RESEARCH CENTRES SERIES
Addiction research centres and the nurturing of creativity. The Korean Institute on Alcohol Problems (KIAP)
Sungsoo Chun, Korean Institute on Alcohol Problems (KIAP), 815 Hwarang-ro, Nowon-gu, Seoul 139742, Republic of Korea. E-mail: email@example.com
The aim of this paper is to provide an account of the history, current status and vision of the Korean Institute on Alcohol Problems (KIAP). In the context of increasing alcohol consumption, rising second-hand effects and industry-friendly government policy, the Korean College Alcohol Study (KCAS) was established in the Republic of Korea in 1999, and changed its name to the Korean Institute on Alcohol Problems (KIAP) in 2005. KIAP's mission is to decrease alcohol consumption and its related harms by promoting research, advocating policy, developing intervention programmes and preparing media communications. Since 1999, KIAP has published scientific papers and books in alcohol research and used the internet and other media for dissemination of specialized information to the general population. In the last decade, KIAP has trained front-line alcohol researchers, and advanced domestic and international networks to promote evidence-based alcohol control policy in Korea. The light of hope shines brightly as KIAP grows and establishes critical linkages to move forward in its mission.
STEPS OF HISTORY, STRIDES OF DEVELOPMENT
Korea has begun the difficult journey of facing the fact that there are collective and individual harms of being a ‘drinking culture’. Permissive attitudes about drinking in Korea conveyed to the general population through social channels may promote heavy drinking . During the 1990s there were sweeping increases in both alcohol consumption and alcohol-related harms in the Republic of Korea. Alcohol purchases within Korean households increased 156% between 1985 and 1995 , while alcohol-related vehicular crashes increased from 3.3 to 10.5% and deaths from traffic accidents from 3.1 to 8.7% in 1990 and 1997, respectively [3,4]. There were 29 497 alcohol-related deaths in 1995 and the economic loss by alcohol was 4.0% of the gross national product (GNP) in 1995 [5,6].
A major issue of concern has been the emergence of a college drinking problem during the 1990s, as reflected in alcohol-related accidents, injuries, assaults, sexual assaults and deaths among college students [7,8]. During this period approximately 1600 Korean young people between ages 20 and 29 died because of alcohol-related accidents or diseases . Despite this emerging crisis, college drinking was largely ignored or tolerated by the medical and scientific community.
In 1999, the Korean Institute on Alcohol Problems (KIAP) had its foundation in the Korean College Alcohol Study (KCAS) team, led by Sungsoo Chun. The purpose of KCAS was to characterize nation-wide alcohol consumption patterns and problems in university students. Supported by the Korean Ministry of Health, KCAS conducted ongoing surveys of over 3000 students at 63 4-year colleges in nine provinces and Seoul in 1999, 2001 and 2003. The schools and students were selected to provide nationally representative samples. KCAS examined key issues in college alcohol abuse, including the tradition of heavy drinking on college campuses and college policies. The study also provided a continuing examination of other high-risk behaviours, including tobacco and illicit drug use, unsafe sex, violence and other behavioural, social and health problems confronting Korean college students. The study results have been published in more than 10 papers and reports [10–14]. Since KCAS surveyed the first college study in 1999, heavy college drinking has gained national attention . From 2001 to 2002, college prevention programmes for alcohol-related harms were developed [13,15], and in 2003 collaboration began with the Harvard School of Public Health College Alcohol Study [12,16]. Although the KCAS has made contributions to understanding campus drinking problems, and many researchers have been trying to determine the causes of heavy drinking among college students [7,10,11,14], college alcohol problems are still not controlled on campuses because there are no alcohol control policies in Korea to address this . It is necessary to establish a comprehensive alcohol control policy and build public support for such policy. Due to cultural acceptance of social drinking as a part of daily life and a lack of stringent measures to control alcohol sales and consumption, most Koreans do not view alcohol abuse as a social concern .
Since the 1990s, the World Health Organization (WHO) has encouraged strong alcohol control policies to address drinking problems and alcohol consumption . The alcohol control policy paradigm in developed countries changed from a pathological and personal focus to one that was public health and community-orientated . By the new millennium many kinds of alcohol-related problems had been reported in Korea, including college drinking and alcohol-related crimes [5,9,21]. To address these new challenges, in May 2005 KCAS changed its name to the Korean Institute on Alcohol Problems (KIAP).
THE CURRENT SITUATION: CORE OPERATIONS AND EFFECTIVE STRATEGIES
As founding director, Sungsoo Chun set the KIAP mission to study individual, social and national harms caused by alcohol and to develop alcohol intervention programmes and policies. KIAP's aims are to: (i) conduct research on individual, social and national harms from alcohol; (ii) develop intervention strategies and programmes for prevention of alcohol-related harms for individuals, groups, organizations and society; (iii) expand and improve national alcohol policy to guarantee a safer societal environment; and (iv) support joint international efforts focusing on limiting the drinking culture and promotion of evidence-based alcohol control policies.
Specific KIAP activities include domestic and international alcohol epidemiological research, fulfilling alcohol research project requests from governmental and non-governmental organizations, developing alcohol intervention programmes, evaluation of alcohol policies, advancing international alcohol research networks, hosting national and international alcohol-related seminars, publishing scholarly literature and providing work-force development and education support resources. These activities are supported through association with national alcohol research societies such as the Korean Society of Alcohol Science and grants from the National Research Foundation, Ministry of Health and Welfare, Sahmyook University and the US National Institutes of Health. National journals such as Korean Public Health Research, from the Korean Public Health Association, have also facilitated these activities. Full- and part-time professors who work on KIAP projects are supported with salaries from their respective departments at Sahmyook University.
KIAP operates a research promotion system where research assistants and administrative personnel support senior researchers, project development teams and data analysis teams. This creates synergy where personnel skill-sets are matched to optimize productivity. Progressive project milestones with intermediate deadlines are set by the KIAP director. Although autonomous, KIAP is located in Seoul on the campus of Sahmyook University, where working groups meet weekly and review progress or challenges on a rotating schedule. These in-house meetings have been very effective in nurturing creativity and leadership within KIAP. The friendly fire of questions and critiques sharpens presentation skills, refines the research product and builds confidence. To date there are more than 20 researchers, research assistants and administrative personnel that support the KIAP research promotion system.
Key KIAP research strategies involve: (i) improvement of the research environment, convenience of administration and stabilization of the researchers' status; (ii) active support of all personnel; (iii) building stronger research infrastructure; (iv) growing international exchange programmes; and (v) being a readily available resource for Korean governmental agencies and the National Assembly (equivalent to Congress or Parliament in other countries). KIAP researchers are regularly called upon to make presentations before the National Assembly to influence alcohol policy, standards for work certification and graduate health education training. These opportunities are a powerful strategic tool for influencing Korea's political and educational machinery.
OUTCOMES AND EVALUATION
The strong need for research, analysis and policy recommendations drives core operations and publication output. Publications include government commissioned reports, policy analyses and peer-reviewed manuscripts. KIAP has made several submissions for the establishment of a modern national alcohol policy [18,22], which included standards of moderate and excessive drinking for Koreans . KIAP's leading publications and papers have included a discussion on Korean Alcohol Control Policy [18,22,23], companion papers characterizing alcohol-related injuries in emergency rooms [24,25] and a cross-national comparative study of alcohol second-hand effects among Korean and US college students [12,16]. Another significant study analysed drinking problems as well as alcohol use disorders, and estimated the alcohol-attributable fractions of deaths within Korea [26–28]. Altogether, KIAP research strategies are beginning to overcome national inertia and raise consciousness for the need of alcohol control initiatives within Korean society. Indeed, the pendulum of good will is beginning to swing in a health-supportive direction towards alcohol control policy enactment and enforcement.
During the last two decades in Korea, it was essential to describe national alcohol-related harms and drinking patterns. To meet these needs, KIAP performed the first nation-wide alcohol epidemiological survey to calculate the alcohol-attributable fraction of deaths [27,28] and measured drinking problems and alcohol use disorders in Korea . KIAP surveyed alcohol use and related problems, and developed intervention programmes for adolescents [29,30], college students [13,15], workers  and local residents [32,33]. For the implementation of local and national alcohol strategies, KIAP suggested guidelines for monitoring and evaluation of alcohol consumption [34,35] and helped to develop alcohol action plans at both local  and national levels [18,22,37].
In 2006, Korea's first national alcohol action plan was launched by the Korean Ministry of Health and Welfare as the ‘Blue Bird Plan’. The Blue Bird Plan focused on education and moderate drinking campaigns and distanced itself from the research and support of evidence-based alcohol control policy . The government's alcohol policy plan was not very successful because of its content and the lack of national implementation and enforcement. Although partially regulating liquor advertisement, it focuses mainly on education and promotion of moderate drinking . Because Korean alcohol policy emphasizes only alcohol education and health promotion, it is hard to expect a reduction in alcohol intake and related harms . In addition, marketing regulations on liquor are not effective in their restrictions of public broadcasting, print, outdoor areas and web-based media. It is the vision of KIAP to push the Blue Bird Plan in the direction of evidence-based alcohol policy by establishing more robust collaborations with Korean policy makers and non-governmental organizations to reduce alcohol harms in Korean society [18,20,22,37,39]. A key national collaborative study on alcohol problems was conducted with the Korean Society of Alcohol Science in 2006. The ascent of KIAP to national and international influence in research and alcohol control policy led to its 2007 citation as ‘the best research institute’ in Sahmyook University.
In 2008, KIAP collaborated with the WHO to conduct the nation's first hospital emergency room (ER) study on ‘Alcohol and Injuries’[24,25]. In 2009, KIAP expanded its activities by conducting international collaborating studies . Annual international conferences were hosted by KIAP with inaugural presenters from the National Institute on Alcohol, Abuse and Alcoholism in the United States. KIAP has also joined the Global Alcohol Policy Alliance for global networking. Key updates of Korean alcohol policy were developed through review of world alcohol policy, and coordinated international alcohol control policy projects were begun . More than 20 domestic alcohol conferences and two international conferences were hosted by KIAP in 2010. In February 2011, KIAP established ties with the Thai Health Foundation Center on Alcohol Studies by signing a Memorandum of Understanding. This agreement provides for collaborations on research projects and visiting exchanges of faculty, researchers and students of both institutions. KIAP continues its efforts to identify partners to implement its international collaborative research activities .
CHALLENGES AND OPPORTUNITIES
An assessment by Zeigler et al.  of barriers to alcohol control policy created by alcohol industry influence on government resonates in Korea. For example, in 2009, two alcohol industry organizations, the International Center for Alcohol Policies (ICAP) and the Korea Alcohol and Liquor Industry Association (KALIA), hosted an international seminar in Gangnam-gu, Seoul entitled ‘Working together to reduce alcohol related harm’. There, industry, academics and non-governmental organizations forged collaborations to profile Korean drinking patterns, promote responsible marketing and publicize self-regulation. By 2010, ICAP and KALIA announced ‘the signing of Korea's first voluntary code for self-regulation of beverage alcohol advertising’. Government alcohol control policy has been dictated by ICAP and KALIA, as industry-friendly positions have been central to ‘Blue Bird 2010’. KALIA's Korean Alcohol Research Foundation is also a notable source of grant funding for Korean government and university-based researchers. As the alcohol industry continues to drive Korean national alcohol policy, few evidence-based initiatives are being enacted while trends of alcohol consumption and related harms are likely to increase.
KIAP's leading obstacle is the herculean effort to coax evidence-based alcohol control policy forward to enactment. The relative imbalance of industry views over public health has groomed social acceptance and helped to maintain harmful alcohol consumption across Korean society [18,42]. Furthermore, recent changes in Korea's economic status have been associated with significant increases in alcohol-related health conditions as well as social problems, such as violence, employment problems and marital difficulties. The traditional pattern of drinking mild fermented beverages with meals has shifted to drinking strongly distilled liquors without meals or side dishes . Among the nations in the Western Pacific Region, in 2005 the Republic of Korea had the highest average alcohol consumption among adults aged 15 years or older, owing mainly to the consumption of spirits . At the same time, South Korea needs to strengthen the links between science and policy so that promising research findings can be identified, synthesized and communicated effectively to policy-makers and the public . KIAP needs to have not only more domestic but more international partnerships to persuade the government and general population to establish and embrace evidence-based national alcohol policies.
Another challenge for KIAP is the navigation of the Korean (Hangul)–English language barrier with native English-speaking collaborators and publishing media. Significant KIAP intellectual and financial resources are spent in the bidirectional translation of materials between Hangul and English. When researchers and research assistants transition there is a great loss, as pains are taken to find bilingual people with research skill-sets. Although rewarding, the additional time and effort required to publish in international English journals can delay access to time-sensitive results during critical periods of national debate in the direction of alcohol policy. This has led to the primary publication strategy of disseminating results through Korean national journals to influence a national audience and Korean policy makers. Going forward, KIAP will offer stronger financial incentives and fast-track promotion to attract and retain researchers with demonstrated proficiency in preparing timely international English peer-reviewed publications.
Despite these challenges, there are bright areas of opportunity for KIAP. These include an increasing number of international collaborations, which increases the strength of advocacy and quality of research output. There is also an increasing interest among graduate students and researchers to conduct alcohol-related research, because many of their own lives have been touched by alcohol-related harms. An indication of KIAP success is that several research assistants are now pursuing doctoral programmes in public health throughout Asia. These individuals will soon join the ranks of their KIAP mentors in the fight to overcome the global burden of disease and the harms caused by alcohol and other substances. The future of KIAP is bright, and its prospect for continued impact in alcohol research is limitless.
Declarations of interest
This paper has been supported by Sahmyook University.