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Health and Safety European Standards for nightlife venues

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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.
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Resumen Abstract
355ADICCIONES, 2012 · VOL. 24 NÚM. 4 · PÁGS. 355-364
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.
Key words: prevention, nightlife venues, standards, Europe.
Existe una preocupación creciente por comprender aquellas intervenciones
que, cuando son aplicadas de forma efectiva, pueden conllevar la reduc-
ción de los daños asociados a los locales recreativos nocturnos. La gestión
de los entornos donde se consume alcohol varía en toda Europa y nos
enfrentamos a la necesidad de establecer normas comunes en todos los
países. El objetivo de este trabajo es presentar la evidencia destacada por
la literatura a una muestra diversa de representantes de la industria euro-
pea del ocio recreativo y a otros representantes clave (74 participantes
de 14 países europeos), para conocer sus apreciaciones sobre el nivel de
aplicación, aceptación, eficacia y regulación de un conjunto de estánda-
res para su implementación en la vida recreativa nocturna en Europa. Los
resultados revelan que la mayoría de los representantes de la industria
muestran altos niveles de acuerdo con aquellas medidas preventivas des-
tacadas como más importantes por la evidencia, incluyendo la gestión de
los locales, el control de acceso de menores, la formación del personal y
la colaboración con la policía. Sin embargo, los participantes expresaron
dudas sobre una mayor regulación por temor a que significara más obs-
táculos tales como papeleo adicional y costes extra. De hecho, en países
donde la economía nocturna no está muy desarrollada o está sufriendo el
impacto de la crisis económica, encontramos que la industria recreativa
no está dispuesta a adoptar medidas que temen puedan reducir sus ingre-
sos; mientras que en los países donde estas prácticas están ampliamente
implementadas, los representantes de la industria se muestran reacios a su
regulación o a una aplicación más estricta de la ley, ya que requeriría de
un mayor nivel de cumplimiento. Regular y exigir el estricto cumplimiento
de los estándares destacados tanto por la literatura como por los repre-
sentantes de la industria debe constituir una prioridad para garantizar la
promoción de la salud y la seguridad en los locales de ocio nocturno.
Palabras clave: prevención, ocio nocturno, estándares, Europa, locales
recreativos.
recibido: Enero 2012
aceptado: Junio 2012
Estándares europeos en salud y seguridad para los locales
de ocio nocturno
Health and Safety European Standards for nightlife venues
AmAdor CAlAfAt*; mAriAngels duCh*;
montse JuAn*; niColA leCkenby**
* European Institute of Studies on Prevention (Irefrea).
** Centre for Public Health, Liverpool John Moores University
Enviar correspondencia a:
Amador Calafat.
European Institute of Studies on Prevention.
Rambla, 15, 2º, 3ª. 07003 Palma de Mallorca (Spain).
irefrea@irefrea.org
ORIGINAL
356 Estándares europeos en salud y seguridad para los locales de ocio nocturno
It is well documented that a large amount of alcohol and
illicit drug use among young people in Europe occurs
whilst engaging in night-time recreational activities, such
as visiting pubs, bars or nightclubs (Fountain, & Griffiths,
1997, Hughes et al., 2011). Research has suggested that
young Europeans devote between three and seven hours on a
single weekend night to leisure pursuits of this kind (Calafat
et al., 1999; Hughes et al., 2011). While a thriving nightlife
economy can have important benefits to local areas in terms
of employment, regeneration, social wellbeing and tourism,
a wide range of health and social problems are linked to
recreational nightlife activities, including drunkenness, drug
use, unintentional injuries, violence, risky sexual behaviour
and driving under the influence of alcohol and illicit drugs
(Wickham, 2012, Hughes et al., 2011).
In recent years, efforts have been made by researchers
to understand those interventions, which when effectively
implemented, may bring about a reduction in the harms
associated with nightlife environments such as violence and
driving under the influence. The literature generally concludes
that these interventions show limited effectiveness, mostly
due to implementation problems. Indeed, Ker & Chinnock
(2008) carried out a Cochrane review of interventions
designed to prevent injuries related to alcohol and drug use
in recreational nightlife that revealed limited effectiveness
of these interventions due to a lack of compliance on the
implementation of such interventions, often associated with
low wages, frequent staff changes, or workplace stress.
Consequently, unless such interventions were mandatory, or
incentives were given to increase compliance, their efficacy
in reducing the negative health outcomes associated with
nightlife recreational activities showed little effects (Ker, &
Chinnock, 2008).
Calafat and Juan (2009) identified 11 different approaches
to prevention in nightlife. Traditionally, the most prevalent
intervention in Europe and elsewhere has been providing
information on harm reduction to young people. However
there has been little assessment on their effect on patrons’
intoxication levels and their effectiveness in improving health
and safety would be greatly reduced unless combined with
other types of interventions (Graham, 2000). More recently,
the most widely implemented interventions have included
Responsible Beverage Service (RBS), training of door staff
(a component of RBS) and designated driver programmes, in
addition to the well known information-based interventions
promoting responsible drinking or explaining individual harm
reduction strategies. Additional important approaches include
enforcement of regulation and community participation in
prevention activities.
A systematic review identifying the environmental
factors associated with alcohol use and related harm in
drinking venues (Hughes et al., 2011) highlighted that the
management of drinking establishments and the behaviours
of the young people who use them vary widely across Europe.
While international research shows that environmental
factors can have an important influence on alcohol-related
harm in drinking venues, there is currently a scarcity of
knowledge on the relevance and impacts of such factors
in modern European settings. The authors commented that
developing this knowledge will support the implementation of
strategies to create drinking environments in Europe that are
less conducive to risky drinking and alcohol-related harm. A
further review examining the effectiveness of interventions
aimed at the prevention of harmful drug and alcohol use
in nightlife settings concluded that both server training
interventions and policy interventions could have a beneficial
effect on alcohol-use-related problems. In line with Calafat
and Juan (2009), community interventions in which a
combination of approaches, such as enforcement activities
are implemented, were seen as facilitating preventative
factors (Boiler et al., 2011). However, the authors do warn
that some widely promoted preventive interventions, such as
pill testing projects and educational activities by experienced
peers, have not yet been adequately evaluated through
experimental designs. Furthermore, Akbar et al. (2011) notes
that whilst most studies focus on alcohol, very few focus on
illicit drug use. Although recreational nightlife is clearly a
hegemonic phenomenon, in accord with the aforementioned
reviews, Akbar et al., (2011) draw attention to the lack of
European studies in this field; 86% of the studies identified in
this systematic review were interventions targeted at training
service staff who may refuse to serve alcohol to intoxicated
individuals, and a multi-component model was recurrent
in the majority (58%) of initiatives. However, the authors
concluded that the heterogeneity of the measures used to
determine the effectiveness of implemented interventions
makes comparisons between such strategies in order to
determine best practices difficult.
The publication of numerous reviews into interventions
designed to promote health and safety in nightlife settings over
a short time frame indicates that this is a field attracting great
attention across Europe. Although all of the above mentioned
problems exist such as scarcity of evaluation on implemented
interventions, data is becoming available and that will allow
us to identify research needs and work towards the creation
of European standards and guidelines for harm reduction in
European nightlife venues. Indeed, the European Action Plan
on Drugs 2009-2012, agreed by the EU member governments,
stipulated that the European Commission should develop an
EU consensus of minimum quality standards in reducing drug
demand. This interest is also shared beyond Europe; 2011
saw the publication the Portfolio of Canadian Standards for
Youth Substance Abuse Prevention, published by the Canadian
Standards on Substance Abuse (CCSA) and the European
Drug Prevention Quality Standards - A manual for prevention
professionals (Brotherhood and Sumnall, 2011), published by
the European Monitoring Centre for Drugs and Drug Addiction
(EMCDDA) . Other international organisations such as the
Inter-American Drug Abuse Control Commission (CICAD), the
National Institute on Drug Abuse (NIDA) and the United Nations
Office on Drugs and Crime (UNODC) have also published their
guidelines on drug prevention and reducing drug demand.
With regard to promoting health and safety in recreational
venues, we are faced with the need to set standards, best
practices and guidelines to be implemented in Europe, based
on the available evidence summarised above. The EMCDDA
357
Amador Calafat, Mariangels Duch, Montse Juan, Nicola Leckenby
(http://www.emcdda.europa.eu/publications/glossary) has
defined quality standards as ”generally accepted principles or
sets of rules for the best/most appropriate way to implement
an intervention”. Frequently they refer to structural (formal)
aspects of quality assurance, such as environment and staff
composition. However they may also refer to process aspects,
such as adequacy of content, process of the intervention or
evaluation processes. Standards provide tools to professionals
and policy makers for selecting the best practices. Guidelines
are typically based upon systematic reviews of the literature.
They often contain detailed step-by-step instructions
(guideline recommendations) regarding the best option for a
certain condition (e.g. how to respond to specific needs of
the target population). The European Drug Prevention Quality
Standards distinguish between ‘guidelines’ and ‘quality
standards’ (Brotherhood, & Sumnall, 2011).
The aim of the present study is: i) to carry out an
empirical study; and, ii) to propose a set of standards to be
implemented in European recreational nightlife settings.
Which will, according to the existing literature, reflect
relevant and efficacious components of interventions. We
will also add information on their level of implementation by
the recreational industry in practice, their legal status, their
acceptability by the industry itself, in addition to considering
the cultural sensitivities of the European countries explored
which may affect the implementation of such standards.
Furthermore, we will investigate whether any geographical
differences are present across Europe in the acceptability
of, and opinions about, nightlife health and safety standards,
enforcement of regulations, and the training given to nightlife
staff.
Method
Scientific empirical evidence gathered from the
literature review was examined and presented to a diverse
sample of European recreational industry representatives
in order to ascertain their judgements with respect to
the effectiveness, utility, implementation and regulation
of standards/ guidelines to promote health and safety in
European nightlife settings. Evidence was also presented to
other key stakeholders working in the field for comparison.
Research was also designed to investigate potential cultural
sensitivities surrounding personal privacy which may arise
with certain activities, such as CCTV monitoring, random
checks of toilets or drugs checkouts.
Participants
In each participant city1, between five and ten key
professionals working in the field were contacted via
1 Ljubljana (Slovenia), Liverpool, London and Huddersfield (UK), Palma
(Spain) , Coimbra and Lisbon (Portugal), Luxembourg (Luxembourg), Prague
(Czech Republic), Timisoara (Romania), Vienna (Austria), Cork (Ireland), Milan
and Belluno (Italy), Budapest and Nyiregyhaza (Hungary), Ghent (Belgium),
Stockholm (Sweden) and Piraeus and Patras (Greece)
telephone or letter to explain the purpose of the study and
invite them to participate. Representatives of recreational
industry umbrella organizations were contacted to facilitate
access to the industry representatives, mainly managers
and/or owners of popular mainstream venues frequented
by youngsters. The selection of cities and key informants
in each city relied on the Club Health project teams in each
participating country. All participant cities were selected
because of their vibrant nightlife. Venues associated with a
particular music scene, such as rap music, were avoided, as
this may bias the results towards more conflictive contexts.
Over 120 potential informants were contacted. A total of
89 questionnaires were collected; of those, 15 were not
processed due to incompletion and/or lack of consistency
due to comprehension problems. Of the remaining
74 participants, 84% were industry representatives
(representatives of umbrella organizations, club managers/
owners, bar managers/owners, club/event promoters),
and the remaining 16% where completed by the other key
stakeholders including policy makers, police representatives
and public health representatives (see Table 1).
Procedures / delivery
Whenever possible, representatives of the teams visited
the key stakeholders to complete the questionnaire by
interviewing the informant (to ensure comprehension of the
items listed and increase the reliability on data collection).
However, in some cases, due to the irregular working hours
of industry representatives, questionnaires were self-
completed. An interview protocol was prepared in advance
to ensure all researchers could present the project to
potential informants in a consistent manner and thus enable
the attainment of standardized data. Guidance was given as
to how to contact stakeholders in each location so that a
diverse representation of the area could be achieved. Tools
were translated as necessary to facilitate data collection.
Questionnaire
To prepare the assessment tool (the key stakeholders’
questionnaire) an extensive literature review was undertaken
(Calafat et al., 2009). This allowed the identification of
strategies to promote health and safety in recreational
settings and consequently the identification of the best (or
promising) practices in this area. Before a final version of
this assessment tool was produced, strategies were updated
with data from a second literature review (Hughes et al.,
2010). Using this information, a set of standards for health
and safety in European recreational nightlife settings were
prepared and organised into three major categories with
a number of subgroups (to facilitate the assessment and
monitoring of selected key components):
1. Venue conditions
1.1. Access and security admission policies
358 Estándares europeos en salud y seguridad para los locales de ocio nocturno
1.2. Inside the venue: physical environments
1.3. Inside the venue: social environments
1.4. Dispersal policies
2. Staff and management implication
2.1. Managerial approaches
2.2. Serving staff
2.3. Door and non-serving security staff
2.4. Entertainment staff: DJs and speakers
3. Alcohol promotions and regulation of sale
3.1. Pricing and availability
3.2. Special promotions.
For each component of the assessment tool
(questionnaire), participants were requested to: 1) inform
if the component was operational (i.e. carried out in their
premises, in the case of industry respondents or in the
city in the case of other respondents); 2) inform if it was
regulated by law; and, 3) if it was regulated by law, inform
if it was being enforced and by whom. Also, for each of the
standards listed above, the questionnaire/ assessment tool
asked participants to rate: i) ease of implementation; ii) cost
to implement and sustain; iii) self-perceived effectiveness;
iv) self-perceived acceptability (i.e. is it sensitive to local
cultural norms); and finally, v) to rank its importance as a
key element to the overall strategy (using a scale 1-5 from
most important to least important).
Data analysis plan
The diversity of nightlife health and safety regulations
and the number and range of agencies and/or authorities
involved in regulation, implementation and enforcement
varies greatly across Europe, and sometimes within
different cities/regions of the same country, as do licensing
requirements. Consequently, legislation and enforcement
measures are hard to compare.
Respondents’ familiarity with the subject and the
terms used in the questionnaire, and each respondent’s
comprehension of the provisions each term includes, added
some heterogeneity to the completion and analysis of
the questionnaires. In some cases these difficulties were
overcome post-interview using qualitative reports prepared
by local researchers, that provided extra information on
unclear strategies adopted. For instance, although items
under the pricing and availability section were supposed to
be assessed prevention wise, most industry representatives
evaluated them as a marketing strategy.
Results
Key and recommended components of European health
and safety standards for nightlife venues
An important outcome of this research has been the
identification and selection of ‘key and recommended
Table 1. Questionnaires collected and processed by country and key informants
Participants Questionnaires Industry representatives Other key stakeholders
Country Collected Processeda
‘Umbrella’
organiza-
tion
Club man-
ager/owner
Bar man-
ager/owner
Club / Event
promoter Policy maker Police Public
Health Other
United Kingdom 13 10 010 0 0 0 0 0 0
Luxemburg 5514000000
Belgium 5512110000
Spain 7512001100
Slovenia 5401003000
Romania 5502001110
Italy 6512200000
Hungary 10 10 14030002
Portugal 10 10 05220001
Greece 10 502300000
Sweden 1100000010
Germany 0000000000
Ireland 3202000000
Austria 5400400000
Czech Republic 4300300000
Total 89 74 536 15 6 5 2 2 3
a Processed questionnaires are those deemed by the author to be completed, with no comprehension problems encountered
359
Amador Calafat, Mariangels Duch, Montse Juan, Nicola Leckenby
Table 2. Key components, recommended components and components that apply under special circumstances.
Key components* Recommended components** Under special circumstances***
1. Conditions of the venue
1.1 Access and security admission
Under age checkouts CCTV monitoring Weapon checkouts
Limits on patron numbers Monitoring of people in lines (queuing) Avoidance of special passes
Intoxication and drug checkouts Monitoring of people gathering outside the venue
Signs with policy statements Entrance fee
1.2 Inside the venue: physical environment
Room temperature and ventilation Glassware policy
Cleaning of spills and other hazards Availability of food and snacks
Clearing away empty glasses and bottles Free water available
Layout and design
Random check of toilets
Music volume
Availability of chill out and/or seating areas
Avoidance of queuing in bars and toilets
1.3 Inside the venue: social environment
Identification of intoxicated patrons Mix of patrons Entertainment
Level of permissiveness Music policy
Codes of conduct
1.4 Dispersal policy
Exit control and transportation Wind down period or « chill out hour »
Relocating staff
2. Staff and management factors
2.1 Managerial approach
Involvement of key stakeholders Code of practice and other agreements
Collaboration with police House policies and management
Patrons health-care
RBS – Responsible beverage service
2.2 Serving staff
Server training
2.3 Door staff and non-serving security staff
Non-serving security staff training
Tackling drug dealing
2.4 Entertainment staff: DJs and speakers
DJ and speaker training
3. Alcohol promotions and regulation of sale
3.1 Pricing and availability
Pricing policy
Availability
3.2 Special promotions
Avoidance of special promotion
* Key components are those identified within the scientific literature and selected as key by industry representatives and other key stakeholders consulted.
** Recommended components are those having certain supporting evidence, and confirmed by practice, both by nightlife industry representatives and other key stakeholders.
*** Under special circumstances includes those components not signalled by evidence or practice (or with evidence showing contradictory findings) that may only apply to certain venues.
360 Estándares europeos en salud y seguridad para los locales de ocio nocturno
components’ of health and safety standards for nightlife
venues (Table 2). Key components are those identified within
the scientific literature and selected as key by over 50% of the
industry representatives and other key stakeholders consulted.
Recommended components are those having positive supporting
evidence, and confirmed by practice, both by nightlife industry
representatives and other key stakeholders. A few components
not signalled by evidence or practice (or with evidence showing
contradictory findings) that may only apply to certain venues
have been identified as ‘under special circumstances’.
Participants’ attitudes towards key and
recommended components
The assessment tool revealed that most industry
representatives are aware of those components identified
with consistent evidence by the literature search undertaken,
and appear to comply accordingly with legal requirements
and procedures. However, participants expressed doubts
about further regulation on elements which are not yet a
requirement for licensing or are not being currently enforced,
such as training of staff or customary underage checkouts.
Industry representatives expressed their preference for
health and safety ‘guidance’ rather than ‘enforcement’ with
regard to venues:”We already have to follow a thousand
regulations; we do not need any more enforcement. We comply
with the guidelines because of insurance requirements, in
case something would happen”(Club manager - Belgium).
Furthermore, most participants who stated they complied with
procedures, including RBS and health promotion activities, but
do not wish them to be mandatory, also stated that they used
compliance to these health and safety guidelines as a form of
‘differentiation’ to stand out from potential competitors: “Taking
care of customers is key for a long term business relationship. If
clients feel safe in the premises they feel you care about their
comfort” (Club manager – Spain). In other words, compliance
with regulations and procedures can occasionally have an added
value, and is being used as a marketing strategy within nightlife
venues.
The assessment tool revealed that most industry
representatives feared further regulation would mean further
obstacles in everyday management – adding paperwork and
increasing running costs. However, a preference for national/
city regulation by law, instead of just guidance, was detected in
Eastern European countries. Over one third of the respondents
commented that this may be due to the existence of important
illegal or ‘secretive’ nightlife recreational offers: “Some people
do not follow the business rules and become unfair competition
to those who do” (Club manager – Hungary). In some cases,
these operations are run from buildings which are not specially
designed as nightlife recreational venues and as such do not
comply with existing health and safety regulations.
Country/ geographical differences
No major differences were found between countries in
the assessment by the recreational industry representatives
of the key components identified in the literature review.
Most countries are familiar with the key components and are
aware of their effectiveness. Furthermore, many representatives
from nightlife venues stated that they have adopted these key
components. However, differences were found in the number
of enforced legislative standards on the nightlife industry.
The UK was clearly identified as the most regulated country
and as such has enforced a number of legislative standards
on the nightlife industry. Luxemburg respondents were solely
identified as those ready to accept regulation by law of some
procedures (RBS and staff training). In contrast, stakeholders
from Hungary expressed that they would not be keen to accept
new regulations because they believe they are expensive and
ineffective. However, on the contrary, these stakeholders are
highly critical of the proliferation of premises working without
a license or the lack of security in certain venues. Disparities
between countries were also found between the regulations
of licensing hours. In Belgium, it was identified that opening/
alcohol serving hours are not highly regulated. In Portugal,
although licensing hours are regulated, they are not respected
by a large majority (78%) of nightclubs and discos. In Greece,
the recreational nightlife industry is minimally organized, with
no federations or umbrella organizations representing it, and
due to the economic crisis, industry representatives interviewed
were not keen to adopt measures or regulations that, in their
opinion, may potentially lower their incomes further. In Greece,
since serving staff require no training or qualifications, they
are mostly young students working part-time. Also, no formal
training is required for security staff at nightlife recreational
venues. Furthermore, although in Greece smoking is banned by
law neither clients nor venues, who might be afraid of losing
patrons, comply with this law.
Differences were however found across Europe in searching
for drugs and/or weapons in nightlife recreational venues. In
Belgium and Spain, security staff are not permitted to carry
out strip searches for illicit drugs; instead they have to call the
police. This limitation has not been mentioned in other countries.
However, strip searches by the police are possible in Belgium
and Spain under serious allegations. In Belgium, in addition to
other countries consulted, including Portugal and the UK, some
clubs have metal detectors/arches that are used on certain
nights, but most informants view them as unnecessary.
In those countries where non-industry informants were
consulted (see Table 1), about 40% of participants expressed
doubts surrounding the enforcement of certain guidance/
regulations , including random toilet checks and CCTV
monitoring, due to concerns around the protection of privacy.
Nevertheless industry representatives expressed no doubt about
their effectiveness and acceptability among customers. Most
industry representatives stated that having CCTV monitoring
and controlling bathrooms, through the use of toilet attendants
and cleaning staff, increases both perceived and actual security
and safety in nightlife recreational venues.
Preventing underage drinking
Preventing underage access to alcohol is a core element
of any policy (Hughes, Furness, Jones & Bellis, 2010). The
legal drinking age varies around Europe and covers a wide
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Amador Calafat, Mariangels Duch, Montse Juan, Nicola Leckenby
range of issues and behaviours. Minimum ages range from
16 (e.g. Austria, Belgium and Luxemburg) to 20 years of age
(e.g. Norway, Finland and Iceland) and can vary depending
on whether alcohol is being purchased or consumed, and
the type of alcoholic drink. However, despite this regulation,
the 2007 European School survey Project on Alcohol and
Other Drugs (ESPAD) Report, which looked at substance use
amongst students in 35 European countries, found that on
average half of students aged 15 have been intoxicated at
least once during their lifetime; 39% reported having been
intoxicated during the last 12 months and 18% during the
previous 30 days (Hibell et al., 2009).
Checks for proof of age identification should be carried
out routinely to ensure that those under the minimum
age stipulated by law are unable to purchase alcohol. The
majority of industry representatives who participated in our
study agree: about 81% rate underage checkouts as key to
ensuring health and safety inside a venue and categorise
it as a practice that is both ‘easily implementable’ and ‘low
cost’. Still, just 66% of all the industry representatives
reported carrying out underage checks, and in most cases
they are not done routinely, but at discretion of door staff.
Across all countries studied, no established set of protocols
for checking proof of identification were found. The most
common excuse given by industry representatives for not
checking routinely is ‘lack of need’ since they reported they
were targeting an older clientele. However, this was often
accompanied by the admittance that the age of a female is
harder to identify without identification.
Enforcement of regulations
The diversity of recreational nightlife health and
safety regulations, the number and range of agencies and/
or authorities involved in developing or enforcing these
regulations, and the licensing requirements for these venues
varies greatly across Europe, and sometimes even within
different cities/regions of the same country. In certain
countries, such as in the UK, specific conditions can be
imposed on individual premises on a case-by-case basis. In
all countries explored, some legislation is governed nationally
while other is regulated at regional and/or municipal level by
licensing or local authorities. There are also additional laws,
acts and regulations that are not specifically designed for
improving nightlife standards, but may relate to the health
and safety of staff and clients. This makes legislation and
enforcement measures difficult to compare. Furthermore,
difficulties arise with the familiarity of informants (industry
and non-industry representatives) with the several issues
explored (physical and social conditions of the venue,
managerial approaches, staff training, etc.) in addition to
the terms used in the questionnaire, and each informant’s
comprehension of the provisions each term includes, as in
the case of an entrance fee (to avoid ‘hopping’ between
venues especially before closing time) or avoidance of
special passes (some studies show that patrons feeling
unfairly treated may become less cooperative with staff).
Such strategies were not assessed as a marketing strategy,
but as a harm prevention strategy, and as such introduced
some difficulties when comparing geographical areas and/or
industry representatives versus non-industry stakeholders. In
some cases these difficulties were overcome post-interview
using qualitative reports prepared by local researchers.
Nevertheless, with a few exceptions that include those
countries where recreational nightlife is more regulated, such
as the UK, in most interventions assessed, enforcement of
legal regulations was carried out by the manager or owner of
the venue, and as such is under their discretion. Worryingly,
this management commitment to enforcement of regulations
was not evident within the data produced from this study.
Staff training
Door and security staff presence was selected as a key
component to ensure health and safety in recreational
nightlife venues by 83% of the industry respondents, and
it is operational in 81.1% of all the cases. Having a set
number of door and security staff is a legal requirement in
most countries explored, with ratios and numbers generally
depending on venues sizes. However, with the exception
of the UK, where it is a criminal offence to take a job as
a door supervisor without a Security Industry Authority
(SIA) licence, no specific training is required for licensing in
the other European countries assessed. In Belgium, if staff
are licensed, their training includes first aid assistance. In
Spain, training is required by law in certain regions (Balearic
Islands, Catalonia and Madrid) but not nationwide, and
since it is a new and as such under-developed regulation,
no data on enforcement is currently available. Training for
door supervisors has not been found as a requirement for
licensing of nightlife recreational venues in any legislation or
protocol in any other European countries explored.
Although club representatives in all countries
participating affirm that well trained and experienced
security staff will not allow ‘drunken people’ to enter
their venues; there are not clear guidelines regarding the
definition of an intoxicated person, which seems to indicate
that denial of access is at the door staff’s discretion.
Our findings indicate that training programmes for
non-door/ security staff are common in European nightlife
environments. Even though being mandatory only in Sweden,
31.8% of the European industry representatives reported
that in-house training is enforced in their premises. Of the
industry representatives sought, 82.1% reported that they
deployed server training in their premises, although just
58.9% reported the training included RBS practices. An
unwillingness to pay for RBS training was expressed by some
industry representatives due to high staff turnover; while
other state RBS is poorly effective in large venues where
staff cannot control if the same person who purchased the
drinks is the consumer. The fact that it was ranked low as a
key component on the guidance for management and staff
implication, coupled with the big discrepancies between
industry representatives found in the appraisal of ‘easiness of
implementation’, ‘cost’, and ‘acceptability’ of server training
and RBS training indicates the presence of a number of
divergent approaches to these trainings across Europe
362 Estándares europeos en salud y seguridad para los locales de ocio nocturno
Collaboration with other organisations /Working
coalitions
In those cities in the UK where collaboration with
the police is specified as part of a licensing scheme ,
‘implementation’ of this working schemes has been rated
difficult (60%) and ‘acceptability’ is low (70%), despite of
the fact that 60% of the industry respondents rated it as a
key element. On the contrary, in other countries explored,
where there is little collaboration between nightlife
industry and police, ‘implementation’ is rated difficult just
by 31% of the industry respondents , while ‘acceptability’
is rated low by almost 34% of the industry representatives
sought. Again, across studied countries, this collaboration
with the police goes from clearly established protocols
and procedures that venues have to fulfil to eventual calls
to the police when problems arise. The same occurs with
working coalitions that are rated as rather difficult to
constitute, mainly on those countries where collaboration
with other organizations is not common.
Regulation of alcohol: availability, pricing and
special promotions
Amongst all participating countries, availability of
alcohol only within licensed premises is regulated by law
(with the exception of Greece and Belgium that enjoy free
trading) and 57% of nightlife industry respondents declare
that this is legally enforced (by the licensing authority and/
or police). Around 59% rated the availability of alcohol
as a sensitive item that has a direct effect on revenue,
and the majority of the industry respondents are against
further limitations.
Our results reveal that pricing is used by the recreational
nightlife industry as a marketing strategy, not as a strategy
to prevent harm and promote health and safety. Indeed,
when asked if pricing should be regulated by law, 90% of
respondents answered no and 69% stated pricing should
be only in the form of ‘guidance’ for venues. Approximately
59% rated it as a sensitive component and, in terms of its
prevention capacity, around 65% rated is effectiveness
as medium-to-low. The same occurs with special pricing
promotions on alcohol. Although our study was designed to
evaluate the effectiveness, enforcement and acceptability
of the component ‘avoidance of special promotions’,
industry representatives defended the marketing of special
promotions. 88% of industry respondents believed that
special promotions should not be regulated by law and saw
promotions as a necessary marketing strategy to contend
in a very competitive market. Alcohol promotions are rated
as easily implemented (55%) with low implementation and
maintenance costs ( only22% rated them as a high cost)
and high effectiveness in terms of sales (75%). In the UK,
special promotions are not avoided but usually will comply
with company directives (e.g The Portman Group’s Code of
Practice or the British Beer and Pub Association guides).
British respondents commented that they follow company
or alcohol-drinks industry recommendations but this advice
is not commonly followed in any other country consulted.
Discussion
This is an innovative study that combines scientific
findings with operational experience at a European level.
In 14 participating European countries an assessment of
standards to improve health and safety in nightlife venues
was undertaken through the completion of a questionnaire
by selected nightlife industry and non-industry stakeholders.
We found that most recreational nightlife representatives
are conscious of the main negative health outcomes
associated with recreational nightlife venues highlighted by
the literature, including drunkenness, drug use, unintentional
injuries, violence, risky sexual behaviour and driving under
the influence of alcohol and illicit drugs, and are prepared to
work to prevent them. This showed no significant differences
between participating countries. However only a few
countries (Sweden, UK) are currently regulating most of the
key components (table 2) highlighted in this study.
As Brotherhood and Sumnall (2011) indicate, quality
standards provide a consistent framework for the delivery of
prevention, but are not intended to specify what activities
should be delivered. In our study, we have been able to
check which of those practices signalled by scientific criteria
as potentially effective in promoting health and safety
are implemented in European nightlife premises, appraise
which are considered more feasible and important to
ensure health and safety, and assess cultural sensitivities on
their acceptability across countries. The finding that there
are no differences in the acceptability of the health and
safety standards explored amongst industry stakeholders
across Europe indicates that a common policy and common
regulation for health and safety in nightlife is possible.
According to our findings, most industry representatives
display high rates of compliance at an operational level to
those preventive interventions deemed most important by
evidence, including those concerning venue management,
underage checkouts, staff training, and collaboration with
police. However, most of these industry representatives
express doubts about further regulation and fear this would
increase associated paperwork and costs. Indeed, in countries
where the night-time economy is not well developed or
already suffering the impact of the economic crisis, such as
Greece, we found the recreational nightlife industry is not
keen to adopt measures that they may perceive to lower
their incomes. Thus one may question how to guaranty
consistency in the implementation and enforcement of
interventions indicated through the standards suggested
here, if their application is solely left to the judgment or
discretion of the industry. The vast majority of industry
respondents (over 80%), in all interventions explored, do not
feel that more health and safety regulations, or increased
enforcement of existing regulations are needed. This may be
because the majority of industry participants manage well-
kept popular mainstream recreational nightlife venues, (it is
likely that those not complying with those endorsed by law
or players in the ‘underground scene’ would refrain from
participating); or participants feel they know ‘what works’
and are reluctant for these practices to be regulated or
363
Amador Calafat, Mariangels Duch, Montse Juan, Nicola Leckenby
enforced since it would require a higher level of compliance,
increased effort, and the use of financial resources.
In either case, these findings can be interpreted to
indicate that we face a mature recreational nightlife
industry that, implicitly or explicitly, shows a reasonable
agreement on what should be done in order to promote
health and safety in nightlife venues, but a concurrent
fear surrounding the regulation and enforcement of
such procedures. Furthermore, some administrations/
governments are not pro-active in developing and enforcing
new regulations, in times of economic crisis where the
recreational nightlife industry plays a key role in keeping
city centres vibrant. This allows the recreational nightlife
industry to enjoy a great level of freedom when deciding
which procedure to implement and when.
Amongst the procedures that industry representatives
indicated as most important were ‘Cleaning spills and other
hazards’ (89%), ‘Tackling drug dealing’ (88%), ’Intoxication
and drugs checkout’ (86 %), ‘Server training’ (84%),
‘Underage checkouts‘ (81%) and ‘Door staff training‘ (81%).
However, further exploration revealed difficulties with the
practical application of these identified components (table
2). With the exception of the first procedure (cleaning of
spills and other hazards), implementation of the rest is
seen as difficult by industry respondents. For example, in
the case of ‘intoxication and drug checkouts’ and ‘tackling
drug dealing’, although 68% and 71% respectively state
that these procedures are implemented, just 18% and 16%
respectively see them as easy to be implement in practice.
Thus we are presented with difficulties in ensuring such
procedures are adequately implemented, requiring clear
house rules and management protocols, elaborated in
collaboration with the polices, as well as trained door staff
to overcome the technical difficulties of the implementation.
One component; underage checkouts, unanimously
identified as key to ensure health and safety in nightlife
venues, illustrates the problems arising with practical
application of the guidelines. Although the legal age for
alcohol purchase and consumption is regulated by law
in all participating countries, underage checkouts are
performed by only 66 % of the industry representatives
consulted, and not routinely, which indicates poor levels
of compliance to this regulation. This is despite the high
level of agreement on its importance (81%) and the
knowledge of it being regulated by law (84%). Additional
studies confirm this finding, although differences between
countries are evident. A study of shop-floor compliance
with age limits for alcohol purchase found that, in most
cases, age was not asked and age identification was not
required, although managers of those stores selling alcohol
were aware of these regulations. This study related the
low level of motivation for compliance with the fact that
no negative consequences were connected to violation of
the regulations. This exemplified how an intervention to
prevent minors’ access to alcohol might fail unless a valid
and visible system of surveillance to increase the perceived
risk of being caught and punished is established (Gosselt,
van Hoof, & De Jong, 2012).
Experiences in regulated countries, such as the UK,
where licensing is related to scheme requirements, show
that to ensure a good implementation of procedures to
promote health and safety, venues must provide evidence
(i.e. records) of the trainings and implemented strategies
to gain certification from the licensing authority. However,
just half the industry participants indicated that RBS was
being implemented in their venues, and in most cases it
was either performed in-house by management with no
record of training, with no endorsement by management,
or not connected to house policies (written rules specifying
acceptable and unacceptable behaviours for both staff and
customers) , which according to literature, produces little
change or it is not sustained over time (Buka, & Birdthistle,
1999; Calafat et al., 2009; Ker, & Chinnock 2008).
In this study, we have identified 28 standards for
health and safety in recreational nightlife venues indicated
by literature that show a broad level of implementation
across venues, according to the responses of the industry
representatives from the 14 participating European
countries(Table 2). This establishes a wide range of actions
with important implications on health and safety for nightlife
users, that should be considered with high priority at a
European level. To miss this opportunity to embed practice
into policy might be considered a grave irresponsibility with
respect to the promotion of health and safety standards in
nightlife.
Encouraging collaboration between stakeholders involved
in nightlife management is key to guarantee success in the
implementation, regulation, efficiency and acceptability of
interventions. Indeed, implemented collaboration schemes
between licensed traders and other key stakeholders at
community level have been shown to be an effective
method of reducing nuisance and crime and increasing
business profitability and the overall attractiveness of the
area (Wickham, 2012). High levels of collaboration are seen
between the nightlife recreational industry and the police
and other key stakeholders. However, differences in ease
of implementation, cost, and difficulties foreseen in their
constitution and maintenance, between cities where this
collaboration is a licensing requirement and those where
it is not, on indicate that collaboration is limited unless it
becomes a requisite.
While the recreational nightlife industry representatives
who were interviewed as part of this study recognize the
positive effects of several of the interventions listed in table
2, it is evident that they oppose regulation by law, even
though compliance and enforcement would protect them
against unfair competition from nightlife venues violating
the regulations or operating without the legal permits. This is
especially relevant in some Eastern European countries were
club parties are often celebrated in semi-clandestine ways
in venues not specifically designed or suitable as nightlife
venues.
This study has several strengths, namely the inclusion and
representation of 21 cities with a vibrant nightlife located
in 14 European countries through consultation with both
nightlife industry and non-industry stakeholders.
364 Estándares europeos en salud y seguridad para los locales de ocio nocturno
Also, although most of the procedures assessed are
not required for obtaining an alcohol license or operating
the business, respondents affirm they are implemented in
the daily management of their premises to ensure health
and safety. However, we also recognize the limitations
present in this study; since participants’ responses have
not been contrasted with actual implementation of the said
strategies in the premises and, due to the limited sample,
the findings are not representative of the opinions of all
stakeholders in each country explored, and thus the sample
of individuals selected and participating in the study may
bias the results obtained. Nevertheless, efforts were made
to reduce this bias; a protocol for questionnaire application
was produced to ensure consistency in delivery, and the
intervention responses were ranked to ensure consistency in
interpretation.
Regulating and enforcing the key European health and
safety standards for nightlife venues highlighted both by
literature and nightlife industry representatives according to
our search should be a priority to ensure homogenisation in
the promotion of health and safety in nightlife premises.
Acknowledgements
This research is part of the project Club Health (Healthy
and safer nightlife of youth; project-HP-101123-2008 12 11).
This project is been financed by the European Commission
(EAHC).
Our special thanks to Karen Hughes and Mark Bellis
from the Centre for Public Health from the Liverpool John
Moores University, for their help in the research design and
for reading and making comments on the paper.
Conflicts of interest
None.
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Participating in nightlife it is a meaningful cultural activity for young people. Councils welcome a flourishing late-night entertainment industry. But there also problems related to the people involved (alcohol and drug abuse, violence, risky sex...) and to the recreational activity itself (noise, street drinking, vandalism...). Prevention intervention possibilities are numerous, and most have been implemented, however assessment of their outcomes is less common. We have identified 11 types of prevention according to their main objective (venues centred, community, education, law enforcement, industry collaboration...) and we have reviewed the existing evidence in relation to each form of intervention. Popular types of interventions as providing information or pill testing are not evidence based. Other interventions as Responsible beverage services or designated driver programmes, backed by the industry, are not exactly the most effective, especially if they are not enforced. Others like community approaches can be effective but it can be a problem how to achieve their continuity. From the present review, what emerges as the best strategy is the combination of training, cooperation and enforcement. 'Classical' measures (taxation, reduced BAC limits, minimum legal purchasing age...) are also evidence-based and effective. Could be interesting to investigate interventions that address the cultural aspects of nightlife. But this sort of interventions do not depend on the will or the skills of professionals, and are more related to societal changes. The highly frequent use of popular but ineffective interventions contributes more to the problem than to its solution, and only facilitates giving preventive efforts a bad reputation.
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