NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Center for Substance Abuse Prevention (US); Grover PL, editor. Preventing Problems Related to Alcohol Availability: Environmental Approaches (Reference Guide). Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1999. (Prevention Enhancement Protocols System (PEPS), No. 3.)

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

Cover of Preventing Problems Related to Alcohol Availability: Environmental Approaches (Reference Guide)

Preventing Problems Related to Alcohol Availability: Environmental Approaches (Reference Guide).

Show details

3Analysis and Recommendations

Overview

The primary goal of this chapter is to offer planners at the State and community level information on the effectiveness of prevention approaches aimed at reducing the retail availability of alcohol and the incidence and severity of alcohol-related problems. A related goal is to provide practical recommendations about using these prevention approaches - defined as a group of interventions that share essentially common goals, underlying concepts, and methods as well as outcomes - to make policies and programs that are most appropriate for their target populations.

Analysis of the Evidence

The first section of this chapter presents analyses of the effectiveness of six prevention approaches discovered through an extensive search of published and unpublished literature as well as a review of well-designed and -implemented case studies (brief abstracts of all the research and practice studies reviewed for this guide appear at the end of this chapter, pages 55-84). Research studies and practice case studies were systematically reviewed and evaluated by an expert panel using rigorous criteria established under the Prevention Enhancement Protocols System (PEPS) Rules of Evidence (see appendix C for a description of the systematic protocol used for these analyses).

research evidence - in this guide, information obtained from research studies conducted to evaluate the effectiveness of an intervention and typically published in peer-reviewed journals. This information is based on investigations under designs ranging from experimental to quasi-experimental to non-experimental.

This guide uses the term research evidence to refer to the combined body of knowledge gained from research on a specific prevention approach. This information is gained from scientific investigations that are conducted using a variety of designs but are all assessed to have sufficient scientific rigor to constitute valid evidence relevant to the research questions. Also included as evidence are well-evaluated natural experiments, ecological correlations, and econometric analyses. The term practice evidence describes information derived from implementation of prevention interventions based on sound conceptual frameworks, clear chronologies of events, reliable and valid measures of input, and outcome variables. These interventions must include process evaluation information on program implementation and procedures.

research - the systematic effort to discover or confirm facts by scientific methods of observation and experimentation.

This section also presents conclusions that the expert panel drew about each approach from the research and practice evidence, as well as the lessons to be learned from that evidence. In the course of their examinations the panel also identified gaps where further research is required; their recommendations to fill these gaps also appear in this section. The consideration of each approach wraps up with a set of recommendations for practice. While these recommendations are certainly conditioned by the cumulative research and practice experience of the expert panel, it is important for the reader to recognize that not all of these recommendations follow directly from their reviews of the evidence per se.

The extensive search of published and unpublished literature as well as widely solicited effective practice case studies conducted for this guide yielded the following six approaches to reducing the problems related to retail alcohol availability:

  1. Preventing Availability to Underage Youth. Laws can be established and enforced to reduce the likelihood that merchants will sell alcohol to underage youth, that underage youth will attempt to purchase alcohol, and that underage youth will experience alcohol-related problems.
  2. Raising Alcohol Taxes and Prices. States and jurisdictions that have higher taxes tend to have lower rates of consumption, deaths due to motor vehicle crashes, and violent crime.
  3. Responsible Beverage Service. RBS includes server and management training and management policies that are designed to reduce the risks of customer intoxication and that intoxicated persons will harm themselves or others. The goal of RBS is to create safer drinking environments and to reduce the likelihood of intoxication and its related problems.
  4. Changing the Conditions of Availability. State and local governments can modify alcohol availability through conditions such as outlet density regulations and through decisions such as privatizing State retail alcohol monopolies and creating or eliminating restrictions on alcohol sales. Laws also can be established to regulate the sale, purchase, and consumption of alcoholic beverages in municipally owned facilities such as city parks and at special activities such as professional sporting events.
  5. Changing Hours and Days of Sale. State and local governments can modify the availability of alcohol by changing the hours and days when it can be sold, such as by limiting or extending the hours of sale or disallowing sales on certain days.
  6. Community-Based Prevention Activities. Grassroots activities bring together concerned citizens and community groups in efforts to change local laws, regulations, or policies to reduce alcohol-related problems.

Prevention Approach 1: Preventing Availability to Underage Youth

Conceptual Basis for Approach 1

Establishing and enforcing minimum drinking age laws that prohibit alcohol sales to, and the purchase of alcohol by, underage youth tend to reduce alcohol use and related problems. Although all States have already raised the legal drinking age to 21, evidence demonstrating the effectiveness of a high minimum drinking age is pertinent because it not only underscores the importance of enforcement efforts but offers valuable points in the debate over retaining such laws.

Overview of the Research and Practice Evidence on Approach 1

The analysis of the effectiveness of efforts to prevent the availability of alcohol to underage youth is based on 11 research studies and 3 prevention practice cases.

Several studies examined the effects of different State minimum drinking age laws on drinking behaviors and alcohol-related problems. Differences among the States' minimum legal drinking ages were eliminated with the passage of the uniform national minimum age limit in 1984.

  • O'Malley and Wagenaar (1991) compared drinking behaviors and the number of alcohol-related traffic crashes in States with high minimum legal drinking ages with those in States with low minimum legal drinking ages. They also examined changes in drinking behavior and the number of traffic crashes in States that raised their minimum legal drinking age to 21 years with those in States that already had set the minimum at 21.
  • Similarly, Wagenaar (1986) examined the effects of raising the minimum legal drinking age in Michigan on the number of injury-producing traffic crashes among drivers between the ages of 18 and 20.
  • Wagenaar and Maybee (1986) examined the effects on traffic-crash rates of a 1981 Texas State law raising the minimum legal drinking age from 18 to 19 years.
  • Mooney and Gramling (1993) compared a group of college students where the minimum legal drinking age was 21 with another group where the minimum was 18. Patterns of drinking behavior were compared in terms of frequency, quantity, and location of consumption.
  • In 1987, the U.S. General Accounting Office (GAO) applied evaluation synthesis methodology to then-available research studies that analyzed the effects of raising the minimum drinking age laws on traffic crashes and alcohol consumption among those affected by the laws.

Two studies examined the effects of establishing different limits on blood alcohol concentration (BAC) rates for adults and youth.

  • Hingson, Heeren, and Winter (1994) compared the rate of alcohol-related traffic crashes in 12 States where the BAC limit was lower for young drivers than for adults with those in 12 comparison States where the BAC limit was the same for youths and adults.
  • The National Highway Traffic Safety Administration (1992) examined the effectiveness of a Maryland State law that prohibits driving by those younger than 21 who have a BAC of 0.02 percent or more and of a public information campaign designed to promote the law's effects.

Two additional studies examined alcohol purchase attempts by underage youth.

  • Preusser, Williams, and Weinstein (1994) conducted underage alcohol purchase attempts on a subset of all alcohol outlets in Denver, Colorado.
  • Preusser et al. (1995) compared the behaviors of underage youth attempting to purchase alcohol in two States that have substantially different laws regarding the purchase, possession, and consumption of alcohol and the use of false identification by underage youth.

One research study and three practice cases examined prevention programs.

  • Hingson et al. (1996) evaluated the effectiveness of the Saving Lives Program, a community initiative that organized multiple city departments and private citizens to reduce alcohol-impaired driving, alcohol-related driving risks, and traffic deaths and injuries.
  • The Pennsylvania Liquor Control Board conducted activities designed to control the density of alcohol outlets, support the prevention of alcohol abuse, disseminate information on the responsible use of alcohol and responsible alcohol sales and service, and establish partnerships with other State agencies and organizations.
  • The Under 21 Enforcement Project of the Town of Yorktown Police Department was designed to enforce regulations prohibiting the sale of alcohol to persons under 21 years of age, to heighten public awareness of alcohol abuse by youth, to aggressively enforce DWI regulations for underage youth, and to increase the accuracy of police reports concerning traffic crashes.
  • Cops in Shops was an enforcement and media campaign designed to reduce alcohol purchases by underage youth in Las Cruces, New Mexico. The campaign involved police officers posing as employees of licensed establishments.

More detailed abstracts of the above studies appear at the end of this chapter (pp. 60-67).

Levels of Evidence: Availability to Youth

The research and practice evidence reviewed indicates that it is possible to implement and enforce laws designed to prevent alcohol availability to minors.

There is strong evidence that increasing the minimum drinking age results in a decrease in traffic casualties.

There is medium evidence that increasing the minimum drinking age results in a decrease in consumption of alcohol and consequent alcohol problems other than traffic casualties.

There is strong evidence that there are substantial sales to minors and that there is considerable potential for reduction of such sales.

There is medium evidence that the level of enforcement affects the rates of underage purchasing.

Lessons Learned From the Evidence Reviewed for Approach 1

case study - a method for learning about a complex situation, based on a comprehensive understanding of that situation obtained through extensive analysis and description of the situation both as a whole and in its particular context.

The following are the lessons learned from the research and practice evidence reviewed in this section:

Suggestions for Future Research on Approach 1

The expert panel made the following suggestions for future research on preventing availability to underage youth:

  • Studies of tobacco purchases by adolescents show that when one avenue of access is closed, others are devised. Similar research is needed on sources of alcohol other than direct purchase from retail outlets and how such they may be blocked. Such sources include family members, other adults, "shoulder tapping" of strangers at retail outlets, and shoplifting (Preusser et al. 1995; Cops in Shops).
  • Research needs to be conducted on the role of alcohol in teenage subcultures and social life, particularly as a rite of passage in various ethnic, cultural, and regional groups of underage youth. These aspects of social life include team bonding, sexuality, and partying.
  • There is a need for research on the nature, extent, mechanisms, and effects of the advertising and marketing of alcohol to underage youth.
  • Additional research is called for on ways to enforce minimum drinking age laws more effectively and to prevent underage youth from buying alcohol. These research efforts should examine clerks, outlets, and adolescent characteristics associated with successful and failed purchase attempts (Wagenaar et al. 1992).
  • Some universities maintain licensed alcohol sales and service on campus, while others have reduced alcohol availability through community coalitions that include university administrators, students, and local businesses. Other university communities have keg registration laws. Research is needed to examine the enforcement and effectiveness of these laws and policies on underage youth access to alcohol, especially in college areas (Hingson et al. 1996; Mooney and Gramling 1993; Preusser et al. 1995).
  • Research needs to be conducted on potential unintended and untoward effects of the minimum legal drinking age. For example, although the law has contributed to important outcomes such as a decrease in traffic casualties, it may foster a pattern of mildly illicit behavior, such as learning to drink in illegal circumstances. Thus, research should examine whether long-term problems, especially those related to the acceptability of illicit alcohol use by underage youth, are associated with a minimum legal drinking age of 21 years (Hingson, Heeren, and Winter 1994; National Highway Traffic Safety Administration 1992; O'Malley and Wagenaar 1991; Wagenaar 1986).
  • Some areas, such as the Province of Ontario, Canada, have adopted a graduated driver's licensing approach, which typically requires a BAC of 0 percent for novices in their first one or two years of driving. Research should be conducted to examine whether the graduated licensing approach prevents traffic casualties related to youth drinking, as does the minimum drinking age law (Hingson, Heeren, and Winter 1994; National Highway Traffic Safety Administration 1992).
  • Students Against Drunk Driving (SADD) and other organizations promote activities such as assigning designated drivers and having "no-questions-asked" parental transportation policies as alternatives to drinking and driving. These activities may reduce incidents of youth drinking and driving, but research is needed to determine how widespread these strategies are and the extent to which they accomplish their objectives (Hingson et al. 1996).

Prevention Approach 2: Raising Alcohol Taxes and Prices

Conceptual Basis for Approach 2

Because alcohol is a discretionary purchase, especially for social drinkers, demand for it is affected by price fluctuations. An increase in the price as well as in the taxes levied on alcohol should therefore effectively depress its consumption. This should be especially true among underage youth, who generally have relatively low disposable funds.

Overview of the Research and Practice Evidence on Approach 2

happy hour - a promotional activity, usually held during specific evening hours, in which bars and other on-site outlets provide alcoholic beverages at reduced prices.

The analysis of the effects of raising prices and taxes on alcohol sales and consumption and alcohol-related problems is based on 10 studies.

Four of these studies were econometric analyses.

  • Grossman et al. (1987) and Coate and Grossman (1985) developed estimates of the responsiveness of alcohol use by youth aged 16 to 21 years to variations in the price of alcohol.
  • Levy and Sheflin (1983) examined the importance of cross-price effects and provided estimates of price elasticity based on demand.
  • Similarly, Wette et al. (1993) examined the relationship between price and the consumption of beer, wine, and spirits to assess changes in alcohol consumption in New Zealand as a function of increases in the price of alcoholic beverages.
  • Ornstein and Hanssens (1985) estimated the impact of a variety of control measures on the demand for distilled spirits and beer.

Two studies examined the effects of alcohol taxes on alcohol-related problems.

  • Cook and Moore (1993) analyzed the effect of beer excise taxes on rates of homicide, rape, assault, and robbery in the 48 contiguous United States.
  • Saffer and Grossman (1987) examined the relationships of beer taxes and the minimum legal drinking age to traffic fatalities among youth aged 15 to 24 in the 48 contiguous United States from 1975 through 1981.

The common goal of the seven studies outlined above was to examine the effects of State alcohol taxes and retail alcohol costs on alcohol consumption and its impact on behavior as well as physical and social health.

Three studies examined different aspects of "happy-hour" discount drink policies.

  • Babor et al. (1978) examined the effect on drinking behavior of a controlled setting for a happy-hour discount drink policy.
  • Kohn, Smart, and Adlaf (1985) surveyed the prevalence, content, and timing of happy hours in metropolitan Toronto, Canada, during the summer of 1983.
  • Smart and Adlaf (1986) analyzed the impact of a ban on happy-hour discount drink promotions on drinking behavior, overall alcohol sales, and impaired-driving charges in Ontario, Canada.

More detailed abstracts of these studies appear at the end of this chapter (pp. 67-71). The research evidence reviewed indicates the following:

Levels of Evidence: Taxes and Price

The research evidence reviewed indicates the following:

There is strong evidence that increases in alcohol taxes result in a moderate decrease in alcohol consumption.

There is strong evidence that increases in alcohol taxes result in a moderate decrease in alcohol-related problems such as automobile crashes, cirrhosis mortality, and driving under the influence.

There is medium evidence that increases in alcohol taxes result in roughly equivalent reductions in consumption of alcoholic beverages among all drinkers.

There is suggestive but insufficient evidence that increases in alcohol taxes have a strong effect on drinking initiation among youngsters.

There is suggestive but insufficient evidence that happy-hour promotions increase alcohol consumption.

Lessons Learned From the Evidence Reviewed for Approach 2

The following are the lessons learned from the research and practice evidence reviewed in this section:

Suggestions for Future Research on Approach 2

  • Additional research is needed on the short- and long-term effects of alcohol taxation, with particular attention to population subgroups such as heavy alcohol consumers (Coate and Grossman 1985; Cook and Moore 1993; Saffer and Grossman 1987).
  • Some research suggests that alcohol tax increases promote reductions in drinking in approximately equivalent proportions among heavy and light drinkers (Coate and Grossman 1985). Although State tax increases may result in a moderate decrease in alcohol consumption, it seems plausible that other prevention activities may be required to sustain such decreases. Research is required to examine which other prevention activities can boost as well as sustain those decreases over time.

Prevention Approach 3: Responsible Beverage Service

Conceptual Basis for Approach 3

Research shows that the behavior of alcohol servers and the policies of drinking establishments can have an impact on the behavior of their patrons. For example, servers can engage in activities that encourage or increase heavy drinking, allow heavy drinking to be ignored, promote intoxication, and foster problems associated with intoxication. Server interventions, such as server and management training, are a broad set of strategies designed to reduce the risk that patrons will become intoxicated and that intoxicated persons will harm themselves or others. Interventions can include the review and modification of management policies and operations. The combined efforts of server intervention and management policies is referred to as responsible beverage service. RBS should create safer drinking environments and reduce the likelihood of intoxication and related problems.

Overview of the Research and Practice Evidence on Approach 3

The analysis of the effectiveness of RBS is based on eight research studies.

  • Gliksman et al. (1993) evaluated the knowledge, attitudes, and behaviors of alcohol providers at four types of bars (roadhouses, hotel lounges, neighborhood taverns, and skid-row bars) immediately before and after participation in a server training program.
  • Similarly, McKnight (1991) evaluated the effect of server intervention education and the effect of various situational variables on program effectiveness.
  • McKnight and Streff (1994) examined the effects of enforcing the law prohibiting alcohol service to intoxicated patrons on service to patrons, DWI rates, and enforcement costs and benefits.
  • Saltz (1987) compared patrons' consumption of alcoholic beverages in a U.S. Navy enlisted club that had a server intervention program with that in a similar Navy enlisted club that did not have such a program.
  • Holder and Wagenaar (1994) evaluated the effects of the State of Oregon's mandatory Oregon Server Training Program on the number of single-vehicle nighttime crashes in which alcohol was involved that resulted in injuries or fatalities.
  • Similarly, Mosher et al. (1989) examined the efficacy of an intensive community-based RBS training program intended to reduce intoxication rates among patrons of participating establishments. They also conducted formative evaluations to determine community and industry support for an RBS training program.
  • Russ and Geller (1987) evaluated the impact of an alcohol server intervention program on the type and frequency of server interventions, the number of drinks consumed by pseudopatrons, and the BAC's of exiting pseudopatrons who drank three alcoholic beverages per hour for 2 consecutive hours.
  • Wagenaar and Holder (1991a) examined the effects of a sudden change in a Texas law that resulted in exposure to legal liability for alcohol servers in relation to the frequency of single-vehicle, injury- producing traffic crashes.

More detailed abstracts for these studies appear at the end of this chapter (pp. 71-74).

Levels of Evidence: Responsible Beverage Service

The research and practice evidence reviewed indicates that it is possible to implement responsible beverage server interventions:

There is strong evidence that server training and policy interventions are effective in curbing illegal sales to intoxicated and underage individuals when these interventions are combined with enforcement activities.

There is medium evidence that server training and policy interventions are effective in improving some forms of server behavior, at least in the short term.

There is medium evidence that server training can lead to more responsible service practices and management policies.

Lessons Learned From the Evidence Reviewed for Approach 3

The following are lessons learned from the research and practice evidence reviewed in this section.

Suggestions for Future Research on Approach 3

The expert panel made the following suggestions for future research on responsible beverage service:

Prevention Approach 4: Changing the Conditions of Availability

Conceptual Basis for Approach 4

Research suggests that there is an association between alcohol availability, such as outlet density, and alcohol-related social, civic, and health problems. Decreasing alcohol availability should therefore reduce alcohol-related problems such as homicide, suicide, and other types of violence; cirrhosis and other health problems; and traffic crashes.

In addition to availability through permanent outlets, a particular area of concern is alcohol availability at special events and locations. Alcohol is often brought to or purchased and consumed at special occasions such as professional sporting events. Similarly, alcohol is often purchased and consumed in municipally owned facilities such as city parks. Laws established to regulate the sale, purchase, and consumption of alcoholic beverages should affect access, consumption, and alcohol-related behaviors during and after special events and in public places.

Overview of the Research and Practice Evidence on Approach 4

The research studies reviewed on changing the conditions of availability did not evaluate researcher-directed interventions. Rather, they examined outcomes of natural experiments, particularly changes in legislation regarding alcohol sales restrictions and regional differences in laws.

The analysis of the effects of changing the general conditions of alcohol availability is based on nine studies and one prevention practice case. Several studies examined the effects of privatizing Iowa's State retail monopoly on alcohol sales.

  • The effects of a natural experiment involving change in a California State law to remove restrictions on sales of beer and wine was studied on two university campuses by Fillmore and Wittman (1982). They assessed its impact on the quantity of alcoholic beverages sold near the campuses and on student drinking.
  • Fitzgerald and Mulford (1992, 1993) evaluated whether a sudden and dramatic increase in the availability of wine and distilled spirits in Iowa resulted in an increase in alcohol consumption and alcohol-related problems among individuals aged 18 years and older.
  • Using data from 38 States over 12 years, Gruenewald and Ponicki (1993, 1995) evaluated the impact of changes in alcohol sales and the physical availability of alcohol on fatalities from single-vehicle nighttime crashes.
  • Holder and Wagenaar (1990) evaluated the effect on consumption of the privatization of Iowa's State retail monopoly on sales of distilled spirits for off-premise consumption.
  • MacKinnon, Scribner, and Taft (1995) analyzed data on alcohol availability and problems in unincorporated areas and in 84 cities in Los Angeles County to assess the impact of alcohol availability on alcohol-related civic and health outcomes.
  • In a replication of this study, Gruenewald et al. (1995) analyzed data on alcohol availability and alcohol-related traffic crashes across 102 areas of four communities in California.
  • Mulford and Fitzgerald (1988) evaluated the effect of increasing the number of off-sale wine outlets in Iowa on the rates of alcohol purchases, consumption, heavy drinking, and problem drinking.
  • Mulford, Ledolter, and Fitzgerald (1992) examined changes in monthly sales of wholesale wine and spirits in relation to the privatization of State-run wholesale wine and retail wine and spirits sales.
  • Similarly, Wagenaar and Holder (1991b) evaluated whether the privatization of retail wine sales in Iowa and West Virginia affected wine consumption, beer and distilled spirits sales, and alcohol consumption in other States.
  • Laxer et al. (1994) studied the impact of privatization of retail and wholesale distribution of alcohol in Alberta, Canada. They assessed the outcomes of this natural experiment on the availability and price of alcohol and on crimes against outlets.

The analysis of the effects of changing the specific conditions of alcohol availability at special events and locations is based on one study and four practice cases.

  • West et al. (1993) studied drinking, intoxication, and verbally and physically abusive behavior at Ontario's Maple Leaf Gardens during Toronto Maple Leaf hockey games to examine the effects of legislation permitting alcohol sales at sports arenas.
  • Similarly, Fisher and Single (1983) observed drinking and drug consumption, alcohol- and drug-related incidents, and crowd composition at Toronto Blue Jays baseball games following an Ontario provincial law permitting the sale of beer at sporting events.
  • Bjor, Knutsson, and Kuhlhorn (1990) examined interventions related to the celebration of Midsummer's Eve, a popular event in Sweden that has traditionally been associated with alcohol consumption and sexuality. The interventions included an alcohol-rationing rule, prohibitions against congregating at campgrounds or in parking lots near the center of the city, and prohibitions against possessing alcohol or knives in public places.
  • Gliksman et al. (1990) reported the implementation and effects on residents of a social control policy related to the use of alcohol on city-owned properties and facilities.
  • Gliksman et al. (1995) surveyed recreation directors, facility managers, and other appropriate individuals in all Ontario cities, towns, and townships to evaluate the development of alcohol-related policies and their impact on problems and facility rentals.

More detailed abstracts of the above studies appear at the end of this chapter (pp. 74-82).

Levels of Evidence: Conditions of Availability

The research evidence reviewed indicates that it is possible to implement efforts that result in changes in alcohol availability.

There is medium evidence that an increase in the number of outlets per capita increases rates of alcohol consumption and alcohol-related problems.

The research and practice evidence reviewed indicates that it is possible to pass legislation regulating the sale and consumption of alcohol at special events and locations.

There is suggestive but insufficient evidence that controlling alcohol availability and training servers in sporting arenas and at special events reduces the number of intoxicated persons and the rate of abusive incidents involving intoxication.

Lessons Learned From the Evidence Reviewed for Approach 4

The following are the lessons learned from the research and practice evidence reviewed for this section.

Suggestions for Future Research on Approach 4

The expert panel made the following suggestions for future research on changing the conditions of availability:

Prevention Approach 5: Changing Hours and Days of Sale

Conceptual Basis for Approach 5

Research on the effects of changing the hours and days of alcohol sales is based on evaluations of natural experiments. These experiments start with government decisions to extend or decrease the hours or days of alcohol sales at specific sites such as bars or wine and spirits shops. Although these decisions are often unrelated to specific prevention goals, they provide an opportunity to examine the effects of changing sale hours and days on overall alcohol sales and consumption patterns and on related problems.

Overview of the Research and Practice Evidence on Approach 5

community-based approach - a prevention approach that focuses on the problems or needs of an entire community, be it a large city, small town, school, worksite, or public place.

The analysis of the effects of changing the hours and days of alcohol sales is based on six research studies. These studies primarily evaluated outcomes that resulted from natural experiments, particularly changes in legislation regarding alcohol sales restrictions.

Four studies examined the effects of changing the hours of sales in taverns in Australia.

  • Smith (1987) evaluated the effect on traffic crashes of a New South Wales, Australia, state law that allowed the sale of alcohol at taverns on Sunday from noon to 10:00 p.m.
  • Smith (1988a) examined the effects on traffic crashes of a legislative change that introduced flexible tavern operating hours in the Australian state of Tasmania. The study was designed to evaluate whether later closing times (and thus later drinking hours) might decrease the number of crashes from 10:00 p.m. to midnight and increase the number from midnight to 6:00 a.m.
  • In the Australian state of Victoria, a February 1966 regulation changed tavern closing times on Mondays through Saturdays from 6:00 p.m. to 10:00 p.m. Smith (1988b) analyzed data on all injury-producing traffic crashes in Victoria before and after the regulation allowing bar patrons to consume alcohol in taverns later than before.
  • In the Australian city of Brisbane, a regulation allowed the sale of alcohol on Sundays from 11:00 a.m. to 1:00 p.m. and from 4:00 p.m. to 6:00 p.m. Smith (1988c) evaluated the effect of these Sunday alcohol sales on traffic crashes, including resulting casualties and reported property damage.

Two studies in Scandinavia examined the effects of closing retail alcohol stores.

  • Nordlund (1985) examined the effects of forcing wine and spirits shops in six Norwegian towns to close on Saturdays by comparing the outcomes with those in six control towns that allowed Saturday sales. The study measured reports to police of and arrests for drunkenness, reports of incidents of violence, admissions to alcohol detoxification programs, and alcohol sales.
  • In Sweden, all sales of export beer, wine, and spirits take place in special state-owned retail liquor stores. Olsson and Wikstrom (1982) examined whether Saturday closings of these stores would have an impact on total alcohol consumption, drunkenness, public order, and certain types of crime.

More detailed abstracts of the above case studies appear at the end of this chapter (pp. 82-84).

Level of Evidence: Hours and Days of Sale

The research evidence reviewed indicates that, in relation to changes in the days and hours of alcohol sales:

There is medium evidence that expanding the hours or days of alcohol sales increases the rates of alcohol consumption and alcohol-related problems.

Lessons Learned From the Evidence Reviewed for Approach 5

The following are the lessons learned from the research and practice evidence reviewed for this section.

  • Increasing alcohol availability by extending hours of sale tends to increase rates of alcohol consumption and related problems (Nordlund 1985; Olsson and Wikstrom 1982; Smith 1987, 1988a, b, c).
  • Most of the research in this area reflects recent experiences with extending rather than reducing hours or days of alcohol sales (Smith 1987, 1988a, b, c). Moving in the other direction (reducing hours or days of sale) is politically difficult in an era when consumers demand convenience (Nordlund 1985; Olsson and Wikstrom 1982). Even though the Norwegian experiment clearly showed positive results from Saturday closings, the political will was lacking to continue or extend such closings (Nordlund 1985). Proposals to extend the hours or days of sale should be evaluated in light of the near-impossibility of reversing any such changes.

Suggestions for Future Research on Approach 5

The expert panel made the following suggestions for future research on changing the hours and days of alcohol sales:

  • More studies are required on the impacts of late-night closing times, which put drivers and pedestrians on the street under the potential effects not only of an evening of drinking but also of fatigue. The interplay of drinking and fatigue on related casualties needs to be systematically studied (Smith 1987, 1988a, b).
  • Research is needed regarding regulation changes that increase alcohol availability in a community, such as by allowing previously prohibited Sunday sales (Smith 1987, 1988a, b, c).
  • In order to devise effective prevention strategies, research is needed on the characteristics of alcohol users, their preferred hours and days of alcohol consumption, and the rates and types of alcohol-related problems they generate.
  • Where on-premise drinking is a major social pattern, violence and trouble from drinkers outside alcohol outlets have sometimes been attributed to the fact that large numbers of drinkers are on the street at the same fixed closing time. Experiments have been conducted in the Netherlands and Scotland on staggered closing times for different drinking establishments; such research may be valuable in the United States as well.

Prevention Approach 6: Community-Based Prevention Approach

Conceptual Basis for Approach 6

Many alcohol-related problems are local in nature; many prevention activities, therefore, are best conducted at the local level. Although some community coalitions work to identify and evaluate local problems and then select those most appropriate to address, many such organizations emerge in direct response to a specific local problem. These and other community-based activities can be directed toward reducing the availability of alcohol.

intervention - a manipulation applied to a group in order to change the group's behavior. In substance abuse prevention, interventions at the individual or environmental level may be used to prevent or lower the rate of substance abuse or substance abuse-related problems.

Overview of the Research and Practice Evidence for Approach 6

The analysis of the effectiveness of community-based alcohol prevention activities is based on three research studies and six practice cases.

Three research studies evaluated the effectiveness of community-based prevention programs.

  • Giesbrecht, Pranovi, and Wood (1990) evaluated the effectiveness of a community-based project to reduce alcohol consumption among heavy drinkers. The study analyzed whether a change in the proportion of heavy drinkers has a measurable impact on the overall distribution of alcohol consumption. The research also examined interactions between heavy and moderate drinkers and assessed the impact of drinking management interventions on heavier drinkers.
  • Hingson et al. (1996) evaluated the effectiveness of the Saving Lives Program, a community effort that organized multiple city departments and private citizens to reduce alcohol-impaired driving, alcohol-related driving risks, and traffic deaths and injuries. The activities included media campaigns, speeding and drunk driving awareness days, "speedwatch" telephone hotlines, police training, SADD chapters, alcohol-free proms, beer keg registration, increased surveillance of liquor outlets, preschool education programs, and training for staff at hospitals and prenatal clinics.
  • Pentz et al. (1989) evaluated the effects of the Midwestern Prevention Project as administered to the initial 1984 cohort of sixth- and seventh-grade adolescents in Kansas City communities from September 1984 through January 1986. The program components delivered during this period consisted of a 10-session youth education program on skills training for resisting drug abuse, 10 homework sessions involving active interviews and role-playing with parents and family members, and mass-media coverage.

The practice evidence reviewed on community-based prevention activities included six practice case studies.

  • The Association for Responsible Alcohol Control was established by a group of Latino and other activists who were concerned about the relatively high density and rapid growth of alcohol outlets in Latino neighborhoods and the disproportionately high arrest rates for alcohol-related offenses among Latinos. The group focused on passing a law that would require new businesses seeking permission for off-site alcohol sales to undergo a public hearing, giving residents a voice in decisions regarding alcohol availability in their neighborhoods.
  • The Central Precinct Neighborhood Alliance comprised numerous neighborhood associations that worked with the Portland Police Bureau to establish a community-policing, problem-solving action plan and partnership agreement. The alliance and its efforts were designed to reduce alcohol abuse among problem street drinkers and thereby reduce alcohol-related local criminal activity.
  • The Community Coalition for Substance Abuse Prevention and Treatment involved grassroots community activism organized to influence the alcohol licensing process in Los Angeles. The goal was to decrease the density of alcohol outlets and diminish the violence associated with high outlet density.
  • The Escondido Community Alcohol Planning Project set up a city-based planning committee that received technical assistance to document alcohol availability in retail, public, and social environments; to identify strategies for addressing problems in these environments; to select intervention policies and programs; and to implement such interventions.
  • The Minors in Night Clubs public education campaign in New Jersey was organized in response to an action by the Wildwood City Council that would permit youth aged 18 to 20 years access to drinking establishments during normal operating hours but that would not permit them to drink alcohol there.
  • The New Zealand Community Action Project (Casswell and Gilmore 1989; Stewart and Casswell 1993) was designed to examine the relative effect on alcohol-related community activities and public attitudes of a mass-media campaign, with or without the input of alcohol-focused community organizers. The major objective of the project was to increase public support for alcohol policies such as restrictions on availability and advertising.

More detailed abstracts of the above studies appear at the end of this chapter (pp. 84-89).

Levels of Evidence: Community-Based Prevention

The research and practice evidence reviewed indicates that community-based approaches can produce coalitions that include multiple partners and address diverse issues:

There is strong evidence that community-based prevention activities can result in decreases in alcohol consumption.

There is suggestive but insufficient evidence that these programs can diminish driving after drinking, traffic death and injury, and speeding.

Lessons Learned From the Evidence Reviewed for Approach 6

The following are the lessons learned from the research and practice evidence reviewed for this section:

  • Community-based activities to control alcohol availability can lead to the development of other alcohol-related prevention activities.
  • Community-based activities to control alcohol availability can be used to enhance the effectiveness of prevention programs aimed at reducing drinking by individuals.
  • Community coalitions formed in response to specific problems can result in the establishment of permanent entities for the maintenance of changes in alcohol availability policies.
  • Community organizing initiatives can be combined with mass media campaigns to increase coverage of and debate on alcohol availability issues and proposed changes in local laws, regulations, or policies.

Suggestions for Future Research on Approach 6

The expert panel made the following suggestions for future research on community-based prevention activities:

  • Research is needed to examine the extent to which community coalitions can change local norms and standards and the processes for doing so.
  • Further research is needed to study ways for community groups and public agencies to develop mutually supportive relationships to achieve and implement public policy goals.
  • Research also is needed to better understand the factors that account for ongoing success by community-based organizations and the ways to avoid "burnout."

Recommendations for Practice

This section presents the expert panel's observations, comments, and recommendations about the prevention approaches evaluated in the preceding section. Most of the recommendations are derived from the experiences of panel members over many years of involvement in research and practice in the field as well as from their knowledge of extant research. Because these recommendations are not wholly based on documented scientific research, however, the reader should be aware that the potential effectiveness of many of the recommendations has not been assessed. To a large extent, thus, the intent of these recommendations is to convey the thinking of prevention research and practice experts to decisionmakers and other prevention professionals who need practical information, such as State and local prevention authorities and community prevention organizations.

The recommendations presented here vary considerably in nature and breadth, but some similar recommendations are offered for different prevention approaches for two reasons. First, doing so allows for greater specificity; a recommendation for "uniting efforts," for example, could differ from one approach to another because of the actions involved in each. Second, repeating similar recommendations for each approach ensures that readers interested in one particular approach will receive the full benefit of the expert panel's insights.

Recommendations for Prevention Approach 1: Preventing Availability to Underage Youth

The expert panel's recommendations for preventing availability to underage youth focus on laws relating to alcohol purchases and sales and the enforcement of these laws. Their five recommendations in this area are as follows:

  1. Enhance Enforcement. There is strong evidence that laws increasing the minimum legal drinking age result in decreases in traffic casualties, and moderate evidence that such laws result in decreases in alcohol consumption and alcohol-related problems. These laws, however, are often poorly or inconsistently enforced. The expert panel recommends that prevention efforts focus on enhancing enforcement. Such efforts can include creating linkages among several entities, including State ABC's, local police, college administrations, and other groups that promote community values and support enforcement of minimum drinking age laws.
  2. Be Consistent. It is recommended that local community laws, such as on land use, and local community policies, such as on implementation and enforcement, be consistent with local prevention messages.
  3. Unite Efforts. Experience suggests that having a high minimum drinking age is more effective when complemented by adjunct efforts such as implementing land use laws consistent with drinking laws.
  4. Anticipate Crises. Because the enforcement of minimum drinking age laws is often driven by tragedies and crises, there is a practical advantage in anticipating crises, such as those likely to occur during special events, high school and college activities, and holidays. Many college fraternities and sororities, for example, are involved in activities centered around drinking alcohol, promoting heavy drinking as normative behavior and frequently leading to serious alcohol-related problems. When fraternities and sororities are reluctant to respond to efforts aimed at reducing alcohol-related problems, pressure can be applied to their national organizations and insurance companies, which can in turn apply significant pressure and leverage to seek ways to solve the problems. In this way, the self-interest of a fraternity or sorority becomes an important aspect of prevention efforts.
  5. Educate Underage Youth. Research has shown that some young people often mistakenly believe that drinking beer impairs driving ability less than drinking spirits, and they often underestimate the amount of alcohol required to make driving unsafe (Lang, Kass, and Barnes 1983; Williams, Lund, and Preusser 1986). These beliefs are in sharp contrast with research results showing that one or two drinks will impair driving-related skills (Moskowitz, Burns, and Williams 1984); that four or five beers often produce BAC's in excess of the legal limit of 0.10 percent (O'Neill, Williams, and Dukowski 1983); and that compared with older drivers, teenagers with low and moderate BAC's are much more likely to be in traffic crashes (Mayhew et al. 1981). Special efforts should therefore be made to provide underage youth with accurate information on the effects of drinking alcoholic beverages and driving.

Recommendations for Prevention Approach 2: Raising Alcohol Taxes and Prices

The expert panel's recommendations regarding alcohol taxes and prices address issues such as taxation methods and how to prevent the erosion of tax benefits. Their four recommendations in this area are as follows:

  1. Levy Local Taxes. Where State law allows, local taxes such as "nickel-a-drink" levies on on-sale purchases may be an effective way of financing local initiatives to address alcohol problems while reducing rates. Local license fees also may be used as a kind of "user fee" device to mitigate alcohol problems. Because price increases affect the sale of alcoholic beverages, community prevention efforts can include strategies that increase alcohol prices. Although excise taxes have many benefits, resistance to tax increases by voters and beverage industries suggests that a range of approaches to raising prices should be considered.
  2. Equalize Taxes. Most of the adverse consequences of drinking result from the amount of alcohol in each drink, whether the alcohol is concentrated or diluted. To maximize public health benefits, taxes on different beverages can be set so that the retail prices of the most inexpensive form of each beverage are approximately equal. This may require a higher tax level per unit of alcohol on beverages such as spirits, which are more concentrated and thus cheaper to manufacture and distribute than beer and wine.
  3. Index State Taxes. The benefits of increases in State alcohol taxes, such as reductions in alcohol-related health and social problems, are likely to diminish as inflation erodes the real value of the tax increase. To avoid this erosion, the tax can be indexed so that the nominal tax rate rises in step with prices. The expert panel suggests that indexing alcohol taxes to the consumer price index should make the public health gains of higher taxes permanent.
  4. Seek Allies. The benefits of State alcohol taxes erode when the strategy behind them is out of step with neighboring jurisdictions. Where this is the case, countervailing effects such as cross-border shopping, cross-border drinking and driving, theft, and black-market sales can occur. When neighboring jurisdictions adopt equivalent regulations, however, such problems greatly diminish. The expert panel recommends that individuals engaged in planning prevention strategies including alcohol taxes initiate discussions and possible collaboration with their counterparts in neighboring regions.

Recommendations for Prevention Approach 3: Responsible Beverage Service

The expert panel recommendations regarding responsible beverage service focus on enforcement, liability, licensing, and general activities. Their 10 recommendations in this area are as follows:

  1. Enforce the Laws. All States and most jurisdictions already have laws prohibiting alcohol sales to intoxicated and underage individuals. The panel's principal recommendation concerning responsible beverage service is that jurisdictions strictly and uniformly enforce the laws regarding the sale of alcohol to such individuals.
  2. Target Trouble Spots. Although the panel recommends uniform enforcement of drinking laws, it also recommends targeting high-risk drinking establishments for opportunities for enforcement. Lax enforcement of State and local liquor laws may compel some businesses to engage in illegal practices, such as serving intoxicated patrons or underage youth. This may be especially true among drinking establishments in areas with a high density of alcohol outlets and a relatively small consumer base. Establishments that serve intoxicated or underage individuals may attract high-risk patrons, thereby increasing the risk for alcohol-related problems in the community. There are several ways to identify high-risk outlets; in particular, greater attention can be paid to adherence to the laws at establishments linked to substantial incidents of drunk driving arrests. Such high-risk establishments can be singled out by identifying the locations where arrested drunk drivers purchased their last drinks. This information can be collected by the police during arrests, by counselors during hearings, or by trainers during DWI education sessions.
  3. Keep the Burden on the Owner. Since the 1970's, most States have increasingly recognized some form of liability on the part of drinking establishments, whether by legislation, court decisions, or both. In the past few years, however, under the influence of alcohol-retailer lobbies a countertrend has emerged to reverse the court-inspired progress toward increased liability (Wagenaar and Holder 1991a). What's more, in a few States the civil liability for intoxication-related problems following alcohol consumption in a drinking establishment has shifted from establishment owners to their servers. Typically, this shift in liability is accompanied by a mandated server training program, which means that in essence owner liability has been traded for server training. Experience suggests that the strongest incentive to stop service to intoxicated or underage individuals appears to be the threat of business loss due to revocation of an establishment's alcohol license. The expert panel recommends that States and jurisdictions undertake efforts to keep the burden of legal responsibility on the owners of drinking establishments and alcohol licenses rather than their employees, such as servers. Jurisdictions might, in fact, consider increasing such liability burdens, not decreasing them. Interested readers can refer to the model alcoholic beverage retail licensee liability act of 1985 ("Model Alcoholic," 1985), and to the work of Coleman, Krell, and Mosher (1985) and Coleman and Kleinman (1986).
  4. Provide Incentives. Experience suggests that drinking establishments generally will not participate in RBS activities unless they have significant incentives to do so, such as the following:

    • Keeping a license to sell alcohol in order to remain open and avoiding license revocation are the greatest incentives for drinking establishments to participate in RBS training. Because alcohol licenses include specific restrictions, such as prohibiting alcohol sales to intoxicated or underage individuals, enforcement of the relevant laws governing alcohol sales seems to be the best prevention intervention method in this area.
    • Drinking establishments have vested interests in safety and the prevention of injuries for which they are legally liable. As a result, they are naturally concerned with the liabilities associated with serving intoxicated patrons and serving patrons to the point of intoxication. The expert panel recommends that prevention activities involving outlet owners and managers play on these inherent concerns.
    • Although drinking establishments are in the business of selling alcoholic beverages, this does not preclude them from wanting to prevent alcohol abuse, addiction, and related problems. Indeed, individuals who serve and sell alcohol can have strong interests in the overall health of their customers that encourage active partnerships with prevention practitioners.


  5. Close Loopholes. In some cases, the owner of a problem establishment may transfer ownership of the establishment to a friend or relative while continuing to operate it. The panel recommends that when a State or jurisdiction revokes a license, the license should not be allowed to transfer to a new establishment owner. To cut down on such tactics, it is recommended that States and jurisdictions permanently revoke the license to a specific location and force any potential new owner to go through a new formal license-application process. Restricting the transfer of licenses does not, however, guarantee that a previously irresponsible owner will not become involved with a new business. Therefore, it is critical to screen all potential owners and managers of drinking establishments carefully.
  6. Avoid Grandfather Exceptions. In some locations, purchasing an existing business and its alcohol license requires a different legal process than purchasing a new license. In some situations, restrictions that would apply to new licenses do not apply to existing ones. The expert panel recommends that jurisdictions refuse to transfer licenses to new owners unless all restrictions that apply to new licenses are transferred as well.
  7. Intervene Early. States and other jurisdictions are often reluctant to revoke or suspend alcohol licenses, waiting until numerous complaints and severe problems are reported before acting. The panel recommends that States and jurisdictions intervene in problem establishments early rather than waiting until problems associated with a drinking establishment get even worse.
  8. Provide Server Training. It is recommended that RBS training be provided to individuals who serve alcohol at special occasions such as sports and community events, street fairs, and business and private parties. Prevention practitioners can develop productive relationships with hospitality-related organizations, such as professional and trade associations, in developing server training programs. Experience suggests that there is a significant rate of turnover among alcohol servers in the hospitality business. As a result, the expert panel recommends that continuous server training rather than one-time sessions be offered to entrants into the business, and that periodic refresher sessions be held for all servers.
  9. Focus on All Components of Responsible Beverage Service Training. Several national organizations and State agencies are currently delineating which RBS components are essential, optimal, and effective. The panel recommends that server training be understood as one aspect of responsible hospitality, which encompasses the following:

    • Creating positive incentives by recognizing and rewarding businesses and events that practice responsible beverage service.
    • Developing community norms on the principles and practices of responsible hospitality.
    • Developing guidelines for employers and social hosts.
    • Enforcing regulations governing the sales and serving of alcoholic beverages consistently.
    • Instituting professional development programs for management and service staff.
    • Providing information and training for organizers and volunteers at community events.


  10. Offer Alternatives to Alcohol. Providing food and nonalcoholic beverages appears to be a useful way to cut down on alcohol consumption. Depending on the drinking establishment, however, selling these products can range from profitable to revenue-neutral or even unprofitable; as a result, some establishments see little incentive to provide such services. Nevertheless, RBS programs can encourage managers and servers to offer nonalcoholic products by promoting them as ways to encourage designated nondrinking drivers and to reduce intoxication and related problems and liabilities, as well as a potential source of revenue. Experience suggests that server interventions in this regard work only when they are part of management policies that support responsible beverage service; these interventions are most effective when supported by community-based programs for reducing alcohol-related problems. It also appears that RBS is effective only where there is strict enforcement of laws prohibiting sales to intoxicated or underage individuals.

Recommendations for Prevention Approach 4: Changing the Conditions of Availability

geographic density - the density of alcohol outlets per land area for a given geographic region, such as a planning district, police reporting district, ZIP code, or census tract.

The expert panel's recommendations regarding changing the conditions of alcohol availability address general issues such as sales practices and the geographic spacing of outlets as well as the regulation of alcohol at special events and locations. The panel's nine recommendations in this area are as follows:

  1. Collect Data. When communities first perceive problems related to alcohol outlet density, it is important that they set an individual skilled in data collection and analysis to assembling facts relevant to the problems. Important information to obtain includes police activities, citizen complaints, and State license violations.
  2. Learn the Ropes. Research suggests that communities that initiate and enforce restrictions on the spacing of alcohol outlets generally experience a reduction in police problems with off- and on-site sales, at least for several years. The expert panel thus recommends that community-based prevention groups become involved in local control issues such as outlet density and spacing. It is important for these groups to learn about licensing laws and processes and how they can become involved in developing them. Few local laws are changed without such activism, often at the community level. When considering prevention efforts related to alcohol outlet density or spacing, it is recommended that local communities become familiar with their State laws and issues related to State preemption; communities can, for example, explore the use of small claims courts as a remedy for dealing with nuisance outlets. Along the same lines, the panel recommends that State efforts stay sensitive to the needs and requirements of local communities; it is, after all, optimal for States and local communities to work together when either initiates a prevention effort related to outlet density or spacing. In areas with high densities of alcohol outlets, the clustered outlets are likely to be similar in type and to engage in vigorous competition, which can result in conditions conducive to availability-related problems as follows:

    • Competition in high-density areas can lead to increases in high-risk sales practices such as discounting drinks, holding events to attract large crowds, providing marginal entertainment, and lessening supervision of drinkers. Other competitive marketing strategies include providing free food, live music, "happy hours," multiple televisions for viewing sporting events, "ladies' nights," bikini contests, and female mud wrestling. These sorts of stunts are, of course, far less prevalent in high-density areas such as restaurant rows and high-end commercial specialty areas.
    • In fiercely competitive markets where on-sale outlets are competing for the same patrons, successful marketing strategies are likely to be replicated - that is, if one outlet becomes successful by using a specific marketing technique as described above, nearby outlets will try the same or a similar strategy. Merchants can, however, be encouraged to seek alternative strategies for marketing to different types of patrons.


  3. Consider Compatibility. Neighborhood compatibility is an important aspect of prevention efforts aimed at controlling outlet density. For instance, a specific outlet may be incompatible with other surrounding businesses or local residents, such as by providing late-night entertainment or late hours of sale. The expert panel recommends that every alcohol-license applicant be interviewed by local residents and businesses and charged with demonstrating to the city or licensing body that the immediate neighborhood does not object to the business moving in.
  4. Intervene Early. The panel recommends that discussions regarding alcohol control activities such as the provision of nonalcoholic beverages and other measures be introduced early in the planning stages of community-sponsored festivals, street fairs, and other special events.
  5. Train Servers. It is recommended that all individuals responsible for dispensing alcoholic beverages at special events receive server training to learn the relevant laws and policies, including policies for resolving alcohol-related problems. Guidelines for problem resolution should thus be developed in advance of special events and should be understood by all staff working at such events.
  6. Disseminate Rules. Rules regarding alcohol consumption at a special event can be printed and disseminated on signs, brochures, and event tickets. Publishing such rules may diminish the likelihood of trouble related to the enforcement of alcohol regulations.
  7. Use Physical Aids. Experience has shown that age-based and other restrictions on alcohol sales at special events can be more easily and strictly enforced through the use of hand stamps or identification bands issued at locations other than the alcohol purchase site. Experience also suggests that limiting beer sales (e.g., not selling to people in their seats at sporting events and cutting off sales after the seventh inning or third quarter) and providing nondrinking "family areas" decrease alcohol-related problems and attract attendance by families averse to drunken rowdiness.
  8. Educate Promoters. Alcohol-related problems at sporting events, rock concerts, and other large special events fall into two categories. The first includes unpleasant behavior, rowdiness, fights, and personal and property damage at the site before and during the event; the second includes DWI arrests, drunk driving casualties, street fights, and other incidents that occur after the event, away from the event site, and on patrons' way home. Although many event promoters have interests in addressing both types of alcohol-related problems, some promoters do not adequately address the latter. Prevention practitioners can play an important role by providing information to promoters regarding all types of alcohol-related problems associated with special events.
  9. Balance Interests. Permitting and controlling alcohol use at sporting and similar events involves balancing several needs and concerns. Alcohol sales are a substantial source of profit for stadium and arena owners, sports teams, and catering companies. If alcohol-related problems become too numerous and severe, however, attendance may suffer and liability issues may arise. Because community interests can influence those of private businesses, prevention efforts may be more effective if they embrace the need for balance.

Recommendations for Prevention Approach 5: Changing Hours and Days of Sale

community-based prevention - a prevention approach that relies on several interventions in concert, involving various sections of the community, drawing on multiple local resources to address a community problem.

The expert panel's one recommendation regarding changing hours and days of sale concerns familiarity with existing laws is as follows:

  • Know the Laws. It is important for communities to be familiar with State and local laws regarding local control over alcohol outlets' hours and days of operation in order to increase where possible the power localities can exercise in this area.

Recommendations for Prevention Approach 6: Community-Based Prevention Approach

The expert panel's recommendations regarding community-based prevention activities address issues such as forming coalitions, recruiting participation by the retail and wholesale alcohol beverage industry, and sustaining policies. The panel's six recommendations in this area are as follows:

  1. Use Multiple, Integrated Strategies. Research and experience suggest that multicomponent community-based strategies are more effective than those with only one; the individual elements of a multicomponent strategy can strengthen, complement, and support each other in a cumulative effect whose overall impact is greater than the sum of the impacts of the individual components. In addition, if one aspect of a multicomponent strategy is eliminated, the combination of the remaining components may continue to exert a significant preventive effect. For example, a multicomponent RBS strategy could involve server intervention training, the development of management policies and procedures in drinking establishments, and enforcement efforts. The panel therefore recommends that community-based coalitions and practitioners identify and utilize complementary multiple prevention strategies.
  2. Support Policies. Experience suggests that it is important for community coalitions to see prevention activities as having two phases: implementation and sustainment. Community coalitions that focus only on the implementation of a policy or regulation will often see their gains diminish if attention is not paid to sustaining the policy changes and related prevention activities. One way to promote the sustainability of such activities is to institutionalize prevention efforts. For example, ad hoc grassroots groups can evolve into permanent committees within city or county governments. Where this occurs, however, ongoing community participation is important to protect against a loss of vigor in committee activities.
  3. Cultivate Membership. It is recommended that prevention practitioners engage in ongoing efforts to recruit new members, maintain existing ones, and respond to new requests. The panel recommends that community coalitions stay involved in prevention and keep paying attention to the issues. Coalition leaders can take steps to keep members involved, motivated, and educated; government agencies can provide technical assistance to community coalitions to help them stay involved, flexible, tolerant of problems such as staff changes, and willing to examine new goals when previous ones have been attained.
  4. Use Practitioners. Professional prevention practitioners can serve as a primary information source for community-based coalitions. Over time, specific issues will change, partnerships will evolve, and information needs will vary; prevention practitioners can offer important information, guidance, and resources for community coalitions despite such changes.
  5. Organize Mindfully. The expert panel recommends that grassroots community coalitions have control and authority over the direction of local prevention efforts equal to those of service providers, city officials, and other professional participants. In general, the success of community coalitions depends on the participation and collaboration of public agencies, local community groups, and organizers whose mission is to achieve specific goals. Although organizers can be volunteers or paid professionals and may come from public agencies, it is generally not appropriate for organizers to represent any particular agency. Experience demonstrates that some agencies and groups are good partners in certain coalitions but not in others, depending on the issues at hand. For example, entities such as police departments make good coalition partners for dealing with public safety issues, but as public employees police need to remain impartial on certain politicized issues, which would prohibit them from joining coalitions devoted to those issues.
  6. Identify, Secure, and Organize Data. In preparation for community coalition interventions, it is recommended that data be collected on the distribution of retail alcohol availability and the problems associated with it. The goal should be to gather baseline data showing the relationship between outlet density and resulting problems. In many cases, public agencies have such data in public records that can be easily retrieved.

General Recommendations for Alcohol Availability

In addition to its specific recommendations for each of the six prevention approaches considered in this chapter, the expert panel provided six general recommendations regarding alcohol availability, as follows:

  1. Experiment. Many of the variables that make an intervention effective in one situation do not work in others. For this reason, communities would do well to keep an open mind about experimental prevention efforts appropriate to their particular situation and region. If such interventions do not seem to work, expert advice can be sought and adjustments made. Throughout any such experiments, it is important for communities to document the processes followed, including any adjustments to them.
  2. Head Off Problems. Sometimes the motivation for instituting specific prevention efforts is to address a particular crisis; at other times it may be to identify and resolve problems early in their manifestation. Whenever possible, it is important for community practitioners to focus on identifying and intervening in problems before they become crises. Local groups can seek collaboration with other components of the prevention system, such as internal liquor control committees, to obtain evidence of burgeoning problems with an eye toward early intervention. At the same time, when possible it should be determined whether prevention efforts will be short- or long-term so that appropriate approaches and tools are used.
  3. Foster Trust. It is important in prevention efforts to take steps designed to promote a trusting relationship between law enforcement and local businesses and merchants. This can be accomplished through formal or informal committees or boards set up to reduce specific alcohol-related problems or to study general problems related to alcohol availability.
  4. Promote Cooperation. Community members and retailers may be unaware that police powers supersede the authority of retail alcohol merchants, and that prevention efforts might be enhanced by cooperation among merchants, police, and other regulatory authorities. When considering policy changes at the local level, it is advisable for prevention practitioners to work with State agencies to establish joint regulations to ensure coordination with State and local policies. A useful approach for enhancing cooperation and collaboration among State and local efforts involves establishing a single point of contact, such as a coalition, committee, or working group within a city government that focuses on alcohol availability issues through the city manager's office.
  5. Empower Community Members. Empowerment activities can be used to develop new power centers in underrepresented parts of a community. Under such strategies, community members are encouraged to pool their collective resources to define and solve shared problems and to develop action plans for solving or preventing identified problems with alcohol availability. By sharing the process of problem assessment, a common vision can emerge and agreements can be reached on how to proceed.
  6. Use Free Legal Aid. Nuisance abatement can be pursued through the civil section at the county attorney level. Whereas many city attorneys provide contract services at an hourly rate, State and county attorneys may provide pro bono assistance to community groups seeking to do something about nuisances related to alcohol availability.

Recommendations for ABC-Related Activities

The expert panel formulated the following two general recommendations for ABC-related activities:

  1. Communicate With ABC's. The orientations and missions of ABC's differ among the States with regard to staffing, police powers, legal mandates, and policy direction from legislative and executive offices. Many States, such as California, have a public health, welfare, and safety mandate in addition to a legal mandate to prevent the development of marketing conditions that disrupt the orderly distribution and sale of alcoholic beverages. Both mandates are important to the effective and efficient regulation of the industry; they also share a common purpose, which is to regulate the industry in a manner consistent with the welfare of the public as a whole. Therefore, some ABC's place greater emphasis on enforcing marketing regulations than others because of State legislative policies. The expert panel recommends that communities establish consistent and open communication with ABC's, supporting and encouraging the agency to recognize public health, welfare, and safety mandates while supporting legislation for alcohol licensing that promotes and emphasizes public health goals. When prevention groups have difficulties getting appropriate responses from an ABC, State and local officials can be called upon to urge the board to respond. When working with ABC's, the best approach is cooperation, collaboration, and a focus on common grounds.
  2. Alert ABC's. It is recommended that State ABC's be alerted to the initiation of new prevention initiatives so they can provide support for them when appropriate.

Recommendations for Outlet-Related Activities

The expert panel formulated three recommendations for alcohol outlet-related activities, as follows:

  1. Exercise Police Powers. Communities have significant police powers to support public health issues, a fact that is often overlooked. Some individuals in the alcohol industry believe that public health authorities cannot exert significant control over their activities; in fact, there is considerable control at the local level under the authority of public health and safety agencies.
  2. Pressure Problem Outlets. Although many communities that issue conditional-use permits have been successful in slowing the opening of new alcohol outlets, many remain frustrated with the problems associated with existing outlets. Groups may need to establish problem prevention strategies for existing outlets that differ from those for new outlets. For example, groups may collaborate with the local police and may request assistance with priority problem outlets. Letters can be sent to these outlets requesting reasons why the prevention group should not announce a public hearing concerning the outlet. Merchants will often cooperate under these circumstances. When they do not, hearings can be held to discuss problems and potential solutions regarding the outlet. If the problems are not resolved within a year, another hearing can be held during which a recommendation can be made to close any problem establishments.
  3. Explore Alternative Fixes. Economic incentives can be effective when working with problem outlets. For example, owners of problem drinking establishments can be offered extra incentives to reorient their businesses, such as by turning a bar into a coin-operated laundromat. Community economic development departments can be helpful during these negotiations. Overall, alcohol outlets are owned by individuals with substantial financial and commercial stakes, keeping which can be a powerful incentive to cooperate with local values. The expert panel recommends that prevention efforts consider the needs of these businesspeople, including their need to avoid liability problems.

Recommendations for Zoning-Related Activities

The expert panel made the following two recommendations for zoning-related activities:

  1. Document and Test Successful Practices. Local officials and community groups in thousands of cities and counties often use planning and zoning ordinances to prevent, reduce, and respond to problems related to retail alcohol outlets. A substantial disparity exists between the wealth of undocumented practice experience and the level of scientific attention applied to understanding and improving the preventive uses of that experience. The value of this work to prevention efforts may be clear to the many officials, citizens, and outlet operators who are directly involved, but their practical experience has yet to be fully documented or rigorously tested.
  2. Enhance Zoning-Related Activities. Prevention practice and some research on the uses of local planning and zoning ordinances suggest that enhancing the application of local planning and zoning to alcohol outlets can be effective in preventing alcohol-related problems. Various hypotheses can be tested to evaluate the effectiveness of zoning-related activities and thus to help communities make informed decisions about strengthening their prevention efforts by expanding enforcement activities directed at alcohol outlets; making greater and more efficient use of existing ordinances; and developing stronger local ordinances to reduce the density of alcohol outlets, as follows:

    • If problems related to alcohol outlets can be reduced or eliminated through a variety of enforcement actions, and if those enforcement actions are applied, then the problems of individual outlets should be reduced or eliminated. Despite insufficient documentation and analysis practice, experience suggests that this hypothesis holds true.
    • If local planning and ordinances related to alcohol outlets and availability reduce alcohol-related problems, and if communities use these interventions, then alcohol problems in the community should decrease after community-level initiatives are applied through local planning and zoning ordinances.
    • If higher densities of alcohol outlets in a community are associated with higher problem rates, and if the introduction of local CUP zoning ordinances will reduce the density of alcohol outlets, then alcohol problems in the community should decrease when such ordinances are applied.

Abstracts of Research and Practice Evidence Reviewed for Prevention Approaches1

Research Evidence Reviewed for Approach 1

time-series design - a research design that involves an intervention group that is evaluated at least once prior to the intervention and is retested more than once after the intervention. A time-series analysis involves the examination of fluctuations in the rates of a condition over a long period in relation to the rise and fall of a possible causative agent.

O'Malley and Wagenaar (1991) conducted two studies designed to (1) compare drinking behaviors and the number of alcohol-related motor vehicle collisions in States with a high minimum legal drinking age with those in States with a low minimum legal drinking age, and (2) examine changes in drinking behavior and the number of motor vehicle collisions in States that raised the minimum legal drinking age to 21 years with those in States that maintained the minimum legal drinking age at 21 years. The first study was a cross-sectional survey comparing two conditions across time; the second was a time-series analysis examining data collected annually over a period during which a policy change occurred. The findings included the following:

  • Before the Federal Government required the States to raise the minimum legal drinking age, high school seniors in States with a minimum legal drinking age of 21 consumed less alcohol than their counterparts in States where the minimum legal drinking age was lower than 21. In the former States, lower rates of drinking among teenagers appeared to persist as these youth entered their 20s.
  • Raising the minimum legal drinking age from 18 to 21 years reduced alcohol consumption among high school seniors.
  • Alcohol-involved highway collisions declined among those aged 18 through 20 years after the minimum legal drinking age was raised.
  • High school seniors spent less time in bars and taverns in States that raised the minimum legal drinking age to 21 years.

In December 1978, Michigan raised its minimum legal drinking age from 18 to 21 years. Wagenaar (1986) examined the effects of raising the minimum legal drinking age on the number of injury-producing traffic crashes among drivers between the ages of 18 and 20. This time-series study compared the rates of motor vehicle collisions before and after the change among drivers police officers said "had been drinking," the rates of single-vehicle nighttime traffic crashes before and after the change, and the rates of injury-producing crashes among drivers 21 years and older who "had been drinking" with those for drivers aged 18 through 20 years. The study found the following after the minimum legal drinking age was increased to 21:

  • The number of crashes involving drinking drivers between the ages of 18 and 20 decreased by 6 percent, while crashes involving drinking drivers aged 21 and older rose by 13 percent.
  • The overall reduction in crashes attributable to raising the drinking age among drinking drivers was 19 percent.
  • The number of single-vehicle nighttime crashes among drivers aged 21 and older increased by 16 percent.

Wagenaar and Maybee (1986) examined the effects on motor vehicle collision rates of a 1981 Texas State law raising the minimum legal drinking age from 18 to 19 years. Their study, which covered 1978 through 1984, employed a quasi-experimental, nonequivalent, interrupted, multiple time-series design. The rates of motor vehicle collisions per 100,000 licensed drivers were examined for three levels of severity: (1) serious injury; (2) minor injury; and (3) property damage only for four age groups: (1) 16 to 17 years; (2) 18 years; (3) 19 to 20 years; and (4) 21 years and older. Among the study's findings were the following:

  • The group of licensed drivers aged 18 years experienced significant reductions in rates of single-vehicle nighttime collisions at all levels of collision severity (serious injury collisions, 10.8 percent; minor-injury collisions, 14.3 percent; property damage-only collisions, 12.8 percent). Drivers aged 16 through 17 years experienced similar reductions.
  • The relative rate of decline in single-vehicle nighttime collisions between drivers aged 18 years and those 21 and older was 9.5 percent for serious-injury collisions, 7.6 percent for minor-injury collisions, and 7.8 percent for property damage-only collisions. There was no significant change in single-vehicle nighttime collisions among drivers aged 19 years and older.
  • Reductions in rates of nonsingle-vehicle nighttime collisions for drivers aged 18 years were consistently smaller than the reductions in the rates of single-vehicle nighttime collisions.

Many States have established lower legal BAC limits for drivers younger than age 21 than for older drivers. Hingson, Heeren, and Winter (1994) compared the rate of alcohol-related automobile crashes in 12 States where the BAC limit was lower for young drivers than for adults with those in 12 comparison States where the BAC limit was the same for youths and adults. Matches were made for States that had BAC limits of 0.00 percent, 0.02 percent, and 0.04 to 0.06 percent. Data on fatal crashes were based on the U.S. Department of Transportation's Fatal Accident Reporting System. Data were collected over a 12-month period, beginning with the month in which the reduced-BAC law was enacted. Log linear analyses were used to test the significance of differential shifts in the proportion of single-vehicle fatal nighttime crashes. The study's findings included the following:

  • Among drivers aged 15 through 20 years, single-vehicle fatal nighttime crashes were three times more likely than other fatal crashes to be alcohol-related.
  • The proportion of single-vehicle fatal nighttime crashes declined by 16 percent among young drivers in States that had lowered BAC limits for underage youth, whereas it rose 1 percent among drivers of the same age in comparison States where the BAC limits were not changed.
  • After the BAC laws were enacted, the proportion of single-vehicle fatal nighttime crashes declined by 5 percent in States that had lower levels for young drivers and by 6 percent in the group of neighboring comparison States.
  • The proportion of single-vehicle fatal nighttime crashes declined by 22 percent among drivers in States with a BAC limit of 0.00 percent but by only 2 percent among drivers of the same age in the comparison States.
  • Among those targeted by 0.02 percent BAC limits, the proportion of single-vehicle fatal nighttime crashes declined by 17 percent but rose by 4 percent in the comparison States.

A 1988 Maryland State law prohibits driving by those younger than 21 who have a BAC of 0.02 percent or more (in contrast to a 0.10 percent BAC limit for drivers older than 21). This law effectively prohibits underage youth from operating motor vehicles after consuming even a small amount of alcohol. Their driver's licenses are imprinted with the phrase "Under 21 Alcohol Restricted." Underage youth with a 0.02 percent BAC can be charged with violating the restriction and may be punished with a fine up to $500 and suspension of their driver's licenses for up to a year. Underage youth in Maryland can be charged with driving under the influence (DUI) if their BAC is 0.07 percent or more and with DWI if it is 0.10 percent or more.

The National Highway Traffic Safety Administration (1992) examined the effectiveness of the Maryland BAC law and of the State's public information campaign to promote its effects. The experimental campaign was launched in six counties; two others served as comparison counties. The campaign included broadcasting television and radio public service announcements, brochures, and posters; informing police agencies of the importance of the law and promoting its enforcement; and encouraging local groups to help teach the public about the BAC law. Statewide crash statistics from 1985 to 1990 were obtained from the Maryland State police; measurements of the public information campaign's exposure were derived from surveys conducted during driver's license applications and renewals at colleges and high schools. Among the findings were the following:

  • The Maryland BAC law was associated with a significant statewide reduction (about 11 percent below the baseline mean) in the number of accident-involved drivers who were under age 21 and judged to have been drinking.
  • In the six experimental counties, the percentage of all underage drivers involved in crashes was 8.9 percent at baseline, 7.4 percent during the early law period, 6.3 percent after licenses were imprinted, and 5 percent after the public information campaign. This 44 percent drop from the pre-law period through the information campaign compares with a 30 percent drop in the comparison counties.
  • In the experimental counties, significant baseline-to-posttest increases appeared in public recall of information about alcohol license restrictions being provided through print media (23 percent), television (25 percent), and radio (26 percent).

Hingson et al. (1996) evaluated the effectiveness of the Saving Lives Program, a community effort to organize multiple city departments and private citizens to reduce alcohol-impaired driving, alcohol-related driving risks, and traffic deaths and injuries. In each of the six program communities a full-time coordinator from the mayor's or city manager's office organized a task force of concerned private citizens, organizations, and officials representing various city departments. The communities developed initiatives such as media campaigns, speeding and drunk driving awareness days, "speedwatch" telephone hotlines, police training, SADD chapters, alcohol-free proms, beer keg registration, increased surveillance of liquor outlets, preschool education programs, and training for staff at hospitals and prenatal clinics. The intervention cities were compared with the rest of Massachusetts and with five cities that prepared high-quality proposals that were not funded. This quasi-experimental study evaluated the impact of the intervention on traffic crashes and injuries, safety belt use, vehicle travel speeds, and driving after drinking.

Monitoring of crashes was based on data from the Department of Transportation's Fatal Accident Reporting System. These data were collected 5 years before and 5 years after the start of the program. Additional data came from the Massachusetts Registry of Motor Vehicles and were collected 4 years before and 5 years after the start of the program. Five annual direct observation surveys of speeding and safety belt use were conducted 1 year before and 4 years after the start of the program; these surveys involved using radar from unmarked cars for detecting speeding vehicles at randomly selected roadways at intervention and comparison cities, as well as direct observation at signalized road intersections and freeway off-ramps using a stratified random sampling procedure. To assess program awareness, beliefs about police enforcement, and the frequency of driving after drinking, four independent cross-sectional, random-digit-dial telephone surveys of 15,188 young people aged 16 to 19 years and adults aged 20 years and above were conducted in intervention cities and the rest of the State between 1988 and 1993.

Compared with the rest of the State and with the 5 years before the intervention, the following findings were noted in the Massachusetts intervention cities during the 5 years of the program:

  • Alcohol-related fatal crashes declined by 42 percent.
  • Fatal crashes declined by 25 percent.
  • Fatal crashes involving drivers aged 15 to 25 years declined by 39 percent.
  • The number of fatally injured drivers with positive BAC's declined by 47 percent.

Compared with the rest of the State and with the 4 years before the intervention, the following findings were noted in the Massachusetts intervention cities during the 5 years of the program:

  • The number of pedestrian injuries per 100 crashes declined by 10 percent.
  • The number of visible injuries declined by 5 percent.

In contrast to five nonintervention comparison cities, the Massachusetts intervention cities experienced a 33 percent decline in fatal crashes and a 42 percent decline in alcohol-related fatal crashes. The following outcomes were also reported:

  • Safety belt use increased from 22 percent in 1989 to 29 percent in subsequent years, an increase 17 percent proportionately greater than in the rest of the State.
  • The proportion of vehicles observed at speeds more than 10 miles per hour over the speed limit declined from 19 percent in 1989 to 9 percent in subsequent years. This decline was 43 percent greater than in comparison areas.
  • The proportion of youths aged 16 to 19 years who reported driving after drinking in the month before being interviewed declined from 19 percent in 1988 to 9 percent in 1993, a decline 43 percent greater than in the rest of the State.
  • From 1987 to 1992, combined police traffic citations declined by 12 percent, speeding citations declined by 14 percent, and citations for DWI declined by 13 percent.

quasi-experimental design - a research design that includes intervention and comparison groups and measurements of both groups, but in which assignments to the intervention or comparison groups are not done randomly.

Preusser, Williams, and Weinstein (1994) conducted underage alcohol-purchase attempts on a subset of all alcohol outlets in Denver, Colorado. In this staggered quasi-experimental design with random selection, underage male police cadets attempted to purchase six-packs of beer. Three sets of 100 stores were randomly selected from alcohol beverage license lists. Three days after the first set was visited to establish a baseline, a press conference announced the results and warning letters were sent to violators. One month later, all visited stores were revisited (the first enforcement wave), and clerks and licensees were cited at violating stores. Three months later, a second set of letters warned licensees that enforcement would continue. Shortly thereafter, a second sample of 100 licensees was randomly selected and visited (the second enforcement wave); violators were cited as before. Six months later, a third sample of 100 licensees randomly selected from updated license lists were visited (the third enforcement wave). Violators were cited. Due to closings and time constraints, the actual number of stores visited was 88 at baseline and in the first enforcement wave, 84 in the second enforcement wave, and 85 in the third enforcement wave. The study's findings included the following:

  • At baseline, 59 percent of the stores sold beer to underage youth. When sales were totaled across the three enforcement waves, it was found that 28 percent of the stores sold beer to underage youth.
  • During the first enforcement wave, 32 percent of the stores sold beer to underage youth. Of the stores that did, half had done so during the baseline visit.
  • During the second enforcement wave, 26 percent of the stores sold beer to underage youth. Of the stores not visited during the baseline or in the first wave of enforcement, 29 percent sold beer to underage youth. Among the remaining 15 stores, which by chance had been on the first two licensee lists, only 2 sold beer to the underage youth.
  • During the third enforcement wave, 26 percent of the stores sold beer to underage youth. Of these 22 sales, 12 occurred at stores that had not been visited before, while 10 occurred at stores that had been visited before.
  • The 11 stores that had sold beer to underage youth during the baseline and in the first enforcement wave were revisited during the third enforcement wave. Three of them sold beer to underage youth, seven did not, and one was closed.

cross-sectional design - a research design that involves the collection of data on a sample population at a single point in time.

Using a self-reporting, cross-sectional survey design, Mooney and Gramling (1993) examined two samples of college students: one from North Carolina, where the minimum legal drinking age was 21, and the other from Louisiana, where the minimum legal drinking age was 18. Patterns of drinking behavior were compared in terms of frequency, quantity, and location of consumption (defined as either controlled locations, where proof of age is required or where there is a higher likelihood of sanctions, or uncontrolled locations such as dormitories and fraternity houses, where sanctions are unlikely). Among the survey's findings were the following:

  • In North Carolina, drinking was deterred in controlled locations but not in uncontrolled locations.
  • In controlled locations, the State/age interactions for frequency and monthly consumption were significant.
  • In uncontrolled locations, none of the State interactions was significant, suggesting that such laws have little effect in situations where the threat of formal social control is absent or minimized.

A study by Preusser et. al (1995) looked at alcohol policies in New York and Pennsylvania, which have substantially different State laws regarding the purchase, possession, and consumption of alcohol and the use of false identification by underage individuals. New York has less stringent laws than Pennsylvania, which has strong laws and State-controlled liquor stores. Because of these differences, and because the prevalence of the use of false identification by underage youth could be related to these variations, the study compared the behaviors of underage youth attempting to purchase alcohol in the two States. The subjects were aged 20 years and younger and included high school juniors and seniors as well as college students. This cross-sectional study was based on surveys that focused on the subjects' (1) frequency of drinking, (2) sources of alcohol, and (3) use of false identification. Completed surveys were obtained from 2,167 underage youth in New York and 2,223 underage youth in Pennsylvania. Among the findings were the following:

  • Although more high school students in New York than in Pennsylvania reported that they had ever consumed alcohol (other than in the presence of their immediate family) and more students in New York than in Pennsylvania reported drinking two or three times per month, the differences in the rates were not significant.
  • High school students in New York (43 percent) were more likely than those in Pennsylvania (30 percent) to have attempted to purchase alcohol at an outlet.
  • College students in New York (75 percent) were more likely than their Pennsylvania counterparts (59 percent) to have attempted to purchase alcohol at an outlet.
  • One-third of all students in both States (about 21 percent of the high school students and 48 percent of the college students) had used false identification in attempts to purchase alcohol. High school students in New York (28 percent) were more likely than those in Pennsylvania (14 percent) to report having used false identification.
  • Among underage youth who did not directly purchase alcohol, the most likely sources of alcohol were friends under 21; other sources were friends over 21 and parents. However, New York underage youth were more likely than their counterparts in Pennsylvania to obtain alcohol from parents.

statistical significance - the strength of a particular relationship between variables. A relationship is said to be statistically significant when it occurs so frequently in the data that the relationship's existance is probably not attributable to chance.

The U.S. General Accounting Office (1987) applied evaluation synthesis methodology to then-available research studies that analyzed the effects of raising minimum drinking age laws on traffic crashes and alcohol consumption among those affected by the laws, generally individuals aged 18 to 20 years. The primary measurements used in the crash studies were police and coroners' reports and surrogate indicators of alcohol use such as single-vehicle nighttime crashes. The crash data were grouped in categories, such as by driver fatalities and injuries. The measures used in the consumption studies were self-reporting surveys, interviews, and alcohol sales data. Findings were reported for the following categories:

  • Consumption After Minimum Age Increases. Four studies evaluated the relationships between increasing drinking age laws and the levels or frequency of consumption by the groups affected by minimum age laws (Coate and Grossman 1985; Lillis 1984; Perkins and Berkowitz 1985; Williams and Lillis 1985). These studies suggest that raising the minimum drinking age by law promotes a significant decrease in the frequency and amount of drinking among the age groups affected by such laws.
  • Driver Fatality Crashes (Multi-State). Four studies evaluated the effects of increasing the drinking age on crashes involving driver fatalities across multiple States (Arnold 1985; DuMouchel, Williams, and Zador 1985; Hoskin, Yalung-Mathews, and Carraro 1986; Williams et al. 1983). Each of these studies showed statistically significant reductions in crashes resulting in driver fatalities, ranging from 5 to 28 percent, for the age groups affected by the law during the study periods. In addition, most of the individual States in each study's subject pool showed significant reductions in such crashes.
  • Driver Fatality Crashes (Selected States). Five studies evaluated the effects of increasing the drinking age on crashes resulting in driver fatalities in individual States (Emery 1983; Florida Department of Community Affairs 1983; Hingson et al. 1983; Lillis 1984; Schroeder and Meyer 1983). All five studies showed reductions in the number of crashes attributable to higher drinking ages, ranging from a 1-percent reduction in "driver-fatal" crashes in Massachusetts to a 35-percent reduction in "driver had been drinking-fatal" crashes in New York. The results were statistically significant in four of the studies.
  • Driver Fatality or Injury Crashes. Four studies in four States evaluated the effects of increasing the drinking age on crashes in which the driver was either killed or injured (Florida Department of Community Affairs 1983; Lillis 1984; Wagenaar 1981, 1987). Each study found reductions among those affected by the law after the minimum drinking age was increased. Results were significant for Florida, Michigan, and New York, ranging from about 10 percent in New York to a 28-percent reduction in Michigan.
  • Driver Injury Crashes. One study examined the effects of increasing the drinking age on crashes resulting in driver injury (Florida Department of Community Affairs 1983). This study observed a statistically significant net reduction of approximately 2 percent during the study period among age groups affected by the law.
  • Driver-Involved Crashes. Four studies evaluated the effects of increasing the drinking age on driver-involved crashes in three States (Klein 1981; Maxwell 1981; Schroeder and Meyer 1983; Wagenaar 1981). All four studies found reductions in driver-involved crashes among the age groups affected by the laws. The reductions in Illinois, Maine, and Michigan were significant, ranging from 9 percent in Illinois to 22 percent in Michigan.
  • Total Crash Fatalities. One study evaluated the effects of increasing the minimum legal drinking age on total crash fatalities (Saffer and Grossman 1985). Analysis of national data during a period after many States increased their minimum legal drinking ages revealed a 7-percent average reduction in fatalities in States with higher drinking ages.

Practice Evidence Reviewed for Approach 1

Through the Pennsylvania Liquor Control Board, the State of Pennsylvania is engaged in activities designed to control the density of alcohol outlets, support the prevention of alcohol abuse, disseminate information on the responsible use of alcohol and responsible alcohol sales and service, and establish partnerships with other State agencies and organizations. The State's results include the following:

  • In 1992, 66 youth DWI arrests were made in Pennsylvania, in contrast to the national average of 134 such arrests.
  • In 1992, a smaller proportion of youths were killed in alcohol-related vehicle collisions in Pennsylvania than in most other States.
  • Underage youth are served alcohol less frequently in Pennsylvania than in open States, where alcohol is sold in drug, grocery, and other retail stores.

The Under 21 Enforcement Project was designed by the Town of Yorktown Police Department to enforce regulations prohibiting the sale of alcohol to persons under 21 years of age, to heighten public awareness of alcohol abuse by youth, to aggressively enforce DWI regulations for underage youth, and to increase the accuracy of police reports concerning motor vehicle collisions. The project targeted premises suspected of selling alcohol to underage youth, issued press releases on violations and enforcement efforts, patrolled youth gathering places, screened drivers, and provided information regarding ABC laws and reporting techniques. The Under 21 Enforcement Project proceeded in three steps. First, letters were mailed to merchants whose clerks requested identification during purchase attempts by underage patrons. Second, patrol supervisors received special orders requesting aggressive investigations of complaints about underage drinking at private residences. Third, inservice police training sessions were held to advise patrol officers of the importance of accurately completing vehicle collision reports. The following outcomes were noted during the project's 1-year grant period:

  • The proportion of alcohol-related violations by underage youth that were not associated with driving declined from 62.7 to 50 percent.
  • The proportion of all drivers between 16 and 20 years of age who were involved in vehicle collisions declined from 18.3 to 17 percent.
  • The proportion of DWI arrests among underage youth increased from 8.1 to 8.4 percent.

Cops in Shops was an enforcement and media campaign designed to diminish alcohol purchases by underage youth in Las Cruces, New Mexico. In the enforcement component, plainclothes police officers posed as employees at seven licensed establishments but did not handle transactions. Customers who appeared to be under 25 years of age and who attempted to purchase alcohol had their identification referred to the police officer in the store. Those patrons who were underage were refused alcohol sales. As each underage customer left the store, another officer stationed outside issued the youth a citation. The intervention was conducted at seven stores in rotation, generally between 5:00 p.m. and 9:00 p.m. A total of 50 hours of enforcement occurred during the course of a month. The media campaign included the use of signs at retail alcohol stores announcing that the police would verify the age of alcohol purchasers and would cite underage youth who attempted to purchase alcohol. Public service announcements were developed for use by local television stations and the local cable company, and advertisements were produced for the city newspaper and the student newspaper at New Mexico State University. Two weeks before the Cops in Shops program was implemented, 75 public service announcements were aired on cable television channels including Cable News Network, Lifetime, MTV, Nickelodeon, and USA Network.

Among the 95 total purchases and purchase attempts made before the program's implementation and the 70 total purchases and purchase attempts made during its implementation, the following was reported:

  • Four fake identifications were used in purchase attempts by underage youth before implementation, while none were used during implementation.
  • Three purchase attempts were aborted when patrons were asked for identification before implementation, while six were aborted after implementation.
  • Transactions between youths and adults in the parking lots outside stores during the enforcement program led police to issue 10 citations to adults for purchasing and distributing alcohol to underage youth and 4 citations to underage purchasers.

Research Evidence Reviewed for Approach 2

A study by Cook and Moore (1993) analyzed the effect of beer excise taxes on rates of homicide, rape, assault, and robbery. They used annual data from 1979 through 1988 on these violent crimes in the 48 contiguous United States to generate three sets of closely related estimates: (1) on the effects of drinking on violent crime; (2) on the effect of the beer tax on drinking; and (3) on the effect of the beer tax on violent crime. The study's findings included the following:

  • A 10-percent increase in per capita consumption was associated with the following increases in violent crimes: homicide, 0.87 percent; assault, 5.85 percent; rape, 6.47 percent; robbery, 9.13 percent.
  • A 100-percent increase in alcohol taxes was associated with the following reductions: assault, 0.26 percent; homicide, 0.32 percent; alcohol consumption, 0.48 percent; robbery, 0.87 percent; rape, 1.32 percent.

Saffer and Grossman (1987) examined the relationships between beer taxes and the minimum legal drinking age on motor vehicle fatalities among youth aged 15 to 24 in the 48 contiguous United States from 1975 through 1981. One goal of this study was to investigate the responsiveness of motor vehicle death rates of youth aged 15 to 24 to variations in the cost of beer as reflected by differences in State excise tax rates on beer. Another goal was to examine the effect of an increase in the legal drinking age on youth motor vehicle deaths. Using a time-series cross-sectional design with historical cohorts, study data were used to predict the effects on fatalities of a uniform drinking age of 21 and of policies that fixed the Federal beer tax in real terms to its 1951 level or taxed the alcohol in beer at the same rate as that in spirits. Among the findings were the following:

  • Higher beer taxes were associated with lower death rates from motor vehicle collisions for youth aged 15 to 17, 18 to 20, and 21 to 24 years.
  • Higher legal drinking ages were associated with lower death rates from motor vehicle collisions only for youth aged 18 to 20.
  • It was projected that the enactment of a uniform drinking age of 21 in all States would have reduced the number of youth aged 18 through 20 killed in motor vehicle collisions by 8 percent from 1975 through 1981.
  • It was projected that policies fixing the Federal beer tax in real terms since 1951 would have reduced the number of lives lost in fatal collisions by 15 percent, whereas a policy that taxed the alcohol in beer at the same rate as that in spirits would have reduced the number of lives lost by 21 percent. A combination of the two tax policies would have caused a 54 percent decline in the number of youth killed.

sociodemographic factors - social trends, influences, or population characteristics that affect substance abuse-related risks, attitudes, or behaviors. Such factors have an indirect but powerful influence because of the limitations of society's political, social, economic, and educationsl systems.

Using a cross-sectional design and a historical cohort, Grossman, Coate, & Arluck (1987) conducted an econometric analysis to develop estimates of the responsiveness of alcohol use by youth aged 16 to 21 years to variations in the price of alcohol. Estimates of the effects of price were also compared with estimates of the effect on alcohol use by youth of raising the minimum legal drinking age. The analysis was based on the first National Health and Nutrition Examination Survey, which was conducted from 1971 through 1974. The study's findings included the following:

  • A 10-cent increase in the price of beer would reduce the number of youth aged 16 through 21 years who drink by about 11 percent, the number who drink two or three times weekly by 8 percent, and the number who consume as many as three to five cans of beer on a typical drinking day by 15 percent.
  • A 30-cent increase in the price of spirits would reduce the number of youth who drink spirits by 23 percent and the number who consume at least three to five drinks on a typical drinking day by 27 percent.
  • Increases in both the minimum legal drinking age and the prices of beer and distilled spirits were associated with decreases in beer consumption.
  • Increases in the price of beer were associated with decreases in wine consumption.
  • Increases in the price of distilled spirits were significantly associated with decreases in their consumption.
  • Overall, the study suggested that the prices of beer and distilled spirits and the minimum legal age for their consumption are likely to affect alcohol use by youth.

Similarly, using a time-series design with a historical cohort, Coate and Grossman (1985) conducted an econometric analysis to develop estimates of the responsiveness of alcohol use by youth aged 16 to 21 years to variations in the price of alcohol. The study was also designed to compare estimates of the effects of price with estimates of the effects of an increase in the legal drinking age on alcohol use by youth. The analysis was based on the second National Health and Nutrition Examination Survey, which was conducted from 1976 through 1980. The study's findings included the following:

  • A Federal policy that simultaneously taxes the alcohol in beer and spirits at the same rates offsets the erosion in the real beer tax since 1951; fixing the beer tax in real terms would reduce the number of youth who drink beer four to seven times weekly (approximately 11 percent of all youth) between 32 and 35 percent. Such a Federal policy would also reduce the number of youth who drink beer one to three times weekly (approximately 28 percent of all youth) by 24 to 28 percent.
  • Increases in alcohol prices and the minimum legal drinking age were not significantly associated with decreases in consumption of spirits for any other outcome category.
  • The inverse effects of alcohol prices and minimum legal drinking age were not limited to reductions among youth who consume beer less than once per week. The numbers of youth who consume beer infrequently (one to three times per week) or frequently (four to seven times per week) fall more in absolute or percentage terms than does the number of infrequent drinkers (less than once weekly) when price or the drinking age rises.
  • Overall, the study suggests that the frequency of the consumption of beer, the most popular alcoholic beverage among youth, is inversely related to the real price of beer and to the minimum legal age for its purchase and consumption.

In an econometric analysis, Levy and Sheflin (1983) examined the importance of cross-price effects and provided estimates of the elasticity of demand according to price. Using annual U.S. data from 1940 through 1980, they estimated a standard-demand equation with per capita alcohol consumption broken down by real per capita income and the real prices of different types of alcoholic beverages. Two variables were used to measure consumption: the volume of absolute alcohol consumed and expenditures on alcoholic beverages. The period of analysis precisely coincided with a period during which consumption rose steadily; it has been falling since 1981. The study's findings included the following:

  • From 1940 through 1980, per capita alcohol consumption increased by an average of 1.2 percent a year according to a volume measure and by 0.95 percent per year according to an expenditure measure.
  • In the same period, real per capita disposable income increased at an annual rate of 1.9 percent, while the relative price measure for alcohol beverages indicated a 1.4 percent decline for the volume measure.
  • Provided real per capita disposable income continues to increase, the income elasticity of 0.5 suggests that each 2-percent increase in per capita income will lead to a 1-percent increase in per capita alcohol consumption. Price policies can be a very effective means of reducing alcohol consumption. A price increase of 2.5 percent, for example, would reduce per capita alcohol consumption by 1 percent. A 2.5-percent increase in price would be necessary to offset a 2-percent increase in income; increases of the same magnitude in price and income would approximately offset each other.

program evaluation - the application scientific research methods to assess a program's concepts, implementation, and effectiveness.

Using an econometric analysis, Ornstein and Hanssens (1985) estimated the impact of a variety of control measures on the demand for distilled spirits and beer. The analysis considered variables such as economic and sociodemographic levels, retail availability, price controls, advertising restrictions, and whether a State had a monopoly on alcohol sales. The sample for distilled spirits was based on 255 observations made in the 50 States and the District of Columbia from 1974 through 1978. For beer, price data were missing for Hawaii and Alaska and were available for the other 48 States only for 1976 through 1978, yielding an initial sample of 147 observations. The authors used a pooled time-series cross-sectional sample. Among their econometric findings and predictions were the following:

  • Control laws are either unrelated to distilled spirits consumption, as in the cases of minimum legal drinking age and Sunday sales, or are related but with very low elasticities, as in the cases of resale price maintenance and print and billboard price advertising. This suggests that control laws that affect price have the greatest impact on consumption.
  • Control laws with the strongest relationship to beer are those regarding minimum legal drinking age and Sunday sales.
  • The main determinants of interstate differences in per capita consumption of distilled spirits are price, income, and interstate travel - not differences in alcohol-control laws.
  • Price and income are far less elastic for beer than for distilled spirits, implying that control laws that affect price will have a relatively lesser effect on the consumption of beer than on that of spirits.
  • Price intervention through tax increases, resale price maintenance, or bans on price advertising will have a much larger effect on the consumption of spirits than on that of beer.

Using a time-series design with a historical cohort, Wette et al. (1993) conducted an econometric analysis to determine the relationship between price and consumption of beer, wine, and spirits from 1983 through 1991. In particular, the study was designed to assess changes in alcohol consumption in New Zealand as a function of increases in the price of alcoholic beverages. Among the findings were the following:

  • For beer, wine, and alcoholic beverages (but not spirits) and for total alcohol, an increase in price led to a decrease in alcohol consumption.
  • Income was not a significant determinant of consumption, suggesting that recent decreases in disposable income in New Zealand have not reduced alcohol consumption.
  • The price of one alcoholic beverage (e.g., wine) had little impact on the consumption of another alcoholic beverage (e.g., spirits), with one exception: an increase in the price of beer appeared to lead to a decrease in the consumption of both beer and wine.

Happy-hour discount drink promotions were banned in Ontario, Canada, in December 1982. Taking advantage of this natural experiment, Smart and Adlaf (1986) conducted measures before and after the ban and analyzed its impact on drinking behavior, impaired-driving charges, and overall alcohol sales in Toronto. An observational component of the study examined alcohol consumption by patrons in five drinking establishments before and after the ban. A baseline evaluation was conducted 2 days before the banning of happy hours; a post-ban evaluation was conducted 4 weeks later. The baseline and post-ban evaluations focused on variables such as the number of patrons at the bar on arrival, the number of tables with one patron, the number of tables with two or more patrons, and the number of patrons arriving during the observation period. Observers selected two tables at which each patron's consumption would be observed. Data were collected on the type and number of alcoholic beverages each patron consumed at the observed tables. Aggregate data on alcohol sales were collected for the study period (October 1984 through February 1985) and for a comparison period (October 1983 through February 1984). Data on the daily number of impaired- driving charges were collected for the study period (November 1984 through January 1985) and for a comparison period (November 1983 through January 1984). The analysis produced the following findings:

  • A decline in impaired-driving charges could not be causally attributed to the independent effect of the ban on happy hours.
  • An analysis of the aggregate data on alcohol sales indicated no significant trends over a similar period.
  • No significant differences in alcohol consumption before and after the ban were noted at either the individual or the aggregate level.

Babor et al. (1978) examined the effect on drinking behavior of a controlled setting for the happy hour discount drink policy. In this quasi-experimental study, conducted in the research ward of a hospital, 34 male subjects were given free access to alcohol during a 20-day period. Half of the subjects could purchase alcohol for a single price, while a matched group was offered a 3-hour period in the afternoon during which the price was reduced by 50 percent (the happy hour condition). Subjects were identified as having a history of either casual or heavy drinking. A secondary purpose of the study was to determine whether alcohol consumption during a period of reduced cost would have a kindling or "priming" effect on subsequent drinking and whether casual and heavy users would be affected differently by this variable. Evaluations conducted during and after drinking occasions focused on the time of day, type of beverage, and consecutive number of drinks. BAC's were estimated through multiple daily Breathalyzer tests. The study's findings included the following:

  • Casual drinkers in the happy hour condition consumed twice as much alcohol as their counterparts in the nonhappy hour condition.
  • Casual drinkers in the nonhappy hour condition had very few incidents of intoxication. In contrast, casual drinkers in the happy hour condition showed a greater frequency of intoxication during the afternoon.
  • Heavy drinkers in the happy hour condition drank twice as much alcohol as their counterparts in the nonhappy hour condition.
  • Heavy drinkers in both conditions experienced greater incidences of intoxication during the later hours of the day, and heavy users in the happy hour condition experienced intoxication more often than did heavy users in the nonhappy hour condition.
  • Reinstatement of the standard alcohol purchase price effectively suppressed happy hourrelated increases in consumption.

Research Evidence Reviewed for Approach 3

Employing a quasi-experimental pre- and posttest design, Gliksman et al. (1993) evaluated the knowledge, attitudes, and behaviors of alcohol providers at four types of bars (roadhouses, hotel lounges, neighborhood taverns, and skid-row bars) immediately before and after participation in the Addiction Research Foundation's Server Intervention Program. Pre- and posttests included scored behavioral observations of servers' responses to actors who posed as patrons and engaged in six typical inappropriate behaviors. The study found the following about server knowledge, attitudes, and behavior:

  • After training, servers' knowledge increased regarding alcohol and its effects, their own legal obligations, and appropriate and inappropriate practices for alcohol service.
  • After training, servers exhibited more appropriate responses to the problem behaviors of customers. However, their responses were less seriously inappropriate rather than as appropriate as the responses presented during the training.
  • Before training, servers were known to encourage, promote, and orchestrate heavy drinking via activities centered on the rapid consumption of alcoholic beverages, such as pouring drinks down patrons' throats. After training, servers did not participate in such activities.
  • Servers scored high on measures of positive attitudes toward the training, perception of management support in implementing server intervention, and sufficient knowledge about alcohol, its effects, and the signs that indicate a need for server intervention.

McKnight (1991) evaluated the effect of server intervention education and the effect of various situational variables on RBS program effectiveness. A 6-hour server education program was administered to 876 servers and 203 managers at 100 licensed drinking establishments in eight States. Each establishment was visited three to four times by staff observers who exhibited visible signs of intoxication. These observers also visited 138 comparison establishments in the same communities. In this quasi-experimental study with matched comparison groups, baseline and postprogram evaluations focused on content knowledge, attitudes regarding responsible beverage service, and frequency of adherence to responsible service practices. Among the findings were the following:

  • After server training and policy changes, server intervention was observed in only 20 percent of the 1,590 visits, and only 7 percent of the visits resulted in service termination.
  • In contrast to the comparison sites, the experimental sites reported positive treatment trends.
  • Overall improvements were noted in knowledge of, attitude toward, and policies involving responsible alcohol service at the experimental sites, but not at the comparison sites.
  • When server intervention was examined State by State, positive changes were reported in only five of the eight States. The differences were related to prior intervention levels, type of establishment, and business volume.

A study by McKnight and Streff (1994) examined the effects of enforcing the law prohibiting alcohol service to intoxicated patrons on service to patrons, DWI rates, and enforcement costs and benefits. The study used a quasi-experimental design with a nonequivalent comparison group and pre- and postintervention measurements. Among its findings were the following:

  • In the county receiving the intervention, refusal of service to observers posing as patrons ("pseudopatrons") and simulating intoxication rose from 17.5 percent to 54.3 percent, eventually declining to 41 percent. In a comparison county, service refusal rose from 11.5 percent to 32.7 percent.
  • In the county receiving the intervention, the number of DWI arrests involving patrons exiting bars and restaurants declined from 31.7 percent to 23.3 percent. No changes in DWI arrests among patrons exiting bars and restaurants occurred in the comparison county.
  • Service refusals were related to volume of business and the number of intoxicated patrons in an establishment at the time of observation. DWI arrest numbers were related to the nature of the establishment's clientele, policies, and practices.
  • The estimated benefits from an alcohol service enforcement program capable of a one-fourth reduction in DWIs from bars and restaurants range from $90 (direct monetary savings) to $260 (total savings) for each dollar invested in enforcement.

Saltz (1987) compared customers' consumption of alcoholic beverages in a U.S. Navy enlisted club that had a server intervention program with that in a similar Navy enlisted club that did not have such a program. The server intervention program included an 18-hour training course for management and staff and a revision of established alcohol service policies. The revised policies promoted the consumption of nonalcoholic beverages and food, the overt delaying of alcohol service to nearly intoxicated patrons, and the discontinuation of selling beer in pitchers. In this study, which used a quasi-experimental design with a nonequivalent control group, baseline and posttest interviews were conducted with 603 randomly selected customers 2 months before and after implementation of the program. Measures focused on customer characteristics and rates of alcohol consumption, specifically whether the patrons were intoxicated according to a system that examined the number of drinks consumed, the duration of time spent consuming them, and the patron's weight. The study's findings included the following:

  • At the intervention site, the rate of intoxication for males was 32 percent at baseline and 15 percent posttest.
  • For females, the rate of intoxication dropped from 5 to 2 percent at the intervention site.
  • While the likelihood of customer intoxication was reduced at the intervention site, the absolute consumption and the rate of consumption of alcoholic beverages were unaffected by the server intervention program.

Holder and Wagenaar (1994) evaluated a natural experiment that started in 1986 when the State of Oregon introduced legislation mandating a training program for all alcohol servers as well as for all owners and managers of establishments that serve alcohol. Using an interrupted, quasi-experimental, time-series design, the authors analyzed the effect of the training program on the number of single-vehicle nighttime collisions in Oregon that resulted in injuries or fatalities and in which alcohol was involved. The study found that the mandatory training program significantly reduced the incidence of single-vehicle nighttime collisions in the State. This effect increased over the first 3 years of the program as the proportion of trained servers increased.

outcome evaluation - an analysis that focuses research questions on assessing the effects of interventions on intended outcomes.

Mosher et al. (1989) conducted a study with two components: outcome-based and community-based. The first component was a quasi-experimental, outcome-based study designed to examine the efficacy of an intensive, community-based RBS training program aimed at reducing intoxication rates among patrons of participating establishments. In the second component, formative and process evaluations were devised to establish community and industry support for a responsible beverage service training program. The findings of the outcome-based study included the following:

  • A risk-assessment survey of servers identified problematic practices in both of the sites studied (Santa Cruz County and Monterey County, California).
  • A significant increase in knowledge was noted after the training among trainees in one of the study sites (Santa Cruz County) but not in the other (Monterey County).
  • Patrons leaving the experimental sites were equally likely to be intoxicated as those leaving the control sites.
  • Patrons who were "censored" by servers for their drinking experienced significant reductions in the risk of becoming intoxicated in Santa Cruz County but not in Monterey County. Reduced probability of intoxication was associated with higher patron weights and female gender. Increased probability of intoxication was associated with spending more time in the drinking establishment.

The findings of the community-based study included the following:

  • Preliminary pre- and posttests of managers and servers initially showed no gains in RBS knowledge. After the measurement instrument was revised to correct ambiguities and unclear wording, however, significant gains were noted.
  • Project activities had greater success in Santa Cruz County, where there was strong preexisting interest in alcohol issues, than in Monterey County, where interest in such issues was low and the hospitality industry was poorly organized.
  • Task force activities, media coverage, and project responses generated community and industry support for establishing a responsible beverage service program in Santa Cruz County, whereas similar efforts in Monterey County failed.

Russ and Geller (1987) evaluated the impact of an alcohol server intervention program called Training for Intervention Procedures by Servers of Alcohol. Using a quasi-experimental design, the authors evaluated pre- and posttest measurements of an intervention group and a comparison group. The study examined the type and frequency of server interventions, the number of drinks consumed by pseudopatrons, and the BAC's of exiting pseudopatrons who drank three alcoholic beverages per hour for 2 consecutive hours. Among the study's findings were the following:

  • Pseudopatrons who had been served by trained personnel had substantially lower BAC's than did those served by untrained personnel, with average levels of 0.059 and 0.103 percent, respectively. None of the pseudopatrons served by trained personnel exceeded the legal limit for intoxication (a BAC of 0.10 percent); by contrast, nearly 45 percent of the pseudopatrons served by untrained personnel had BAC's at or above the legal limit for intoxication.
  • Servers who had undergone training intervened more frequently and in a different way than did untrained servers. Upon serving a customer's first drink, trained servers were more likely than untrained ones to ask for identification and to offer food or water. After a customer's fourth drink, trained servers were more likely than untrained servers to offer food or water, to delay service, or to make a driving-related comment; untrained servers initiated no intervention at this point.
  • The interventions trained servers made most frequently upon serving a customer's first and second drinks were checking identification and offering food or water. Interventions made at the fourth, fifth, and sixth drinks consisted of offering food or water, delaying service, and making driving-related comments.

Before 1983, the State of Texas had no statutory provisions allowing or prohibiting liability for negligent service of alcoholic beverages. There were thus no case-law precedents clearly establishing that retail establishments licensed to sell alcohol were liable for damages resulting from irresponsible serving practices. In 1983 and 1984, however, two cases involving service to intoxicated individuals drastically changed the liability situation in Texas. These two cases (El Chico Corp. v. Poole and Joleemo v. Evans) progressed through the State courts, resulting in a landmark 1987 Texas Supreme Court decision allowing common-law actions against licensed alcohol outlets to proceed. Wagenaar and Holder (1991a) examined the effects of this sudden change in exposure to legal liability for alcohol servers on the major ultimate outcome of interest: the frequency of nighttime, single-vehicle, injury-producing traffic crashes. Using a multiple time-series, quasi-experimental design, data on injuries occurring between 1978 and 1988 were analyzed. The analysis controlled for broader crash trends reflected in data from other States as well as for the effects of other major policy changes in Texas, such as those raising the legal drinking age, strengthening drunk driving laws, and requiring the use of safety belts. The study's findings included the following:

  • Final estimates of the parameters in the time-series model revealed significant reductions in the frequency of nighttime, single-vehicle, injury-producing traffic crashes after the January 1983 and November 1984 filings of major court cases involving server liability.
  • The rate of traffic crashes decreased by 6.5 percent immediately after the 1983 case was filed.
  • The rate of traffic crashes decreased by 5.3 percent after the 1984 case was filed.

Research Evidence Reviewed for Approach 4

Holder and Wagenaar (1990) conducted interrupted time-series analyses of apparent consumption of spirits in Iowa over a 20-year period (1968 to 1989) to evaluate the effect on consumption of the privatization of Iowa's State retail monopoly on distilled spirits sales for off-premise consumption. Their study's findings included the following:

  • During the month in which distilled spirits sales were privatized, sales of spirits rose by 9.5 percent, a statistically significant increase.
  • Even though there was a corresponding decline of 12.1 percent in wine sales and no change in beer sales, privatization of distilled spirits retail sales yielded a net increase in total alcohol consumption in Iowa. The observed decline in wine sales followed a 70.3 percent increase after Iowa's privatization of wine sales in 1985.
  • No changes were found in spirits sales in States bordering Iowa during the period when spirits sales were privatized.
  • Significant stocking effects were found for the month before spirits sales privatization (21.8 percent) and for the first month in which private sales were allowed (15.2 percent).
  • The privatization of distilled spirits sales was associated with an apparent net annual increase in consumption of 24,000 liters of pure ethanol in Iowa.

Using an interrupted, time-series design, Wagenaar and Holder (1991b) examined natural experiments brought about when Iowa and West Virginia eliminated their State monopolies and privatized retail wine sales. The study was designed to assess whether the privatization of retail wine sales in Iowa and West Virginia increased the apparent consumption of wine, affected sales of beer and distilled spirits, or affected alcohol consumption in other States. Among the findings were the following:

  • Compared with 5-year baseline averages, net annual increases in ethanol use per month after the privatization of retail wine sales in Iowa and West Virginia were 28,602 and 25,234 liters, respectively.
  • Sales of beer decreased by 3.1 percent in Iowa and increased by 12.0 percent in West Virginia during the first 18 months after privatization.
  • Sales of distilled spirits significantly decreased, by 5.4 percent in Iowa and 13.8 percent in West Virginia, during the first 18 months after privatization.
  • Sales of wine increased by 93 and 48.2 percent in Iowa and West Virginia, respectively, during the 18 months after privatization.
  • No identifiable decrease in wine sales was reported in other States concomitant with the significant increases in Iowa and West Virginia.

Fitzgerald and Mulford (1992, 1993) conducted three cross-sectional, self-reporting surveys of individuals aged 18 years and older at three points during a 4-year period (1985, 1986, and 1989). In July 1985, the State of Iowa abandoned its monopoly on wholesale and retail sales of bottled wine, and in March 1987 gave up its monopoly on retail but not wholesale sales of bottled spirits. The study was designed to determine whether a sudden and dramatic increase in the availability of wine and distilled spirits in Iowa resulted in an increase in alcohol consumption and alcohol-related problems among individuals aged 18 years and older. Among the findings were the following:

  • No dramatic changes occurred in the rank order of drinking frequencies in different places (bars, restaurants, homes, others' homes, sports events, and outdoor recreation sites) from one year to another.
  • No statistically significant changes occurred in any of the problem indicators of heavy or problem drinking.
  • No statistically significant changes occurred in problems due to drinking associated with privatization of either wine or spirits sales.
  • No statistically significant changes occurred in the frequency of drinking alone or with different companions (spouse, other relative, coworkers, or close friends).
  • The number of off-sale outlets for bottled wine and spirits substantially increased after privatization.

Mulford and Fitzgerald (1988) conducted a study designed to evaluate the effect of increasing the number of off-sale wine outlets in Iowa on rates of consumption and purchase of alcohol and on heavy drinking and problem drinking. The study included a baseline self-reporting survey of adults aged 18 years and older from February through April 1985 (4 months before the wine outlet increases) and a follow-up survey in April 1986, about 9 months after the privatization of wine sales. The study also examined monthly State alcohol sales statistics for table wines, beer, and distilled spirits from 1983 through August 1987, and for wine and distilled spirits coolers from July 1985 through August 1987. The study's findings included the following:

  • Expanded alcohol availability through retail outlets did not result in overall lasting sales increases, greater alcohol consumption, or increased numbers of heavy and problem drinkers.
  • Monthly wine sales surged immediately after the increase in outlets, and the prevalence of self-reported wine purchasers was higher when measured 9 months later. Per capita consumption and purchases were virtually unchanged, however, and monthly wine sales had dropped back to preprivatization levels.
  • Self-reported consumption and sales of beer and distilled spirits were unaffected by the increase in wine outlets.
  • Self-reported total alcohol consumption was unchanged, as were rates of heavy drinking and problem drinking.

Mulford, Ledolter, and Fitzgerald (1992) used a multiple time-series design to analyze changes in monthly sales of wholesale wine and spirits (an approximation of apparent consumption) in relation to the privatization of State-run retail sales of wine and spirits and wholesale wine sales. In addition, the researchers conducted a supplementary quasi-experimental analysis in which Iowa sales were compared with national sales. This study was designed in part to resolve, through a time-series analysis, the contradictory findings of previous research suggesting that privatization did not increase alcohol consumption (Mulford and Fitzgerald 1988) or that it permanently increased wine consumption by 93 percent (Wagenaar and Holder 1991b). The study's findings included the following:

  • Distilled spirits sales increased in February and March 1987 due to stocking effects. Sales increased by 26 percent in September 1985 due to a retailer-announced Federal tax increase in October. The following month, sales decreased by about the same amount. Spirits sales decreased at a slightly faster rate in Iowa than they did nationally from 1980 to 1989.
  • Overall, privatization temporarily increased sales of wine in 1985 and of spirits in 1987, but had no lasting impact.
  • The effect of privatization on wine sales was temporary. Sales diminished over the next 2 years and gradually returned to preprivatization levels.

In an ecological study, MacKinnon, Scribner, and Taft (1995) analyzed data on alcohol availability and related problems in unincorporated areas and 84 cities in Los Angeles County. The sources of data were as follows: ABC reports from 1970 to 1991; California State Department of Justice police crime reports from 1970 to 1990; census data for 1970, 1980, and 1990; Los Angeles County Health Department data on causes of death from 1973 through 1987; data on alcohol-related vehicle collisions from 1970 to 1990; and legislative measures of community involvement in alcohol availability issues in 1990. The study was designed to assess the impact of alcohol availability (i.e., alcohol outlet density) on alcohol-related civil outcomes (e.g., arrests for drunken driving and public drunkenness) and alcohol-related health outcomes (e.g., deaths from liver cirrhosis as well as alcohol-related traffic-crash injuries and fatalities). Among the study's findings were the following:

  • Off-sale alcohol availability was substantially related to rates of arrests for public drunkenness and disturbing the peace.
  • On-sale alcohol availability was substantially related to rates of death from liver cirrhosis and to arrests for drunken driving, public drunkenness, and disturbing the peace. A 1-percent increase in on-sale alcohol availability was associated with a 0.35- to 0.51-percent increase in deaths from liver cirrhosis and a 0.51- to 0.66-percent increase in arrests for drunk driving.
  • Retail alcohol outlet density was found to be substantially and positively related to several alcohol related problems.
  • The density of on-sale outlets was more strongly related to alcohol problems than was the density of off-sale outlets.

In an ecological study, Gruenewald et al. (1995) analyzed data on alcohol availability and alcohol-related traffic crashes across 102 areas of four communities in California. This study replicated the alcohol-related crash component of the study by MacKinnon, Scribner, and Taft (1995), but used improved statistical analyses. The sources of data were ABC records on premise types and locations; California State Highway Patrol data on locations of single-vehicle nighttime crashes; census data on population densities; self-reported data on population demographics, consumption patterns, and drinking and driving patterns among the subject populations (aggregated into the 102 target areas); and extensive measures of the traffic flow and road network characteristics of the selected areas. The study was designed to assess geographical relationships between the physical availability of alcohol (e.g., at bars and restaurants) and alcohol-related traffic crashes within and across geographic areas of the communities. The study provided a statistical means of correcting for biases that arose in the use of these ecological data. The study's findings included the following:

  • Across the studied communities, a 1-percent increase in restaurant densities was associated with a 0.06-percent increase in alcohol-related crashes. Within specific community areas, a 1-percent increase in restaurant densities was associated with a range of changes in crash rates from -0.59 percent to 0.35 percent.
  • Retail outlet density (measured along the roadway network) was substantially and positively related to rates of alcohol-related traffic crashes.
  • The density of restaurants was most strongly related to alcohol-related traffic crashes. This was attributed to the use of alcohol in these relatively unique drinking-and-driving environments.
  • The effect of outlet density on traffic crashes was shown to radiate across community areas away from the areas of greatest density toward areas of lesser density.
  • The effects of outlet density on traffic crashes was shown to depend on the location of the change in density within the community areas.

Research by Gruenewald and Ponicki (1993, 1995) involved a series of analyses of cross-sectional time-series data from 38 States over 12 years (1975 to 1986). The purpose of the studies was to evaluate the impact of changes in alcohol sales and the physical availability of alcohol on fatalities from single-vehicle nighttime collisions. Among the findings were the following:

  • Collision rates were strongly determined by per capita alcohol use, particularly by the use of beer and spirits.
  • Fatality rates from single-vehicle nighttime collisions were not directly related to the physical availability of alcohol, independent of a number of related economic and demographic variables.
  • The effect of beer sales on collision rates exceeded those of either spirits or wine sales. This effect was sustained when the estimates were adjusted for market share, where the impact of beer proved 2.75 times that of spirits and 3.33 times that of wine.

Taking advantage of a natural experiment, Fillmore and Wittman (1982) conducted a study to observe the responses of two university communities to a change in a State law removing off-sale restrictions on the sale of wine and beer near campuses. To assess whether an increase in the availability of alcohol would affect student drinking practices, questionnaires were administered to students enrolled at the University of California at Berkeley and the University of California at Davis shortly after the law took effect in 1979 and again 2 years later. During this time, the number of retail outlets located near the campuses substantially increased. The study's findings included the following:

  • Between 1979 and 1981, the percentage of respondents who had not consumed alcohol in the preceding week increased from 24 to 31 percent among students residing outside of Berkeley and from 26 to 37 percent among those in geographical areas with no more than three alcohol outlets. Among students living in areas with higher outlet densities, the percentage who had not consumed alcohol in the preceding week decreased by 3 to 1 percent, regardless of whether the number of outlets in the study area had increased between 1979 and 1981.
  • Three months after the repeal of off-sale restrictions, the city of Berkeley experienced a 15 percent increase in the number of gallons of alcoholic beverages sold at retail outlets. This increase was concentrated within a 1-mile area surrounding the campus. Almost 4,000 gallons of the increase and three of the five new off-sale outlets were located within a half-mile of the campus.
  • Three months after the repeal, the city of Davis experienced a 140 percent increase in the number of gallons of alcoholic beverages sold at retail outlets and an increase in the number of off-sale outlets from 15 to 21.
  • The mean number of alcohol purchases decreased marginally at both sites between the two measurement points.
  • The percentage of respondents in Davis who had consumed 14 or more beers in the preceding week increased from 14 percent in 1979 to 23 percent in 1981.
  • There were no major changes in the frequency or the volume of student drinking from the baseline to the followup 2 years later.

To assess the effects of legislation permitting alcohol sales at a sports arena, West et al. (1993) conducted a quasi-experimental pre- and posttest observational study to examine drinking, intoxication, and verbally and physically abusive behavior at the Maple Leaf Gardens in Ontario, Canada, during Toronto Maple Leaf hockey games. Ten observers attended 15 games to make pretest (1992) and posttest (1993) observations; a questionnaire was also mailed to a sample of season ticket holders. In addition, a survey of arena security staff was conducted to determine their experiences with and attitudes toward alcohol consumption before and after the legislation was enacted. The study's findings included the following:

  • Men comprised 75 percent of the patrons and committed 95 percent of the reported alcohol-related incidents. Individuals between the ages of 20 and 30 years were responsible for most of the inappropriate behaviors.
  • The most common form of disruptive behavior observed during the 1992 and 1993 games was intoxication followed by verbal abuse.
  • The pattern of disruptive incidents changed. In 1992, when alcohol sales were illegal and many patrons did their drinking before entering the arena, there were more incidents of intoxication before the hockey games. The proportion of intoxicated patrons during the third periods of the games increased from 9 percent of all intoxicated patrons in 1992 to 28 percent in 1993.
  • There was no increase in the number of incidents of inappropriate behavior after the introduction of alcohol sales.

Practice Evidence Reviewed for Approach 4

In 1993, the Alberta Liquor Control Board in Alberta, Canada, decided to privatize retail and wholesale sales and the distribution of alcohol. In an examination of this natural experiment, Laxer et al. (1994) studied the impact of the privatization on consumers, alcohol-related social problems, and government finances. A comparison was made of the previously existing public monopoly system of alcohol control and regulation, the current stage of private independent retailing, and the likely future system of alcohol distribution through private groceries and other chains. The Alberta study's findings included the following:

  • Criminal offenses against liquor stores, including robbery and breaking and entering, increased after privatization.
  • Hours of operation were extended at many alcohol outlets after privatization.
  • In July 1994, retail alcohol prices were 5.9 percent higher than before privatization.

In 1982, an Ontario provincial law permitted the sale of beer at sporting events. To evaluate the effect of the new law, Fisher and Single (1983) conducted a pre- and postlegislation study in which alcohol-related behavior was observed at Toronto's Exhibition Stadium during Blue Jays baseball games. At 7 games before and 11 games after the legislation was enacted, observations were recorded regarding drinking and drug consumption, alcohol- and drug-related incidents, and crowd composition. The study's findings included the following:

  • After enactment of the legislation, the crowd comprised more adolescent and young adult males and fewer women.
  • After enactment of the legislation, there were more incidents of rowdiness, pushing and shoving, harassment, fights, vomiting, and disruptive fans being asked to leave.
  • During the 11 games played after the legislation was enacted, the mean rate of consumption ranged from 0.1 to 2.8 beers per person and averaged 0.9 beers per person. Twelve percent of all the observed drinkers at the games consumed five or more beers.
  • The games at which there was the greatest amount of intoxication and rowdiness were the doubleheaders.

The Province of Ontario offers municipalities the option to sell alcohol. Increasingly, Ontario municipalities are taking this option at municipally owned or managed facilities such as arenas, stadiums, community centers, performance halls, senior centers, parks, beaches, and sports fields, at all of which alcohol may be served during specially licensed social and recreational events. Because such events are usually staffed by inexperienced volunteers who occasionally serve participants to the point of intoxication, the potential exists for alcohol-related fights, injuries, vandalism, and impaired driving - any of which can lead to license suspensions, criminal charges, police involvement, and civil litigation.

A policy model for responding to such problems was therefore developed and disseminated to Ontario's municipalities. The model included recommendations such as making lists of the facilities at which alcohol can and cannot be served; imposing restrictions on serving patrons to the point of intoxication; providing transportation for intoxicated patrons; prohibiting alcohol service to underage patrons; making food and low-alcohol drinks available; and developing a list of required management practices. These recommended practices included providing adequate door and floor supervision, limiting the number of drinks per patron, serving drinks in paper cups, and requiring server training. In a cross-sectional study, Gliksman et al. (1995) surveyed recreation directors, facility managers, and other appropriate individuals from all of Ontario's municipalities to evaluate the development of local alcohol policies and their impact on alcohol-related problems and rentals of public facilities. The study's findings included the following:

  • Among the 477 municipalities with eligible facilities, 59 percent did not have a policy in place and 8 percent had an informal policy that was either implicit or mentioned in city bylaws.
  • Among the remaining municipalities, 22 percent had a formal written policy in place and 12 percent had a formal policy in development. The average time the policies had been in place was 25 months, while the average time to complete a policy was 10 months.
  • Among the 162 municipalities with a formal policy in place or in development, 40 percent were in townships, 35 were in towns, 7 percent were in villages, and 19 percent were in cities. These percentages are consistent with the proportions of the types of communities.
  • Among the 162 municipalities with formal policies in place or in development, only 7 percent did not receive assistance from outside sources and developed their policies independently. The rest received assistance from sources such as the Addiction Research Foundation Community Program Offices (73 percent); provincial or municipal police representatives (50 percent); Public Health Unit staff (41 percent); Liquor License Board of Ontario inspectors (22 percent); and other nonprofit and private sources.
  • Among the 107 municipalities that had adopted formal policies, 49 percent reported that facility rentals had remained the same or had increased, 22 percent reported a decrease, and 7 percent were unsure.
  • Of these 107 formal policies, 47 percent had been in place for a year or less. Twenty-six percent had been in place for 13 months to 2 years, 16 percent for 25 months to 5 years, and 11 percent for more than 5 years.
  • Of the 107 municipalities that had adopted formal policies, 44 perceived a reduction in alcohol-related problems and 7 did not. Of the remainder, 34 said it was too soon to know or that they had not yet implemented their policies, 14 were uncertain, and 8 said they had never experienced problems.
  • The major problem areas in which the 44 respondents indicated a noticeable reduction were fighting, vandalism, and underage drinking. Significant decreases were also seen in the numbers of police interventions and public complaints.

control group - in experimental evaluation design, a group of participants that is essentially similar to the intervention group but is not exposed to the intervention. Participants are designated to be part of either a control or an intervention group through random assignment.

During the mid-1970s, the city of Thunder Bay, Ontario, experienced problems related to the inappropriate and excessive use of alcohol at city-owned parks and other recreational facilities. Some citizens demanded the removal of alcohol from such facilities, whereas others wanted more alcohol-related functions for social enjoyment and for fundraising activities. The city developed a social control policy for the use of alcohol on city-owned property and in facilities operated by its Parks and Recreation Department. The process of implementing this policy included a promotional component designed to increase awareness of and subsequent voluntary compliance with the policy. Gliksman et al. (1990) used before- and after-policy questionnaires to examine the implementation of the policy and to evaluate the impact of the promotional campaign on Thunder Bay residents. The responses from random samples of Thunder Bay residents were compared with those of comparison samples drawn from a nonintervention community. The study's findings included the following:

  • After the policy was implemented, the attitudes of subjects in the intervention group became less liberal regarding legal control over the sale and use of alcohol, while those of the control group did not change over time.
  • After the policy, subjects in both the intervention and control groups became more positive than they had been before about renting facilities where alcohol would not be available.
  • After the policy, subjects in both the intervention and control groups reported greater intentions than they had before to attend functions at facilities where alcohol would not be served.
  • Attitudes among the intervention group regarding underage drinking became less positive over time, whereas those of the control group changed very little.
  • Subjects in the intervention group became less positive regarding the use of alcohol at recreational facilities.
  • Subjects in the intervention group became more knowledgeable about the laws concerning alcohol use in general and the Thunder Bay policy in particular.
  • Subjects in the intervention group demonstrated an increase in their intentions to comply with alcohol-control laws, whereas those in the comparison group demonstrated little change in such intentions over time.

In a nonexperimental study, Bjor, Knutsson, and Kuhlhorn (1990) examined interventions related to the celebration of Midsummer's Eve in Borgholm, a small Swedish town on the island of Oland in the Baltic Sea. Midsummer's Eve is a popular event in Sweden that has traditionally been associated with alcohol consumption and open sexuality. The partying often begins the day before Midsummer's Eve and lasts for 3 days. During these celebrations, large crowds gather and threaten public order with disorderly and drunken behavior. At Borgholm in 1987, a baseline was established through participant observation. That celebration of Midsummer's Eve began with drinking parties at camping sites outside of town and progressed to public intoxication within the town. Ultimately, thousands converged upon the town, creating a crush of people and a tensely charged atmosphere. Fearing a riot, police marched into the crowd and arrested individuals for intoxication and disorderly conduct. An intervention was introduced for the next year's celebration.

First, an alcohol-rationing rule was established under which each visitor was limited to one bottle of distilled spirits and 24 cans of beer. Second, participants were prohibited from congregating at the campgrounds or in the parking lots near the center of the city. Finally, the celebration was declared a public event, under which conditions individuals are forbidden to possess alcohol or knives, and alcohol consumption was forbidden in public places. These new rules were publicized via the Swedish media. After the 1988 Midsummer's Eve celebration, interviews were conducted with 34 key people, including both those who had an interest in promoting the celebrations (generally local businessmen) and those who did not. Among the findings regarding the 1988 intervention were the following:

  • Fewer people went to Borgholm for Midsummer's Eve than in the previous year.
  • The troubles experienced the previous year did not materialize.
  • Celebrants who attempted to enter campgrounds were sent away. Many appeared to leave the event entirely, some going to a different location at which public intoxication and disorderly conduct were observed.
  • The number of people arrested for intoxication dropped from 131 in 1987 to 120 in 1988.
  • The number of people arrested for disorderly conduct dropped from 42 in 1987 to 15 in 1988.
  • In interviews with 34 key individuals, nearly all reported that the negative consequences associated with drunkenness, accidents, public disorder, and vandalism at the celebration were "better" in 1988 than in 1987.

Research Evidence Reviewed for Approach 5

In New South Wales, Australia, a December 1979 state regulation allowed the sale of alcohol at taverns on Sundays from noon to 10:00 p.m. Using a quasi-experimental, multiple time-series design with a comparison area, Smith (1987) evaluated the effect on vehicle collisions of Sunday sales of alcohol at taverns. Because Sunday sales were already permitted at sports and returned-servicemen's clubs, which have large memberships in Australia, the objective of the study was to determine the effect of further increases in Sunday sales of alcohol. A comparison of Sunday vehicle collisions in New South Wales in the 3 years before and the 2 years after the regulation went into effect indicated the following outcomes:

  • A 22-percent increase in fatal collisions between noon and 11:50 p.m.
  • A 28-percent increase in collisions between 6:00 p.m. and 11:50 p.m. resulting in injury but not in hospital admission.
  • A 21-percent increase in collisions between 6:00 p.m. and 11:59 p.m. resulting in injury but not in hospital admission.
  • A 12-percent increase in tow-away collisions between 6:00 p.m. and 11:59 p.m.
  • A 16-percent increase in collisions resulting in death or injury between 6:00 p.m. and 7:59 p.m.
  • A 38-percent increase in collisions resulting in death or injury between 8:00 p.m. and 9:59 p.m. and a 22-percent increase in such collisions between 10:00 p.m. and 11:59 p.m.

Using a quasi-experimental, multiple time-series design, Smith (1988a) examined the effects on vehicle collisions of a legislative change that introduced flexible tavern operating hours in the Australian state of Tasmania. Prior to the legislation, tavern operating hours in Tasmania were 10:00 a.m. to 10:00 p.m. Mondays through Saturdays and noon to 8:00 p.m. on Sundays. After the introduction of flexible outlet operating hours, taverns could remain open for as few or as many hours as they chose, with certain exceptions: they could not open from 5:00 a.m. to noon on Sundays or from 8:00 p.m. to midnight on Sundays or Good Friday. Thus, the study was designed to evaluate whether later closing times (and hence later drinking hours) might decrease the number of vehicle collisions from 10:00 p.m. to midnight and increase the number of collisions from midnight to 6:00 a.m. The study found the following to be the case after the introduction of flexible tavern hours:

  • No significant changes occurred in the number of vehicle collisions resulting in casualties between 6:00 p.m. and 10:00 p.m.
  • The rate of vehicle collisions between 10:00 p.m. and 6:00 a.m. increased by nearly 11 percent.
  • The rate of vehicle collisions resulting in casualties increased from 49 to 56 percent.

In the Australian state of Victoria, a February 1966 regulation changed the times at which taverns closed on Mondays through Saturdays from 6:00 p.m. to 10:00 p.m., allowing bar patrons to consume alcohol in taverns later than before. To evaluate the effect of this regulation on vehicle collisions resulting in casualties, Smith (1988b) analyzed data on all such collisions that occurred in Victoria before and after the regulation went into effect. In addition, in December 1966 it became compulsory for the police to use a Breathalyzer test to determine the BAC's of drivers suspected of drinking. Thus, this quasi-experimental, multiple time-series study was also designed to evaluate whether compulsory tests for suspected drinking drivers had an effect on the number of collisions. Among the study's findings for the year after the introduction of the 10:00 p.m. tavern-closing regulation were the following:

  • A considerable and immediate increase occurred in the number of collisions resulting in casualties between 10:01 p.m. and 2:00 a.m.
  • Annual collisions resulting in casualties between 6:01 p.m. and 2:00 a.m. were 11.5 percent higher during the 8-hour experimental period than during the 16-hour control period.
  • During the second year, the increase in collisions resulting in casualties was apparently offset by the compulsory use of the Breathalyzer. The number of casualty-causing collisions between 10:01 p.m. and 2:00 a.m. decreased by 9.2 percent.

In the Australian city of Brisbane, an April 1970 regulation allowed the sale of alcohol on Sundays from 11:00 a.m. to 1:00 p.m. and from 4:00 p.m. to 6:00 p.m. Using a quasi-experimental, multiple time-series design, Smith (1988c) evaluated the effect of Sunday alcohol sales on vehicle collisions, including reported casualties and property damage. The study's findings included the following:

  • In the 2 hours after the period from 4:00 p.m. to 6:00 p.m., the number of collisions resulting in property damage increased by 85 percent and the number resulting in casualties by 129 percent.
  • On Sundays between noon and 1:50 p.m. (after the period from 11:00 a.m. to 1:00 p.m.), the number of collisions resulting in property damage increased by 52 percent.
  • Overall, the introduction of Sunday alcohol sales had a close temporal relationship with the increase of collisions resulting in casualties or property damage in the Brisbane area, but not in the rest of the state of Queensland.

Nordlund (1985) examined the effects of closing wine and spirits shops in Norway on Saturdays. In an experimental study, wine and spirits shops were forced to close in six Norwegian towns receiving the intervention, whereas shops were allowed to remain open in six matched control towns. Measures included police records on arrests for drunkenness, reports of drunkenness, and reports of violent incidents; admissions to alcohol detoxification programs; and alcohol sales. The study's findings for towns receiving the intervention included the following:

  • Sales of pure alcohol decreased by 3 percent and those of beer by 6 percent compared with the year before the intervention.
  • The number of arrests for drunkenness decreased on Saturday nights and in the early hours of Sunday mornings.
  • The number of reports to the police regarding drunkenness decreased markedly on Saturdays and early Sundays.
  • The number of reports to the police regarding violence increased considerably on Fridays and the early hours of Saturday mornings.
  • The number of admissions to alcohol detoxification facilities in Oslo decreased considerably more for weekends than for weekdays.

In Sweden, all sales of export beers, wines, and spirits take place in special State-owned retail liquor stores. In May 1981, the Swedish Riksdag decided to close these stores on Saturdays between June and September of that year. In a quasi-experimental study, Olsson and Wikstrom (1982) examined whether these Saturday closings would have an impact on total alcohol consumption, drunkenness, public order, and certain types of crime. Data were collected primarily from official statistics, generally covering the study period (June through September 1981) and the same period during the prior year. Among the findings on outcomes compared with those in the same period during the prior year were the following:

  • The mean number of domestic disturbances during the study period was substantially lower on Saturdays (25 percent lower) and Sundays (26 percent).
  • The mean number of indoor assaults decreased by 18 percent on Saturdays and by 12 percent on Sundays, but increased by 4.3 percent on Tuesdays, Wednesdays, and Thursdays.
  • The mean number of outdoor assaults diminished substantially on Saturdays (by 25 percent) and Sundays (by 11 percent).
  • The mean number of police interventions against intoxicated individuals during the study period decreased by 39 percent on Saturdays and Sundays.
  • The mean number of police interventions against public disturbances during the study period decreased substantially on Saturdays (by 17 percent) and Sundays (by 21 percent).
  • The number of disturbances on the Stockholm Underground diminished substantially on Saturdays (by 19 percent) and Sundays (by 11 percent).
  • It was estimated that the number of detentions of intoxicated persons decreased by about 5,000, the number of domestic disturbances by 900, the number of assaults by 600, and the number of "other disturbances" by 700.

Research Evidence Reviewed for Approach 6

As cited in the research evidence reviewed on approach 1, Hingson et al. (1996) evaluated the effectiveness of the Saving Lives Program, a community effort to organize multiple city departments and private citizens to reduce alcohol-impaired driving, alcohol-related driving risks, and traffic deaths and injuries. In each of the six program communities a full-time coordinator from the mayor's or city manager's office organized a task force of concerned private citizens, organizations, and officials representing various city departments. The communities developed initiatives such as media campaigns, speeding and drunk driving awareness days, "speedwatch" telephone hotlines, police training, SADD chapters, alcohol-free proms, beer keg registration, increased surveillance of liquor outlets, preschool education programs, and training for staff at hospitals and prenatal clinics. The intervention cities were compared with the rest of Massachusetts and with five cities that prepared high-quality proposals that were not funded. This quasi-experimental study evaluated the impact of the intervention on traffic crashes and injuries, safety belt use, vehicle travel speeds, and driving after drinking.

Monitoring of crashes was based on data from the Department of Transportation's Fatal Accident Reporting System. These data were collected 5 years before and 5 years after the start of the program. Additional data came from the Massachusetts Registry of Motor Vehicles and were collected 4 years before and 5 years after the start of the program. Five annual direct observation surveys of speeding and safety belt use were conducted 1 year before and 4 years after the start of the program; these surveys involved using radar from unmarked cars for detecting speeding vehicles at randomly selected roadways at intervention and comparison cities, as well as direct observation at signalized road intersections and freeway off-ramps using a stratified random sampling procedure. To assess program awareness, beliefs about police enforcement, and the frequency of driving after drinking, four independent cross-sectional, random-digit-dial telephone surveys of 15,188 young people aged 16 to 19 years and adults aged 20 years and above were conducted in intervention cities and the rest of the State between 1988 and 1993.

Compared with the rest of the State and with the 5 years before the intervention, the following findings were noted in the Massachusetts intervention cities during the 5 years of the program:

  • Fatal crashes declined by 25 percent and alcohol-related fatal crashes by 42 percent.
  • The proportion of vehicles observed speeding was reduced by 43 percent and the use of seat belts increased 17 percent.
  • The proportion of teenagers who drove after drinking declined by 40 percent.

The Midwestern Prevention Project was a 6-year longitudinal study of community-based efforts to prevent alcohol, cigarette, and marijuana use among adolescents. The project included mass media programming, a school-based educational program for youth, parent education and organizing, community organizing, and health policy programming components, all of which were introduced sequentially into communities over the 6-year period. Pentz et al. (1989) evaluated the effects of the project components administered to the initial 1984 cohort of sixth- and seventh-grade adolescents in Kansas City communities from September 1984 through January 1986. The overall research design for the Midwestern Prevention Project included a quasi-experimental study in Kansas City and a randomized experimental study in Indianapolis.

The project components administered from September 1984 through January 1986 consisted of a 10-session youth education program on skills for resisting drug abuse, 10 homework sessions involving active interviews and role-playing with parents and family members, and mass-media coverage. The Midwestern Prevention Project's effectiveness was evaluated through annual assessments of adolescent drug use in schools assigned either an immediate-intervention or a delayed-intervention control condition. Measurements focused on demographic characteristics, drug use, and psychosocial variables related to drug use. Immediately before administration of the questionnaire, a breath test was used to measure carbon monoxide concentrations in subjects' expired air to increase the accuracy of subsequent self-reports. The study's findings included the following:

  • Analyses of 42 schools indicated that the prevalence rates of alcohol (and marijuana and cigarette) use were lower at the 1-year followup in the immediate-intervention condition schools than in the delayed-intervention condition schools.
  • These lower prevalence rates were demonstrated with and without controlling for race, grade, socioeconomic status, and urbanism (11 percent versus 16 percent for alcohol use).
  • The net increase in the prevalence of drug use at immediate-intervention schools was half that in delayed-intervention schools.

Giesbrecht, Pranovi, and Wood (1990) evaluated the effectiveness of a community-based project to reduce alcohol consumption among heavy drinkers. They analyzed whether a change in the proportion of heavy drinkers has a measurable impact on the overall distribution of alcohol consumption. They also examined the interaction between heavy and moderate drinkers and assessed the impact of a drinking-management intervention on heavier drinkers that offered them an educational and counseling program. Behavioral change was also pursued through more general educational measures, influence on local alcohol policies, server intervention programs, and training workshops. In addition, project staff joined several community health and social service committees.

The community-based, multisite study was conducted with an intervention community and two control communities, the last being the "pure" control community. Community 1 (the intervention community) and community 2 (the regular control community) were surveyed twice; the second survey was done 24 months after the baseline. During the interval between surveys, an 18-month, multifaceted alcohol reduction project was implemented in community 1. Surveys conducted in the midwinters of 1984 and 1986 assessed individual alcohol consumption through various indicators of typical and heavy drinking and attitudes toward alcohol use, prevention, and treatment. The surveys evaluated the volumes and frequency of alcohol use; the context and nature of drinking occasions; the pressures to drink or to stop doing so; the health and social consequences related to alcohol use; attitudes and norms about drinking and alcohol-related behavior; views on alcohol addiction and treatment; and demographics. Among the study's findings were the following:

  • Members of the subject group reduced their consumption of alcohol during the course of their participation in the study. The percentage of the client group consuming more than 14 drinks per week declined between the week before the program began and the last week for which data were available for each client. The median dropped from 20 to 9 drinks per week, and the mean from 15 to 7 drinks per week during this interval.
  • Overall, the percentage of subjects who consumed more than 14 drinks per week declined from 54 percent before the program began to 43 percent after the first counseling session and to 21 percent in the last week for which data were available.
  • The number of opportunities to promote the intervention through public service announcements, speaking engagements, training sessions, committee work, and consultations on alcohol issues in the community increased over time.
  • A local server intervention committee was established to set guidelines for serving alcoholic beverages in licensed premises and at special occasions.

Practice Evidence Reviewed for Approach 6

The aim of the New Zealand Community Action Project (Casswell and Gilmore 1989; Stewart and Casswell 1993) was to examine the relative effect on alcohol-related community activities and public attitudes of a mass-media campaign, with or without the participation of alcohol-focused community organizers. The project's main objective was to increase the level of public support for alcohol-control policies such as restrictions on availability and advertising. An intermediate objective was to increase the amount of alcohol-related material in the local print media and on local radio programs.

The project involved print media advertising campaigns and community organizing strategies. The latter involved community activists who worked closely with local media and alcohol councils, which included representatives from community institutions such as social welfare, police, traffic enforcement, and alcohol treatment agencies. The demonstration project, which took place between October 1982 and February 1985, used a quasi-experimental design in which six provincial cities were roughly matched to form two groups of three cities. Each group included a comparison city in which no planned alcohol-prevention activities took place, a target city that was exposed to a mass-media campaign largely directed toward reducing high-volume drinking by young males through television and radio commercials, and an intensive-intervention city exposed to the same mass-media campaign along with a community organizing effort. The study's findings included the following:

  • In the four cities in which mass media only or intensive intervention were employed, local newspaper coverage of alcohol-related issues such as moderation and social policies increased.
  • More cautious attitudes regarding the harmfulness of alcohol increased in the intervention but not in the reference cities.
  • Support increased for alcohol policies regarding age limits and limits on alcohol sales in supermarkets in the intervention but not in the reference cities. Support declined for alcohol policies regarding advertising, price, and general restrictions on alcohol sales in the reference but not in the intervention cities.
  • Surveys of both key-participant and man-on-the-street interviews suggested that the program had a positive effect in the media-only and intensive-intervention cities compared with the reference cities.

In response to an increase in the numbers of transients and chronic street drinkers along with associated crimes and other alcohol-related problems in Portland, Oregon, merchants, citizens, and city bureaus entered into a partnership agreement to address those and other problems affecting the community. The resulting Central Precinct Neighborhood Alliance included numerous neighborhood associations that combined their efforts with those of the Portland Police Bureau to establish a community-policing action plan. The alliance and its efforts were designed to reduce alcohol abuse among problem street drinkers and thereby reduce alcohol-related criminal activity. Their efforts included the following:

  • Merchants, community organizations, and the police entered into a Community Policing Partnership Agreement.
  • Merchants, police officers, and community organizations worked together to identify the alcoholic beverages associated with street drinking.
  • Portland police vigorously enforced city ordinances and State statutes related to liquor law violations.
  • The partnership agreement included an understanding that sales of domestic beers and malt beverages in containers larger than 16 ounces would be phased out and then discontinued.

The Minors in Night Clubs public education campaign was organized by the Cape May, New Jersey, County Council on Alcoholism and Drug Abuse in response to an action by the Wildwood City Council, acting as the city's ABC authority. Under the action, which was approved for a trial period only, underage youth aged 18 to 20 years would be permitted access to drinking establishments during normal operating hours but would not be permitted to drink alcohol there. The City Council was expected to pass a law making the ordinance permanent after the trial period ended. The campaign's efforts included the following:

  • Alcohol-free activities were established for underage youth, as were an adventure course and peer leadership groups.
  • The local Hotel/Motel Association collaborated with the Prosecutor's Working Group on Substance Abuse to resolve problems associated with underage youth drinking alcohol on hotel or motel premises.
  • The local Municipal Alliance sponsored a campaign against underage drinking ("We 4 for 21").
  • With broad support from local organizations and agencies, the Cape May County Council on Alcoholism and Drug Abuse mounted a vigorous media campaign against the law. In response to public outcry, the City Council decided to terminate the trial period and not to make the ordinance permanent.

The Community Coalition for Substance Abuse Prevention and Treatment involved grassroots community activism organized to influence the alcohol licensing and regulation process in Los Angeles. The goal was to reduce the density of alcohol outlets and to diminish the violence associated with high outlet densities. This activism intensified after the 1992 race riots, during which 400 alcohol outlets were damaged or destroyed, prompting the city to inaugurate a fast-track process to reduce the bureaucratic red tape associated with rebuilding businesses. The coalition's aims included giving a voice to citizen opposition to the licensing of new alcohol outlets; ensuring that those outlets would not be rebuilt without community input; urging the Los Angeles City Council to exempt alcohol outlets from ordinances designed to facilitate rapid rebuilding after the riots; and developing a plan to support alcohol outlet owners who agreed to convert their property to alternative land uses. The coalition's efforts produced the following results:

  • After 15 days of pressure, the city enacted an ordinance with amendments that excluded alcohol outlets from the fast-track rebuilding process.
  • Citizens were mobilized to force the city to withdraw proposed amendments that would have exempted grocery stores and other businesses occupying 1,400 or more square feet from the outlet-overconcentration ordinance review process.
  • Community pressure prompted the city to establish a Mayor's Task Force on Problem Liquor Stores, through which citizens had the opportunity to air their concerns to the mayor, the planning commissioner, and the zoning administrator.
  • Only 56 rebuilding permits were granted as of 1994 for the 400 alcohol outlets that were burned or damaged during the 1992 riots.

The Escondido Community Alcohol Planning Project (ECAPP) was a prevention program designed by the Community Prevention Planning Demonstration Project of the Institute for the Study of Social Change at the University of California at Berkeley. ECAPP consisted of a city-based planning committee that received technical assistance regarding the documentation of alcohol availability in retail, public, and social environments; the identification of strategies to address problems in these environments; the selection of intervention policies and programs; and the implementation of interventions.

The project found the following regarding implementation, integration, and institutionalization of alcohol prevention policies:

  • The City Council of Escondido approved the city's participation in ECAPP and assigned a council member to the planning group.
  • A representative of the Community Services Department was invited to join the local group responsible for reviewing alcohol license applications.
  • The council endorsed ECAPP's mission, adopted prevention policies, directed staff to develop implementation strategies, and incorporated elements of ECAPP's initiatives into its annual program.
  • By the second year, alcohol prevention was incorporated into the city's organizational policies and procedures. Examples included limiting alcohol outlets through passage of an interim ordinance, prohibiting banners that included alcohol or tobacco sponsorship or advertising, and limiting conditional-use permits for outlets near schools and residential areas.
  • A request to serve beer at the annual Escondido street fair was denied.

ECAPP also reported the following proofs of community support:

  • The city developed and implemented prevention-oriented special-permit guidelines governing the use of alcohol at city parks and recreation areas, and extended the ban on alcohol use to city lakes and recreation areas.
  • The city developed a draft alcohol outlet permit ordinance.
  • The city developed a database of problem and prevention indicators for prevention planning, monitoring, and evaluation.
  • The city developed and approved a policy for the California Center for the Arts in Escondido regarding substance abuse.
  • The city incorporated alcohol policies into its criteria for designating apartment complexes as "Drug-Free Zones."
  • A resolution supporting beer-keg registration was passed and forwarded to the State legislature.

The Association for Responsible Alcohol Control (ARAC) was established by a group of Latino and other activists in San Jose, California. The activists had heard a report by a representative of the Prevention Division of the Santa Clara County Bureau of Alcohol Services describing the relatively high density and rapid growth of alcohol outlets in Latino neighborhoods as well as the disproportionately high arrest rates for alcohol-related offenses among Latinos. ARAC members focused on changing alcohol policies at the city level, beginning with a concerted effort to pass a law that would require new businesses seeking permission for off-site alcohol sales to apply for a CUP, a process that requires a public hearing and gives residents a voice in decisions regarding alcohol availability in their neighborhoods. ARAC's activities produced results including the following:

  • The alcohol industry mounted little opposition to the proposed CUP law.
  • The San Jose City Council voted unanimously in favor of the CUP law.
  • ARAC created media interest by issuing news releases concerning the relationship between alcohol accessibility and alcohol-related problems.
  • ARAC convinced local merchants to discontinue selling inexpensive fortified wines.
  • The county health department created a Responsible Hospitality Council to examine alcohol use in public and private settings and to develop guidelines for alcohol use on county property.

References for Research Evidence Reviewed

  1. Babor, T. F., Mendelson, J. H., Greenberg, I., Kuehnle, J Experimental analysis of the "happy hour": Effects of purchase price on alcohol consumption. Psychopharmacology . 58:35–41. [PubMed: 97717]
  2. Coate, D., & Grossman, M Effects of alcoholic beverage prices and legal drinking ages on youth alcohol use: Results from the Second National Health and Nutrition Examination Survey , Cambridge, , MA: . National Bureau of Economic Research.
  3. Cook, P. J., & Moore, M. J Violence reduction through restrictions on alcohol availability. Alcohol Health & Research World . 17:151–156.
  4. Fillmore, K. M., & Wittman, F. D The effects of availability of alcohol on college student drinking: A trend study. Contemporary Drug Problems . 11:455–492.
  5. Fitzgerald, J. L., & Mulford, H. A Consequences of increasing alcohol availability: The Iowa experience revisited. British Journal of Addiction . 87:267–74. [PubMed: 1555003]
  6. Fitzgerald, J. L., & Mulford, H. A Alcohol availability, drinking contexts, and drinking problems: The Iowa experience. Journal of Studies on Alcohol . 54:320–325. [PubMed: 8487541]
  7. Giesbrecht, N., Pranovi, P., & Wood, P Impediments to changing local drinking practices: Lessons from a prevention project In N. Giesbrecht, P. Conley, R. W. Denniston, L. Gliksman, H. Holder, A. Pederson, R. Room, & M. Shain (Eds.), Research, action, and the community: Experiences in the prevention of alcohol and other drug problems (OSAP Prevention Monograph No. 4, pp. 161--181), Rockville, , MD: . Center for Substance Abuse Prevention.
  8. Gliksman, L., McKenzie, D., Single, E., Douglas, R., Brunet, S., & Moffatt, K The role of alcohol providers in prevention: An evaluation of a server intervention programme. Addiction . 88:1195–1203. [PubMed: 8241919]
  9. Grossman, M., Coate, D., & Arluck, G. M Price sensitivity of alcoholic beverages in the United States. Advances in Substance Abuse. pp. 169–198.
  10. Gruenewald, P. J., Millar, A. B., Treno, A. J., Yang, Z., Ponicki, W. R., & Roeper, P The geography of alcohol availability and driving after drinking: A cross-sectional spatial analysis , Berkeley, , CA: . Prevention Research Center.
  11. Gruenewald, P. J., & Ponicki, W. R The relationship of the retail availability of alcohol and alcohol sales to alcohol-related traffic crashes. Accident Analysis and Prevention . 27:249–259. [PubMed: 7786392]
  12. Gruenewald, P. J., Ponicki, W. R., & Holder, H. R The relationship of outlet densities to alcohol consumption: A time-series cross-sectional analysis. Alcoholism: Clinical and Experimental Research . 17:38–47. [PubMed: 8452207]
  13. Hingson, R., Heeren, T., & Winter, M Lower legal blood alcohol limits for young drivers. Public Health Reports . 109:738–744. [PMC free article: PMC1403574] [PubMed: 7800781]
  14. Hingson, R., McGovern, T., Howland, J., Heeren, T., Winter, M., & Zakocs, R Reducing alcohol-impaired driving in Massachusetts: The Saving Lives Program. American Journal of Public Health . 86:791–797. [PMC free article: PMC1380396] [PubMed: 8659651]
  15. Holder, H. D., & Wagenaar, A. C Effects of the elimination of a state monopoly on distilled spirits' retail sales: A time-series analysis of Iowa. British Journal of Addiction . 85:–. [PubMed: 2289062]
  16. Holder, H. D., & Wagenaar, A. C Mandated server training and reduced alcohol-involved traffic crashes: A time-series analysis of the Oregon experience. Accident Analysis and Prevention . 26:89–97. [PubMed: 8110360]
  17. Kohn, P. M., Smart, R. G., & Adlaf, E. M Happy hours in metropolitan Toronto: Their prevalence, timing, and content. Canadian Journal of Public Health . 76:62–63. [PubMed: 3978529]
  18. Levy, D., & Sheflin, N New evidence on controlling alcohol use through price. Journal of Studies on Alcohol . 44:929–937. [PubMed: 6664090]
  19. MacKinnon, D. P., Scribner, R. A., & Taft, K. A Development and applications of a city-level alcohol availability and alcohol problems database. Statistics in Medicine . 14:591–604. [PubMed: 7792450]
  20. McKnight, A. J Factors influencing the effectiveness of server-intervention education. Journal of Studies on Alcohol . 52:389–397. [PubMed: 1943093]
  21. McKnight, A. J., & Streff, F. M The effect of enforcement upon service of alcohol to intoxicated patrons of bars and restaurants. Accident Analysis and Prevention . 26:79–88. [PubMed: 8110359]
  22. Mooney, L., & Gramling, R The differential effects of the minimum drinking age law. Sociological Inquiry . 63:330–338.
  23. Mosher, J. F., Delewski, C., Saltz, R., & Hennessy, M Monterey-Santa Cruz Responsible Beverage Service Project: Final report, San Rafael, , CA: . Marin Institute for the Prevention of Alcohol and Other Drug Problems.
  24. Mulford, H. A., and Fitzgerald, J. L Consequences of increasing off-premise wine outlets in Iowa. British Journal of Addiction . 83:1271–1279. [PubMed: 3233402]
  25. Mulford, H. A., Ledolter, J., and Fitzgerald, J. L Alcohol availability and consumption: Iowa sales data revisited. Journal of Studies on Alcohol . 53:487–494. [PubMed: 1405642]
  26. National Highway Traffic Safety Administration. Lower BAC Limits for Youth: Evaluation of the Maryland .02 Law. by Blomberg, R.D DOT Pub. no. HS 807-860, Washington, , DC: . U.S. Department of Transportation, National Highway Traffic Safety Administration, 1992.
  27. Nordlund, S Effects of Saturday closing of wine and spirits shops in Norway Oslo: National Institute for Alcohol Research.
  28. Olsson, O., and Wikstrom, P. H Effects of the experimental Saturday closing of liquor retail stores in Sweden. Contemporary Drug Problems . 11:325–353.
  29. O'Malley, P., & Wagenaar, A. C Effects of minimum drinking age laws on alcohol use, related behaviors, and traffic crash involvement among American youth: 1976--1987. Journal of Studies on Alcohol . 52:478–491. [PubMed: 1943105]
  30. Ornstein, S. I., & Hanssens, D. M Alcohol control laws and the consumption of distilled spirits and beer. Journal of Consumer Research . 12:200–213.
  31. Pentz, M. A., Dwyer, J. H., MacKinnon, D. P., Flay, B. R., Hansen, W. B., Wang, E. Y. I., & Johnson, A A multicommunity trial for primary prevention of adolescent drug abuse: Effects on drug use prevalence. Journal of the American Medical Association . 261:3259–3266. [PubMed: 2785610]
  32. Preusser, D. F., Ferguson, S. A., Williams, A. F., & Farmer, C. M Underage access to alcohol: Sources of alcohol and use of false identification , Arlington, , VA: . Insurance Institute for Highway Safety.
  33. Preusser, D. F., Williams, A. F., & Weinstein, H. B Policing underage alcohol sales. Journal of Safety Research . 25:127–133.
  34. Russ, N. W., & Geller, E. S Training bar personnel to prevent drunken driving: A field evaluation. American Journal of Public Health . 77:952–954. [PMC free article: PMC1647259] [PubMed: 3605473]
  35. Saffer, H., & Grossman, M Beer taxes, the legal drinking age, and youth motor vehicle fatalities. Journal of Legal Studies . 16:351–374.
  36. Saltz, R. F The roles of bars and restaurants in preventing alcohol-impaired driving. Evaluation & Health Professions . 10(1):5–27.
  37. Smart, R. G., & Adlaf, E. M Banning happy hours: The impact on drinking and impaired-driving charges in Ontario, Canada. Journal of Studies on Alcohol . 47:256–258. [PubMed: 3724165]
  38. Smith, D. I Effect on traffic accidents of introducing Sunday hotel sales in New South Wales, Australia. Contemporary Drug Problems . 14:279–293.
  39. Smith, D. I Effect on traffic accidents of introducing flexible hotel trading hours in Tasmania, Australia. British Journal of Addiction . 83:219–222. [PubMed: 3345399]
  40. Smith, D. I Effect on casualty traffic accidents of the introduction of 10 p.m. Monday to Saturday hotel closing in Victoria. Australian Drug and Alcohol Review . 7:163–166.
  41. Smith, D. I Effects on traffic accidents of introducing Sunday alcohol sales in Brisbane, Australia. International Journal of the Addictions . 23:1091–1099. [PubMed: 3235224]
  42. U.S. General Accounting Office. Drinking-age laws: An evaluation synthesis of their impact on highway safety (Pub. No. GAO/PEMD 87-10), Washington, DC: Author .
  43. Wagenaar, A. C Preventing highway crashes by raising the legal minimum age for drinking: The Michigan experience 6 years later. Journal of Safety Research . 17:101–109.
  44. Wagenaar, A. C., & Holder, H. D Effects of alcoholic beverage server liability on traffic crash injuries. Alcoholism Clinical and Experimental Research . 15:942–947. [PubMed: 1789390]
  45. Wagenaar, A. C., & Holder, H. D A change from public to private sale of wine: Results from natural experiments in Iowa and West Virginia. Journal of Studies on Alcohol . 52:162–173. [PubMed: 2016877]
  46. Wagenaar, A. C., & Maybee, R. G The legal minimum drinking age in Texas: Effects of an increase from 18 to 19. Journal of Safety Research . 17:165–178.
  47. West, P., Dick, R., Ferris, J., Giesbrecht, N., & Wong, S The Maple Leaf Gardens study, Toronto, , Ontario, . Canada: Addiction Research Foundation.
  48. Wette, H. C., Zhang, J., Berg, R. J., & Casswell, S The effects of prices on alcohol consumption in New Zealand 1983--1991. Drug and Alcohol Review . 12:151–158. [PubMed: 16818324]

References for Practice Evidence Reviewed

  1. Alberta Liquor Control Board, Alberta, Canada
  2. Association for Responsible Alcohol Control, San Jose, CA
  3. Bjor, J., Knutsson, J., & Kuhlhorn, E The celebration of Midsummer's Eve in Borgholm: An example of effective alcohol use prevention In T. K. Greenfield & R. Zimmerman (Eds.), Experiences with community action projects: New research in the prevention of alcohol and other drug problems (pp. 181–188)., Rockville, , MD: . Center for Substance Abuse Prevention.
  4. Central Precinct Neighborhood Alliance, Portland, OR
  5. Community Coalition for Substance Abuse Prevention and Treatment, Los Angeles, CA
  6. Cops in Shops, Las Cruces, NM
  7. Escondido Community Alcohol Planning Project of the Community Prevention Planning Demonstration Project, Escondido, CA
  8. Fisher, H., & Single, E Beer in the ballpark: Recommendations to the liquor license board of Ontario concerning the renewal of beer sales at sporting events , Toronto, , Ontario, . Canada: Addiction Research Foundation.
  9. Gliksman, L., Douglas, R. R., Rylett, M., & Narbonne-Fortin, C Reducing problems through municipal alcohol policies: The Canadian experiment in Ontario. Drugs: Education, Prevention, and Policy . 2(2):105–118.
  10. Gliksman, L., Douglas, R. R., Thomson, M., Moffatt, K., Smythe, C., & Caverson, R Promoting municipal alcohol policies: An evaluation of a campaign. Contemporary Drug Problems . 17:391–420.
  11. Laxer, G., Green, D., Harrison, T., & Neu, D Out of control: Paying the price for privatizing Alberta's Liquor Control Board , Alberta, . Canada: Canadian Centre for Policy Alternatives.
  12. Minors in Night Clubs project of the Cape May County Council on Alcoholism and Drug Abuse, Cape May, NJ
  13. New Zealand Community Action Project, Auckland, New Zealand
  14. Pennsylvania Liquor Control Board, Harrisburg, PA
  15. Under 21 Enforcement Project of the Town of Yorktown Police Department, Yorktown Heights, NY

Other References Cited

  1. Arnold, R. D Effect of raising the legal drinking age on driver involvement in fatal crashes: The experience of thirteen states , Washington, DC: National Center for Statistics and Analysis.
  2. Casswell, S., & Gilmore, L An evaluated community action project on alcohol. Journal of Studies on Alcohol . 50:339–346. [PubMed: 2755135]
  3. Coleman, V., & Kleinman, D Model responsible server training act: 1986, Berkeley, , CA: . Prevention Research Center.
  4. Coleman, V., Krell, B., & Mosher, J Preventing alcohol-related injuries: Dram-shop liability in a public health perspectiveWestern State Law Review, 12417–441.
  5. DuMouchel, W. A., Williams, A. F., & Zador, P Raising the alcohol purchase age: Its effect on fatal motor crashes in 26 states. Journal of Legal Studies . 16:249–266.
  6. Emery, J Young drinking drivers involved in fatal crashes: Statewide problem identification for FY 1984 highway safety plan , Des Moines, , IA: . Governor's Highway Safety Office.
  7. Ferris, F., Dunning, R., Giesbrecht, N., & West, P. (Eds.) International Symposium on Alcohol Monopolies and Social and Health Issues , Toronto, Canada: Addiction Research Foundation.
  8. Florida Department of Community Affairs, Bureau of Highway Safety. (1983). Relation of the legal drinking age to young drivers' involvement in traffic accidents, Tallahassee, , FL: . Author .
  9. Hingson, R. W., Scotch, N., Mangione, T., Meyers, A., Glantz, L., Heeren, T., Lin, N., Mucatel, M., & Pierece, G Impact of legislation raising the legal drinking age in Massachusetts from 18 to 20. American Journal of Public Health . 73:163–170. [PMC free article: PMC1650505] [PubMed: 6849474]
  10. Holder, H. D., Janes, K., Mosher, J., Saltz, R., Spurr, S., & Wagenaar, A. C Alcohol beverage server liability and the reduction of alcohol-involved problems. Journal of Studies on Alcohol . 54:23–36. [PubMed: 8355497]
  11. Hoskin, A. F., Yalung-Mathews, D., & Carraro, B. A The effect of raising the legal minimum drinking age on fatal crashes in 10 states. Journal of Safety Research . 17(3):117–121.
  12. Klein, R. M The effect of raising the minimum legal drinking age on traffic accidents in the state of Maine , Washington, DC: National Highway Traffic Safety Administration.
  13. Lang, A. R., Kass, L., & Barnes, P The beverage type stereotype: An unexplored determinant of the effects of alcohol consumption. Bulletin of the Society of Psychologists in Addictive Behaviors . 2(1):46–49.
  14. Lillis, R. P Special policy considerations in raising the minimum legal drinking age: Border crossing by young drivers Paper presented at the meeting of the National Alcoholism Forum, Detroit, , MI..
  15. Maxwell, D. M Impact analysis of the raised legal drinking age in Illinois , Washington, DC: National Highway Traffic Safety Administration.
  16. Mayhew, D. R., Warren, R. A., Simpson, H. M., & Haas, G. C Young driver accidents: Magnitude and characteristics of the problem , Ottawa, , Ontario, Canada: Traffic Injury Research Foundation.
  17. Model alcoholic beverage retail licensee liability act of 1985. (1985).Western State Law Review, 12442–517.
  18. Moskowitz, H., Burns, M. M., & Williams, A. F Skills performance at low blood alcohol concentrations , Washington, DC: Insurance Institute for Highway Safety.
  19. Mulford, H. A., & Fitzgerald, J. L Consequences of increasing off-premise wine outlets in Iowa. British Journal of Addiction . 83:1271–1279. [PubMed: 3233402]
  20. Mulford, H. A., Ledolter, J., & Fitzgerald, J. L Alcohol availability and consumption: Iowa sales data revisited. Journal of Studies on Alcohol . 53:487–494. [PubMed: 1405642]
  21. O'Neill, B., Williams, A. F., & Dukowski, K. M Variability in blood alcohol concentrations: Implications for estimating individual results. Journal of Studies on Alcohol . 44:222–230. [PubMed: 6645508]
  22. Perkins, W. H., & Berkowitz, A. D Attitudes and behavioral responses to changes in the legal drinking age in a college population Paper presented at the annual conference of the Alcohol and Drug Problem Association, Washington, DC.
  23. Saffer, H., & Grossman, M Effects of beer prices and legal drinking ages on youth motor vehicle fatalities , Cambridge, , MA: . National Bureau of Economic Research.
  24. Schroeder, J. K., & Meyer, E. D Influence of raising the legal drinking age in Illinois , Springfield: Illinois Department of Transportation, Division of Traffic Safety.
  25. Stewart, L., & Casswell, S Media advocacy for alcohol policy support: Results from the New Zealand Community Action Project. Health Promotion International . 8:167–175.
  26. Wagenaar, A. C Raising the legal drinking age in Michigan and Maine: Final report , Ann Arbor: University of Michigan, Highway Safety Research Institute.
  27. Wagenaar, A. C Effects of minimum drinking age on alcohol-related traffic crashes: The Michigan experience five years later In H. Holder (Ed.) Control issues in alcohol abuse prevention strategies for states and communities 117–129., Greenwich, , CT: . JAI Press.
  28. Wagenaar, A. C., & Holder, H. D Effects of alcoholic beverage server liability on traffic crash injuries. Alcoholism Clinical and Experimental Research . 15:942–947. [PubMed: 1789390]
  29. Wagenaar, A. C., & Holder, H. D A change from public to private sale of wine: Results from natural experiments in Iowa and West Virginia. Journal of Studies on Alcohol . 52:162–173. [PubMed: 2016877]
  30. Wagenaar, A. C., & Holder, H. D Changes in alcohol consumption resulting from the elimination of retail wine monopolies: Results from five U.S. States. Journal of Studies on Alcohol . 56:1–7. [PubMed: 7475038]
  31. Williams, A. F., Lund, A. K., & Preusser, D. F Drinking and driving among high school students. International Journal of the Addictions . 21:643–655. [PubMed: 3744616]
  32. Williams, A. F., Zador, P. L., Harris, S., & Karpf, R. S The effect of raising the legal drinking age on involvement in fatal crashes. Journal of Legal Studies . 12:169–179.
  33. Williams, T. P., & Lillis, R. P Changes in alcohol consumption by eighteen-year-olds following an increase in New York State's purchase age to nineteen Paper presented at the National Council on Alcoholism, National Alcoholism Forum, Washington, DC.

Views

  • PubReader
  • Print View
  • Cite this Page

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...