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Tourism and violence in nightlife Main results Teams involved in this project: IREFREA. European Institute of Studies on Prevention IREFREA Liverpool John Moores University (LJMU) Centre for Public Health, Faculty of Health and Applied Social Sciences - United Kingdom SPI Forschung GMBH (SPI Research Institute) - Germany (This project has received funding from the European Commission. The views expressed in this report can in no way be taken to reflect the official opinion of the European Commission) Index Introduction 3 Background 3 Some comparative data about the surveyed placed (Majorca & Ibiza) 4 Key points 6 Methodology 7 Qualitative research 7 Quantitative research 8 Main statistical results 9 The sample 9 Reasons for visiting Majorca and Ibiza 9 Nightlife participation 10 Substance use 10 Perceptions of safety 12 Experience of violence on holiday 13 Sexual behaviour during the holiday 15 Main qualitative results. Findings from key informants - qualitative 16 approach Literature evidence 17 Recommendations 19 General policy recommendations 19 Specific recommendations 20 New approaches, new proposals 23 References 24 2 Introduction Whilst health risk behaviours such as alcohol and drug use among young people are known to escalate during short holidays in international nightlife resorts, research has only just begun to explore the problem of violence in youth holidaymakers. During the last two years, three European teams have been conducting innovative research into the subject of violence and its relationships with alcohol and drug use in Spanish tourist resorts (Mallorca and Ibiza islands). Specific qualitative and quantitative methodologies have been set up in order to understand the contextual risk factors associated with violence. The study has also examined the interaction between violence and other health and safety risks that arise in those contexts, including the use of alcohol and other drugs. Results show that context conditions and the chosen tourist destination are related to differences in the prevalence of violent behaviours, as are gender and substance use behaviours. However, the Balearic Islands are just one of the many international nightlife destinations routinely visited by an increasing number of young Europeans. Research results highlight the urgent need for the development of prevention and harm minimisation fieldwork in international nightlife settings to protect the health of those on holiday and to reduce the international spread of violent youth cultures. A collateral benefit is that prevention programmes will also extend benefits to local populations in contact with those visiting nightlife tourist resorts. Background Studies of holidaymakers have shown holiday periods to be times of excess for young people, when both alcohol and illicit drug use increase (Bellis et al 2003, Lee 2006, Bellis 2007, Hughes 2004, Grekin 2007). Participation in nightlife is often a key holiday priority for young travelers and a major factor in their choice of destination (Bellis 2003). Consequently, to cater for widespread demand for nightlife, youth-oriented holiday resorts often contain concentrations of bars and nightclubs that specifically target young, partying holidaymakers. Thus holiday resorts can feature many of the most recognized risk factors for violence; high levels of substance use, large numbers of drinking settings catering for heavy substance-using youth and, where drug use is a feature of holiday nightlife, the presence of an illicit drug trade. Despite this, there is a scarcity of research on violence occurring in international holiday resorts. However, media reports show that such violence does occur and that its impacts can be devastating for both victims and local tourism-dependent populations (BBC 2003, 2004). Localities that contain popular nightlife areas often find their resources stretched through violence linked to nightlife activity. Thus, health services must treat injuries sustained in violent assaults; criminal justice agencies deter violence and prosecute offenders; and local councils deal with the fall-out of aggression, including property damage and negative impacts on businesses, regeneration and tourism (Bellis and Hughes 2008, Mayor of London 2007). Nevertheless this problem is underreported; the 3 tourist industry and local authorities can be afraid of possible economical problems if such negative issues are aired in the media. As a consequence there is a lack of implementation of preventive measures. Meanwhile millions of young people now holiday in international destinations specifically chosen for their vibrant nightlife. Despite historical narratives that suggest such settings contribute to the spread of recreational drug use, problems of violence, sexual risk behaviours, etc., relatively few empirical studies have addressed this issue. With international tourism growing (Forschungsgemeinschaft Urlaub und Reisen 2007), authorities in popular youth holiday destinations must increasingly manage nightlife cultures that can be far removed from those of their native youth. With the availability of low cost air travel having increased dramatically over the last few decades (Dobruszkes 2006), young people are now able to spend more of their recreational lives abroad. The international reputation of nightlife in cities and resorts is a major factor in destination choice (Bellis et al 2003), and consequently many destinations are specifically marketed at young travellers as international nightlife resorts (Sellars 1998). Such settings attract individuals from within nations and from around Europe whose principal reasons for travel are clubbing and other nightlife pastimes, usually under the influence of alcohol and often also recreational drugs (Bellis et al 2003, Apostolopoulos et al 2002; Josiam et al 1998). Spain is the most popular holiday destination for many young Europeans (National Statistics 2008) and in particular the Balearic islands of Mallorca and Ibiza (Ministerio de Industria, Turismo y Comercio 2007) are known for their sunshine, beaches and thriving nightlife environments. Media reports of serious incidents suggest nightlife violence is an issue in the islands during the summer season; yet experience of violence among holidaymakers has not previously been explored. Thus we surveyed 3,003 British, German and Spanish tourists (aged 16-35) to Mallorca and Ibiza during the summer of 2007. Some comparative data about the surveyed places (Majorca & Ibiza): Mallorca, with the provincial capital, Palma de Mallorca, is the largest of the Balearic Islands and is around six times bigger than Ibiza. Both islands are famous for their tourist resorts and have the highest occupation during the summer. Although both receive Spanish, German and English tourism, the island of Ibiza is visited mainly by English tourists (but also Spanish, German and Italian) and Mallorca by Germans (as well as Spanish and English). Within Mallorca, there are areas that attract specific nationalities: for example, the area of S’Arenal is typically visited by Germans, with advertisements in German and German speaking bar staff, while Punta Ballena, Magalluf, is geared towards English tourism. In Mallorca, during the year there are 12 visitors per resident, compared with 20 in Ibiza (see table 1). When analysing the ages of all tourists to each island (see table 2), Ibiza tends to have slightly more younger visitors while Mallorca is more a family resort with a greater number of visitors aged over 25. 4 Table 1: Comparative data from Majorca & Ibiza Km2 Kms Number Number Number Main tourist Main of of of tourist visitors nationalities recreational coast habitants visiting per year areas the / number Spa Ger Eng island habitants 2007 Arenal Magaluf Mallorca 3.640 623 814,275 9,716,091 11.9 14.8% 37.4% 26.9% Palma Alcudia Ibiza Ibiza 541 239 111,107 1,910,446 19.9 29.9% 20% 29.4% Santa Eulalia Table 2: Age group distribution for tourist visiting Majorca & Ibiza islands Age groups Mallorca Ibiza < 25 22.1% 25.1% Between 25 y 44 35.3% 44.6% Between 45 y 64 28% 21.9% > 64 14.5% 8.4% One phenomenon that is quite relevant in resort nightlife areas, especially across Ibiza, is the transformation of tourist areas from day to night, with usually quiet streets becoming crowded, bustling places; below is an example of a popular street in Ibiza town, during the day and 12 hours later. BY DAY BY NIGHT 5 KEY POINTS Millions of young people choose to visit international destinations specifically for their vibrant nightlife. Despite historical narratives that suggest such settings contribute to the international spread of recreational drug use relatively few empirical studies have addressed this issue. Violence in nightlife-focused tourist areas is underreported. The industry and the local authorities are often anxious of publicity surrounding this issue as this can damage tourism; however, localities with an important nightlife often find their resources stretched (health services, security and justice, property damage) because of violence. Despite this, there is a scarcity of research on violence occurring in international holiday resorts. The study identifies how, depending on destination and nationality, up to one in five individuals (e.g. British in Ibiza) may try a new drug for the first time while on holiday while others may return to using a substance after at least 12 months abstinence. We highlight how many international nightlife settings will have both a high concentration of recreational drug users and substantial numbers who are naive users combining recreational drugs with high levels of alcohol use. Results suggest that prevention and harm minimisation work in international nightlife settings is urgently required - to protect the health of those on holiday and to reduce the international spread of youth drug cultures. 6 Methodology The main aim of this study is to generate relevant information on emerging violence involving young people in tourist resorts, to evaluate and propose preventive actions at policy levels and also at practical implementation levels. All this will be achieved by comparing levels of violence between different geographical destinations. Both qualitative and quantitative methodologies have been used. Qualitative research This section of the research focuses on staff working in institutions involved with tourist resorts of Ibiza and Mallorca. Semi-structured interviews were conducted with 38 key individuals involved with local nightlife (such as police, health services personnel, consulate staff) in order to assess violence prevention methods. Interviews were conducted in person and were tape recorded and transcribed, or were completed via email. Interviewees were chosen for their direct role in dealing with nightlife issues (see below table) and common themes were identified from the interviews. Key interviewees: Number Professional Roles group Head of regional department; heads 9 Police staff of town police; Key staff police officers. interviewed Emergency doctors, 8 Health staff and nurses; forensic doctors Managers; Waiters; 19 Nightlife staff DJs; gogo dancers; door staff 2 Consulate staff Consul 7 Quantitative research To assess tourists’ experience and perceptions of violence and other health-related risk behaviours, a short, anonymous questionnaire was designed to explore: holidaymakers’ characteristics; experiences of violence and alcohol and drug use during the holiday and at home; and other nightlife-related factors including features of bars and preferred nightclubs. The questionnaires were originally written in English and were translated into German and Spanish (for more details, see tools/questionnaires section at www.irefrea.org) following a research meeting to ensure questions and the meaning of the term ‘fight’ were consistent between languages. As a result of this meeting, a separate question was included, asking if participants had been involved in arguments to allow participants to distinguish between verbal and physical aggression. Experienced researchers from the UK, Germany and Spain were recruited and trained to carry out the survey, which took place in local airport departure areas in Mallorca (30th July to 5th August 2007) and Ibiza (21st to 28th August 2007). Researchers were instructed to target all individuals that appeared to be aged 16 to 35 and travelling without children or older relatives, and who were waiting to check-in to flights bound for the UK, Germany or Spain. A target sample of 500 participants for each nationality was set for each location, with researchers instructed to over-sample if possible. Spanish researchers were instructed to confirm that individuals were not residents of Mallorca or Ibiza before including them in the study. 8 Main statistical results The Sample Table 1 presents the characteristics of the samples surveyed in Majorca and Ibiza. There were differences in age between both nationalities and survey locations; specifically Ibiza provided an older sample of holidaymakers, whilst Spanish participants in both locations were older than those from the UK and Germany. Overall, approximately half the sample was male with no significant gender differences between survey locations. However in each location a larger proportion of German participants were male. Mean length of stay in Majorca or Ibiza for all nationalities ranged between seven and ten days. Table 1: Basic characteristics of the sample, by survey location Majorca Ibiza British Spanish German Total P1 British Spanish German Total P1 P2 Sample (n) 505 487 484 1476 528 499 500 1527 Age (%) 16-19 61.6 14.2 48.8 41.7 12.1 4.8 31.4 16.1 20-25 33.9 43.3 40.3 39.1 56.4 40.9 46.0 47.9 26-35 4.6 42.5 11 19.2 *** 31.5 54.3 22.6 36 *** *** Sex (%) Male 48.7 50.3 60.7 53.2 45.1 49.9 57.2 50.6 Female 51.3 49.7 39.3 46.8 *** 54.9 50.1 42.8 49.4 *** NS Mean length 10.04 9.39 7.89 9.12 *** 8.87 7.43 8.45 8.26 * ** of stay (days) P1 shows significant differences between nationalities within each location. P2 shows significant differences overall between locations. *** P<0.001; **P<0.01; *P<0.05; NS = not significant Reasons for visiting Majorca and Ibiza Participants were asked to identify reasons why they had chosen to visit Majorca or Ibiza, with a list of options provided to choose from (multiple options could be selected). In both locations, nightlife was the most popular option selected overall, followed by the weather (Table 2). However, nightlife was not a major attraction for Spanish participants visiting Majorca, who were more likely to be visiting family and friends. 9 Table 2: Reasons for choosing the holiday destination Majorca Ibiza British Spanish German Total P1 British Spanish German Total P1 P2 Cost 17.5 17.9 31.3 22.1 *** 7.4 5.6 15.5 9.5 *** *** Nightlife 82.9 18.9 78.1 60.1 *** 89.0 64.5 74.5 76.2 *** *** Culture 4.8 8.8 4.8 6.1 ** 13.3 11.4 7.2 10.7 ** *** Weather 55.5 37.4 72.3 55.0 *** 43.4 45.2 64.5 50.9 *** * Work 1.8 8.0 1.0 3.6 *** 3.4 1.0 0.0 1.5 *** *** Visiting family/friends 8.3 39.8 9.3 19.1 *** 9.9 19.6 7.8 12.4 *** *** P1 shows significant differences between nationalities within each location. P2 shows significant differences overall between locations. *** P<0.001; **P<0.01; *P<0.05 Nightlife participation Corresponding to participants’ reasons for choosing their holiday destination, the majority of British (82.1%) and German (71.1%) holidaymakers to Majorca reported visiting bars or nightclubs on five or more nights per week during their holiday, compared to just 29.6% of Spanish holidaymakers. In Ibiza, however, almost half (47.0%) Spanish holidaymakers visited bars of nightclubs five or more nights per week, similar to German participants (46.5%) yet lower than British holidaymakers (82.5%). Substance use To use and abuse alcohol and other drugs is a key risk factor associated to aggression and violence. It is for this reason that we explored specifically that behaviour. In order to measure changes in substance use during the holiday, participants were asked if, and how frequently, they used alcohol, tobacco and a range of illicit drugs at home over the past 12 months and during their holiday in Ibiza or Mallorca. Table 3 shows the proportion of participants who reported having used each substance at home and during their holiday. The vast majority of holidaymakers to both locations had used alcohol, both at home and during their holiday, with Spanish participants displaying lower prevalence of alcohol use than British and German participants. To measure levels of alcohol use on holiday, participants were asked how frequently they got drunk during their stay in Majorca or Ibiza. There were significant differences between nationalities in levels of drunkenness (Figures 1). In both Majorca and Ibiza, over half of British participants reported having been drunk on five or more days per week during their holiday, and the majority of German participants reported drunkenness at least twice a week on holiday. However, the majority of Spanish participants did not get drunk during their holiday. For all nationalities, prevalence of illicit drug use both at home and on holiday was higher among the Ibiza samples. For example, during their holiday 2.1% of Spanish visitors to Majorca used ecstasy compared with 16.0% of Spanish visitors to Ibiza. However, overall 10 illicit drug use was highest amongst British visitors to Ibiza, Here, for example, 44.2% used ecstasy during their holiday and 34.2% used cocaine. German participants were least likely to use illicit drugs on holiday. Table 3 also shows that for many substances, levels of use on holiday, particularly in Ibiza, were higher than levels of use at home. This shows that a proportion of holidaymakers were using drugs for the first time during their holiday. For example, 8.6% of British, 7.2% of Spanish and 1.8% of German holidaymakers to Ibiza used ecstasy for the first time during their stay. Table 3: Prevalence of substance use at home and during the holiday, by nationality and location of survey Majorca Ibiza British German Spanish Total P British German Spanish Total P Alcohol 97.8 97.9 84.1 93.3 *** 98.1 96.8 87.7 94.3 *** Ever used at home (%) Tobacco 65.4 50.5 56.0 57.4 *** 40.8 55.1 52.9 49.4 *** Cannabis 13.7 10.1 17.6 13.8 ** 19.4 14.0 21.2 18.2 ** Ecstasy 7.3 2.3 1.2 3.7 *** 33.5 4.0 6.9 15.2 *** Cocaine 9.3 2.5 3.3 5.1 *** 33.7 3.6 12.9 17.1 *** Amphetatmine 1.6 2.3 0.4 1.4 * 4.2 3.4 4.7 4.1 NS Ketamine 1.8 0.2 0.4 0.8 * 7.8 1.0 3.4 4.2 *** GHB 1.2 0.6 0.4 0.8 NS 7.8 1.0 3.4 4.2 *** Alcohol 99.4 96.7 87.4 94.6 *** 98.7 95.4 92.5 95.6 *** Used on this holiday (%) Tobacco 39.4 52.2 46.2 45.8 *** 47.2 57.9 58.5 54.4 *** Cannabis 9.5 6.0 12.6 9.4 ** 20.1 11.1 23.0 18.1 *** Ecstasy 4.0 2.3 2.1 2.8 NS 44.2 5.7 16.0 22.4 *** Cocaine 7.5 2.9 3.9 4.8 ** 34.2 5.0 17.3 19.2 *** Amphetatmine 1.8 0.6 1.3 1.2 NS 5.1 2.8 8.3 5.4 ** Ketamine 1.6 0.4 0.9 1.0 NS 14.2 0.8 5.9 7.1 *** GHB 1.8 0.6 0.4 1.0 NS 3.6 1.0 4.1 2.9 ** *** P<0.001; **P<0.01; *P<0.05; NS = not significant Figure 1: Frequency of drunkenness on holiday by holiday destination and nationality 70 60 Never Once a week or less 50 2-4 days a week 40 5+ days a week % 30 20 10 0 11 British German Spanish British German Spanish Majorca Ibiza For individuals who used substances both at Figure 2: Frequency of cannabis use at home and on holiday, it was possible to home and on holiday among those who explore changes in the frequency of use used in both locations whilst on holiday. Figures 2, 3 and 4 show changes in frequency of use for the three 50 Home most commonly used substances: cannabis, Holiday ecstasy and cocaine (nationalities and holiday 40 locations combined). For all drugs, frequency % of users 30 of use increased during the holiday period. For example, whilst 80% of ecstasy users 20 reported using the drug less than once a week when at home, during their holiday 80% 10 reported using at least twice per week. Over 0 40% of ecstasy users reported using the drug five or more days per week during their <1 day 1 day 2-4 days 5+ days holiday. Days used per week Figure 3: Frequency of ecstasy use at home Figure 4: Frequency of cocaine use at home and on holiday among those who used in both and on holiday among those who used in both locations locations 100 80 Home Home 80 Holiday 60 Holiday % of users % of users 60 40 40 20 20 0 0 <1 day 1 day 2-4 days 5+ days <1 day 1 day 2-4 days 5+ days Days used per week Days used per week Perceptions of safety Participants were asked a range of questions aimed at gaining an insight into how they felt nightlife safety and management varied between their home environments and nightlife environments in their holiday destination. Table 4 shows that over 60% of holidaymakers of all nationalities believed that nightlife environments in their holiday location were better managed than nightlife environments at home. However, perceptions for all other questions differed between countries. For example, whilst three quarters of German and Spanish holidaymakers felt safer on a night out at home than on holiday, for British participants this dropped to just over half. British and German, but not Spanish, 12 holidaymakers believed it was easier to get drugs in the holiday location than it was at home. Over three quarters of British and German holidaymakers believed bar staff in the holiday resort were more tolerant of drunkenness than those at home, and that door supervisors working in the resort were less aggressive than those at home. German participants in particular thought that the legal consequences of violence would be stricter in their own countries than in the holiday destination. Table 4: Perceptions of nightlife safety and management between home and holiday nightlife environments, by nationality (Majorca and Ibiza samples combined)1 British German Spanish At On At On At On Home Holiday Home Holiday Home Holiday P I feel safer when out at night 55.8 44.2 75.5 24.5 74.7 25.3 *** Bars/nightclubs are more crowded 30.1 69.9 24.2 75.8 31.2 68.8 ** Bar staff appear better trained 58.4 41.6 71.8 28.2 47.2 52.8 *** It is easier to get illegal drugs 34.6 65.4 23.8 76.2 53.1 46.9 *** Nightlife seems more violent 86.1 13.9 74.1 25.9 60.0 40.0 *** It is easier to get home after a night out 45.4 54.6 66.9 33.1 77.0 23.0 *** There are more underage drinkers in bars 51.9 48.1 64.1 35.9 53.0 47.0 *** Legal consequences of violence are harsher 47.0 53.0 86.4 13.6 66.7 33.3 *** Bar staff are more tolerant of drunkenness 22.0 78.0 17.3 82.7 38.0 62.0 *** Door supervisors are more aggressive 73.4 26.6 80.0 20.0 59.1 40.9 *** Nightlife seems better managed 39.3 60.7 37.3 62.7 38.1 61.9 NS 1 Each question was answered by at least 75% of participants. *** P<0.001; **P<0.01; *P<0.05; NS = not significant Experience of violence on holiday To explore holidaymakers’ experiences with violence on holiday, the questionnaire asked whether they had seen any physical fights during their holiday and whether they had themselves been involved in a physical fight. Figure 4 shows the proportion of Figure 4: Percentage of participants having seen holidaymakers of each nationality that physical violence during their holiday reported having seen fighting at least once during their holiday, by holiday 70 UK destination. There were significant 60 Germany differences between nationalities and Spain 50 locations. Among British and Spanish 40 holidaymakers, those visiting Majorca % were more likely to report having seen 30 violence than those visiting Ibiza. 20 However in German holidaymakers, a 10 0 Majorca Ibiza 13 higher proportion of visitors to Ibiza Table 5: Participants’ involvement in physical reported seeing violence on holiday violence on holiday than visitors to Majorca. Majorca Ibiza All n 1420 1484 2904 Table 5 shows the proportion of All (%) 6.2 2.8 4.4 holidaymakers that were themselves Nationality (%) involved in a fight during their holiday, British 11.6 2.9 7.2 by location, nationality, age and gender. German 4.8 2.5 3.6 Spanish 1.7 2.9 2.3 Again there were significant differences P *** NS *** between locations with prevalence of Age (%) fighting higher in Majorca. Here, 16-19 10.0 5.0 8.6 fighting was most commonly reported 20-25 4.2 2.5 3.2 26-35 1.9 2.1 2 by British holidaymakers, with over P *** NS *** one in ten involved in violence on Sex (%) holiday. In Ibiza, however, there were Male 9.9 3.7 6.8 no significant differences between Female 2.1 1.8 1.9 P *** * *** nationalities. Group size (%) 1-2 2.4 2.2 2.3 Fighting was most prevalent among 3-4 2.2 2.1 2.2 younger participants in each location, 5+ 10.7 3.7 7.3 P *** NS *** although in Ibiza differences were not *** P<0.001; **P<0.01; *P<0.05; NS = not significant significant. Males were significantly more likely to be involved in violence in both Majorca and Ibiza. Involvement in violence was also analysed by the size of the group that participants travelled to Majorca and Ibiza in. In Majorca only, fighting was significantly more prevalent among those that had travelled in a group of more than four people (including the participant). 14 Sexual behaviour during the holiday Overall, 28.9% of participants travelled to their holiday destination with a sexual partner. However, one third (33.8%) of those travelling without a sexual partner had sex during their holiday and 17.9% had sex with more than one person. Of those arriving in the holiday destination without a sexual partner and having sex, a third (34.8%) did not always use a condom and 16.0% had sex with more than one partner without using condoms. Table 6 shows a breakdown of sexual behaviour among those arriving without a sexual partner, by holiday location and nationality. There were significant differences between nationalities in the number of sexual partners reported on holiday, with British holidaymakers to both locations least likely to have sex with a new partner. In Majorca, German holidaymakers were most likely to report having sex with a new partner without a condom, while in Ibiza such risky sexual behaviour was most commonly reported by Spanish holidaymakers, although here differences between nationalities did not reach significance. Table 6: Sexual behaviour among holidaymakers travelling without sexual partners, by holiday location and nationality Majorca Ibiza British German Spanish P British German Spanish P Number of sexual partners on holiday (%) 0 70.4 60.5 57.3 74.7 65.2 61.9 1 12.1 18.1 25.3 13.4 15.7 16.0 2 to 4 11.1 10.4 10.1 8.2 12.5 15.5 5 or more 6.5 11.0 7.3 ** 3.7 6.7 6.6 * Number of unprotected sexual partners (%)1 0 66.9 53.8 74.3 65.1 70.4 63.8 1 17.8 22.2 20.3 19.3 18.5 13.0 2 to 4 7.6 10.3 4.1 6.0 4.6 10.1 5 or more 7.6 13.7 1.4 * 9.6 6.5 13.0 NS 1 Analyseslimited to individuals who had sex on holiday *** P<0.001; **P<0.01; *P<0.05; NS = not significant 15 Main qualitative results FINDINGS FROM KEY INTERVIEWEES. QUALITATIVE APPROACH The main reasons that encourage the emergence of violence among tourists visiting the Balearic islands are: ♦ Abuse of alcohol ♦ Low risk perception of being punished if they “break rules” ♦ Intake of illegal drugs (less frequent than alcohol intoxication) ♦ Small illegal drug dealing ♦ Overcrowding of nightlife venues ♦ Poor training of private security / door staff in venues ♦ Underage users in nightclubs and similar recreational venues ♦ Competition between men for sexual partners (women) ♦ World football matches like The Champions’ League, etc. (mainly between English population) The most frequent incidents are: ♦ Fights between male groups, without presence of weapons ♦ Fights between men to obtain sexual partner ♦ Fights under influence of alcohol (mainly) and other drugs ♦ Thefts among tourists under the influence of alcohol or drugs. ♦ Sexual harassment of people under the influence of alcohol or drugs (mainly GHB). 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Nightlife Violence – a gender specific view on risk factors for violence in nightlife settings; a cross sectional study in nine European countries (submited in Journal of Urban Health), 2008. Silverman JG, Raj A, Mucci LA, Hathaway JE. Dating violence against adolescent girls and associated substance use, unhealthy weight control, sexual risk behavior, pregnancy, and suicidality. Journal of the American Medical Association 2001; 286(5):572-579. United Nations Office on Drugs and Crime. 2007 World Drug Report. Vienna: United Nations Office on Drugs and Crime, 2007. Vergewaltigungen nach K.O. –Tropfen [consuted on http://www.frauennotruf- muenster.de/shared/download/K_O_Tropfen.pdf ] Vermeiren R, Schwab-Stone M, Deboutte D, Leckman PE, Ruchkin V. Violence exposure and substance use in adolescents: findings from three countries. Pediatrics 2003; 111(3):535-540. VPA Working Group on Youth Violence, Alcohol and Nightlife. Fact Sheet 1. An introduction to youth violence, alcohol and nightlife. Global Campaign for Violence Prevention – WHO (World Health Organization), 2007. Wells S, Graham K, Speechley M, et al. Drinking patterns, drinking contexts and alcohol-related aggression among late adolescent and young adult drinkers. Addiction 2005; 100:933-944. Wells S. Drinking patterns, drinking contexts and alcohol related aggression among late adolescents and young adult drinkers. Addiction 2005; 100:933-944. WHO. Preventing violence. A guide to implementing the recommendations of the alcohol: minimising the harm. What works? London, Free Association Books, 2004. Winlow S, Hall S. Violent night. Urban Leisure and Contemporary Culture. New York: Berg, 2006. 18 Recommendations This section includes some concluding general policy recommendations along with some key recommendations addressed at specific stakeholders and local authorities. General policy recommendations: Synergic working: Violence in holiday resorts requires multi-agency networking, within locations and international, to exchange intelligence on how violence can be managed in particular settings, as well as the contributions of each nationality when engaging in international nightlife tourism; in particular, this network should include data on: Regional epidemiological information on tourism behaviors: alcohol and drug use, violent behaviors, reasons for choosing a destination (why tourists feel attracted to a resort). Preventive programs being carried out and their effects on local and visiting populations. New ideas for preventive measures and interventions which could be carried out at local, national and mainly international level, engaging countries which have a constant tourist flow amongst them (e.g. Germany, England, Spain). Data presented in this study highlights the relationship between alcohol and substance misuse, environmental and cultural issues (nationality, reasons to choose a holiday destination) and levels of violence. We recommend policies to set up international quality standards to promote health and security conditions for tourists as well as local residents. The environment is a major risk factor. Prevention should include environmental measures (transportation, lighting, venues design and management, etc) as well as staff training and health interventions aimed at tackling risk behaviors. There is scarce information available to analyse the risks that specifically affect nightlife behaviours. In addition, some countries show little interest in creating and disseminating information on the subject. We recommend promoting the research to create evidences on alcohol use, other drugs consumption, and risk behaviors related to nightlife. Tackling the drug problems that multi-national communities present in international settings requires concerted coordination beyond most prevention and harm reduction organizations. Therefore, incoming tourist countries must assume their responsibility regarding the conditions holidaymakers find and create cooperation protocols for all the institutions involved (particularly policymakers, police, health agencies, recreational industry professionals, etc.) 19 Measures that are merely informative, or that just attempt to make young people accountable, may be effective but are insufficient. Approaches should not only seek to implement prevention and harm minimisation measures for nightlife tourists, but also explore what such settings have learnt from managing hundreds of thousands of binge drinkers and drug users all socialising within a relatively contained environment. Results suggest that prevention and harm minimization work in international nightlife settings is urgently required - to protect the health of those on holiday and to reduce the international spread of youth drug cultures. SPECIFIC RECOMMENDATIONS: ♦ Tourist destinations are strong economic and cultural sources, social meeting points for youth arriving from diverse countries, as well as places expected to provide fun and well-being. ♦ Because of its specific features, those locations can sometimes be holding a social paradox: while security and health for both tourist visitors and local population must be guaranteed, authorities are worried about bringing to the public opinion issues regarding violence and alcohol and drug consumption, because these concerns could seriously damage the image of those tourist destinations. ♦ Therefore, it becomes crucial to set up international quality standards that would have to be offered by the local agencies and requested by the tour- operators. ♦ Such actions –creating and sharing international quality standards- would depend on the establishment of an in depth and long lasting network, at local, national and international levels, involving tourist providers as well as recipient countries. All implied stakeholders, from the very local ones such as club and bar owners, night staff, or young users (the tourists themselves) going through health and police services, consulates, and local authorities, to reaching national and international organizations, should assume their responsibility and duties concerning safe and health conditions to be guaranteed for all visitors and local residents in international resorts. Apart from some concrete actions, suggested below, it is very important to keep in mind as a background reference this new philosophy of collaboration at the different levels. This should cover any concrete preventive action started, planed or promoted. 20 ♦ Administration: Authorities have great responsibilities in terms of public health and security. Important actions such as controlling opening times in leisure venues, organizing night public transportation, promoting law reinforcement, or calling for international quality standards that will stimulate the visit of tourists to the resorts should be carried out. ♦ Authorities are in a great place to act as mediators between the different converging interests: tourists, industry, local residents, etc. So they should promote their role at local and international levels. ♦ In general terms, they should: Design common strategies between local police, national police, and private security staff in order to maximize human and technical resources Show publicity surrounding the consequences of tourists’ negative behavior including violence. Such as: being caught by police, having to undergo a quick trial (in 48 hours) foreseen by the Spanish law. Ensure public transport during nightlife ♦ Tour-operators: Create strategies for systematically control the contents of tourist advertisement in the mass-media: TV, radio, the internet, newspapers, travel agency pamphlets, airport and street hoardings, etc., in order to report publicly non- ethical advertisement and apply the corresponding sanctions for it - For example: by creating a web page in which concrete rules are specified, and summarizing acceptable terms and types of publicity - Creating a permanent commission of experts to detect irregularities Promote an international tender to reward, for example: - The best/ most healthy advertisement linked to tourist publicity; and - The advertisement that promotes the best image of the tourist destination; and - The most innovative advertisement in promoting a good image of tourist destination Avoid using sexual and/or violent contents (e.g. inciting tourists to be violent or to show uninhibited behaviors), as well as symbols relating to alcohol and drug consumption in their publicity campaigns 21 Stress should be placed on avoiding all subliminal and indirect messages that promote an image of tourist resorts as a “place to have fun through breaking rules” Offer alternative activities, related to the resort’s culture, including open air activities, sports etc. ♦ Local recreational nightlife industry: Should be responsible for putting into practice international quality standards of best practices for their customers and the local residents. Therefore, they should work on prevention as dependable agents like other industry organizations in different European countries are since they became aware that carrying on these politics works in their benefit. Managers of nightlife industry: Apply a standardized protocol to ensure door staff is adequately screened. Create a support network for door staff to prevent burn-out syndrome (debriefing techniques; frequent staff rotation and longer breaks at the end of the season, etc.) Create and guarantee the minimum health conditions at the venues, such as plastic glasses, condoms in the toilets, hygienic conditions, adequate lightening, emergency exits well indicated and located, and maximum capacity per m2. Establish specific training for all night staff, commission specific tasks and responsibilities to waiters, door personnel, dancers, DJs, etc. Establish restrictions on opening hours for discotheques and especially for after parties. This has been shown to effectively reduce number and/or seriousness of hospital emergency cases Set up sobriety checkpoints for staff working in nighttime venues In activities for youngsters, such as parties (regionally referred to as galas de tarde) where the minimum age for entrance is 13, only non-alcoholic beverages should be on sale and alcohol drinks should be at all times out of the sight of teenagers. Establish specific context strategies to control overcrowdings and group formation. In places were tourist concentrations are more likely to provoke violent outbreaks would require actions designed specifically for each context. Tap water should be supplied in the nightlife venues free of charge to all customers According to different studies, higher alcohol prices have a preventive effect. For this reason there should be some control to prevent certain practices that use low alcohol prices as a marketing strategy. At the same time, prices for non-alcoholic beverages should be much less expensive than the alcoholic ones. 22 Door staff: Deny entrance to persons who have previously been involved in any violent incident in the venue. Willingly to undertake sobriety check points Training for all door staff providing: A minimum of foreign language knowledge (English, German, etc) to avoid language misunderstandings Conflict resolution skills De-escalation training (also for waiters and other staff). Specific medical/first aid training (heat stroke, heart attack, paranoid behavior, overdose, etc.) Specific information about the risks and overdose effects of most frequently consumed party drugs. NEW APPROACHES, NEW PROPOSALS: The promotion of tourist areas under a positive light may help to reverse some of the adverse effects which are a consequence of negative and harmful nighttime behaviors. Visible public information campaigns can encourage pro-social norms, by establishing the consequences of antisocial or illegal behavior that involve criminal justice agencies 1 . New trends in emerging violence in tourist resorts may be attributable to the social image of the destination promoted by tour-operator in mass media campaigns 2 . Such negative images may encourage lack of inhibitions and behaviors not usually performed in their home countries. The perceived lack of punishment may also encourage such behaviours. Suggested initiatives to highlight the real consequences for tourists could be: Creating a video using, for example, a YouTube-style format (to be broadcast through the same mass media and distribution channels that promote the opposite image) showing that using alcohol and drugs and/or being violent often ends up with visits to the hospital or the police station. 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"Nightlife violence in youth tourism"