alcohol and tobacco consumption among albanian immigrants in florence

Substance Use & Misuse, 44:282–300Copyright © 2009 Informa Healthcare USA, Inc.ISSN: 1082-6084 (print); 1532-2491 (online)DOI: 10.1080/10826080802353287

Acculturation and Substance Use

Alcohol and Tobacco Consumption among AlbanianImmigrants in Florence

ALLAMAN ALLAMANI,1 FEDERIGO BRUNO INNOCENTI,1

ANDREA INNOCENTI,1 FRANCESCO CIPRIANI,2

AND FABIO VOLLER3

1Alcohol Centre, Research Group, Florence Health Agency, Florence, Italy2Epidemiology Unit, Prato Health Agency, Florence, Italy3Tuscan Region Health Agency, Epidemiology Unit, Florence, Italy

The aim of the present study was to obtain information about both drinking and smoking,as well as about alcohol consumption-related problems, among Albanians who haveimmigrated to Florence, Italy, after the collapse of the Communist regime in 1990.Between October 2001 and January 2002, an opportunistic sample of 141 Albaniansliving in the city of Florence were interviewed about their alcohol and tobacco use, aswell as about their drinking pattern and health problems

Interviewees were mainly (81%) males, of an average age of 28, who had beenliving in Italy for the last 4 years; 92.9% drank alcoholic beverages, the preferredbeverages were wine and liquor, and the average daily consumption was 39.5 grams ofpure alcohol—males consumed 48.1 grams per day, which was 3.5 times more than acomparable sample of Florentine males. Also Albanians overtook Florentines in termsof the rate of smokers (49.6% vs. 39.6%) and of contact with the emergency rooms(24.1% vs. 0.37%). Such high amounts of alcohol intake may contribute to the reportedhigh rates of accidents and acts of violence involving Albanians in Florence.

Some hypotheses were discussed to explain such a high level of alcohol consump-tion, including the sociocultural change due to emigration. The study’s limitations arenoted.

Address correspondence to Allaman Allamani, via Toselli 140 50144 Florence Italy. E-mail:[email protected].

The authors thank the following for their assistance: Salvina Di Cangi, Vat Marashi, AlketaProko, Vitore Cockaj, and Oltion Vesh for the interviews; Ferruccio Aquilini for data processing;Merkur Babameto for the history profile; Andrea Quartini, Simona Bartolini, and Maria LuigiaMarcias for their support with the Project; The Administration of Sollicciano Prison, Florence, forthe data provided; Maria Cristina Manca for her anthropological observations; Visnja Hudolin for thedata about CAT in Albania; and Sarah Barker for her assistance.

This study was partially financed in 2000 by the 1997, 1998, and 1999 National Fund for theFight against Drugs (Fondo nazionale di intervento per la lotta alla droga), CRT 159 8/06/1999, aspart of the project, “Identification of alcohol-related problems among Albanian immigrants in theFlorentine district and related primary, secondary, and tertiary preventive interventions.”

282

Subs

t Use

Mis

use

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Mic

higa

n U

nive

rsity

on

11/0

7/14

For

pers

onal

use

onl

y.

Alcohol and Tobacco Consumption among Albanian Immigrants in Florence 283

Keywords Albanians; migration; alcohol beverage use and misuse; depression; acci-dents; health problems; violence; social marginalization

Land of Albania! Where Iskander rose!Land of Albania! Let me bend mine eyes

On thee, thou rugged nurse of savage men!The cross descends, thy minarets arise . . .

(G. Byron, Childe Harold Pilgrimage, Canto II, XXXVIII)... se erzin e kena bashke ... together we have the honour, which is only one.

si bulle ashtu e kshetne. in the Christian and Muslim ones.(song by Kupe Danja, Koliqi, 1957)

Introduction

Despite the geographical and cultural proximity of Italy and Albania and the frequent in-teractions throughout history between these two countries, we still have scarce informationto allow us to compare the epidemiological, social, and cultural characteristics of Italiansand Albanians, and also little information about the Albanians who emigrated to Italy since1990, when in the years following the collapse of the barriers created by the Albaniancommunist regime toward the western world occurred. Notwithstanding, it is evident thata sort of cultural proximity exists between the two populations, Italy being consideredby the Albanians as being a leading country in terms of culture and economy. Duringthe recent immigration of Albanians to Italy, a general stereotype appears to have beenestablished amongst many Italians, which has not infrequently depicted these immigrantsas being violent or as criminals. However, due consideration must be given to the complextransformations brought about by immigration, as well as the role that the use and misuseof alcoholic beverages can play in depression and aggressive behaviors.

Indeed, while the literature about immigration, ethnicity, and integration has focusedon the importance of the acculturation processes of individuals and populations, especiallywithin the United States context, studies about the relationship between alcohol and differentethnicities began in the United States during the 1940s and 1950s, while only in the 1970ssome ideas about how an ethnicity’s drinking culture can change under new circumstancescame into the alcohol literature (Room, 1985). It is possible that if members of an ethnicalgroup experience their acculturation process as an overwhelming pressure by the dominantnorms of the country of immigration, this would create a great psychological stress or acondition of vulnerability, which could be expressed through an increased risk of drug oralcoholic beverage misuse (Heath, 1985). Furthermore, easy access to alcoholic drinks inthe new country, and also disruption of the family that is typical when young men immigrate,may contribute to immigrants’ alcohol misuse. This approach was traditionally an objectof the anthropological research indicating that after the introduction of a dominant Westernculture to a non-Western population, difficulties arise in the maintenance of traditionalcultural reference points. A cultural clash, which develops since the people’s capacity to givecollective responses to crises had been heavily affected, “often translates to situations thatwear down the psychic equilibrium and frequently lead to episodes of physical, emotional,and sexual violence towards the weakest . . . in alcoholism, in depressive forms . . .” (Manca,2002).

In fact, the studies on the subject of immigration and drinking may appear conflicting:while some indicate that the immigrants’ drinking pattern as well as the amount of alcoholic

Subs

t Use

Mis

use

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Mic

higa

n U

nive

rsity

on

11/0

7/14

For

pers

onal

use

onl

y.

284 Allamani et al.

beverages typical of original culture are maintained or slowly changed through generationswithin the new country (see e.g., the classical study about Italian Americans by Lolli 1959;the book on different American ethnical groups in Bennet and Ames, 1985; the paperon alcohol drinking pattern of Muslims in Oslo in Amundsen, Rossow, and Skurtveit,2005), other research emphasizes that new drinking practices are learned in the country ofimmigration, which may even exceed the norms shared over there (in the United States,Rumbaut, 1997; in Israel, Hasin, Rahav, Meydan, Neumark, 1998; in Italy, Bonesso et al.,2003; Farina, 2007). These differences may be attributed to: the different cultures involved,the immigration being more or less recent, the difference in degree of generations that residein the foreign country, and the various levels of acculturation of the immigrated population.Indeed, according to Berry’s observation, the aspects of acculturation are to be divided upinto “assimilation” and “integration” on one side, and “isolation” and “marginalization” onthe other side (Berry, 2005).

The present study is the first published about alcohol and tobacco consumption amongAlbanians in Italy and may provide an initial base of information in order to delineate theimpact that alcoholic beverages and alcohol consumption-related problems have on thispopulation and also to propose adequate solutions.

Albanians and Italy

Italy and Albania have been engaging in political, commercial, and cultural relationshipssince Hellenistic and ancient Roman times and still maintain strong ties. The Illyrianpeople, from whom the Albanians originated, were subject to the rule of the Romans in168 b.c., after which Illyria became an important Roman province, where the emperorsAurelian, Diocletian, and Constantine were born. Justinian, a ruler of the Roman empireof the Orient, was also an Illyrian. In the fifteenth century the Albanians—lead by thenational hero Scanderbeg, who was able to forge fruitful relationships with the EuropeanChristian world, in particular with the Kingdom of Naples and Sicily, and the Papal State ofRome—resisted against the Ottomans for 25 years during their Balkan expansion (Albanie,Encyclopedie de Voyage, 1988). After Scanderberg’s death in 1468 and the surrender of thenorthern Albanian town of Skutari after the second siege of 1479, many Albanians began tomigrate, particularly to southern Italy, where they established enclaves, building small townsand villages. The inhabitants (called Arberesh) of these enclaves still speak the languageand practice the customs of their ancestors (Conti and Marquet, 1988, pp. 39–48). Alsosome noteworthy popular Arberesh poetry seems to have preserved the Albanian traditionsmore effectively than motherland Albanians could do under the Turkish domination (seeKoliqi, 1957).

With the fall of the Ottoman Empire, at the beginning of the twentieth century, Italyreestablished its influence on Albania, which culminated in the 1939 annexation and sub-sequent transformation of the Kingdom of Italy into the short-lived Kingdom of Italy andAlbania. By the end of the second world war, with the establishment of the Marxist-Leninistsystem and Enver Hoxha’s dictatorship, the small “land of the eagles,” in a progressive pro-cess of isolation, closed its doors on the western world and then even to the majority ofcommunist countries (Marcetti et al., 2000, pp. 18–22).

Soon after the death of Enver Hoxha in 1985, his successor Ramiz Alıa faced majorproblems following both the great political changes in 1989 among the communist EastEuropean countries, and an increasing economical crisis, which weakened the positionof the Albanian Labor Party. Examples of such problems were the early protest in the

Subs

t Use

Mis

use

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Mic

higa

n U

nive

rsity

on

11/0

7/14

For

pers

onal

use

onl

y.


region of Skutari, together with an increasing absenteeism in the plants and dissolutionof the rural social cooperatives during 1990; the students’ protest in 1990, followed by alarger protest in the capital city Tirana, where a gigantic statue of Hoxha was pulled down;a collective push to leave the country for Italy and Greece, which generated several riotsbetween 1990 and 1991. Alıa was able to initiate diplomatic relations with foreign countries,allow private production and private sales, permit free parties and religious freedom, andabolish political imprisonment. In March 1991 Albania had free elections and a democraticgovernment started to rule the country. Coming out of the international isolation and thepassage from a planned economy to a free market system have been major changes in recentyears (Marcetti et al., 2000, pp. 11–14).

With the collapse of the Marxist-Leninist regime, more than four hundred years afterthe arrival of the first Arberesh people, there was another wave of immigration from Albaniato Italy. Since 1990 there has been a constant influx of Albanians arriving in Italy, legally oroften illegally, by dangerous boat trips across the sea strait that separates the two countries.The peaks of immigration occurred in 1991 (the Italian movie Lamerica, directed by GianniAmelio in 1994, beautifully described that event) and in 1997, after a dramatic collapse inthe national bank system that ate into the savings of the majority of people. Some of theseimmigrants had experienced imprisonment for political reasons during the communist era;and a few were just criminals who were freed from the national prisons due to the generalconfusion in the country at the time. By and large all these people, mostly young men, lefttheir land for a western world that was perceived as being free, rich, and full of opportunity,and looked for work in Italy, where they found unqualified jobs in sectors that were oftenunappealing to their Italian peers. They expected to save their earnings and also to supporttheir families at home, and maybe return one day. In fact blood ties are highly respected inAlbania and the Albanian society is actually strongly structured in systems of families.

Albania, with a surface of 28.748 km2, has a population of around three millionone hundred thousand inhabitants (48.9% males; 51.1% females) and a density of 107inhabitants per square kilometer. Tirana, the capital, officially has 279,000 inhabitants,although the number of actual residents is estimated to reach one million, due to theincreasing urbanization of the country. It was estimated that more than 10% of Albaniansleave Albania for work reasons, with the majority going to Greece and Italy, but also to otherEuropean countries and the United States. The main religions, which show great respectfor each other, are Islam, Orthodox Christianity, and Catholicism, and the official figuresfor those who identify with these religions are 84.4%, 8.7%, and 6.2% respectively. Evenif in the 1960s, and in the years to follow during the Communist regime, an atheist statehad been declared, a number of Albanians kept practicing their own religion at home. Thereligious freedom deliberated by the new democratic nation allowed mosques and churchesto be restored. The per capita income is very low and the country’s economy, still drawingon agriculture (49%), and to a lesser extent onto industry (27%), and the service sector(24%), relies on the emigrants’ remittances and international support (Calendario Atlante[De Agostini Atlas], 2004).

Albanian Immigration to Tuscany

According to recent reports, Albanians represent the largest population among the immi-grants from countries outside the European Union (EU) who have arrived in Italy since the1990s (Caritas, 2005).

Subs

t Use

Mis

use

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Mic

higa

n U

nive

rsity

on

11/0

7/14

For

pers

onal

use

onl

y.

286 Allamani et al.

As is the case for Eastern Europe, most of the immigration waves from Albaniato Italy and to Tuscany have occurred, as previously mentioned, since 1990. Prior to this,Albanians were virtually not in Italy: only two Albanians were officially resident in Florence(Fondazione Michelucci, 1998).

According to the ISTAT (Italian Institute of Statistics) data in 2000 (ISTAT, 2001),which was the year in which the present study commenced, amongst over 113,000 for-eigners officially resident in Tuscany, Albanians represented the largest community withalmost 21,000 residents (62% male; 38% female) (i.e., 18.4% of total foreign residents).In Florence, Albanians were ranked as the second biggest community (outnumbered onlyby the Chinese) with 5,909 residents (62.6% male; 37.8% female), and up to 14.9% of the40,000 total foreign residents. According to common opinion, considering illegal residents,it is estimated that these figures may be 30% to 100% higher than that indicated by officialdata sources.

Foreign immigration to the Italian sociocultural context did highlight a series of prob-lems that were unseen until the 1970s, because Italy had historically been a land of emigra-tion into other richer countries such as the United States, Australia, Canada, and northernEurope (Bassetti 2003). An important problem was, and is, the spread of the phenomenon ofmarginalization, which is related to the difficulty of settling into cultural contexts that differto those of the country of origin. Another problem is the situation and state of illegality inwhich Albanians as well a several non-EU citizens can find themselves. These issues, alongwith the discomfort of integration into different cultural contexts, could give rise to a stateof individual and family “vulnerability” (Moro, 1998) or acculturation stress (Berry, 1998).

Although at the start of the 1990s Italians perceived Albanians to be closer than anyother immigrant population, because of the aforementioned historical and cultural ties,after a few years they started to consider them to be among the immigrants who weredisliked the most. Indeed, the image of the “delinquent Albanian” was created throughthose individuals who, different from the majority of subjects who are appreciated fortheir work and behavior, began to be involved in criminal behavior like violence, theft,and prostitution. Such criminalization was also interpreted as a social construction basedon media reports, which expressed both feelings of insecurity and a sort of identity crisis,recently affecting Italians, who are nowadays facing the many problems of the presentaffluent metropolitan areas, immigration being one of the most evident (Meli, 2003). Thosedeviant Albanians were probably earmarked with both a poor social support in their originalcountry and a process of exclusion that affected them in the new country (Marcetti et al.,2000, pp. 34–43).

Albanians and Alcoholic Beverages

With regard to alcohol, Albanian drinking habits are, and have always been, acceptable inspite of the prevalence of Islam, a religion that prohibits the consumption of any alcoholbeverage (see Michalak, 2003). Islam has always peacefully coexisted with Christianitythroughout Albanian history, well before the declaration of the atheist state in the 1960s.

A 1993 anecdotal report of the behavior of Albanians in Albania, conducted shortlyafter the fall of the communist regime, indicated that, for example, a young man in anAlbanian town could drink up to an average of 80 grams of absolute alcohol per day(Allamani, 1994). This amount was twice as much as that consumed by an average urbanItalian man at the time (Allamani et al., 1988). The national drink was, and is, raki, alocal brandy with between 35% and 45% alcohol content, which is regularly consumed

Subs

t Use

Mis

use

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Mic

higa

n U

nive

rsity

on

11/0

7/14

For

pers

onal

use

onl

y.


on social occasions such as holidays or visits, although wine and beer were also drunk.Excessive drinking, which was attributed to the young unemployed who frequented barsthat had opened in the city in the new permissive climate, was regarded as a possible sourceof fights. The same report also stated how women of all ages drank—wine and beer—andsmoked. Illegal drug use in Albania was, until relatively recently, almost nonexistent. Itwas first apparent in the capital of Tirana in the 1990s, and in a certain sense reflectedthe contrast between Albanian civil society and the social issues in the western world(Allamani, 1994).

According to a telephone interview conducted by Kristach Vojo at the Albanian Min-istry of Health in 2003, there were no data or official studies showing alcohol misuseor related problems in the country (Vojo, 2003). The WHO 2001 report on alcohol con-sumption in European countries also did not report on any information regarding alcoholconsumption and policies on alcohol in Albania (Rehn, 2001). According to Sekulli, anewspaper published in the Albanian language, there was, however, a survey carried out bythe Public Health Institute of Tirana, which stated that 78% of Albanians consider the useof alcohol to be “a normal thing,” 14.5% refer to themselves as “a habitual drinker,” 5.4% asa “frequent drinker,” and 2% would consider themselves to be “alcoholics” (Osservatoriodei Balcani, 2003).

Indicators of mortality or morbidity related to alcohol are not noted but, according todata on the Albanian Institute of Statistics Web site, alcohol is said to be one of the maincauses of death or disease in Albania (Instituti i Statistikes Tirane, 2005).

Since 1993 some Alcoholics under Treatment clubs a la Hudolin1 (self-help groupsfor alcoholism that are widespread in Croatia and Italy) have started in the Elbasan district,in the central-south of Albania. Although such groups do not appear to exist nowadays(Ursella, 2005), their appearance seems to indicate at least an initial focus of attention onalcohol consumption-related problems.

There is still no documentation concerning the alcohol consumption of, or alcoholconsumption-related harm, regarding Albanians in Italy and Tuscany. Indirect data regard-ing the latter can be drawn from prison or emergency room services statistics. As a matter offact, being in jail could serve as an indicator of marginalization and crime potentially relatedto alcohol misuse or alcoholism. The image of the Albanian committing violent crimes,which was often presented by the Italian national and local media, could be explained byalcohol misuse—that could lead to aggressive behavior.

In fact the prevalence of Albanians in the Florentine Sollicciano prison is remarkable.According to the statistics on the Albanians in prison there were 124 Albanians there in1995 and 316 in 2000. In December 2004 there were 103 Albanians who accounted for21.4% of the non-EU prison population (i.e., 481 people) and 11.4% of the total prisonpopulation (which comprised 907 EU and non-EU people). However, there is no currentinformation on what impact the alcohol consumption and its effects had on the crime, norabout the drinking practices of the Albanian prisoners.

Admission to emergency room services following an accident or assault can alsoindicate possible alcohol consumption-related misuse. However, there are no current avail-able data records concerning Albanians accessing Florentine or Tuscan emergency roomservices.

1The Croatian psychiatrist, Vladimir Hudolin (1922–1996), created a program for alcoholicsand their family members that was an adaptation of Alcoholics Anonymous in a socialist country. Theprogram first started in Zagreb and was successfully exported into Italy in the 1970s. (See Patussi,Tumino, and Poldrugo, 1996)

Subs

t Use

Mis

use

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Mic

higa

n U

nive

rsity

on

11/0

7/14

For

pers

onal

use

onl

y.

288 Allamani et al.

Alcohol Dependence/Abuse and Depression

Mood disorders, and depression in particular, are the most common psychiatric distur-bances related to alcohol dependence (see e.g., Conti and Zaccagnini, 2000) to the extentthat depression could be considered an indirect indicator of alcohol dependence. Moreover,DSM IV-TR (American Psychiatric Association, 2000) emphasizes the correlation betweenalcohol dependence and abuse, and mental disorders, including mood and depressive disor-ders. From a pharmacological viewpoint, alcohol is a substance that in the short-term canfacilitate brightness and assertiveness in relationships with others, while in the long run ithas a depressing effect on the central nervous system.

Alcohol dependence and alcohol abuse create a series of complications in patientsalready affected by bipolar disorders, and are associated with an increased number ofhospitalizations and an increased risk of suicide (Sonne et al., 2002). According to theESEMeD Project (European Study of the Epidemiology of Mental Disorders) that examined21,425 (of 213 million) adults aged over 18 from the general population in six countries(France, Belgium, Spain, Italy, Holland, and Germany) between 2001 and 2003, 3.9% hadsuffered from mood disorders in the last 12 months (3.8% in Italy). Within the same periodalcohol dependence and alcohol abuse in the six countries were calculated to be present in5.2% of the general population (ESEMeD Project, 2004).

In general, the connection between mental disorders and substance use has been estab-lished. Three possible types of relationship were identified (Edwards, Arif, and Hodgson,1981): (a) mental disorders cause substance use; (b) substance use causes mental disorders;or (c) there is only a casual association between substance use and mental disorders. Asidefrom whichever pathology appears first, this will tend to influence the appearance andmaintenance of the other one.

Thus, if depression appears first, the person is prone to later present with alcoholdependence. If, vice versa, alcoholism appears first, the person may later experience adepressive disorder (Kessler et al., 1997). It follows that the presence of one of the twodisorders might represent a possible indicator of the copresence of the other, and that data onthe prevalence of depression in some populations could indicate the copresence of alcoholdependence.

However, even though Albanian clinicians report that it is common to observe a linkbetween alcohol consumption and depression, data about the prevalence of depression inAlbania are unfortunately not yet available (Sqerra, 2005).

Epidemiological Investigation of Alcohol and Tobacco Useamong Albanians in Florence

The Research Aim

Especially in the 1990s and during the first years of this millennium, it was commonlyreported, by the media and by Florentine residents that there are frequent behavior problemsamong the Albanian immigrants in Florence and Tuscany, which may be related to alcoholuse. Some violent behaviors that are attributed to subgroups of Albanian immigrants couldin fact be caused by the use and misuse of alcoholic beverages, which, in turn, may bedue to the fact that this population has been culturally uprooted, and also to a lack ofreadjustment to formal or informal controls regarding drinking habits that are typical of theItalian culture—in other words, to a process of acculturative isolation (Berry, 2005). On

Subs

t Use

Mis

use

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Mic

higa

n U

nive

rsity

on

11/0

7/14

For

pers

onal

use

onl

y.


the other hand, prevention and treatment may be made difficult by cultural, linguistic, oradministrative factors—including lack of legal access to health services.

These observations are obviously also valid for other ethnics groups in the Florentinedistrict. Nevertheless, problems could vary from one ethnic group to another, which requirespecific investigation and interventions.

The project arose from a collaboration with two migrant resource associations inFlorence: “Albania in Tuscany” and “Missing links”—the former being an association ofAlbanians living in Tuscany, the latter giving help to poor immigrants in Florence, amongthem Albanians. We should add that the researcher promoting this project was born inAlbania and has a certain number of links with the Albanian community in Tuscany.

The project aim was to improve health and reduce alcohol consumption-related prob-lems among Albanians in Florence, starting with an epidemiological investigation to gainadequate information about the use of alcoholic beverages among the Albanians residentin Florence A parallel investigation was also conducted on tobacco consumption, which isknown to be often associated with alcohol use and misuse.

Moreover, two other secondary aims were considered: to implement a preventiveprogram, which would inform the Albanian immigrants about the outcome of the above-mentioned epidemiological survey; and to create a subsequent treatment program, namelyan outpatient treatment program to be dedicated to Albanians, as part of a preexisting ItalianHealth Service program for alcoholics in Florence. Such programs had to be provided withAlbanian health professionals. In the authors’ mind, this would help Albanians with alcohol-related problems to avoid the embarrassment related to the admission of the problem ofalcoholism in front of Italian professionals who were not part of their culture.

Subjects and Method

One hundred and forty one adult Albanians were interviewed in Florence between October2001 and January 2002. The sampling took place on the basis of the practicality of theinterview and the opportunity of the contact. Indeed a normal sampling on the base ofthe electoral lists, or of the telephone book number was not possible, since people mightlive without a stable housing, or might work irregularly. Therefore two main conditionswere identified, and Albanians to be interviewed were preliminarily divided up into twogroups, based on their level of social integration: those without a fixed address and witha precarious housing situations—who were considered “marginalized”; and those with aresidence and better housing as well as better economic conditions,—who were considered“integrated.” The former were mainly looked for and interviewed in meeting places such asthe Caritas cafeteria (a center that distributes free food to homeless people), the “MissingLinks” office, and the central railway station in Florence. The latter were mainly contactedat the “Albania in Tuscany” offices; moreover, when they were known to the interviewersor to the researchers, they were interviewed at home, or, as far as students were concerned,on their way to or from University.

Questions were asked by Italian and Albanian interviewers, who were duly preparedwith a structured questionnaire routinely utilized in Tuscany in different surveys (see, e.g.,Cipriani, Voller, Allamani, Aquilini, 2002) translated into Albanian and preliminarily testedwith native Albanians. The questionnaire garnered information about sociodemographicfactors; their migration history; the quantity, frequency, and the patterns of their wine, beer,and liquor consumption; as well as about their cigarette-smoking habits and use of thehealth services (hospitalization, emergency room treatment, and medical appointments).Grams of alcohol were calculated assuming an average of 11% for wine, 4% for beer, and

Subs

t Use

Mis

use

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Mic

higa

n U

nive

rsity

on

11/0

7/14

For

pers

onal

use

onl

y.

290 Allamani et al.

Table 1Selected sample characteristics (N = 141)

Males Females

Interviewed 114 (81%) 27 (19%)Mean age 29.0 27.6Married 38% 56%Living alone 41% 15%“Marginalized” 40% 3%

40% for liquors, and that the average drink was 135 cc for wine, 330 cc for beer and 35 ccfor liquors. Individuals who refused to answer were about 25%.

Results

The 141 interviewees were mainly male and young (ranging from 18- to 63-years-old, witha mean age of 28 years), and had been in Italy for an average of about 4 years. Fifty-sevenpercent were regularly resident in Italy (i.e., residents and in possession of stay permits),while 43% were not.

Thirty-five and a half percent lived alone. Forty-two percent lived in their own house(purchased or rented). They had been to school for an average of 12 years, and the majoritywere not married (59%) and had a good, or good enough, knowledge of the Italian language(80%). Albanians interviewed within the facilities of Florence University were 7%.

There were remarkable gender differences (see Table 1). Women, in fact, had arrivedin Italy later (on average 2 years later), were more often married and mostly lived with theirfamilies. Compared to males, they were more likely to be legally resident with stay permitsand enjoyed better living conditions. Their level of marginalization appeared low. Theseindicators highlight that women tended to come to Italy to reunite with their husband orrelative who had already obtained legal employment in Italy.

In regard to employment in Italy, 34.6% of the working males worked in construction,20.6% worked in the hospitality, 20.6% worked in trades and services, and 15% in factories.On the other hand, other types of work that Albanians reported having in Albania (e.g., inthe sectors of agriculture, public administration, and health) were lost or greatly decreasedafter their immigration.

Almost 93% of the sample drank alcoholic beverages, while 2.1% had stopped drinkingand 5.0% were teetotalers (2.6% male; 14.8% female). The average daily amount of alcoholconsumption was 39.5 grams for the entire population sample, and 42.5 g/day for thesubsample of drinkers. Among this subsample, males drank substantially more than females(drinking males: 48.1 g/day; females: 14.6 g/day). Considering the conventional “safe”alcohol consumption levels (<40 g/day for males and <20 g/day for females), 48.2% ofmales and 22.2% of females were drinking at risk (Figure 1). Moreover, 30.7% of malesand 3.7% of females exceeded 60 g/day and 40 g/day, respectively. Only males drank over80 g/day and many of them did so (19.3%).

The daily alcoholic intake mainly constituted wine (44% of total alcohol), followed byliquors (30.4%), and beer (25.4%). The distribution was different among Albanian femaledrinkers, whose moderate alcohol consumption mainly derived from wine (49.1% of totalalcohol), followed by liquors (36.5%), and beer (14.4%). Sweet liquors were a favorite ofboth genders (39.5% of total consumed liquor), followed by grappa (29.1%), brandy and

Subs

t Use

Mis

use

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Mic

higa

n U

nive

rsity

on

11/0

7/14

For

pers

onal

use

onl

y.


Figure 1. Alcohol consumption among Albanian immigrants in Florence (N = 141): Percent distri-bution by 4 alcohol consumption categories (g/capita/day)

cognac (24.5%), alcoholic aperitifs (20%), vodka (19%), coffee with liquor (18.2%), bitters(14.5%), and others.

Approximately a fifth of the interviewees (21.9%) reported to have drunk too muchor been drunk at least once in the last 3 months (8.5% once, 5.4% twice, 2.3% three tofive times, and 3.1% six times or more), while 45.7% reported that since she/he had beenin Italy, at least one person (medical doctor, family member, partner, other) had criticizedhis/her drinking habits.

It appears that Albanians who were not legally residing in Italy (N = 43) were inclinedto drink more than those who had legal residence (50 g/day and 34.9 g/day, respectively),while the proportion of smokers in the two groups was not substantially different (51.2%and 49.0%, respectively).

Over a third of the sample (37.7%) reported that she/he now drinks a little more thanthe amount she/he used to drink in Albania, while 15.6% reported drinking much more inItaly than in Albania. On the other hand, for 26.8% consumption levels had not changed,and 20.0% reported that they drank less.

At the time of interview 49.6% of the sample smoked, 13.4% used to smoke buthad quit, while 36.2% had never smoked. Gender differences were evident: male smokerssmoked more than a pack a day (an average of 24 cigarettes/day), while female smokerssmoked about half a pack (an average of 12 cigarettes/day).

Considering both alcohol use and smoking, 57.8% of males and 27.3% of femalesdrank and smoked, while only 4.4% of males (five males) and 14.8% of females (fourfemales) neither drank nor smoked. All male smokers were also drinkers. In both genders,the average alcohol consumption was higher among smokers than nonsmokers (54.8 g/dayand 35.4 g/day in males and 18.0 g/day and 9.6 g/day in females, respectively).

In regard to health factors, twenty-three people reported that they had been hospitalized(the majority were men) due to: (a) work accidents; (b) road accidents; and (c) other types ofaccidents and unspecified illnesses. There had been thirty-four emergency room admissions(without hospitalization) for twenty-six people, mostly for work accidents (14) and roadaccidents (13). In relation to alcohol consumption, it emerged that among those who drank

Subs

t Use

Mis

use

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Mic

higa

n U

nive

rsity

on

11/0

7/14

For

pers

onal

use

onl

y.

292 Allamani et al.

Figure 2. Alcohol consumption among Albanian immigrants in Florence: Average alcohol con-sumption (g/capita/day) by beverage type among male Albanians (n = 114) and a sample of 18–30year-old male Florentines (n = 104)

more than 40 g/day, more than half had needed to apply for emergency room services.Twenty-eight percent had been examined by a medical doctor in the last 3 months.

Discussion

The results of the present study show that the Albanians who had immigrated to Florenceare mostly young males, with good education, and a fair knowledge of the Italian languageas an average; a notable part of them (7%) were students attending Florence University. Inless than 50% of cases they had their own housing. They were able to find a job especiallyin the areas of construction, services, and hospitality (while often they could not continuethe work they did in their homeland (e.g., in agriculture, public administration, and thehealth sector). Such data are in agreement with the results of another survey on fifty-four immigrant Albanians who were interviewed in 1998 about their living conditions inFlorence (Marcetti et al., 2000).

Also, the present study demonstrates that alcohol and tobacco consumption by Alba-nians in Florence (and possibly by Italian Albanians) is considerable. On an average animmigrated Albanian drinks 39.5 grams of alcohol per day (equivalent to a little less thanhalf a liter of wine), while for an average male this figure becomes 48.1 grams. This is 3.5times more than the alcohol consumption of a sample of 18- to 30-year-old male Florentines(cf. Cipriani et al., 2002), the age range of which was approximately comparable to that ofthe Albanian sample in the current study (Figure 2). The difference is highly remarkablewith regard to liquor consumption (14.5 g/day for Albanians; 1.6 g/day for Florentines).Illegally residing Albanians drank quite more (50 g/day on average) than legally residentAlbanians (34.9 g/day on average).

Further, interviewees reported a difference in their alcohol consumption level duringtheir time in Italy compared to when they lived in Albania, with 54% drinking more in Italy.

Excessive drinking was notably more frequent among Albanians in Italy (who, in 21.9%of cases, were drunk at least once in the last 3 months) than among Italians. Accordingto a national study in 2000, 4.1% of Italians were drunk at least once during the last 3months—a percentage that rose to 12% for the 15- to 24-year-old age group (OsservatorioPermanente Giovani e Alcool, 2000).

Subs

t Use

Mis

use

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Mic

higa

n U

nive

rsity

on

11/0

7/14

For

pers

onal

use

onl

y.


With regard to smoking habits, our study showed that 49.6% of Albanians in Florencewere smokers. Such a figure is in keeping with the information from a WHO document,which reported a 49.8% prevalence of smoking among adult males in the early- to mid-1990sin Albania (Harkin, Anderson, and Goos, 1997). Smoking differences between Albaniansand Florentines were less marked than those concerning alcohol consumption. Neverthe-less, the percentage of smokers was higher among Albanians in our study (50%) than inthe 18- to 39-year-old Florentine sample (39.6%). In particular, Albanian male smokerssmoked almost twice as much as Florentines (24.4 cigarettes/day and 12.3 cigarettes/dayrespectively), while such differences were much less evident in females (11.7 and 9.2cigarettes/day, respectively).

Finally, Albanians in Italy had an extraordinarily high level of contact with the emer-gency room services (34 out of 141 interviewees or 24.1%) compared to the generalpopulation where 373.9 per 1,000 residents contacted the emergency room services (i.e.,0.37%) (Osservatorio di Epidemiologia ARS, 2005). People drinking a larger amount ofalcohol beverages appeared more prone to enter and use the services.

What could be the reasons for these differences in consumption levels, particularlyregarding alcohol consumption? Since drinking is contextualized in a culture that endorsesit, these differences could be due to two interacting orders of phenomena.

According to an acculturative “isolation” hypothesis (Berry, 2005), one might positthat alcohol consumption by Albanians, be it in Albania or Italy, is representative oftypical alcohol consumption in rural Mediterranean areas, which was particularly high,especially following the Second World War. In fact, such quantities are indeed similarto the consumption levels that occurred during the 1980s in Italy, such as those doc-umented by an investigation in a factory in Florence, which reported an average con-sumption of 41.2 grams of absolute alcohol per day for employees, or by a study in therural area of Chianti, which revealed a remarkable average consumption of 80 grams ofabsolute alcohol per day (Allamani et al., 1988). In Italy such high consumption levelshave been decreasing and have now reached today’s relatively low alcohol consumptionlevels, in parallel with the urbanization, industrialization, and globalization processes oc-curring in Italy (Allamani and Beccaria, 2007), which are still in their initial phase inAlbania.

Such a conclusion is questionable since the information regarding the quantity, con-texts, and meaning of drinking in Albania is largely insufficient.

Another perspective deals with the implications of the sociocultural change relatedto emigration, and the social vulnerability, or acculturation stress, which it causes theindividual and his or her family. According to some opinions (Heath, 1985), culturaluprootedness, or marginalization, is a cause of the loss of informal controls which asociety establishes throughout its history, thus leading to the loss of bonds and inhibitionsthat regulate, among other things, the specific quantity and quality of drinking within agiven society. This loss is related to both changes in the community context as well asto employment changes. In fact, our study reveals that Albanians often go from doingqualified, skilled, and professional work in their home country to unqualified work in Italy.For example, they work more in construction and less in trades and services.

In support of this interpretation is the fact that more than half of the intervieweesreported that they drink more, or much more, in Italy than at home, and that illegal workersarrived and drank even more (on average 50 grams of absolute alcohol per day) than thosewho were legal (on average 34.9 grams). From this perspective, the increased alcoholconsumption levels could be either due to the loss of informal control, which is normallypresent as a result of the person’s awareness of social rules, or to the psychotropic use

Subs

t Use

Mis

use

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Mic

higa

n U

nive

rsity

on

11/0

7/14

For

pers

onal

use

onl

y.

294 Allamani et al.

of alcohol to alleviate the discomfort associated with social marginalization, the latter ofwhich could be a kind of self-therapy. Another contributing factor seems to be the greateravailability of alcoholic beverages in Italy than in Albania in terms of type of beverages,the number of places from which alcohol can be obtained, and the trading hours. Such useof alcohol is reflected in behaviors, which are typical of alcohol misuse (e.g., aggressivedriving, social violence within friendship groups or with people from other cultures), andends up increasing the alcohol user’s social vulnerability and marginalization.

From an epidemiological and preventive point of view, Albanians’ high alcohol con-sumption levels, particularly, as demonstrated by the research findings, in males and illegalresidents, define them as being a high-risk group for alcohol consumption-related behav-ioral problems as well as, especially in the long run, alcohol consumption-related physicalharm. The interaction of alcohol with elevated tobacco consumption levels may increasethe severity of risk for health in terms of respiratory tract or oropharyinx and oesophagusdisease. The relatively high level of contact with the emergency room services reportedby the interviewees as a result of accidents is in keeping with this prediction and this iscorroborated by the frequent media reports about accidents and acts of violence involvingAlbanians.

Study Limitations

One limitation is that the study’s sample is an opportunistic one. In fact it was not possibleto have a usual random sampling because of the frequent irregular living and workingconditions of the people to be interviewed. As a consequence, the study conclusion may benot representative of the universe of Albanians who immigrated to and who live in Florence.

Two secondary aims of the study were both implementing a preventive initiative onthe issue of the risk of alcoholic beverage drinking among the Albanian immigrants,and creating a temporary outpatient treatment program for Albanians affected by alcoholdependence.

In fact, the preventive action was not particularly successful. After some informationdisseminated in the Albanian community, through a few posters and by word of mouth,only about thirty people, among them a few Albanian medical doctors working in Florenceand the consul of a northern Italian city, attended one “evening” dedicated to this topic ina restaurant bar owned by an Albanian resident in the center of Florence.

Also the experimental 6-month outpatient program, involving both an Albanian medicaldoctor and an Albanian language mediator once a week, had very limited success, Onlythree patients manifesting alcohol dependence applied for a medical interview and justentered the program, making it impossible for any attempt to continue the experience.The small number of patients could be explained through different factors. One factormight have been the little time that was available to make the program known amongAlbanians before it actually started. Another factor could hypothetically have been thecentralization of the program, versus a community-oriented approach. A further reasoncould be the prudence of Albanian males when they have to talk about their own medical oralcohol consumption-related problems, the latter being perceived as potentially detrimentalto their status within their family even in the circumstances where their women werenot physically attending the medical interview. Finally, it has been argued that such aprogram could have been too ambitious for the small number of persons that should beexpected to enter it (Quartini, 2004); in fact applying the standard estimation of 0.5%–5% of alcoholics per each general population (cfr. Voller and Cipriani 2007), one wouldestimate that alcoholic Albanians in Florence were 25–250 out of 5,000, which would turn

Subs

t Use

Mis

use

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Mic

higa

n U

nive

rsity

on

11/0

7/14

For

pers

onal

use

onl

y.


into 2–25 individuals potentially entering the program—since it has been estimated thatonly about 10% of the alcohol-dependent individuals go to mutual-help groups or to theHealth Services to treat their problems due to drinking alcoholic beverages (see Allamani,2007).

Notwithstanding, the number of Albanians manifesting alcohol dependence that en-tered the outpatient program in the alcohol Center, where the experimental program, whichwas designed only for Albanians, increased by a few units after the cessation of the study.Even if numbers are still too small to allow any conclusion, such an event might indicatesome level of integration of Albanians in the Italian Health System, where they might feelrelatively comfortable relating to Italian doctors and nurses, which they could also perceiveas being more qualified than the Albanian counterparts.

In conclusion, it is possible that an adequate and culturally sensitive and tailoredalcohol-misuse prevention program among Albanian immigrants, which should be bet-ter planned than the one that has been presented in this paper, could help the immi-grants to integrate into the local community. Moreover, adequate information about alcoholconsumption-related risks could prevent a series of harmful outcomes. Better informationabout the health problems of Albanians and, more generally, about the immigrants in theFlorentine metropolitan district, could improve knowledge about their needs for care andtheir patterns for seeking a range of services and treatments and thus inform the preventionand treatment necessary for the most vulnerable groups of the population.

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the contentand writing of the paper.

RESUME

Le but de cette etude a ete celui de reunir du materiel d’information sur les habi-tudes concernant les modalites de boire et de fumer, et sur l’eventualite de problemescorreles a l’alcool, parmi les Albanais immigres a Florence, Italie, apres la fin duregime communiste en 1990. Entre le mois d’octobre 2001 et le mois de janvier 2002on a interviewe 141 Albanais, qui vivaient a Florence, sur la consommation et sur lesmodalites d’usage des boissons alcoolisees, des problemes de sante correles ainsi que sur letabac.

Les interviewes etaient pour la plupart des hommes (81%), 28 ans en moyenne, etils avaient passe en Italie leurs quatre dernieres annees; 92.9% d’eux consommaient desboissons alcoolisees, de preference du vin et des liqueurs, et leur consommation moyenned’alcool absolu par jour oscillaient aux alentours de 39.5 grammes. Les hommes en pre-naient 48.1 grammes par jour, c’est-a-dire une quantite 3.5 fois en plus par rapport aun echantillon equivalent d’hommes florentins. En outre l’echantillon albanais depassaitles Florentins en termes de pourcentage de fumeurs (49,6% contre 39.6%) et de con-tacts avec le service des urgences (24.1% contre 0.37%). Telles consommations peuventcontribuer aux pourcentages eleves d’accidents et de violence attribues aux Albanais aFlorence.

On a discute deux hypotheses pour expliquer ce niveau tres eleve de consommationd’alcool: (a) le modele, concernant les boissons, typique des cultures encore ruraux, (b) lechangement socioculturel du a l’immigration.

Les limitations de cette etude ont ete rapportees.

Subs

t Use

Mis

use

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Mic

higa

n U

nive

rsity

on

11/0

7/14

For

pers

onal

use

onl

y.

296 Allamani et al.

RESUMEN

El objetivo del siguiente estudio ha sido el de recoger informacion sobre las costum-bres de beber y fumar y, en la eventualidad de problemas vinculados al alcohol, entre losalbaneses inmigrados en la ciudad de Florencia, Italia, tras el final del regimen comunistaen el 1990. Entre octubre 2001 y enero 2002 han sido intervistados 141 Albaneses, quevivıan en Florencia, sobre el consumo y sobre el modo de usar las bebidas alcoholicas,sobre los problemas de salud vinculados a los mismos y tambien sobre el humo detabaco.

Los entrevistados fueron con prevalecıa hombres (81%), con una edad promedio de28 anos, y que habıan vivido en Italia durante los ultimos 4 anos. El 92.9% consumababebidas alcoholicas, con preferencia de vino y licores y un consumo promedio diario de39.5 gramos de puro alcohol. Los hombres asumıan 48.1 gramos por dıa, 3.5 veces mas deun campeon comparable a los hombres florentinos. Ademas el campeon albaines superabaa los florentinos con respecto al porcentaje de fumadores (49.6% contra 39.6%) y decontactos con el Primer Auxilio (24.1% contra 0.37%). Estas consumiciones tan elevadaspueden contribuir con los altos porcentajes de accidentes y de violencias que tiene que vercon los albaneses en Florencia.

Dos hipotesis se discuten para explicar este elevado nivel de consumacion de alcohol:a) el modelo del beber tıpico de las culturas todavıa rurales, como por ejemplo las de EuropaMediterranea; b) el cambiamiento socio-cultural debido a la emigracion. Son tratados loslimites del estudio.

THE AUTHORS

Allaman Allamani, M.D. (Italy). Gastroenterologist,Family Therapist, Psychiatrist; Researcher; Coordinator,Centro Alcologico, Florence Health Agency; author orcoauthor of 130 articles, editor or coeditor of thirteenbooks. Member of the editorial board of Substance Useand Misuse, and a faculty member of the Middle East-ern Summer Institute on Drug Use (MESIDU) in Israel,Spain, and Italy. Member of the exhibit planning commit-tee For Whom is it Permitted, For Whom is it Forbidden.In the 1980s contributed to a Regione Toscana project onTherapeutic Communication for helping professions. Inthe 1990s he initiated a comprehensive Alcohol ProblemTreatment and Prevention program in Florence, which

also focused on eating problems, based on low access threshold, family and motivationalapproach, and in cooperation with mutual-help groups. He developed the first commu-nity action alcohol consumption prevention projects in Italy, in the Florence area. He wasthe first nonalcoholic trustee of Italian Alcoholics Anonymous from 1997 to 2003. He istrustee of the Psychosomatics Training Institute, Florence, and member of the Kettil BruunSociety.

Subs

t Use

Mis

use

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Mic

higa

n U

nive

rsity

on

11/0

7/14

For

pers

onal

use

onl

y.


Federigo Bruno Innocenti, Ph.D. (Italy), psychologist,psychotherapist, Assistant Professor of Dynamic Psychol-ogy and Family Relationship Psychology, University ofFlorence. He collaborates with Centro Alcologico, Flo-rence Health Agency. Individual and group Trainer ofPsychodynamic and Integrative Psychotherapy.

Andrea Innocenti, Ph.D., Psychologist (Italy), Train-ing Manager, School of Comparative Psychotherapy, Flo-rence. He collaborates with Centro Alcologico, FlorenceHealth Agency. Individual and group Trainer of Integratvepsychotherapy.

Francesco Cipriani, M.D., is a Nutritional Epidemiolo-gist who heads the Epidemiology Department of AziendaSanitaria, Prato, Region of Tuscany. He is advisor of thepublic health authorities in Tuscany on lifestyle habits, so-cial consequences of public health and intervention poli-cies. A gastroenterological expert in alcohol treatment.He has published numerous articles on food and alcoholconsumption and health in Tuscany and Italy.

Fabio Voller is a Sociologist at the Osservatorio diEpidemiologia dell’Agenzia Regionale di Sanita dellaToscana. He has worked on epidemiological studies oflifestyle, on alcohol consumption, and on psychoactivedrugs in the Tuscan population. Among his publications,he is coauthor of a number of monographs about the healthconsequences of alcohol consumption in Italy.

Subs

t Use

Mis

use

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Mic

higa

n U

nive

rsity

on

11/0

7/14

For

pers

onal

use

onl

y.

298 Allamani et al.

Glossary

Acculturation: A process in which individuals and populations of different ethnicitiesexperience the dominant norms of the country where they live. By and large, such aprocess is characterized either by integration or by marginalization.

Immigration: The geographical and cultural experience of change by which individualsmove from their own country to another one for economical as well as ideologicalreasons.

Marginalization: An acculturation processes that individuals experience as a cultural clash,the people’s capacity to give collective responses to crises being heavily affected.

Alcohol beverage drinking: It may be maintained or changed within the new country; alsonew drinking practices can be learned there, which may exceed the shared norms.

Integration: The process by which patterns typical of the immigrant’s original culture (e.g.,drinking patterns) more or less slowly merges into the patterns of the new country.

Depression and alcohol: Among mood disorders, depression is the most common psychi-atric disturbance related to alcohol dependence.

Social vulnerability: Coming to a new country may generate an acculturation stress forthe individual and his/her family, which may wear down their psychic and socialequilibrium.

References

Albanie, encyclopedie de voyage [Albania, a traveler’s encyclopedia]. (1988). Les Edition Nagel.Paris: Geneve.

Allamani, A., Cipriani, F., Innocenti, S., Lomuto, C., Marchi, M. (1988). Alcohol drinking patternsand work areas: Epidemiological study of factory and rural workers in Florence, Italy. BritishJournal of Addiction, 83: 1169–1178.

Allamani, A. (1994). Albania: Cambiamenti sociali e aumento dei problemi alcologici. Note daun viaggio[Albania:social changes and increase in alcohol problems. [Notes from a journey].Alcologia, sez. italiana, 6(2):25–28 1994.

Allamani, A. (2007). The treatment system. In Allamani A., Anav S., Cipriani F., Rossi D., Voller F.(2007), Italy and Alcohol:A country profile. I Quaderni dell’Osservatorio Permanente Giovani eAlcool n.19. Casa Editrice Litos Roma.

Allamani, A., Beccaria, F. (2007). Editors’ introduction: Changes in the consumption of alcoholicbeverages in Italy. Studies of the decrease in consumption between 1970 and 2000. ContemporaryDrug Problems 34(2):183–186.

American Psychiatric Association. (2000). DSM IV-TR, Diagnostic and Statistical Manual of MentalDisorders, Fourth Edition, Text Revision. Washington.

Amundsen, E., Rossow, I., Skurtveit, S. (2005). Drinking pattern among adolescents with immigrantand Norwegian backgrounds: A two-way influent. Addiction, 100(10):1453–1463.

Bassetti, M. (2003). Contro la sindrome del riccio [against the Curl Syndrome]. Testimonianze432(6):20–25.

Bennet, L., & Ames, G. (1985) (Eds.). The Americanexperience with alcohol. contrasting culturalperspectives. New York: Plenum Press.

Berry, J.W. (1998). Acculturative stress. In P.B., Chun, K.M., & Marin, G. (Eds.). Organista. Readingsin ethnic psychology. New York: Rutledge.

Berry, J.W. (2005). Acculturation: Living successfully in two cultures. International Journal ofIntercultural Relations, 29(6):697–712.

Bonesso, G., Baldassa, L., Selmani, F., Salhi, M., Felisati, S., Fromaggi, S. (2003). Riflessionesul lavoro comune e di ricerca svolti dal Servizio Immigrazione del Comune di Venenzia eSerT Venezia Terraferma. [Reflecting on common work and research done by the immigration

Subs

t Use

Mis

use

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Mic

higa

n U

nive

rsity

on

11/0

7/14

For

pers

onal

use

onl

y.


service of Venice Municipality and Venice Drug Addiction Unit]. In: Alcologia e Immigrazione.Available at http//www.ristretti.it/areestudio/droghe/acat/mestre.htm.

Byron, G. (1889). The poetical works of Lord Byron. Edinburgh: W.P. Nimmo, Hay & Mitchell.Calendario Atlante De Agostini [De Agostini Atlas]. (2004). Novara: Istituto Geografico De Agostini.Caritas/Migrantes. (2005). Immigrazione: Dossier Statistico 2004. [Immigration:Statistical Dossier].Cipriani, F., Voller, F., Allamani, A., Aquilini, F. (2002). Variazioni temporali dei consumi alcolici

nell’area dell’intervento preventivo. [Temporal changes of alcohol consumption in the preven-tive intervention community]. In A. Allamani & I. Basetti Sani, L’esperienza di un progettodi prevenzione alcologico di comunita nel quartiere di Rifredi a Firenze, CEDEAS AziendaSanitaria di Firenze, Firenze.

Conti, L., Marquet, O. (1988). Spirito regale nei costumi della donna arbereshe- Shpirti mbretero neveshjet e gruas arbereshe. [Royal spirit of dresses of Arbereshe women]. Castrovillari (Cosenza):Edizioni il Coscile.

Conti, L., Zaccagnini, E. (2000). I quadri clinici dell’alcolismo. [Alcoholism, a clinical outline]. InA. Allamani, D. Orlandini, G. Bardazzi, A. Quartini, & A. Morettini (Eds.). Libro Italiano diAlcologia. [Italian Textbook of Alcohology]. Vol. I. Florence: SEE Editrice.

Edwards, G., Arif, A., Hodgson, R. (1981). Nomenclature and classification of drug and alcohol-related problems: A WHO memorandum. Bulletin of the World Health Organization, 59(2):225–242.

ESEMeD Project. (2004). Sampling and methods of the European study of the epidemiology ofmental disorders (ESEMeD) project. Acta Psychiatrica Scandinava, 109(Suppl. 420): 8–20.

Farina, P., a cura di. (2007). Futuro plurale. Percorsi e progetti dei giovani stranieri nel mantovano.[A plural future. Processes and projects of foreign youngsters in the community of Mantua].Osservatorio Provinciale di Mantova. Milano: Fondazione ISMU.

Fondazione Michelucci. (2000). L’Abitare Inferiore. [Dwelling in a lower condition]. Available athttp://www.michelucci.it/ convivenza urbana/ abitare inferiore.htm.

Harkin, A. M., Anderson, P., Goos, C. (1997). Smoking, drinking and drug taking in the EuropeanRegion. Alcohol, drug and tobacco programme. Copenhagen: WHO Regional Office for Europe.

Hasin, D., Rahav, G., Meydan, J., Neumark, Y. (1998). The drinking of earlier and more recent Russianimmigrants to Israel: Comparison to other Israelis. Journal of Substance Abuse 10:341–353.

Heath, D. (1985). American experiences with alcohol, commonalities and contrasts. In Bennet L.,and Ames G. (Eds.). The American Experience with Alcohol. Contrasting Cultural Perspectives.New York: Plenum Press.

Instituti i Statistikes Tirane. (2005). Available at http://www.instat.gov.al.Istituto Nazionale di Statistica (ISTAT). (2001). Immigration Report. Available at http://www.istat.it.Kessler, R. C., Crum, R. M., Warner, L. A., Nelson, C. B., Schulenberg, J., Anthony, J.C. (1997).

Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatricdisorders in the National Comorbidity Survey. Archives of General Psychiatry, 54:313–321.

Koliqi, E. (1957). Poesia Popolare Albanese. [Albanian people’s poetry]. Firenze: Fussi Sansoni.Lolli, G. (1959). Alcohol in Italian culture; food and wine in relation to sobriety among Italians and

Italian Americans. Glencoe, ILL: Free Press.Manca, M. C. (2002). Il Centro della Terra: Dove convivono vita e distruzione, salute e malattia. [The

center of earth where life and destruction, health and disease live together]. L’Arco di Giano,32:149–163.

Marcetti, C., Solimano, N., Colombo, M., Meister, C., Mori, T., Marashi, V. (2000). L’AbitareInferiore. Gli immigrati albanesi a Firenze. [Dwelling in a lower condition. Albanian immigrantsin Florence]. Livorno: Media Print.

Meli, A. (2003). Nel circolo vizioso della rappresentazione mediatica [Within the vicious circle ofthe media representation]. Testimonianze, 432(6):78–85.

Michalak, L. (2003). Advice for Muslims about alcohol via the Internet. Paper presented at KettilBruun Society Symposium, Krakow, June 5.

Moro, M. R. (1998). Psychoterapie transculturelle des enfants de migrants. [Transcultural psychiatryof children of immigrants]. Paris: Dunod.

Subs

t Use

Mis

use

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Mic

higa

n U

nive

rsity

on

11/0

7/14

For

pers

onal

use

onl

y.

300 Allamani et al.

Osservatorio dei Balcani. (2003). L’alcolismo in Albania: malati di ‘transizione’? [Alcoholism inAlbania: Individuals affected by “transition”?]. Available at http://www.osservatoriobalcani.org/article/articleview/2361/1/41.

Osservatorio di Epidemiologia ARS Area di Epidemiologia Sociale. 2005 L’infortunistica stradale inToscana [Road Accidents in Tuscany]. Agenzia Regionale di Sanita. Firenze.

Osservatorio Permanente sui Giovani e l’Alcool—Doxa. (2000). Italians and alcohol. Consumption,trends and attitudes in Italy and in the regions. 4th Doxa National Survey. Quaderno n. 14.Roma: Casa Editrice Risa.

Patussi, V., Tumino, E., Poldrugo, F. (1996). The development of the alcoholic treatment club systemin Italy: 15 years of experiences. Contemporary Drug Problem, 23(1):29–42.

Quartini, A. (2004). Personal communication.Room, R. (1985). Foreword. In Bennet, L., & Ames, G. (Eds.). The American experience with alcohol.

Contrasting cultural perspectives. New York: Plenum Press.Rumbaut, R. G. (1997). Assimilation and its discontent: Between rhetoric and reality. Internazional

Migration Review, 31(4):923–938.Rehn, N. (2001). Alcohol in the European region—consumption, harm and policies. World Health

Organization.Sonne, C., Brady, K. (2002). Bipolar disorders and alcoholism. Alcohol Research and Health, 26: 2.Sqerra, H. (2005). Personal communication.Ursella, L. (2005). La diffusione dei Club degli alcolisti in trattamento nel mondo. [Diffusion of clubs

for treated alcoholics in the world]. Quaderno delle 300 ore, 2:24–25.Vojo, K. (2003). Personal communication.Voller, F., Cipriani, F. (2007). Consumption of alcohol beverages. In Allamani, A., Anav, S.,

Cipriani, F., Rossi, D., & Voller, F. (2007). Italy and alcohol: A country profile. I Quadernidell’Osservatorio Permanente Giovani e Alcool n.19. Roma: Casa Editrice Litos.

Subs

t Use

Mis

use

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Mic

higa

n U

nive

rsity

on

11/0

7/14

For

pers

onal

use

onl

y.

alcohol and tobacco consumption among albanian immigrants in florence

Documents