The Evolution of Research into Responsible Beverage Service as a Preventive Intervention
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Transcript of The Evolution of Research into Responsible Beverage Service as a Preventive Intervention
Prevention Research CenterPRCPacific Institute for Research and Evaluation
The Evolution of Research into The Evolution of Research into Responsible Beverage Service as Responsible Beverage Service as
a Preventive Interventiona Preventive Intervention
Bob SaltzBob SaltzPrevention Research CenterPrevention Research Center
Berkeley, CaliforniaBerkeley, California
Public Health ModelPublic Health ModelPublic Health ModelPublic Health Model
Individual
Alcohol Environment
Alcohol-Related Problems
Environmental InfluenceEnvironmental InfluenceEnvironmental InfluenceEnvironmental Influence
((3) Economic - Cost of alcohol, drugs, tobacco, or economic geography of availability
(1)Physical - Proximity of alcohol, drugs, tobacco outlets, places of publicuse
(2) Social - (2) Social - Family, peers and larger Family, peers and larger social networks, mediasocial networks, media
Evolving ConceptEvolving ConceptEvolving ConceptEvolving Concept
Server as referral agent – “Patron Care”Server as referral agent – “Patron Care”
Server Intervention - to reduce harm in Server Intervention - to reduce harm in case of intoxicationcase of intoxication
Responsible Beverage Service (RBS)Responsible Beverage Service (RBS)- to reduce likelihood of intoxication and - to reduce likelihood of intoxication and harmharm
Server as referral agent – “Patron Care”Server as referral agent – “Patron Care”
Server Intervention - to reduce harm in Server Intervention - to reduce harm in case of intoxicationcase of intoxication
Responsible Beverage Service (RBS)Responsible Beverage Service (RBS)- to reduce likelihood of intoxication and - to reduce likelihood of intoxication and harmharm
RationaleRationaleRationaleRationale
Historical & legal precedentsHistorical & legal precedents Potential impact may be highPotential impact may be high Very proximal to danger of harmVery proximal to danger of harm Minimizes reliance on drinker Minimizes reliance on drinker
judgment judgment Indirect evidence of potential efficacyIndirect evidence of potential efficacy
Historical & legal precedentsHistorical & legal precedents Potential impact may be highPotential impact may be high Very proximal to danger of harmVery proximal to danger of harm Minimizes reliance on drinker Minimizes reliance on drinker
judgment judgment Indirect evidence of potential efficacyIndirect evidence of potential efficacy
Effect of Allowing Liquor by the Drink onEffect of Allowing Liquor by the Drink onSingle Vehicle Nighttime Traffic Crashes Single Vehicle Nighttime Traffic Crashes Males 21 Years and Older in North CarolinaMales 21 Years and Older in North Carolina
Effect of Allowing Liquor by the Drink onEffect of Allowing Liquor by the Drink onSingle Vehicle Nighttime Traffic Crashes Single Vehicle Nighttime Traffic Crashes Males 21 Years and Older in North CarolinaMales 21 Years and Older in North Carolina
Month and YearMonth and Year
1/821/821/811/811/801/801/791/791/781/781/771/771/761/761/751/751/741/741/731/73
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170170
150150
130130
110110
9090
7070
5050
Liquor by the drink Liquor by the drink begins November 1978begins November 1978
16% increase16% increase0% control counties0% control counties
Early Efficacy StudiesEarly Efficacy Studies
Can RBS reduce intoxicationCan RBS reduce intoxicationor harm?or harm?
TIPS EvaluationTIPS EvaluationTIPS EvaluationTIPS Evaluation
Commercial training programCommercial training program Six-hour trainingSix-hour training 17 Servers from 2 businesses17 Servers from 2 businesses Pseudopatrons consume drink every Pseudopatrons consume drink every
20 minutes20 minutes Outcome = Number of Interventions Outcome = Number of Interventions
plus BAC of pseudopatronsplus BAC of pseudopatrons
Commercial training programCommercial training program Six-hour trainingSix-hour training 17 Servers from 2 businesses17 Servers from 2 businesses Pseudopatrons consume drink every Pseudopatrons consume drink every
20 minutes20 minutes Outcome = Number of Interventions Outcome = Number of Interventions
plus BAC of pseudopatronsplus BAC of pseudopatrons
FindingsFindingsFindingsFindings
Trained servers intervened more Trained servers intervened more frequently, 3.24 vs. .75 at baselinefrequently, 3.24 vs. .75 at baseline
BAC for pseudopatrons was lower BAC for pseudopatrons was lower for trained servers (.059 vs. .10)for trained servers (.059 vs. .10)
Trained servers intervened more Trained servers intervened more frequently, 3.24 vs. .75 at baselinefrequently, 3.24 vs. .75 at baseline
BAC for pseudopatrons was lower BAC for pseudopatrons was lower for trained servers (.059 vs. .10)for trained servers (.059 vs. .10)
Navy Server StudyNavy Server StudyNavy Server StudyNavy Server Study
Revision in House PoliciesRevision in House Policies Sixteen-hour manager & server Sixteen-hour manager & server
trainingtraining One intervention and one One intervention and one
comparison sitecomparison site Outcome = Imputed BAC from self-Outcome = Imputed BAC from self-
reported and observed consumption reported and observed consumption datadata
Revision in House PoliciesRevision in House Policies Sixteen-hour manager & server Sixteen-hour manager & server
trainingtraining One intervention and one One intervention and one
comparison sitecomparison site Outcome = Imputed BAC from self-Outcome = Imputed BAC from self-
reported and observed consumption reported and observed consumption datadata
FindingsFindingsFindingsFindings
Proportion of intoxicated drinkers at Proportion of intoxicated drinkers at experimental Navy bar cut in half (e.g., experimental Navy bar cut in half (e.g., males dropped from 33% to 15%)males dropped from 33% to 15%)
No change at comparison siteNo change at comparison site No change in overall sales (more No change in overall sales (more
drinks to 1 and 2 drink orders)drinks to 1 and 2 drink orders)
Proportion of intoxicated drinkers at Proportion of intoxicated drinkers at experimental Navy bar cut in half (e.g., experimental Navy bar cut in half (e.g., males dropped from 33% to 15%)males dropped from 33% to 15%)
No change at comparison siteNo change at comparison site No change in overall sales (more No change in overall sales (more
drinks to 1 and 2 drink orders)drinks to 1 and 2 drink orders)
Thunder Bay, OntarioThunder Bay, OntarioThunder Bay, OntarioThunder Bay, Ontario
Manager and Server TrainingManager and Server Training Four intervention & 4 comparison Four intervention & 4 comparison
sitessites Expanded pseudopatron protocol Expanded pseudopatron protocol
with scenarioswith scenarios Outcome = Responsible Service Outcome = Responsible Service
ScoreScore
Manager and Server TrainingManager and Server Training Four intervention & 4 comparison Four intervention & 4 comparison
sitessites Expanded pseudopatron protocol Expanded pseudopatron protocol
with scenarioswith scenarios Outcome = Responsible Service Outcome = Responsible Service
ScoreScore
FindingsFindingsFindingsFindings
Trained servers scored higher in the Trained servers scored higher in the post-test while comparision sites did post-test while comparision sites did not change significantlynot change significantly
Trained servers scored higher in the Trained servers scored higher in the post-test while comparision sites did post-test while comparision sites did not change significantlynot change significantly
From Efficacy to EffectivenessFrom Efficacy to Effectiveness
What might effect adoption of What might effect adoption of RBS practices?RBS practices?
McKnight NHTSA StudyMcKnight NHTSA StudyMcKnight NHTSA StudyMcKnight NHTSA Study
100 Establishments in 8 cities100 Establishments in 8 cities Three-hour trainingThree-hour training 135 Comparison sites135 Comparison sites Pseudopatron protocolPseudopatron protocol Outcome = Server interventionOutcome = Server intervention
100 Establishments in 8 cities100 Establishments in 8 cities Three-hour trainingThree-hour training 135 Comparison sites135 Comparison sites Pseudopatron protocolPseudopatron protocol Outcome = Server interventionOutcome = Server intervention
FindingsFindingsFindingsFindings
Trained servers more likely to Trained servers more likely to intervene in some way, 27% vs. 14% intervene in some way, 27% vs. 14% at baselineat baseline
Outright refusal unchanged at 5%Outright refusal unchanged at 5%
Trained servers more likely to Trained servers more likely to intervene in some way, 27% vs. 14% intervene in some way, 27% vs. 14% at baselineat baseline
Outright refusal unchanged at 5%Outright refusal unchanged at 5%
Central California RBSCentral California RBSCentral California RBSCentral California RBS
Two Communities (Santa Cruz & Two Communities (Santa Cruz & Monterey, CA)Monterey, CA)
Three commercial businesses in Three commercial businesses in each communityeach community
Compared 2 trainings with 1 Compared 2 trainings with 1 comparisoncomparison
Outcome = Observed consumptionOutcome = Observed consumption
Two Communities (Santa Cruz & Two Communities (Santa Cruz & Monterey, CA)Monterey, CA)
Three commercial businesses in Three commercial businesses in each communityeach community
Compared 2 trainings with 1 Compared 2 trainings with 1 comparisoncomparison
Outcome = Observed consumptionOutcome = Observed consumption
FindingsFindingsFindingsFindings
RBS programs reduced likelihood of RBS programs reduced likelihood of impairment and intoxication in one of impairment and intoxication in one of two communities two communities
No difference between RBS No difference between RBS programsprograms
RBS programs reduced likelihood of RBS programs reduced likelihood of impairment and intoxication in one of impairment and intoxication in one of two communities two communities
No difference between RBS No difference between RBS programsprograms
Probability of Impairment and IntoxicationProbability of Impairment and IntoxicationFollowing Alcohol Beverage Server TrainingFollowing Alcohol Beverage Server Training
Santa Cruz, CASanta Cruz, CA
Probability of Impairment and IntoxicationProbability of Impairment and IntoxicationFollowing Alcohol Beverage Server TrainingFollowing Alcohol Beverage Server Training
Santa Cruz, CASanta Cruz, CA
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20202020
30303030
40404040
50505050
PretestPretestPretestPretest PosttestPosttestPosttestPosttest
T = T = Server Training SiteServer Training Site, C = , C = Comparison SiteComparison Site
T = T = Server Training SiteServer Training Site, C = , C = Comparison SiteComparison Site
Pre
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Pro
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Pre
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ImpairmentImpairmentImpairmentImpairment
IntoxicationIntoxicationIntoxicationIntoxication
Oregon Server Training LawOregon Server Training LawOregon Server Training LawOregon Server Training Law
Training mandated for all servers of Training mandated for all servers of alcoholic beveragesalcoholic beverages
Outcome = Single-vehicle night-time Outcome = Single-vehicle night-time crashescrashes
ARIMA model to control for other ARIMA model to control for other influencesinfluences
Training mandated for all servers of Training mandated for all servers of alcoholic beveragesalcoholic beverages
Outcome = Single-vehicle night-time Outcome = Single-vehicle night-time crashescrashes
ARIMA model to control for other ARIMA model to control for other influencesinfluences
FindingsFindingsFindingsFindings
23% reduction in crashes net of other 23% reduction in crashes net of other influencesinfluences
23% reduction in crashes net of other 23% reduction in crashes net of other influencesinfluences
Texas Liability LawTexas Liability LawTexas Liability LawTexas Liability Law
Established through case lawEstablished through case law
Court ruling heavily publicizedCourt ruling heavily publicized
Time series analysis over 10 yr Time series analysis over 10 yr periodperiod
Outcome = SVN crashesOutcome = SVN crashes
Established through case lawEstablished through case law
Court ruling heavily publicizedCourt ruling heavily publicized
Time series analysis over 10 yr Time series analysis over 10 yr periodperiod
Outcome = SVN crashesOutcome = SVN crashes
FindingsFindingsFindingsFindings
First case produced a reduction in First case produced a reduction in SVN crashes of 6.5% net of other SVN crashes of 6.5% net of other influences influences
Second case reduced crashes an Second case reduced crashes an additional 5.3% net of other additional 5.3% net of other influencesinfluences
First case produced a reduction in First case produced a reduction in SVN crashes of 6.5% net of other SVN crashes of 6.5% net of other influences influences
Second case reduced crashes an Second case reduced crashes an additional 5.3% net of other additional 5.3% net of other influencesinfluences
Freo Respects YouFreo Respects YouFreo Respects YouFreo Respects You
50 Establishments in Freemantle, WA50 Establishments in Freemantle, WA Comparison communityComparison community Training supported by media Training supported by media
campaigncampaign Included risk assessmentIncluded risk assessment Outcomes included service to Outcomes included service to
pseudopatrons and BAC of patronspseudopatrons and BAC of patrons
50 Establishments in Freemantle, WA50 Establishments in Freemantle, WA Comparison communityComparison community Training supported by media Training supported by media
campaigncampaign Included risk assessmentIncluded risk assessment Outcomes included service to Outcomes included service to
pseudopatrons and BAC of patronspseudopatrons and BAC of patrons
FindingsFindingsFindingsFindings
Low participation and challenges to Low participation and challenges to program fidelityprogram fidelity
Outright refusal low (10%) with no Outright refusal low (10%) with no difference across communitiesdifference across communities
Lower patron BACs in intervention Lower patron BACs in intervention communitycommunity
Low participation and challenges to Low participation and challenges to program fidelityprogram fidelity
Outright refusal low (10%) with no Outright refusal low (10%) with no difference across communitiesdifference across communities
Lower patron BACs in intervention Lower patron BACs in intervention communitycommunity
Community TrialsCommunity TrialsCommunity TrialsCommunity Trials
RBS part of comprehensive community-RBS part of comprehensive community-level prevention intervention to reduce level prevention intervention to reduce injuries and deaths related to alcoholinjuries and deaths related to alcohol
Combined voluntary training and Combined voluntary training and limited but publicized enforcement limited but publicized enforcement campaigncampaign
Outcome = Refusal to drinking Outcome = Refusal to drinking pseudopatron (drink every 20 minutes)pseudopatron (drink every 20 minutes)
RBS part of comprehensive community-RBS part of comprehensive community-level prevention intervention to reduce level prevention intervention to reduce injuries and deaths related to alcoholinjuries and deaths related to alcohol
Combined voluntary training and Combined voluntary training and limited but publicized enforcement limited but publicized enforcement campaigncampaign
Outcome = Refusal to drinking Outcome = Refusal to drinking pseudopatron (drink every 20 minutes)pseudopatron (drink every 20 minutes)
Alcohol-involved Trauma at the Community Level: Alcohol-involved Trauma at the Community Level: Conceptual ModelConceptual Model
MOBILIZATIONMOBILIZATIONMOBILIZATIONMOBILIZATION DRINKING AND DRIVINGDRINKING AND DRIVINGDRINKING AND DRIVINGDRINKING AND DRIVING
UNDERAGE DRINKINGUNDERAGE DRINKINGUNDERAGE DRINKINGUNDERAGE DRINKING
ALCOHOL ACCESSALCOHOL ACCESSALCOHOL ACCESSALCOHOL ACCESS
RESPONSIBLE BEVERAGE RESPONSIBLE BEVERAGE SERVICESERVICE
RESPONSIBLE BEVERAGE RESPONSIBLE BEVERAGE SERVICESERVICE
Non-Traffic Risk ActivitiesNon-Traffic Risk Activities
Local News about AlcoholLocal News about AlcoholProblems & EnforcementProblems & Enforcement
Retail Alcohol Retail Alcohol AvailabilityAvailability
(On and Off-premise)(On and Off-premise)Alcohol IntoxicationAlcohol Intoxication or Impairmentor Impairment
Alcohol-involvedAlcohol-involvedInjury and DeathInjury and Death
(Traffic and Other)(Traffic and Other)
Driving afterDriving afterDrinkingDrinking
Perceived Perceived Risk of ArrestRisk of Arrest
Local LawLocal LawEnforcementEnforcement
Social Access Social Access to Alcoholto Alcohol
Alcohol Alcohol Serving and Serving and
Sales PracticesSales Practices
Local Regulation Local Regulation of Alcoholof Alcohol
(Density, Hours (Density, Hours of Sale)of Sale)
FindingsFindingsFindingsFindings
Refusal rates of servers to drinking Refusal rates of servers to drinking pseudopatrons were lowpseudopatrons were low
Observed differences not significantObserved differences not significant
Refusal rates of servers to drinking Refusal rates of servers to drinking pseudopatrons were lowpseudopatrons were low
Observed differences not significantObserved differences not significant
Enforcement of Serving LawsEnforcement of Serving LawsEnforcement of Serving LawsEnforcement of Serving Laws
Washtenaw County, MIWashtenaw County, MI Warning notices to employees observed Warning notices to employees observed
(by plainclothes officers) serving to (by plainclothes officers) serving to obviously intoxicated customersobviously intoxicated customers
Comparison siteComparison site Outcomes = refusal to serve Outcomes = refusal to serve
pseudopatron, and proportion of arrested pseudopatron, and proportion of arrested DUI cases that drove from a licensed DUI cases that drove from a licensed premisepremise
Washtenaw County, MIWashtenaw County, MI Warning notices to employees observed Warning notices to employees observed
(by plainclothes officers) serving to (by plainclothes officers) serving to obviously intoxicated customersobviously intoxicated customers
Comparison siteComparison site Outcomes = refusal to serve Outcomes = refusal to serve
pseudopatron, and proportion of arrested pseudopatron, and proportion of arrested DUI cases that drove from a licensed DUI cases that drove from a licensed premisepremise
FindingsFindingsFindingsFindings
Outright refusals increased from 16% Outright refusals increased from 16% to 53%to 53%
Proportion of DUI from businesses Proportion of DUI from businesses dropped from 32% to 23%dropped from 32% to 23%
Outright refusals increased from 16% Outright refusals increased from 16% to 53%to 53%
Proportion of DUI from businesses Proportion of DUI from businesses dropped from 32% to 23%dropped from 32% to 23%
Surfer’s ParadiseSurfer’s ParadiseSurfer’s ParadiseSurfer’s Paradise
Case study – pre/post comparisonCase study – pre/post comparison Australia’s Gold CoastAustralia’s Gold Coast Targeted alcohol-related violence and Targeted alcohol-related violence and
general disordergeneral disorder Community mobilizationCommunity mobilization
Risk assessmentsRisk assessmentsEnforcement of license lawsEnforcement of license lawsStaff trainingStaff trainingEliminated price promotionsEliminated price promotions
Outcome = observed assaults & Outcome = observed assaults & intoxicationintoxication
Case study – pre/post comparisonCase study – pre/post comparison Australia’s Gold CoastAustralia’s Gold Coast Targeted alcohol-related violence and Targeted alcohol-related violence and
general disordergeneral disorder Community mobilizationCommunity mobilization
Risk assessmentsRisk assessmentsEnforcement of license lawsEnforcement of license lawsStaff trainingStaff trainingEliminated price promotionsEliminated price promotions
Outcome = observed assaults & Outcome = observed assaults & intoxicationintoxication
FindingsFindingsFindingsFindings
Note: weak design…Note: weak design…
Assaults dropped from 9.8 per 100 Assaults dropped from 9.8 per 100 hrs. of observation to 4.7hrs. of observation to 4.7
Lower frequency of observed Lower frequency of observed intoxicationintoxication
Note: weak design…Note: weak design…
Assaults dropped from 9.8 per 100 Assaults dropped from 9.8 per 100 hrs. of observation to 4.7hrs. of observation to 4.7
Lower frequency of observed Lower frequency of observed intoxicationintoxication
Primary ConclusionsPrimary ConclusionsPrimary ConclusionsPrimary Conclusions
RBS RBS cancan significantly reduce alcohol significantly reduce alcohol impairment and intoxicationimpairment and intoxication
Training alone seems unpromising, Training alone seems unpromising, but Oregon results argue otherwisebut Oregon results argue otherwise
RBS RBS cancan significantly reduce alcohol significantly reduce alcohol impairment and intoxicationimpairment and intoxication
Training alone seems unpromising, Training alone seems unpromising, but Oregon results argue otherwisebut Oregon results argue otherwise
Responsible Service
Practices
Reduced Intoxication
Reduced Harm
Fairly ConfidentFairly ConfidentFairly ConfidentFairly Confident
What We What We Don’tDon’t Know… Know…What We What We Don’tDon’t Know… Know…
What What kindskinds of harm RBS can reduce of harm RBS can reduce
What combination of incentives will What combination of incentives will reliably change serving practicesreliably change serving practices
What combination of incentives will What combination of incentives will reduce harm most cost-effectively reduce harm most cost-effectively
What What kindskinds of harm RBS can reduce of harm RBS can reduce
What combination of incentives will What combination of incentives will reliably change serving practicesreliably change serving practices
What combination of incentives will What combination of incentives will reduce harm most cost-effectively reduce harm most cost-effectively
Responsible Service
Reduced Intoxication
Reduced Harms?
?
What We Don’t KnowWhat We Don’t KnowWhat We Don’t KnowWhat We Don’t Know
• Training (skills)
• Community Pressure
• Enforcement
• Insurance
• Liability Law
• Violence• DUI• Injuries
FINFIN