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The Evolution of Research into Responsible Beverage Service as a Preventive Intervention

The Evolution of Research into Responsible Beverage Service as a Preventive Intervention. Bob Saltz Prevention Research Center Berkeley, California. Prevention Research Center. Pacific Institute for Research and Evaluation. Public Health Model. Individual. Environment. Alcohol.

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The Evolution of Research into Responsible Beverage Service as a Preventive Intervention

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  1. The Evolution of Research into Responsible Beverage Service as a Preventive Intervention Bob SaltzPrevention Research CenterBerkeley, California Prevention Research Center Pacific Institute for Research and Evaluation

  2. Public Health Model Individual Environment Alcohol Alcohol-Related Problems

  3. Environmental Influence • Physical - Proximity of alcohol, drugs, tobacco outlets, places of public use (2) Social - Family, peers and larger social networks, media (3) Economic - Cost of alcohol, drugs, tobacco, or economic geography of availability

  4. Evolving Concept • Server as referral agent – “Patron Care” • Server Intervention - to reduce harm in case of intoxication • Responsible Beverage Service (RBS)- to reduce likelihood of intoxication and harm

  5. Rationale • Historical & legal precedents • Potential impact may be high • Very proximal to danger of harm • Minimizes reliance on drinker judgment • Indirect evidence of potential efficacy

  6. 170 150 130 Number of Accidents 110 90 70 Liquor by the drink begins November 1978 50 1/73 1/74 1/75 1/76 1/77 1/78 1/79 1/80 1/81 1/82 Month and Year Effect of Allowing Liquor by the Drink onSingle Vehicle Nighttime Traffic Crashes Males 21 Years and Older in North Carolina 16% increase0% control counties

  7. Early Efficacy Studies Can RBS reduce intoxicationor harm?

  8. TIPS Evaluation • Commercial training program • Six-hour training • 17 Servers from 2 businesses • Pseudopatrons consume drink every 20 minutes • Outcome = Number of Interventions plus BAC of pseudopatrons

  9. Findings • Trained servers intervened more frequently, 3.24 vs. .75 at baseline • BAC for pseudopatrons was lower for trained servers (.059 vs. .10)

  10. Navy Server Study • Revision in House Policies • Sixteen-hour manager & server training • One intervention and one comparison site • Outcome = Imputed BAC from self-reported and observed consumption data

  11. Findings • Proportion of intoxicated drinkers at experimental Navy bar cut in half (e.g., males dropped from 33% to 15%) • No change at comparison site • No change in overall sales (more drinks to 1 and 2 drink orders)

  12. Thunder Bay, Ontario • Manager and Server Training • Four intervention & 4 comparison sites • Expanded pseudopatron protocol with scenarios • Outcome = Responsible Service Score

  13. Findings • Trained servers scored higher in the post-test while comparision sites did not change significantly

  14. From Efficacy to Effectiveness What might effect adoption of RBS practices?

  15. McKnight NHTSA Study • 100 Establishments in 8 cities • Three-hour training • 135 Comparison sites • Pseudopatron protocol • Outcome = Server intervention

  16. Findings • Trained servers more likely to intervene in some way, 27% vs. 14% at baseline • Outright refusal unchanged at 5%

  17. Central California RBS • Two Communities (Santa Cruz & Monterey, CA) • Three commercial businesses in each community • Compared 2 trainings with 1 comparison • Outcome = Observed consumption

  18. Findings • RBS programs reduced likelihood of impairment and intoxication in one of two communities • No difference between RBS programs

  19. Probability of Impairment and IntoxicationFollowing Alcohol Beverage Server TrainingSanta Cruz, CA 50 40 T T Impairment 30 C C Predicted Probability 20 T T Intoxication 10 C C 0 Pretest Posttest T = Server Training Site, C = Comparison Site

  20. Oregon Server Training Law • Training mandated for all servers of alcoholic beverages • Outcome = Single-vehicle night-time crashes • ARIMA model to control for other influences

  21. Findings • 23% reduction in crashes net of other influences

  22. Texas Liability Law • Established through case law • Court ruling heavily publicized • Time series analysis over 10 yr period • Outcome = SVN crashes

  23. Findings • First case produced a reduction in SVN crashes of 6.5% net of other influences • Second case reduced crashes an additional 5.3% net of other influences

  24. Freo Respects You • 50 Establishments in Freemantle, WA • Comparison community • Training supported by media campaign • Included risk assessment • Outcomes included service to pseudopatrons and BAC of patrons

  25. Findings • Low participation and challenges to program fidelity • Outright refusal low (10%) with no difference across communities • Lower patron BACs in intervention community

  26. Community Trials • RBS part of comprehensive community-level prevention intervention to reduce injuries and deaths related to alcohol • Combined voluntary training and limited but publicized enforcement campaign • Outcome = Refusal to drinking pseudopatron (drink every 20 minutes)

  27. Alcohol-involved Trauma at the Community Level: Conceptual Model MOBILIZATION DRINKING AND DRIVING Local News about AlcoholProblems & Enforcement Perceived Risk of Arrest Local Law Enforcement RESPONSIBLE BEVERAGE SERVICE Driving after Drinking Social Access to Alcohol Alcohol Serving and Sales Practices UNDERAGE DRINKING Retail Alcohol Availability (On and Off-premise) Local Regulation of Alcohol (Density, Hours of Sale) Alcohol-involved Injury and Death (Traffic and Other) Alcohol Intoxication or Impairment ALCOHOL ACCESS Non-Traffic Risk Activities

  28. Findings • Refusal rates of servers to drinking pseudopatrons were low • Observed differences not significant

  29. Enforcement of Serving Laws • Washtenaw County, MI • Warning notices to employees observed (by plainclothes officers) serving to obviously intoxicated customers • Comparison site • Outcomes = refusal to serve pseudopatron, and proportion of arrested DUI cases that drove from a licensed premise

  30. Findings • Outright refusals increased from 16% to 53% • Proportion of DUI from businesses dropped from 32% to 23%

  31. Surfer’s Paradise • Case study – pre/post comparison • Australia’s Gold Coast • Targeted alcohol-related violence and general disorder • Community mobilizationRisk assessmentsEnforcement of license lawsStaff trainingEliminated price promotions • Outcome = observed assaults & intoxication

  32. Findings • Note: weak design… • Assaults dropped from 9.8 per 100 hrs. of observation to 4.7 • Lower frequency of observed intoxication

  33. Primary Conclusions • RBS can significantly reduce alcohol impairment and intoxication • Training alone seems unpromising, but Oregon results argue otherwise

  34. Fairly Confident Reduced Intoxication Responsible ServicePractices Reduced Harm

  35. What We Don’t Know… • What kinds of harm RBS can reduce • What combination of incentives will reliably change serving practices • What combination of incentives will reduce harm most cost-effectively

  36. What We Don’t Know ? Reduced Intoxication Responsible Service • Training (skills) • Community Pressure • Enforcement • Insurance • Liability Law Reduced Harms? • Violence • DUI • Injuries

  37. FIN

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