Community action--challenges and constraints--implementing evidence-based approaches within a context of reorienting services.

Community action on alcohol use-related projects face significant challenges in focusing efforts where they are most likely to be effective--on environmental strategies for optimum impact and sustainable institutional change. Reorienting and enhancing the efforts of existing services is a crucial issue for all countries with limited resources. This paper evaluates the use of a public health partnerships model to reorient resources and enhance cross sector collaboration to reduce alcohol consumption-related harm in a large New Zealand city from 2001-2004. The evaluation assessed changes in the management practices of participating health provider organisations, the reorientation of activities and the redeployment of provider resources, in light of evaluation evidence from collaborative initiatives undertaken by key stakeholder organisations. Despite the considerable challenges inherent in reorienting existing health sector resource and encouraging more evidence-based practice, this evaluation found encouraging signs of positive systemic changes, both within the health sector and with external stakeholders, in the redirection of priorities and resources. The focus on collaborative environmental strategies has also contributed to some limited, but promising structural changes to reduce harm in the licensed alcohol availability, accessibility and promotion environment.

The use of an evidence-based community action intervention to improve age verification practices for alcohol purchase.

Alcohol purchase surveys were undertaken as part of two New Zealand community action projects (one in a large metropolitan area and one in a small town) that aimed at reducing alcohol consumption-related harm for young people. Baseline surveys in both places indicated poor age verification practices. The two follow-up surveys in the metropolitan area showed a decrease in sales made without age identification between 2002 (60%) and 2003 (46%). However, an increase between 2003 (46%) and 2004 (55%) occurred. In the metropolitan area, regulatory staff in three out of seven jurisdictions increased enforcement due to the 2002 survey and follow-up work; this did not happen following the 2003 survey. In the small town, results indicated positive changes in verification practices over time. In addition, licensee meetings, host responsibility training, and a regional project all occurred following the surveys. The surveys have also had important indirect effects. Closer monitoring and enforcement activity due to the surveys has contributed to the amendment of alcohol legislation in New Zealand.