Denise Leite Vieira, MSc Psychologist Alcohol and other Drugs Research Unit - UNIAD Federal University of São Paulo - BRAZIL Denise Leite Vieira, MSc Psychologist Alcohol and other Drugs Research Unit - UNIAD Federal University of São Paulo - BRAZIL International Alcohol Enforcement Seminar Falls Church, Virginia November , 2005 International Alcohol Enforcement Seminar Falls Church, Virginia November , 2005 Restricting Hours of Sale,Diadema Effects on Homicides and Assaults on Women Restricting Hours of Sale,Diadema Effects on Homicides and Assaults on Women by Sergio M. Duailibi*, Ronaldo Laranjeira*, by Sergio M. Duailibi*, Ronaldo Laranjeira*, William Ponicki, Joel W. Grube, John H. Lacey by Sergio M. Duailibi*, Ronaldo Laranjeira*, by Sergio M. Duailibi*, Ronaldo Laranjeira*, William Ponicki, Joel W. Grube, John H. Lacey

ALCOHOL POLICY Basic principle: Environmental interventions are more powerful than those focused on the individual Price Place Product Promotion

ALCOHOL POLICY Municipal Interventions Advantages: 1.More flexible 2.Greater mobilization and community support 3.Easier to visualize benefits 4.Easier to expand 5.Easier to evaluate

SÃO PAULO, BRAZIL EXPERIENCE Public Policies Project – FAPESP –Paulínia –Diadema

PURPOSE OF THE STUDY Can Restricting Hours of Sale Policy prevent homicides in Diadema? Can Restricting Hours of Sale Policy prevent violence against women in Diadema?

ALCOHOL REGULATION : HISTORICAL Diadema population: 383,064 inhabitants (2004-IBGE) Total area : 30.7 km² Annual population growth rate : 2.48% Population economically active : 215,000 inhabitants Commercial and industrial activity Low income population: less than US $500.00/year

ALCOHOL REGULATION : REASONS Diadema violence: 1999 = 374 homicides (the highest Brazilian’s homicides rate) Violence against the woman: high prevalence (especially after 11:00 pm) % of homicides occurring from 9:00pm to 6:00am Alcohol and Teens: high rates of car accidents, gangs violence and riots

ALCOHOL REGULATION Ordinary Municipal Law n° (03/13/2002) In force since 07/15/2002 Art.1: it has been established permitted working hours of alcohol outlets from 6:00 am to 11:00 pm Alcohol outlets: any place where alcohol is sold and allows local consumption

ALCOHOL REGULATION If there is any public interest, special authorizations shall be emitted to extend the working hours. Besides that, there’s need for hygiene and safety conditions – public and personal – to prevent violence by: # Sanitary license # Compliance to environmental law/sound # Fire Department audit and authorization

ALCOHOL REGULATION No kind of working permit will be emitted to any liquor store, deli, pub, bar, etc, that is located less than 300m from public or private schools

ALCOHOL REGULATION : INTRODUCTION AND POPULARIZATION Released in the local news, radios and through educational pamphlets and brochures to the community. Bar owners, consumers and community leaders got the information previously High level of receptivity and participation of the community (82% of approval before the intervention and more than 90% of approval after 1 year) After 3 years 88% of approval

ALCOHOL REGULATION : ENFORCEMENT Enforcement: local police First time caught: warning Second time: US $ fee/ticket Third time: US $ fee/ticket and working permit license temporary suspense. Fourth time: Working license canceled Anonymous call:

CONCLUSION The implementation of more restrictive sales hours was related to a significant reduction in homicides rates in Diadema, Brazil.  Overall, it is estimated that restricting sales hours saved 273 lives in the 24 months following implementation.  An estimated 224 assaults on women were prevented, although the 95% confidence interval for this estimate was large (-66 – 514) and the effect was not statistically significant.  The lack of effects on assaults on women may be due, in part, to the relatively short time series and the high variability of the data.  Although alcohol availability theory predicts decreases in consumption and concomitant problems following increased restrictions on hours of sales, previous research has been inconclusive.

CONCLUSION In some studies, changes in hours of sale have been associated with changes in problems, including assaults (Chikritzhs & Stockwell,2002), fatal traffic crashes (Smith 1988a), and intoxication (Voas, Lange, & Johnson, 2002). Other studies have found no effects of changes in sales hours (Bruce, 1980; McLaughlin & Harrison-Stewart, 1992; Smith, 1988b). The effects of restrictions on hours of sale may be greatest when they represent a substantial environmental change as was the case in the present situation. Relatively minor or temporary changes may have no or minimal effect. Effective enforcement is probably a key element.

CONCLUSION: SUCCESS FACTORS Inicial problems assessment Precise data recording Politics decision in response to these problems Public divulgation and law community support Alcohol sellers guidance Daily and active enforcement Progressive administrative penalties

ALCOHOL POLICY: NEXT STEPS IN DIADEMA Political uniformity in neighboring cities Drinking and Driving Enforcement of purchase age limit of 18

Alcohol Control Strategies: Effective Public Health Education Strategies for Changing Social Norms 1.Rely on research epidemiology. 2.Develop a strategic plan to educate society incrementally and sequentially. 3.Stay on message. 4.Utilize mass media. Slide by Robert Reynolds

Implementing Alcohol Control Strategies in Brazil A.Strengthen alcohol surveillance systems 1.Epidemiologic surveys: household, school, roadside, emergency room, special events, alcohol sales and service practices, industry marketing, etc. 2.Increase expertise in behavioral health research methods and analysis. 3.Create and staff a Brazilian alcohol research center and develop an integrative and multi-disciplinary research strategy. Slide by Robert Reynolds

Implementing Alcohol Control Strategies B.Establish a Brazilian technical assistance center for implementation of alcohol control strategies 1.Organize services by problems, not by control policies (violence, youth drinking, traffic safety, noise and neighborhood disruption, etc.) 2.Local communities are the first priority for services. 3.Develop and implement a public health education strategy to change social norms. 4.Respond quickly to “unscheduled opportunities”. Slide by robert Reynolds

Implementing Alcohol Control Strategies C.Increase enforcement of existing alcohol control policies. 1.Public health and law enforcement are not traditional allies – build relationships! 2.Support creation of law enforcement units which specialize in enforcement of alcohol laws. 3.Document, and then acknowledge publicly, the results of alcohol law enforcement. Slide by Robert Reynolds

Other cities in Brazil that took a step forward regarding Alcohol Policies: Barueri, Embu, Embu-Guaçu, Ferraz de Vasconcelos, Itapecirica da Serra, Itapevi, Jandira, Juquitiba, Mauá, Osasco, Poá, São Caetano do Sul, São Lourenço da Serra, Suzano, Vargem Grande Paulista

The Pacific Institute for Research and Evaluation (PIRE): * Robert Reynolds*Bill Ponicki, Ph.D. Director, Alcohol Policy InitiativesSenior Researcher, Calverton, Maryland Prevention Research Center Berkeley, California *Joel Grube, Ph.D. *John Lacey Director, Deputy Director, Prevention Research Center Public Services Research Institute Berkeley, California Calverton, Maryland NIAAA grant #AA06282 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) FAPESP - Ref. Processo: 01/ PROGRAMA DE PESQUISAS EM POLÍTICAS PÚBLICAS Alcohol and other Drugs Research Unit - UNIAD Federal University of São Paulo -UNIFESPwww.uniad.org.br THANKS TO:

REFERENCES Bruce, D. (1980). Changes in Scottish drinking habits and behavior following the extension of permitted evening opening hours. Health Bulletin, 38, Chikritzhs, T. & Stockwell, T. (2002). The impact of later trading hours for Australian public houses (hotels) on levels of violence. Journal of Studies on Alcohol, 63, McLaughlin, K. L & Harrison-Stewart, A. J. (1992). Effect of a temporary period of relaxed licensing laws on the alcohol consumption of young male drinkers. International Journal of the Addictions, 27, Smith, D. I. (1988a). Effect of casualty traffic accidents of the introduction of 10 p.m. Monday to Saturday hotel closing in Victoria. Australian Drug and Alcohol Review, 7, Smith, D. I. (1988b). Extended alcohol trading hours during the 1982 Brisbane Commonwealth Games and traffic accidents. Australian Drug and Alcohol Review, 7, Voas, R. B., Lange, J. E., Johnson, M. B. (2002). Reducing high-risk drinking by young Americans south of the border: The impact of a partial ban on sales of alcohol. Journal of Studies on Alcohol, 63,