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Article ; Online: Compliance Checks Decrease Cigarette Sales Rates to Pseudo-Underaged Mystery Shoppers: A Quasi-Experimental Control Group Study.

Feltmann, Kristin / Gripenberg, Johanna / Elgán, Tobias H

International journal of environmental research and public health

2022 Volume 19, Issue 20

Abstract: To control adherence to age limits regarding sales of tobacco products, Swedish authorities can conduct compliance checks. Compliance checks involve prior information to all retailers, mystery shopping, and subsequent feedback to the retailers. This ... ...

Abstract	To control adherence to age limits regarding sales of tobacco products, Swedish authorities can conduct compliance checks. Compliance checks involve prior information to all retailers, mystery shopping, and subsequent feedback to the retailers. This study investigated whether compliance checks can decrease the rates of cigarette sales to underaged adolescents. Test purchases of cigarettes were conducted using pseudo-underaged mystery shoppers, i.e., 18-year-old adolescents with a younger appearance not carrying ID, to measure the refusal rate and rate of ID checks. Test purchases were conducted at 257 retail outlets in 13 municipalities in Stockholm County at baseline 2017 and follow-up 2019, respectively. In between the measurements, six municipalities (intervention area) conducted compliance checks, and seven municipalities were used as a comparison. Comparing baseline and follow-up, rates of refusal (70.4 to 95.8%) and ID checks (80.3 to 95.8%) improved in the intervention area. In the comparison area, refusal rates increased (80.9 to 85.2%), and ID check rates remained stable (at 86.1%). Significant group × time interaction effects reveal that the rates of refusal and ID checks differently changed in the study areas over time. These results indicate that compliance checks are an effective method to decrease cigarette sales to underaged adolescents.
MeSH term(s)	Adolescent ; Humans ; Control Groups ; Tobacco Products ; Commerce ; Feedback
Language	English
Publishing date	2022-10-13
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph192013161
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Increasing prevalence of illicit drug use among employees at Swedish workplaces over a 25-year period.

Feltmann, Kristin / Villén, Tomas / Beck, Olof / Gripenberg, Johanna

European journal of public health

2022 Volume 32, Issue 5, Page(s) 760–765

Abstract: Background: Reports indicate that the proportion of adults using drugs of abuse has been increasing in recent years in Europe. Although there are various indicators of increased drug use in Sweden over time, few studies could demonstrate an increase in ... ...

Abstract	Background: Reports indicate that the proportion of adults using drugs of abuse has been increasing in recent years in Europe. Although there are various indicators of increased drug use in Sweden over time, few studies could demonstrate an increase in the proportion of adults using drugs. To investigate changes in drug use prevalence over time, drug testing at the workplace has been used for a 25-year period. Methods: The urine samples of employees sent by occupational health services from all over Sweden during a 25-year period were analyzed. The analyzing capacity increased over time (from 3411 in 1994 to 60 315 samples analyzed in 2019), and the majority of the samples was analyzed for the following drugs: cannabis (tetrahydrocannabinol), amphetamine, opiates, cocaine, and benzodiazepines. Results: There was an overall increase in the proportion of samples that tested positive for illicit drugs over a 25-year period. This increase seemed to take place step-wise, with phases of linear increases and plateaus that over time became shorter. About 1.3% of samples tested positive for drugs in 1994, whereas 5.6% tested positive in 2019. Since 2007, the rate of positive samples has increased for cannabis and decreased for benzodiazepines. Although the rate of samples tested positive for opiates had remained relatively stable over the last 20 years, this rate had increased for amphetamine and cocaine between 2013 and 2019. Conclusion: The results indicate that the use of illicit drugs among employees at Swedish workplaces has increased during a 25-year period.
MeSH term(s)	Adult ; Amphetamine ; Benzodiazepines ; Cannabis ; Cocaine ; Dronabinol ; Humans ; Illicit Drugs ; Opiate Alkaloids ; Prevalence ; Substance Abuse Detection/methods ; Substance-Related Disorders/epidemiology ; Sweden/epidemiology ; Workplace
Chemical Substances	Illicit Drugs ; Opiate Alkaloids ; Benzodiazepines (12794-10-4) ; Dronabinol (7J8897W37S) ; Amphetamine (CK833KGX7E) ; Cocaine (I5Y540LHVR)
Language	English
Publishing date	2022-08-25
Publishing country	England
Document type	Journal Article
ZDB-ID	1129243-x
ISSN	1464-360X ; 1101-1262
ISSN (online)	1464-360X
ISSN	1101-1262
DOI	10.1093/eurpub/ckac105
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Article ; Online: Effects of the COVID-19 pandemic on mental health, working, and life situation of employees in the Swedish hospitality industry.

Feltmann, Kristin / Gustafsson, Nina-Katri J / Elgán, Tobias H / Gripenberg, Johanna / Kvillemo, Pia

Frontiers in public health

2023 Volume 11, Page(s) 1178847

Abstract: Introduction: Previous studies reported that the coronavirus disease (COVID-19) pandemic has negatively affected the mental health of employees in the hospitality industry internationally, however, its effect in Sweden has not been studied. Unlike ... ...

Abstract	Introduction: Previous studies reported that the coronavirus disease (COVID-19) pandemic has negatively affected the mental health of employees in the hospitality industry internationally, however, its effect in Sweden has not been studied. Unlike several other countries, Sweden never enforced a lockdown. Restaurants, bars, and hotels could remain open and host a limited number of guests but had to abide by certain restrictions. Methods: A cross-sectional survey was distributed among hospitality industry employees containing questions regarding the perceived effects of the pandemic on the respondents' working and life situations and their physical and psychological health. The sample consisted of 699 individuals, with a response rate of 47.9%. Results: Although several respondents had been laid off or furloughed, the majority of the sample remained at the same employer. However, more than half of the respondents reported that their economic situation had deteriorated. Compared to before the pandemic, 38.1% experienced elevated levels of stress, 48.3% experienced elevated levels of worry, and 31.4% reported worsened mood. A deteriorating personal economy and difficulty in following COVID-19-related restrictions at work were associated with the worsening of these three mental health aspects. While the fear of becoming infected with COVID-19 was related to higher levels of stress, the fear of infecting others was related to higher levels of worry. Conclusion: Although Sweden imposed less strict measures than most other countries, the personal economy and mental health of hospitality workers were negatively affected by the COVID-19 pandemic.
MeSH term(s)	Humans ; Pandemics ; Sweden/epidemiology ; Mental Health ; Cross-Sectional Studies ; COVID-19/epidemiology ; Communicable Disease Control
Language	English
Publishing date	2023-06-14
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2711781-9
ISSN	2296-2565 ; 2296-2565
ISSN (online)	2296-2565
ISSN	2296-2565
DOI	10.3389/fpubh.2023.1178847
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Article ; Online: Sales of cigarettes to pseudo-underage mystery shoppers: Experiences from Stockholm County.

Feltmann, Kristin / Gripenberg, Johanna / Elgán, Tobias H

Nordisk alkohol- & narkotikatidskrift : NAT

2021 Volume 38, Issue 6, Page(s) 573–585

Abstract: Aims: There is an 18 years age limit for cigarette purchase in Sweden and in order to implement this law outlets need to perform ID checks. This study investigates the rate of cigarette sales and ID checks when pseudo-underage mystery shoppers attempted ...

Abstract	Aims: There is an 18 years age limit for cigarette purchase in Sweden and in order to implement this law outlets need to perform ID checks. This study investigates the rate of cigarette sales and ID checks when pseudo-underage mystery shoppers attempted to purchase cigarettes. It explores possible factors associated with sales outcomes. Design: Nine mystery shoppers (6 females and 3 males) attempted to purchase cigarettes without providing ID. The mystery shoppers were 18 years old but had a younger appearance as judged by an expert panel. During each attempt, the adolescents worked in pairs (shopper and observer). A total of 320 outlets in 13 municipalities in Stockholm County were randomly selected based on an outlet type stratum (i.e., gas station, convenience store, kiosk, grocery store). Effects of variables on sales outcomes were analysed using Pearson's chi-square and binominal regression analysis. Results: In 25.4% of the purchase attempts (total Conclusions: The results of the present study indicate that cigarettes could potentially and frequently be sold to underage adolescents by outlets within Stockholm County. Therefore, routines established for checking IDs clearly need to be improved. For example, strategies to improve adherence to the legal age limit on the purchase of cigarettes, such as compliance checks using mystery shopping with feedback to retailers, are needed.
Language	English
Publishing date	2021-04-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2824032-7
ISSN	1458-6126 ; 1458-6126
ISSN (online)	1458-6126
ISSN	1458-6126
DOI	10.1177/14550725211003423
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Article ; Online: Evaluation of the Implementation of a 25-Year Outdoor School Ground Smoking Ban: A Qualitative Interview Study With Implications for Prevention Practise.

Kvillemo, Pia / Feltmann, Kristin / Elgán, Tobias H / Gripenberg, Johanna

Frontiers in public health

2021 Volume 9, Page(s) 628748

Abstract: Introduction: ...

Abstract	Introduction:
MeSH term(s)	Humans ; Qualitative Research ; Schools ; Smoke-Free Policy ; Sweden/epidemiology ; Tobacco Products
Language	English
Publishing date	2021-04-01
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2711781-9
ISSN	2296-2565 ; 2296-2565
ISSN (online)	2296-2565
ISSN	2296-2565
DOI	10.3389/fpubh.2021.628748
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Effects of the COVID-19 pandemic on mental health, working, and life situation of employees in the Swedish hospitality industry

Kristin Feltmann / Nina-Katri J. Gustafsson / Tobias H. Elgán / Johanna Gripenberg / Pia Kvillemo

Frontiers in Public Health, Vol

2023 Volume 11

Abstract: IntroductionPrevious studies reported that the coronavirus disease (COVID-19) pandemic has negatively affected the mental health of employees in the hospitality industry internationally, however, its effect in Sweden has not been studied. Unlike several ... ...

Abstract	IntroductionPrevious studies reported that the coronavirus disease (COVID-19) pandemic has negatively affected the mental health of employees in the hospitality industry internationally, however, its effect in Sweden has not been studied. Unlike several other countries, Sweden never enforced a lockdown. Restaurants, bars, and hotels could remain open and host a limited number of guests but had to abide by certain restrictions.MethodsA cross-sectional survey was distributed among hospitality industry employees containing questions regarding the perceived effects of the pandemic on the respondents’ working and life situations and their physical and psychological health. The sample consisted of 699 individuals, with a response rate of 47.9%.ResultsAlthough several respondents had been laid off or furloughed, the majority of the sample remained at the same employer. However, more than half of the respondents reported that their economic situation had deteriorated. Compared to before the pandemic, 38.1% experienced elevated levels of stress, 48.3% experienced elevated levels of worry, and 31.4% reported worsened mood. A deteriorating personal economy and difficulty in following COVID-19-related restrictions at work were associated with the worsening of these three mental health aspects. While the fear of becoming infected with COVID-19 was related to higher levels of stress, the fear of infecting others was related to higher levels of worry.ConclusionAlthough Sweden imposed less strict measures than most other countries, the personal economy and mental health of hospitality workers were negatively affected by the COVID-19 pandemic.
Keywords	nightlife ; restaurants ; worry ; sadness ; stress ; COVID-19 crisis ; Public aspects of medicine ; RA1-1270
Subject code	150
Language	English
Publishing date	2023-06-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Compliance to the Alcohol Law: Overserving to Obviously Intoxicated Visitors at Music Festivals.

Feltmann, Kristin / Gripenberg, Johanna / Elgán, Tobias H

International journal of environmental research and public health

2020 Volume 17, Issue 22

Abstract: Music festivals are often high-risk settings associated with large numbers of visitors and high alcohol intoxication levels, which contribute to a number of public health-related problems. According to the Swedish Alcohol Act, servers are responsible for ...

Abstract	Music festivals are often high-risk settings associated with large numbers of visitors and high alcohol intoxication levels, which contribute to a number of public health-related problems. According to the Swedish Alcohol Act, servers are responsible for not overserving alcohol to obviously intoxicated patrons. The aim of the current study was to examine compliance to the Swedish Alcohol Act at music festivals by assessing the rate of alcohol overserving to festival-goers. We conducted a study at a large music festival in Sweden hosting approximately 50,000 visitors. Professional actors, i.e., pseudo-patrons, enacted a standardized scene in which a highly intoxicated festival-goer attempted to buy beer at licensed premises inside the festival. Observers monitored each attempt. A total of 52 purchase attempts were conducted. The rate of overserving was 26.9% and was not influenced by the server's gender, the number of servers, or the level of crowdedness at the bar area. Overserving differed between server age groups, which was not statistically significant when controlling for other factors. Compliance to the Alcohol Act at the festival can be improved. Intoxication levels and related problems can be reduced by implementing a multicomponent intervention including staff training, policy work, and improved enforcement.
MeSH term(s)	Alcohol Drinking ; Alcoholic Intoxication ; Anniversaries and Special Events ; Holidays ; Humans ; Music ; Sweden
Language	English
Publishing date	2020-11-23
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1660-4601
ISSN (online)	1660-4601
DOI	10.3390/ijerph17228699
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: High levels of alcohol intoxication and strong support for restrictive alcohol policies among music festival visitors.

Feltmann, Kristin / Elgán, Tobias H / Gripenberg, Johanna

Substance abuse treatment, prevention, and policy

2019 Volume 14, Issue 1, Page(s) 15

Abstract: Background: Alcohol intoxication is associated with problems such as violence, injuries, drunk driving and sexual risk-taking, and music festivals are considered a high-risk setting for high levels of alcohol consumption. This study investigates ... ...

Abstract	Background: Alcohol intoxication is associated with problems such as violence, injuries, drunk driving and sexual risk-taking, and music festivals are considered a high-risk setting for high levels of alcohol consumption. This study investigates intoxication levels, drinking habits, and opinions on alcohol use and alcohol policies among visitors at one of the largest music festivals in Sweden in 2017. Methods: A cross-sectional study assessing alcohol intoxication levels was conducted at a music festival (~ 50,000 attendees). Two research teams collected data at the two festival entrances during two nights, from approximately 6:00 pm to 01:30 am. Blood alcohol concentration (BAC) levels were measured using breath analyzers. A face-to-face questionnaire was used to interview attendees about their alcohol use in the past 12 months using the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C), as well as about their personal opinions on alcohol use and alcohol policies (statement). BAC levels were compared between categories of various factors using Mann-Whitney U test and Kruskal-Wallis test. The distributions of BAC, AUDIT-C and statement category across gender was analyzed using Pearson's Chi-square tests. Associations of BAC levels with different factors were analyzed using Spearman rank correlation and multinomial logistic regression. Results: A total of 1663 attendees were randomly selected and invited to participate, and 1410 consented (63.7% men, 34.9% women, age 16-64 years). The proportion of drinkers was 81%. Among the drinkers, the median BAC level was 0.082%. Thirty-one percent of the participants had a BAC level above 0.10%. Forty-two percent of the participants reported binge drinking monthly, and 20% said that they binge drank weekly. Sixty-three percent of participants reported risky drinking habits. A self-reported risky alcohol habit increased the risk of a high alcohol intoxication level at the festival. Respondents were supportive of restrictive alcohol policies. Men had significantly higher BAC levels, reported more often risky alcohol habits and were less supportive of restrictive alcohol policies than women. Conclusions: The results indicate that participants at music festivals in Sweden have high levels of alcohol intoxication and largely support restrictive alcohol policies. Thus, there is both a need and support for the implementation of alcohol prevention strategies at festivals.
MeSH term(s)	Adolescent ; Adult ; Alcohol Drinking ; Alcoholic Intoxication/epidemiology ; Alcoholic Intoxication/psychology ; Binge Drinking/epidemiology ; Blood Alcohol Content ; Cross-Sectional Studies ; Female ; Health Risk Behaviors ; Humans ; Leisure Activities/psychology ; Male ; Middle Aged ; Public Opinion ; Public Policy ; Sex Factors ; Sweden/epidemiology ; Young Adult
Chemical Substances	Blood Alcohol Content
Language	English
Publishing date	2019-04-15
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1747-597X
ISSN (online)	1747-597X
DOI	10.1186/s13011-019-0203-8
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Compliance to the Alcohol Law

Kristin Feltmann / Johanna Gripenberg / Tobias H Elgán

International Journal of Environmental Research and Public Health, Vol 17, Iss 8699, p

Overserving to Obviously Intoxicated Visitors at Music Festivals

2020 Volume 8699

Abstract	Music festivals are often high-risk settings associated with large numbers of visitors and high alcohol intoxication levels, which contribute to a number of public health-related problems. According to the Swedish Alcohol Act, servers are responsible for not overserving alcohol to obviously intoxicated patrons. The aim of the current study was to examine compliance to the Swedish Alcohol Act at music festivals by assessing the rate of alcohol overserving to festival-goers. We conducted a study at a large music festival in Sweden hosting approximately 50,000 visitors. Professional actors, i.e., pseudo-patrons, enacted a standardized scene in which a highly intoxicated festival-goer attempted to buy beer at licensed premises inside the festival. Observers monitored each attempt. A total of 52 purchase attempts were conducted. The rate of overserving was 26.9% and was not influenced by the server’s gender, the number of servers, or the level of crowdedness at the bar area. Overserving differed between server age groups, which was not statistically significant when controlling for other factors. Compliance to the Alcohol Act at the festival can be improved. Intoxication levels and related problems can be reduced by implementing a multicomponent intervention including staff training, policy work, and improved enforcement.
Keywords	pseudo-intoxication ; pseudo-patron ; alcohol policy ; alcohol prevention ; large events ; Medicine ; R
Subject code	390
Language	English
Publishing date	2020-11-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Evaluation of the Implementation of a 25-Year Outdoor School Ground Smoking Ban

Pia Kvillemo / Kristin Feltmann / Tobias H. Elgán / Johanna Gripenberg

Frontiers in Public Health, Vol

A Qualitative Interview Study With Implications for Prevention Practise

2021 Volume 9

Abstract: Introduction: Tobacco use, often initiated in younger ages, is a serious health challenge worldwide. In Sweden, smoking has been prohibited on school grounds since 1994. Municipal environmental and health inspectors control the compliance of the ban. ... ...

Abstract	Introduction: Tobacco use, often initiated in younger ages, is a serious health challenge worldwide. In Sweden, smoking has been prohibited on school grounds since 1994. Municipal environmental and health inspectors control the compliance of the ban. Nevertheless, the enforcement and maintenance of the ban are inadequate. The aim of the current study was to identify facilitators, barriers, and the potential for improved implementation of a 25-year outdoor school ground smoking ban in upper secondary schools.Materials and Methods: A process evaluation was conducted using semi-structured interviews with principals in upper secondary schools, local environmental and health inspectors, and local politicians (n = 30) in Stockholm County, with purposive sampling for informant recruitment. A qualitative content analysis of the transcribed interviews was performed.Results: Three main categories and 10 subcategories were generated from the interviews, revealing facilitators, barriers, and the potential for improvement of the implementation of the ban. A prominent facilitator of the ban was informed and engaged principals and inspectors. Prominent barriers were conflicting goals governing the schools, which reduce staffs' motivation to maintain the ban, unclear school ground boundaries, and lack of resources. Potential for improvement was found in a new tobacco act with an extended ban on smoking at school entrances, extended support for schools and staff to strictly enforce the ban, and a continued denormalisation of smoking in society.Conclusion: To achieve effective implementation of outdoor school ground smoking bans in upper secondary schools, authorities need to address conflicts between different goals governing the schools and give necessary support to the staff to strictly enforce the ban. Policies on smoke-free working hours in the municipalities along with tobacco restrictive policies in the surrounding society may increase the possibility to maintain the smoking ban in upper secondary school grounds.
Keywords	tobacco ; outdoor school ground smoking ban ; qualitative content analysis ; policy ; students ; public health ; Public aspects of medicine ; RA1-1270
Subject code	370
Language	English
Publishing date	2021-04-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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