecstasy and amphetamines current use), but not for all of them. Further research in depth is needed in order to clarify the relations between cultural patterns, social norms and nightlife risk behaviours assumed by the young people.

Breath Alcohol Concentration and Perception of Drunkenness: A Comparison between Adolescents and Young Adults Drinking Alcohol in Public Settings.

Alcohol use is a persisting social and health problem in Spain that often takes place within the recreational context. This study aims to analyze objective and self-reported measures of alcohol use and to assess the potential role of social factors on alcohol intake in open-air public settings. A total of 1475 participants (47.4% women), including 27.8% adolescents organized into 355 natural groups of friends, were interviewed while they were socializing at night in the streets of Palma (Spain). Breath alcohol concentration (BrAC), self-reported measures of alcohol use, and social variables were assessed. Men showed statistically higher scores in BrAC than women. However, adolescents' Alcohol Use Disorders Identification Test (AUDIT) scores were not statistically different by gender. Correlation between objective and self-reported measures was low. Interestingly, BrAC of drinkers was lower when some friends in the group were sober. Moreover, especially in young adults, variables related to the social environment were statistically significant factors to predict BrAC. In conclusion, we found a high prevalence of alcohol intake in young people in open-air public settings, low relationship of objective and self-reported measures, and social factors linked to alcohol use, although differences by age and gender must be considered.

Adolescents' Alcohol Use in Botellon and Attitudes towards Alcohol Use and Prevention Policies.

Alcohol is a common drug misused by young people worldwide. Previous studies have found that attitudes towards heavy consumption are stronger predictors than general norms concerning alcohol. This study aims to explore adolescents' alcohol use and drunkenness, to understand adolescents' attitudes towards alcohol use, drunkenness and prevention approaches, and to explore associations between attitudes and personal alcohol use and demographics. Methods: Cross-sectional face-to-face survey of 410 adolescents (61.2% women) who were socializing at night in the streets of Palma (Spain). Breath Alcohol Concentration (BrAC), self-reported measures of alcohol use and social variables were assessed. Results: 70.7% of respondents had a BrAC score higher than 0. The full sample reported having a mean of 3.9 drunk episodes in the last month, and a mean of 7.34 in Alcohol Use Disorders Identification Test (AUDIT). A total of 30.7% were under the minimum age limit for alcohol drinking in Spain and males showed higher BrAC than females. Bivariate analyses identified some differences in attitudes across participant demographics and personal alcohol use. In conclusion, we found high levels of alcohol use and drunkenness amongst adolescents, and adolescents' attitudes towards drunkenness and prevention approaches were associated with their alcohol consumption as well as with age.

Effectiveness of a Community-Based Intervention to Increase Supermarket Vendors' Compliance with Age Restrictions for Alcohol Sales in Spain: A Pilot Study.

In Spain the legal age to buy alcohol is 18 years. However, official surveys show that minors perceive alcohol availability to be easy. This paper describes the impacts of a community-based intervention to increase vendors' compliance with age limits regarding alcohol sales in supermarkets. The aim of this study was to explore the association between implementation of a multicomponent intervention to reduce adolescents' alcohol use and sale of alcohol to minors in the city of Palma (Spain). Twenty trained adolescents (14-17 years old) conducted 138 alcohol test purchases in nine supermarket chains in August 2018 (baseline; n = 73) prior to the intervention, and again in January 2020 (follow-up; n = 65). Analysis was conducted according to three levels of intervention implemented across the supermarkets: (i) personnel from the supermarkets' Human Resources or Corporate Social Responsibility teams received alcohol service training as trainers (i.e., community mobilization); (ii) managers and vendors training by the capacitated trainers; and (iii) no training of managers or vendors (i.e., control group). In the supermarkets that completed the Training of Trainers and the vendors' training program, average sales decreased significantly from 76.9% in 2018 to 45.5% in 2020, asking for the age of the shopper significantly increased from 3.8% to 45.4%, and asking for proof of age significantly increased from 15.4% to 72.7%. Additionally, a statistically significant increase was observed in the visibility of prohibition to sell alcohol to minors' signs, from 61.5% to 100%. No statistically significant differences were found for the Training of Trainers intervention alone nor in the control group. In conclusion, community mobilization combined with staff training is associated with significant increases in supermarket vendors' compliance with alcohol legislation in Spain.

Improving follow up after predictive testing in Huntington's disease: evaluating a genetic counselling narrative group session.

Recently updated Huntington's disease (HD) predictive testing guidelines emphasise clinicians' responsibility to facilitate emotional support following testing, regardless of the result. Yet models of post-test counselling support are poorly defined. Moreover, it is unclear how these might be best delivered. In this project, a genetic counsellor and clinical psychologist developed standalone group sessions using collective narrative practices for individuals post-predictive testing. Here we present an evaluation of the experiences of one group of six people who have tested mutation positive for HD and remain pre-symptomatic. Two partners also attended the session. Observations, evaluation forms and telephone interviews were used in data collection. Interview data was available from five mutation-positive individuals and one partner. Qualitative data were analysed using a thematic framework approach. Responses were overwhelmingly positive, emphasising the importance of a specifically arranged time and space to share experiences in a structured way. This was typically the first time participants had spoken openly with someone in their situation. Narrative facilitation of discussion encouraged participants to re-discover their strengths and resiliences, with similar experiences being discovered through connections with others. The evaluation was successful in implementing group narrative interventions as part of the predictive test counselling support for Huntington's disease. Participants suggested that the approach could be extended and adopted for other genetic conditions.

Genetic Counselling and Narrative Practices: A Model of Support following a "Negative" Predictive Test for Huntington's Disease.

BACKGROUND: Predictive testing for Huntington's disease (HD) has been available for individuals at risk of HD by direct mutation analysis since 1993. International Predictive test guidelines recommend that support is offered following the result regardless of test outcome. However, there is lack of an evidence base regarding what this support should look like and how it might work in practice. OBJECTIVE: A service improvement initiative looked at the feasibility of offering a narrative group session co-facilitated by a genetic counsellor and clinical psychologist, to individuals who had tested mutation negative for HD. The narrative session was evaluated from the perspective of group participants. METHODS: Individuals who tested mutation negative at a genetic centre in the North of England over a 5-year period were invited to attend a narrative group session. 52 people were contacted and 9 people agreed to participate. Participants completed standardised questionnaires (PHQ-9 and GAD-7) before and after the session and a detailed written evaluation. Participants' comments were analysed thematically. RESULTS: Participants were overwhelmingly positive about the narrative session finding it a safe and enjoyable way to explore difficult life experiences. Reported benefits included feeling less isolated, being inspired by other people's stories and connecting as a group. All 9 participants said they would recommend the narrative session to anyone impacted by HD. CONCLUSIONS: The narrative group session was considered an interesting and useful approach to facilitating adaptation following a negative predictive test result for HD.

Drunk and disorganised: relationships between bar characteristics and customer intoxication in European drinking environments.

Preventing alcohol-related harm in drinking environments is a growing international priority. Factors relating to the physical, social and staffing environments in bars can contribute to increased alcohol consumption and harm. Understanding the relationships between such factors and intoxication in European drinking environments is critical to developing appropriate interventions. We undertook a quantitative observational study in 60 bars in four European cities, in The Netherlands, Slovenia, Spain and the UK (n = 237 observational visits). Using a structured observational schedule, researchers recorded characteristics of the bar environment and rated customer intoxication levels. All physical bar characteristics showed associations with intoxication before interactions between them were controlled for. Hierarchical modelling found significant independent associations between intoxication and use of plastic glassware, promotion of non-alcoholic drinks (often energy drinks), permissive environments, poor washroom facilities, the presence of a dance floor, customer sexual activity/competitiveness and later observational time. Findings suggest that prevention efforts should focus on raising and enforcing managerial standards in bars. While harm reduction measures such as plastic glassware are often promoted for high risk bars, such measures are inadequate to address public health concerns and insufficient to demonstrate social responsibility.