ALLCOOL is a project where a consortium of research and collaborating stakeholders in 3 South European countries (Portugal, Spain and Italy) aim to tackle the growing trend of Heavy Episodic Drinking (HED) in the region. More research is needed to analyse the relationship between HED and lower socio-economic youth and young adults (15-30 years old). This is particularly relevant in Southern European countries going through a socioeconomic crisis, with increasing unemployment rates especially among recently graduated students and decreasing family income. By promoting healthy lifestyles, filling research gaps and implementing innovative and replicable local interventions focusing on prevention of heavy episodic drinking among youth this project will: 1) promote good health among EU youth population; 2) in the long-term, contribute to the sustainability of the health systems and healthy work forces.
To achieve this, this project intends to conduct research at the local level (WP4) that will be later compared in order to understand the local, national and south European similarities of drinking patterns, context and policy. The research results will be crucial for the development of local interventions, and produce the necessary knowledge about HED in Southern Europe, especially among low-income and unemployed young adults. This project expects also to empower and raise awareness about binge HED, especially among low-income groups, both on a local and European level. This will be done through the creation of 3 local consultative forums, the production and dissemination of local, national and European recommendations to inform comprehensive HED policy measures, in line with WHO Global Strategy to reduce harmful use of alcohol (WP25. Intervention pilots will also be implemented on a local level, in order to design and experiment adapted and effective approaches to intervene on HED, especially among low income youth and unemployed graduated young adults (WP6).
ALLCOOL – Raising awareness and action research on Heavy Episodic drinking (HED) among low-income youth and young adults in Southern Europe is a project that is being implemented in Portugal, Spain and Italy, since May 2016. This project elects as its main priority HED phenomena, namely to contribute to a better understanding of this complex drinking pattern in order to inform comprehensive interventions and policies.
Heavy Episodic Drinking is a challenging phenomenon that can be found widely in several groups of the general population, however it is the main drinking pattern found in youth and young adults (WHO, 2014). This pattern of alcohol use is growing among adolescents and young adults, mainly in low-income countries and in western societies. This is related with an active search for pleasure and disinhibition and in some cases to self-medication. Social pressure induced by night time economies, beverage promotions and peer pressure are also important predictors for HED (Kuntsche et al., 2004; WHO, 2014; Bartoli, 2014; Devaux & Sassi, 2015). Although there seems to be no clear pattern between alcohol consumption and socio-economic status in adolescents (Hanson, 2007) low-income youth and unemployed in adult populations seem to be an important predictor of HED among adults (Kuntsche et al., 2004). On the contrary, employment, marriage and parenthood can function as protective factor for HED in adulthood (Kuntsche et al, 2004; Jager et al., 2015).
Socioeconomic status is also associated with specific harms on alcohol use. Population-wide rates of drinking of alcoholic beverages are markedly lower in poorer societies than in wealthier ones. However, for a given amount of consumption, poorer populations may experience disproportionately higher levels of alcohol-attributable harm (WHO, 2010:7).
Acute and chronic alcohol-related mortality seem to be predicted by socio economic status (Makela, 1999). Also low-income people showed stronger associations between unfair treatment and depressive symptoms and between depressive symptoms and heavy drinking (Mulia & Zemore, 2012).
Considering this and the challenges that Europe and particularly Portugal, Spain and Italy face nowadays in what concerns financial and social crisis, ALLCOOL aims to integrate research, intervention and policy tools in order to contribute to produce knowledge and effective responses on the phenomena. By addressing economic dimensions of HED in different contexts ALLCOOL is also addressing a cluster of social problems that result from economic crisis.
The research component of the project (WP4) was implemented in order to understand regional, national and south European similarities and differences. This research dimension is considered crucial to the development of local interventions, and is contributing to increase knowledge on HED in southern Europe, especially among low-income and unemployed youth and young adults. Another project aim is to empower and raise awareness about HED, especially among low-income groups, both on a local and European level. This is being achieved through the creation of 3 local consultative forums, the production and dissemination of local (regional and national) and European recommendations to advice comprehensive HED policy measures, in line with WHO Global Strategy (WP5). The project includes also the design and implementation of pilot interventions at a local level (WP6), according with the data collected in the research and with the inputs of the consultative forums. In order to be effective in reaching strategic stakeholders and to increase the range of its outputs, the project includes a dissemination plan (WP3) targeting researchers, ONGs, Health services, social, health and education professionals and decision-makers. Evaluation (WP2) and contributions from the external evaluator will be essential to motorize the project´s implementation and its processes, identify conflicts and problems in useful time, and to
The main objective of this project is to contribute for the reduction of alcohol-related harms among low-income youth and unemployed graduated young adults. Given the complex dynamics underlying this aim, one of the major concerns of AllCool project is to promote the close articulation between research, intervention and policies. In this sense, AllCool combines the articulation between 4 main methodologies: (i) action-research, (ii) networking, (iii) non formal education through training and (iv) informal education through consultative forums and harm reduction interventions.
Action-research (AR) is a methodology that combines three fundamental dimensions of action: technical, scientific and political action. Action research is an intervention that aims "to make scientific discoveries and to solve practical problems" (Clark, 1997 cit in Ho, S. 2002) allowing not only to contribute to the resolution of practical problems, but also to increase knowledge of the phenomena. Networking with local stakeholders is considered a good practice for assessing both local roots design, and promote the availability of services tailored to users / customer’s needs (Correlation Network, 2011). This is a comprehensive and integrated approach (Canario, 2008) that can be considered an appropriate and efficient interventional strategy for the success of a project in a given area / community. Non-formal education is defined as “any organized educational activity outside the established formal system - whether operating separately or as an important feature of some broader activity - that is intended to serve identifiable learning clienteles and learning objectives” (Branco, Valente, Vale Pires, Mora, & Soares, 2014, p.11). Informal education “is a truly lifelong process whereby every individual acquires attitudes, values, skills and knowledge from daily experience and the educative influences and resources in his or her environment” (Branco et al., 2014, p.11). Other strategies concerning AllCool methodologies, as snowball sampling, mixed and multi-sited research, are being also implemented in order to enhance the project participation and a deep understanding of HED consequences and prevention strategies.
Additionally, all activities of the project are being conducted using a participative methodology framework. This requires a close communication and horizontal relationships between the partners and all the stakeholders that work in the project. It is expected that the combination of different participatory methods will ultimately contribute to the design of humanistic and effective practices and policies at the European level.
The timetable of the project has been fulfilled and the activities conducted in the first year of the project were achieved. During this first year of the project 13 deliverables were uploaded, 3 Project meetings conducted, 8 skype meetings, 4 scientific presentations, 1141 questionnaires collected and analysed, 6 focus groups with a total of 48 participants, 3 group interviews gathering 15 professionals and 12 consultative forums were conducted. A brief description of the tasks conducted so far in each WP will be further described:
1. WP1 - Project Management and Coordination:
• Administrative management - on-going
Development of technical and financial reports to the European Commission. So far, technical part (periodic technical report, summary for publication update and the amendment to the gran agreement) and financial report were conducted in the middle of the implementation period.
• Project monitoring - on-going
With the support of the coordination of the project all partners developed project work plan concerning the activities outlined in the WP they were leading. In this sense 4 Work plans were developed:
- WP2- Evaluation Plan (D2.1)
- WP3- Allcool Communication Plan (D3.2);
- WP4- Desktop research guidelines (D4.1)
- WP5 – Consultative Forums Work Plan (document not required for uploaded but included in the annexes of the technical intermediate report)
- WP6- Guide for intervention (D6.1)
Additionally for coordination purposes a monitoring schedule with a brief description of activities per stakeholder and for the external evaluator was also developed. Considering the number of deliverables, activities and outputs of the project, this tool together with the timeline helped the monitorization process.
• Supervision and support to WP coordinators and monitoring of the project progress and work flow - on-going - These tasks were achieved through 4 face-to-face meetings (3 PMs and 1 with external evaluator, and implementer coordinators from APDES and from SPORA), Skype meetings (8 Skype meetings: 3 for addressing coordination’s tasks 9.06.2016, 28.03.2017, 26.06.2017, 1 for external evaluation tasks - 2.06.2017 and 4 research field monitoring meetings- further developed on WP3 description). Email exchange occurred at least every two weeks.
Considering the frequency of contacts conducted with the project leaders, members of the team and with the external evaluator in the 1st year of the implementation of the project (note that 3 from the 4 project meetings occurred in the 1st of year of implementation, plus the skype meetings and the emails exchanged) and the amount and complexity of work that each partners had to implement in this first year of the project, we didn´t ask for internal reports for considering that they wouldn’t added greater additional information for the monitoring process. Instead a more closed monitoring process, responding to real time needs of partners both for technical as for financial issues. Workflows were managed during PMs and Skype meetings.
• Coordination of the project products,
All the deliverables and project products were conducted with a close support from the Allcool implementation coordinator. All documents were revised and sent back to partners when needed for revision purposes. Also, the coordination uploaded all the deliverables in the CHAFEA system.
• Preparation, organization and report of 3 Project Meetings (M2, M7, M13)
This included previous discussion topics of the agenda, logistic concerning PM organization, and minutes of the meeting. The steering committee meetings occurred at the same time considering that coordination and implementation tasks were integrated and debated in all PM. Additionally, with the exception of the Italian partner, there were always the coordinator and at least one member of the team.
• Management of conflicts risks and eventual lack of agreement in certain specificities of the project were fully resolved through horizon
So far the main outputs of the project are directly associated with the deliverables produced and milestones achieved. Main outputs will be analysed regarding main impacts already achieved and used by the target groups of the project.
The project consortium has been actively involved in managing and working on local and European networks. This was achieved through online and offline meetings, contacts with stakeholders during consultative forums and dissemination activities. Also, networking skills with researchers, technicians and decision-making actors were enhanced through national and international presentations. Deliverables produced in the scope of the research domain of the project, presentation of results, the intervention guide and time invested (with stakeholders and partners of the consortium, namely in the short skills building session) discussing tailored interventions that respond directly to the target group needs and to local specificities (namely to develop responses that are not being implemented by other projects or stakeholders) are considerable outputs of the project. For researchers these participatory methodology seems to be of grater value and the feedback given from presentations from this key actors is that Allcool results can give important contributions for bridging the gap between research, decision making and interventions on heavy episodic drinking. Additionally, by calling individual and social dimensions for explaining the phenomena, by implementing a study that include similarities and differences between countries in South Europe, this project has the potential to inform public policies at National and European levels. Nevertheless, the advocacy domain of the project will be more prominent during the 2nd year of implementation.
For local communities, these project aims to provide sustainable and consequent networks. In the consultative forums for instance is interesting to assist that contacts and discussions were not strictly limited to the activities of the Allcool project. People discuss intervention methods, evaluation tools, domains, levels and modalities of intervention, prevention, treatment or harm reduction frameworks. Besides the enriching exchange of experiences on intervening on alcohol use, networking skills seem to be major outputs for local communities and stakeholders. So far, there are non-results regarding pilot interventions and outputs for low income and unemployed graduated young adults to report.
In what concerns decision makers and politicians, although the activities planned for advocacy domain, namely on raising awareness on alcohol related harms among low-income youth and unemployed graduated young adults, are formally more intensive on the last semester of the project implementation, impact on decision makers could be already achieved through stakeholders from consultative forums that work on local municipalities, law enforcement, and on health authorities.
Although there are deviations concerning the pre-established timetable (see amendment to the grant agreement), outcomes are being achieved as expected.
In what concerns the project consortium, the following outcomes are in process or were fully achieved:
i) Increase of professional skills and confidence in managing and working in European partnership
ii) Design and implementation of innovative interventions on a local level, namely in what concerns the development of a tailored intervention locally adapted to the contingencies and specificities of each city of the consortium, this has been achieved through a close articulation between action research, communitarian intervention, consultative forums and interventions. This outcome was also enhanced through the short skills building session implemented with partners during the 3rd PM in Porto.
iii) Increased professional skills in articulating research with implementation and advocacy – enhanced by scientific presentations of project results, close articulation and intensive communication with consultative forums stakeholders and project outputs dissemination through website, social media and newsletters.
Considering the strong commitment with research, the project aims to increase knowledge on alcohol use, alcohol related harm, on health and social determinants. In this sense awareness on alcohol related harms, risk behaviours, consequences of HED, intensity of HED and gender, age and social position differences were already achieved. Scientific presentations and scientific papers will maximize this outcome.
Given the strong commitment with the Allcool project with communitarian intervention and on the empowerment communitarian key actors, major outputs of the project concern local communities. The following outcomes were or are being presently achieved:
i) Empowerment and capacitate local community to identify monitor and intervene on HED- namely on consultative forums meetings where discussion on research outputs, pilot intervention and exchange of best practices by stakeholders were promoted.
ii) Capacitate strategic local stakeholders to act on HED, namely in the present moment where a small group of stakeholders are involved in the design, implementation and evaluation of the pilot intervention to be implemented locally.
iii) Awareness on alcohol related harms among low-income youth and unemployment graduated young adults in regional, national and European decision makers and politicians. This outcome will be more fully achieved during the second year of the Allcool implementation since the advocacy work with decision makers on national and European level will be more intensive and consequent. So far, the main advocacy activities concerned the presentations and discussion of main research outputs during consultative forums and presentation of Allcool project to national meetings such as the national presentations conducted on the Portuguese National Forum on Alcohol and Health and the two presentations conducted in Check!n Lx Seminar, Lisbon, Portugal. In this two events decision makers from the Portuguese National Health department and drug and alcohol use were present. As previously stated, a list of events and policy meetings will be particularly useful for improve the project outputs and disseminate results for decision makers at national and European level.
iv) Capacitate local stakeholders with networking skills. As stated on the 3rd PM minute, Consultative forums are considered by all partners of the consortium “as excellent tools for implementing interventions that respond to the specific needs of the target groups. Partners presented several examples that showed the importance of this meeting for producing synergies between projects that are already working on the field.” In this sense CF serve as an excellent network tool that works at local level (by maximizing contacts exchange between stakeholders and projects), at national level (because this tool
As previous stated dissemination activities/tasks were carried out by all partners, being the partner AUSL responsible for leading the WP. So far dissemination activities included the production of the Allcool Communication Plan (D3.2), the logo and the visual identity manual (D3.1), the website and social media tools (D3.3) (website, Facebook, twitter). Additionally, all partners have been actively involved in making contributions for increasing dissemination outputs, based on activities conducted in research (scientific presentations, reports, national and comparative data analysis), consultative forums, coordination (project meetings) and on communication activities (newsletters). Additionally, external activities, such as scientific events, and papers associated with heavy episodic drinking were also disseminated through social media. So far there was produced: 2 newsletters sent to 6104 emails, website with 400 visitors, facebook page with 709 "likes” and 50 posts, twitter with 113 tweets.
Additionally there were dissemination activities produced by all partners that were not planned in the grant agreement but added value to the project. A total of 4 scientific presentations already presented and 1 accepted for presentations so far; 2 scientific publications already accepted and 3 national data reports produced in National languages. A list of events and policy meeting is already being prepared in order to disseminate results for decision makers at national and European level.
The evaluation tasks are under the responsibility of all partners and the external evaluator with the leading role of the WP attributed to SPORA.
So far, the deliverables produced were: the evaluation plan (D2.1) and its revision, the evaluation intermediate report (D2.2) and evaluation tools developed in collaboration with the consortium partners, such as the project meetings evaluation questionnaire, consultative forums questionnaire and SPSS base for inserting data. All required documents to conclude the reports were sent to the external evaluator (deliverables, data bases, minutes of the consultative forum meeting, list of attendees and additional data that partners considered important for the report).