Effects of a Community-Level Intervention on Alcohol-Related Motor Vehicle Crashes in California Cities: A Randomized Trial

INTRODUCTION

This trial assesses the effects of a community-level alcohol prevention intervention in California on alcohol-related motor vehicle crashes.

STUDY DESIGN

The study is a group RCT with cities as the unit of assignment to condition and as the unit of analysis.

SETTING/PARTICIPANTS

A total of 24 California cities with populations between 50,000 and 450,000 were chosen at random and roughly matched into pairs before randomly assigning 12 each to the intervention and control conditions.

INTERVENTION

The intervention, aimed at reducing excessive drinking among adolescents and young adults, included driving under the influence sobriety checkpoints, saturation patrols, and undercover operations to reduce service of alcohol to intoxicated patrons in bars, all including high visibility so the public would be aware of them. A measure of overall intervention intensity or dosage was created.

MAIN OUTCOME MEASURES

The outcome was a monthly percentage of all motor vehicle crashes that were single vehicle nighttime crashes for drivers aged 15-30 years.

RESULTS

Multilevel analyses were conducted to examine intervention effects on alcohol-related crashes among drivers aged 15-30 years. Crash data were obtained in 2018 with data preparation and analysis conducted in 2019. Intent-to-treat analyses indicated a 17% reduction in the percentage of alcohol-involved crashes among drivers aged 15-30 years relative to controls, which translates to about 310 fewer crashes. Dosage was found to have a statistically significant effect on crashes among this age group, although not in the expected direction.

CONCLUSIONS

Enhanced alcohol enforcement operations involving both community health and law enforcement agencies can help to reduce alcohol-impaired driving and related consequences among young people. Including measures of intervention dosage raises interesting questions about the understanding of the impact of the community intervention. Future studies should continue to further develop implementation strategies that may more effectively and efficiently reduce community alcohol-related harm.

Results of a Randomized Trial of Web-Based Retail Onsite Responsible Beverage Service Training: WayToServe

OBJECTIVE

Research in Responsible Beverage Service (RBS) training indicates that such training can prevent over-service of alcohol and reduce drunk driving. However, reviews of the RBS literature suggest that the quality of training methods and the stability of implementation are important factors in determining RBS training effectiveness. Most RBS classes have been taught live, where the quality of instruction varies across instructors and classes, and the stability of the implementation of an RBS curriculum is variable. Web-based RBS training may carry important advantages by stabilizing instruction and implementation factors. Randomized trial results of a web-based onsite RBS training program (WayToServe® [WTS]) are reported here. It was hypothesized that servers trained by WTS would refuse alcohol service at significantly higher rates compared with Usual and Customary (UC) live training.

METHOD

On-site alcohol-serving establishments in New Mexico communities were randomized to receive WTS training (n = 154) or the Usual and Customary live RBS training (n = 155). Premises were assessed at baseline, immediate post-training, 6-months post-training, and 1-year post-training intervals. Pseudo-intoxicated patron protocols were used to assess premise alcohol service during the early to mid-evening hours of 6:30 P.M. to 8:30 P.M., with the percentage of alcohol service refusals to apparently intoxicated pseudo-patrons as the primary outcome variable.

RESULTS

Results indicate significantly higher refusal rates for WTS than for UC premises at the immediate (WTS = 68% vs. UC = 49%) and the 1-year post-training assessment points (WTS = 68% vs. UC = 58%) but not at the 6-month post-training assessment (WTS = 69% vs. UC = 64%). Differences in refusal rates based on pseudo-patron age were observed where younger pseudo-patrons were consistently refused more often than older pseudo-patrons.

CONCLUSIONS

Effective RBS training can be delivered online, making it a potentially cost-effective way of reaching large alcohol server populations.

The Roles of Bars and Restaurants in Preventing Alcohol-Impaired Driving

Server intervention is a community-based approach to preventing alcohol-impaired driving. It refers to a set of strategies designed to alter the drinking environment so as to reduce the likelihood of a drinker becoming intoxicated or, failing that, to prevent him or her from driving while intoxicated. The research reported here evaluates the impact of a server intervention program on customer's consumption of alcoholic beverages using a quasi-experimental nonequivalent controlgroup design. The program entailed revision of establishment policies and job descriptions and an 18-hour trainingfor management and staff. Interviews with randomly selected customers for two months prior to and following program implementation provided data on customer characteristics and consumption. Multivariate linear and logistic regression analyses reveal that although absolute consumption and rate of consumption were unaffected by the program, the likelihood of a customer's being intoxicated was cut in half

Party Characteristics, Drinking Settings, and College Students' Risk of Intoxication: A Multi-Campus Study

We examined party characteristics across different college drinking settings, associations between party characteristics and likelihood of drinking to intoxication, and the mediating role of perceived prevalence of intoxicated partygoers. Students (N = 6903) attending 14 public universities in California during the 2010 and 2011 fall semesters completed surveys on individual and party characteristics in six unique settings (e.g., residence hall). We used descriptive statistics to examine party characteristics by setting. We estimated multilevel logistic regression models to identify party characteristics associated with drinking to intoxication, and we used RMediation to determine significance of mediating effects. Individual and party characteristics varied by drinking context. Greater time at a party was associated with drinking to intoxication at five of six settings, while larger party size was significant only for outdoor settings. Enforcing the legal drinking age and refusing to serve intoxicated patrons were associated with lower likelihood of intoxication at Greek and off-campus parties. The presence of a keg was associated with drinking to intoxication at Greek, off-campus and outdoor parties; at bars, cover charges and drink promotions were positively associated with drinking to intoxication. In four of six settings, we found evidence of significant mediating effects through perceived prevalence of intoxicated partygoers. Findings highlight risk and protective characteristics of parties by drinking setting, and have prevention implications.

Apparent Motives for Aggression in the Social Context of the Bar

OBJECTIVE

Little systematic research has focused on motivations for aggression and most of the existing research is qualitative and atheoretical. This study increases existing knowledge by using the theory of coercive actions to quantify the apparent motives of individuals involved in barroom aggression. Objectives were to examine: gender differences in the use of compliance, grievance, social identity, and excitement motives; how motives change during an aggressive encounter; and the relationship of motives to aggression severity.

METHOD

We analyzed 844 narrative descriptions of aggressive incidents observed in large late-night drinking venues as part of the Safer Bars evaluation. Trained coders rated each type of motive for the 1,507 bar patrons who engaged in aggressive acts.

RESULTS

Women were more likely to be motivated by compliance and grievance, many in relation to unwanted sexual overtures from men; whereas men were more likely to be motivated by social identity concerns and excitement. Aggressive acts that escalated tended to be motivated by identity or grievance, with identity motivation especially associated with more severe aggression.

CONCLUSIONS

A key factor in preventing serious aggression is to develop approaches that focus on addressing identity concerns in the escalation of aggression and defusing incidents involving grievance and identity motives before they escalate. In bars, this might include training staff to recognize and defuse identity motives and eliminating grievance-provoking situations such as crowd bottlenecks and poorly managed queues. Preventive interventions generally need to more directly address the role of identity motives, especially among men.

Effects of AlcoholEdu for college on alcohol-related problems among freshmen: a randomized multicampus trial

OBJECTIVE

AlcoholEdu for College is a 2- to 3-hour online course for incoming college freshmen. This study was the first multicampus trial to examine effects of AlcoholEdu for College on alcohol-related problems among freshmen.

METHOD

Thirty universities participated in the study. Fifteen were randomly assigned to receive AlcoholEdu, and the other 15 were assigned to the control condition. AlcoholEdu was implemented by intervention schools during the summer and/or fall semester. Cross-sectional surveys of freshmen were conducted at each university beginning before the intervention in spring 2008/2009; post-intervention surveys were administered in fall 2008/2009 and spring 2009/2010. The surveys included questions about the past-30-day frequency of 28 alcohol-related problems, from which we created indices for the total number of problems and problems in seven domains: physiological, academic, social, driving under the influence/ riding with drinking drivers, aggression, sexual risk taking, and victimization. Multilevel Poisson regression analyses were conducted to examine intent-to-treat and dosage effects of AlcoholEdu for College on these outcomes.

RESULTS

Multilevel intent-to-treat analyses indicated significant reductions in the risk for past-30-day alcohol problems in general and problems in the physiological, social, and victimization domains during the fall semester immediately after completion of the course. However, these effects did not persist in the spring semester. Additional analyses suggested stronger AlcoholEdu effects on these outcomes at colleges with higher rates of student course completion. No AlcoholEdu effects were observed for alcohol-related problems in the other four domains.

CONCLUSIONS

AlcoholEdu for College appears to have beneficial short-term effects on victimization and the most common types of alcohol-related problems among freshmen. Universities may benefit the most by mandating AlcoholEdu for College for all incoming freshmen and by implementing this online course along with environmental prevention strategies.

Behavioural indicators of motives for barroom aggression: implications for preventing bar violence

INTRODUCTION AND AIMS

To develop new strategies for preventing violence in high-risk licensed premises, we identify behavioural indicators of apparent motives for aggression in these settings and outline the implications of different motivations for prevention.

DESIGN AND METHODS

The four types of motives for aggressive or coercive acts defined by the theory of coercive actions framed the research: gaining compliance, expressing grievances/restoring justice, attaining a favourable social identity and pursuing fun/excitement. Incidents of aggression from the Safer Bars evaluation research were analysed to identify behavioural indicators of each motivation.

RESULTS

Compliance-motivated aggression typically takes the form of unwanted social overtures, third party intervention to stop conflicts or staff rule enforcement. Prevention strategies include keeping the aggressor's focus on compliance to avoid provoking grievance and identity motives that are likely to escalate aggression. Grievance motives are typically elicited by perceived wrongdoing and therefore prevention should focus on eliminating sources of grievances and adopting policies/practices to resolve grievances peacefully. Social identity motives are endemic to many drinking establishments especially among male patrons and staff. Prevention involves reducing identity cues in the environment, hiring staff who do not have identity concerns, and training staff to avoid provoking identity concerns. Aggression motivated by fun/excitement often involves low-level aggression where escalation can be prevented by avoiding grievances and attacks on identity.

DISCUSSION AND CONCLUSIONS

Knowledge of behavioural indicators of motives can be used to enhance staff hiring and training practices, reduce environmental triggers for aggression, and develop policies to reduce motivation for aggression.

Young adults and casual sex: the relevance of college drinking settings

This study investigated the relevance of college drinking settings on the likelihood of students having sexual intercourse with a stranger. A random sample of 7,414 undergraduates at 14 public California universities responded to questions regarding frequency of attendance at six different setting types since the beginning of the semester (e.g., Greek, residence-hall parties, and bars or restaurants), drinking behavior, and sexual activity. Multi-level modeling examined the association between each setting type and the occurrence of alcohol-related sexual intercourse with a stranger. Findings indicated strong, positive associations between frequency of attendance at Greek parties, residence-hall parties, off-campus parties, and the occurrence of alcohol-related sex with a stranger. Frequency of attending the six settings and proportion of times drunk at the settings were also positively associated with alcohol-related sex with a stranger. Efforts aimed at preventing outcomes associated with casual sex (e.g., pregnancy, sexually transmitted infections, or mental health) should target specific drinking settings where students might be at high risk for risky alcohol use and unsafe sex behaviors.

Evaluation of an Internet-based alcohol misuse prevention course for college freshmen: findings of a randomized multi-campus trial

BACKGROUND

Internet-based alcohol misuse prevention programs are now used by many universities. One popular 2- to 3-hour online course known as AlcoholEdu for College is typically required for all incoming freshmen and thus constitutes a campus-level strategy to reduce student alcohol misuse.

PURPOSE

Multi-campus study to evaluate the effectiveness of an Internet-based alcohol misuse prevention course.

DESIGN

RCT with 30 universities: 21 entered the study in Fall 2007, nine in Fall 2008. Fifteen were randomly assigned to receive the online course and the other 15 were assigned to the control condition. The course was implemented by intervention schools during the late summer and/or fall semester. Cross-sectional surveys of freshmen were conducted at each university, beginning prior to the intervention in Spring 2008-2009; post-intervention surveys were administered in Fall 2008-2009 and Spring 2009-2010.

SETTING/PARTICIPANTS

Public and private universities of varying sizes across the U.S. Random samples of 200 freshmen per campus were invited to participate in online surveys for the evaluation. Overall survey response rates ranged from 44% to 48% (M ≈ 90 participants per campus).

INTERVENTION

The online course includes five modules; the first four (Part I) are typically offered in the late summer before matriculation, and the fifth (Part II) in early fall. Course content includes defining a standard drink, physiologic effects of alcohol, the need to monitor blood alcohol level, social influences on alcohol use, alcohol laws, personalized normative feedback, and alcohol harm-reduction strategies. Students must pass an exam after Part I to advance to Part II.

MAIN OUTCOME MEASURES

Past-30-day alcohol use, average number of drinks per occasion, and binge drinking.

RESULTS

Multilevel intent-to-treat analyses indicated significant reductions in the frequency of past-30-day alcohol use (beta = -0.64, p<0.05) and binge drinking (beta = -0.26, p<0.05) during the fall semester immediately after completion of the course. However, these effects did not persist when assessed in the spring semester. Post hoc comparisons suggested stronger course effects on these outcomes at colleges with higher rates of student course completion. No course effects were observed for average number of drinks per occasion or prevalence of binge drinking, regardless of the campus course completion rate.

CONCLUSIONS

This study provides initial evidence that the Internet-based alcohol misuse prevention course has beneficial short-term effects on hazardous drinking behavior among first-year college students, which should be reinforced through effective environmental prevention strategies.

Types of drinkers and drinking settings: an application of a mathematical model

AIMS

US college drinking data and a simple population model of alcohol consumption are used to explore the impact of social and contextual parameters on the distribution of light, moderate and heavy drinkers. Light drinkers become moderate drinkers under social influence, moderate drinkers may change environments and become heavy drinkers. We estimate the drinking reproduction number, R(d) , the average number of individual transitions from light to moderate drinking that result from the introduction of a moderate drinker in a population of light drinkers.

DESIGN AND SETTINGS

Ways of assessing and ranking progression of drinking risks and data-driven definitions of high- and low-risk drinking environments are introduced. Uncertainty and sensitivity analyses, via a novel statistical approach, are conducted to assess R(d) variability and to analyze the role of context on drinking dynamics.

FINDINGS

Our estimates show R(d) well above the critical value of 1. R(d) estimates correlate positively with the proportion of time spent by moderate drinkers in high-risk drinking environments. R(d) is most sensitive to variations in local social mixing contact rates within low-risk environments. The parameterized model with college data suggests that high residence times of moderate drinkers in low-risk environments maintain heavy drinking.

CONCLUSIONS

With regard to alcohol consumption in US college students, drinking places, the connectivity (traffic) between drinking venues and the strength of socialization in local environments are important determinants in transitions between light, moderate and heavy drinking as well as in long-term prediction of the drinking dynamics.

Environmental approaches to prevention in college settings

Because of concerns regarding drinking among college students and its harmful consequences, numerous prevention efforts have been targeted to this population. These include individual-level and community-level interventions, as well as other measures (e.g., online approaches). Community-level interventions whose effects have been evaluated in college populations include programs that were developed for the community at large as well as programs aimed specifically at college students, such as A Matter of Degree, the Southwest DUI Enforcement Project, Neighborhoods Engaging With Students, the Study to Prevent Alcohol-Related Consequences, and Safer California Universities. Evaluations of these programs have found evidence of their effectiveness in reducing college drinking and related consequences. The most effective approaches to reducing alcohol consumption among college students likely will blend individual-, group-, campus-, and community-level prevention components.

Alcohol risk management in college settings: the safer California universities randomized trial

CONTEXT

Potentially effective environmental strategies have been recommended to reduce heavy alcohol use among college students. However, studies to date on environmental prevention strategies are few in number and have been limited by their nonexperimental designs, inadequate sample sizes, and lack of attention to settings where the majority of heavy drinking events occur.

PURPOSE

To determine whether environmental prevention strategies targeting off-campus settings would reduce the likelihood and incidence of student intoxication at those settings.

DESIGN

The Safer California Universities study involved 14 large public universities, half of which were assigned randomly to the Safer intervention condition after baseline data collection in 2003. Environmental interventions took place in 2005 and 2006 after 1 year of planning with seven Safer intervention universities. Random cross-sectional samples of undergraduates completed online surveys in four consecutive fall semesters (2003-2006).

SETTING/PARTICIPANTS

Campuses and communities surrounding eight campuses of the University of California and six in the California State University system were utilized. The study used random samples of undergraduates (∼500-1000 per campus per year) attending the 14 public California universities.

INTERVENTION

Safer environmental interventions included nuisance party enforcement operations, minor decoy operations, driving-under-the-influence checkpoints, social host ordinances, and use of campus and local media to increase the visibility of environmental strategies.

MAIN OUTCOME MEASURES

Proportion of drinking occasions in which students drank to intoxication at six different settings during the fall semester (residence hall party, campus event, fraternity or sorority party, party at off-campus apartment or house, bar/restaurant, outdoor setting), any intoxication at each setting during the semester, and whether students drank to intoxication the last time they went to each setting.

RESULTS

Significant reductions in the incidence and likelihood of intoxication at off-campus parties and bars/restaurants were observed for Safer intervention universities compared to controls. A lower likelihood of intoxication was observed also for Safer intervention universities the last time students drank at an off-campus party (OR=0.81, 95% CI=0.68, 0.97); a bar or restaurant (OR=0.76, 95% CI=0.62, 0.94); or any setting (OR=0.80, 95% CI=0.65, 0.97). No increase in intoxication (e.g., displacement) appeared in other settings. Further, stronger intervention effects were achieved at Safer universities with the highest level of implementation.

CONCLUSIONS

Environmental prevention strategies targeting settings where the majority of heavy drinking events occur appear to be effective in reducing the incidence and likelihood of intoxication among college students.

Communication between researchers and practitioners: findings from a qualitative evaluation of a large-scale college intervention

Many community-based intervention studies experience problems with collaboration between researchers and practitioners. A preferred strategy appears to be to form community coalitions to carry out the proposed interventions in the community, but doing so risks shifting the focus from intervention objectives to coalition process. As a by-product, coalitions often lack understanding of the project goals and are not given specific instructions on how to implement the intervention. In contrast to conventional wisdom, the Safer California Universities study implemented a very directive approach in collaboration with local liaisons on the participating campuses, even though this approach is seen to risk cooperation or commitment from collaborators. This paper reports on the findings of a qualitative study based on interviews with campus liaisons of how the directive approach was perceived on the participating campuses. Findings indicate that the strategy was successful in terms of "getting things done" but could have been improved in terms of liaison involvement in setting objectives, and in finding the optimal level of specificity.

Evaluating a comprehensive campus-community prevention intervention to reduce alcohol-related problems in a college population

OBJECTIVE

This article evaluates Western Washington University's Neighborhoods Engaging with Students project-a comprehensive strategy to decrease disruptive off-campus parties by increasing student integration into and accountability to the neighborhoods in which they live. The intervention includes increasing the number of and publicity regarding "party emphasis patrols" and collaboration with the city to develop a regulatory mechanism to reduce repeat problematic party calls to the same address. The enforcement components are complemented by campus-based, late-night expansion programming, as well as neighborhood engagement strategies including an educational Web site designed to increase students' knowledge of and skills in living safely and legally in the community, service-learning projects in the campus-contiguous neighborhoods, and a neighborhood-based conflict-resolution program.

METHOD

The evaluation comprised data from three public universities in Washington. In addition to the Western Washington University site, a second campus created an opportunity for a "natural experiment" because it adopted a very similar intervention in the same time frame, creating two intervention sites and one comparison site. Annual, Web-based student surveys in 2005 and 2006 included measures of alcohol consumption, alcohol-related problems, and student perception of alcohol control and prevention activities.

RESULTS

Although statistical power with three campuses was limited, results using hierarchical linear modeling showed that the prevalence of heavy episodic drinking was significantly lower at the intervention schools (odds ratio = 0.73; N = 6,150 students).

CONCLUSIONS

The results suggest that alcohol control measures can be effective in reducing problematic drinking in college settings. These findings strongly support conducting a replication with greater power and a more rigorous design.

The effect of the Safer Bars programme on physical aggression in bars: results of a randomized controlled trial

The purpose of this study was to evaluate the effectiveness of Safer Bars, an intervention to reduce aggression in bars. A total of 734 pre - post-intervention observations were conducted by trained observers on Friday and Saturday nights between midnight and 2 a.m. in 18 large capacity ( > 300) Toronto bars and clubs assigned randomly to receive the intervention (69% participation rate of the 26 assigned) and 12 control bars. As part of the intervention, owners/managers completed the risk assessment workbook to identify ways of reducing environmental risks, and 373 staff and owners/managers (84% participation rate) attended a 3-hour training session focused on preventing escalation of aggression, working as a team and resolving problem situations safely. The main outcome measures were rates of severe aggression (e.g. punching, kicking) and moderate physical aggression (e.g. shoving, grappling). Hierarchical linear modelling (HLM) comparing pre - post aggression for intervention versus control bars indicated a significant effect of the intervention in reducing severe and moderate aggression. This effect was moderated by turnover of managers and door/security staff with higher post-intervention aggression associated with higher turnover in the intervention bars. The findings indicate the potential for a stand-alone relatively brief intervention to reduce severe and moderate physical aggression in bars.

Relationships between college settings and student alcohol use before, during and after events: a multi-level study

INTRODUCTION AND AIMS

We examined how alcohol risk is distributed based on college students' drinking before, during and after they go to certain settings.

DESIGN AND METHODS

Students attending 14 California public universities (N=10,152) completed a web-based or mailed survey in the fall 2003 semester, which included questions about how many drinks they consumed before, during and after the last time they went to six settings/events: fraternity or sorority party, residence hall party, campus event (e.g. football game), off-campus party, bar/restaurant and outdoor setting (referent). Multi-level analyses were conducted in hierarchical linear modeling (HLM) to examine relationships between type of setting and level of alcohol use before, during and after going to the setting, and possible age and gender differences in these relationships. Drinking episodes (N=24,207) were level 1 units, students were level 2 units and colleges were level 3 units.

RESULTS

The highest drinking levels were observed during all settings/events except campus events, with the highest number of drinks being consumed at off-campus parties, followed by residence hall and fraternity/sorority parties. The number of drinks consumed before a fraternity/sorority party was higher than other settings/events. Age group and gender differences in relationships between type of setting/event and 'before,''during' and 'after' drinking levels also were observed. For example, going to a bar/restaurant (relative to an outdoor setting) was positively associated with 'during' drinks among students of legal drinking age while no relationship was observed for underage students.

DISCUSSION AND CONCLUSIONS

Findings of this study indicate differences in the extent to which college settings are associated with student drinking levels before, during and after related events, and may have implications for intervention strategies targeting different types of settings.

Friday Class and Heavy Alcohol Use in a Sample of New Zealand College Students

OBJECTIVE

This study examined the association between scheduling at least one Friday class and the pattern and levels of alcohol use and heavy drinking in a sample of New Zealand college students.

METHOD

Two waves of survey data were collected from 866 college students in New Zealand in the first and second semesters of the 2000 academic year. Descriptive and regression analyses were conducted to examine the associations between scheduling Friday class in the second semester, levels of alcohol use and heavy drinking in the past month, and alcohol use on different weeknights. We hypothesized that (1) heavier-drinking students would be less likely to schedule any Friday classes, (2) having at least one Friday class would be inversely related to concurrent alcohol use and heavy drinking when adjusting for potential confounders, and (3) having Friday class would be inversely related to alcohol use and heavy drinking on Thursdays and prior week- nights.

RESULTS

Analysis results supported the hypothesis that heavier- drinking students would be less likely to schedule Friday classes but did not support the hypothesis that scheduling at least one Friday class would be inversely related to concurrent alcohol use and heavy drinking when adjusting for potential confounders. Having Friday class also was not associated with typical drinking on Thursday or Friday, but having Friday class was inversely associated with Thursday as the biggest drinking day when controlling for background variables.

CONCLUSIONS

Findings of this study indicate that heavier-drinking students are less likely to schedule Friday classes. Scheduling at least one Friday class may reduce the likelihood of heavy drinking on Thursdays but may have no effect on the overall levels of alcohol use and heavy drinking among college students.

Drinking to extremes: theoretical and empiricalanalyses of peak drinking levels among college students

OBJECTIVE

Heavy drinking among college students continues to be a substantial problem on campuses across the United States. Attempts to predict these drinking events have been restricted to assessments of the correlates of heavy drinking (measured at 4 or 5 drinks) and have not examined the peak drinking levels that can be fatal to students. This article presents a theoretical analysis of college drinking patterns that provides a basis for estimating peak drinking levels and predicts future risks related to peak drinking events.

METHOD

Survey data were collected on sociodemographics and drinking patterns of 2,102 college students from two college campuses in California. A mathematical model of drinking patterns was used to characterize the stochastic distribution of drinking events among 1,273 students who drank five or more times and consumed more than one drink on some occasion since the beginning of the school year. An application of extreme value theory enabled the estimation of peak drinking levels for every college drinker. These estimates were related to self-reported maximum drinking levels and sociodemographic characteristics of respondents.

RESULTS

Among these drinkers, the distribution of self-reported maximum drinking levels ranged from 2 to 43 drinks per occasion. Estimated peak drinking levels ranged from 3 to 49. Maximum drinking levels were well characterized by peak drinking estimates (R2 = 0.503). Variations in peak drinking levels were large and specifically related to particular sociodemographic groups (i.e., white male freshmen).

CONCLUSIONS

The theoretical model of peak drinking events effectively characterizes maximum drinking levels among college students. High levels of peak drinking are to be expected among specific sociodemographic subgroups. These risks can be assessed on an individual basis. At the population level, risks for harm related to peak drinking events are predictable.

Understanding college drinking: assessing dose response from survey self-reports

OBJECTIVE

One of the most difficult challenges confronting alcohol researchers is the assessment of specific risks associated with specific drinking levels (one, two or three or more drinks). In this article, a model-based method is presented that provides specific measures of dose, exposures and risks related to drinking and enables adequate assessment of dose-response relationships using survey data.

METHOD

Survey data collected from 2,102 college students on drinking patterns and related problems were analyzed using a mathematical model that extracts separable measures of dose (number of drinks consumed per occasion) and exposures (numbers of occasions) for every respondent. A constrained class of quadratic risk models was estimated that relates units of exposure at each dose (e.g., number of occasions drinking five drinks) to problem outcomes (e.g., number of hangovers). The resulting dose-response functions provided an estimate of the rate of problems produced on each occasion of drinking at a given drinking level. Population risks were estimated by reintegrating dose response with the population distribution of drinking exposures.

RESULTS

The distribution of drinking exposures among college drinkers was markedly peaked at a modal dose of two drinks, with variations in light and heavy drinking between demographic groups. Multivariate analyses showed relative rates of heavier drinking were greatest among white male freshmen and unrelated to residential settings. Most drinking problems showed a marked dose-response relationship to drinking levels. Population risks, however, were typically unimodal, with many problems reported at moderate drinking levels (two or three drinks).

CONCLUSIONS

Distributed across a large number of drinkers and drinking occasions, problems reported by students occurred most often at moderate drinking levels (two to three drinks). Nevertheless, heavier drinking remained substantively related to many drinking problems. These observations encourage aview of college drinking that supports interventions related to both moderate and heavy drinking.

General and job-related alcohol use and correlates in a municipal workforce

We examined the prevalence and correlates of both general and workplace-related drinking measures using data from a telephone survey of 673 workers in a large municipal bureaucracy and tested the hypothesis that observed differences across job categories can be explained by compositional difference in terms of demographic variables known to be related to drinking behavior. Results suggest such factors account for much of the variation in general drinking measures (prior-28-day quantity, CAGE score, indicating risk for dependence), but that significant variation in a workplace-related drinking measure (times ever drank before, during, or just after work) remains even after such factors are controlled. Implications of these findings for existing theories of workplace effects on drinking are discussed, along with a consideration of appropriate levels of analysis for future studies.

Effect of community-based interventions on high-risk drinking and alcohol-related injuries

CONTEXT

High-risk alcohol consumption patterns, such as binge drinking and drinking before driving, and underage drinking may be linked to traffic crashes and violent assaults in community settings.

OBJECTIVES

To determine the effect of community-based environmental interventions in reducing the rate of high-risk drinking and alcohol-related motor vehicle injuries and assaults.

DESIGN AND SETTING

A longitudinal multiple time series of 3 matched intervention communities (northern California, southern California, and South Carolina) conducted from April 1992 to December 1996. Outcomes were assessed by 120 general population telephone surveys per month of randomly selected individuals in the intervention and comparison sites, traffic data on motor vehicle crashes, and emergency department surveys in 1 intervention-comparison pair and 1 additional intervention site.

INTERVENTIONS

Mobilize the community; encourage responsible beverage service; reduce underage drinking by limiting access to alcohol; increase local enforcement of drinking and driving laws; and limit access to alcohol by using zoning.

MAIN OUTCOME MEASURES

Self-reported alcohol consumption and driving after drinking; rates of alcohol-related crashes and assault injuries observed in emergency departments and admitted to hospitals.

RESULTS

Population surveys revealed that the self-reported amount of alcohol consumed per drinking occasion declined 6% from 1.37 to 1. 29 drinks. Self-reported rate of "having had too much to drink" declined 49% from 0.43 to 0.22 times per 6-month period. Self-reported driving when "over the legal limit" was 51% lower (0. 77 vs 0.38 times) per 6-month period in the intervention communities relative to the comparison communities. Traffic data revealed that, in the intervention vs comparison communities, nighttime injury crashes declined by 10% and crashes in which the driver had been drinking declined by 6%. Assault injuries observed in emergency departments declined by 43% in the intervention communities vs the comparison communities, and all hospitalized assault injuries declined by 2%.

CONCLUSION

A coordinated, comprehensive, community-based intervention can reduce high-risk alcohol consumption and alcohol-related injuries resulting from motor vehicle crashes and assaults. JAMA. 2000;284:2341-2347.

Gender, acculturation, and alcohol consumption among Mexican Americans

OBJECTIVE

This study examines the relationship between level of acculturation and drinking status among Mexican American males and females in three northern California cities.

METHOD

The data analyzed were collected through the use of a telephone survey. The sample size is 932.

RESULTS

Our results show that acculturation has a direct effect on drinking status for women in the sample but not for men. At low levels of acculturation, our results show the expected difference in drinking status by gender; with high abstention rates for women and low abstention rates for males. At high levels of acculturation there is a convergence in drinking status with females approximating the proportion of male drinkers in the sample. Additionally, acculturation was associated with "heavier" drinking for females while place of birth was associated with "heavier" drinking for males.

CONCLUSIONS

Studies of drinking patterns and related problems need to consider these factors.

Summing up: lessons from a comprehensive community prevention trial

This paper presents the findings and lessons from a community prevention trial involving three experimental communities in the United States to reduce alcohol-involved trauma. The paper provides recommendations for other community prevention efforts. Effectiveness was demonstrated by: (a) 78 fewer alcohol-involved traffic crashes as a result of the Drinking and Driving Component alone (approximately a 10% reduction); (b) a significant reduction in underage sales of alcohol, i.e. off-premise outlets sold to minors about one-half as often as in comparison communities; (c) increased implementation of responsible beverage service policies by bars and restaurants; and (d) increased adoption of local ordinances and regulations to reduce concentrations of alcohol outlets.

A community prevention trial to reduce alcohol-involved accidental injury and death: overview

The 5-year "Preventing Alcohol Trauma: A Community Trial" project in the United States was designed to reduce alcohol-involved injuries and death in three experimental communities. The project consisted of five mutually reinforcing components: (1) Community Mobilization Component to develop community organization and support, (2) Responsible Beverage Service Component to establish standards for servers and owner/managers of on-premise alcohol outlets to reduce their risk of having intoxicated and/or underage customers in bars and restaurants, (3) Drinking and Driving Component to increase local DWI enforcement efficiency and to increase the actual and perceived risk that drinking drivers would be detected, (4) Underage Drinking Component to reduce retail availability of alcohol to minors, and (5) Alcohol Access Component to use local zoning powers and other municipal controls of outlet number and density to reduce the availability of alcohol. This paper gives an overview of the rationale and causal model, the research design and outline of each intervention component for the entire prevention trial.

A community-wide Responsible Beverage Service program in three communities: early findings

Evidence accumulating over the past 10 years or so suggests that commercial servers of alcoholic beverages will intervene to reduce levels of impairment among their patrons and will refuse service to intoxicated customers. While some Responsible Beverage Service (RBS) programs have had significant effects on server and patron behavior, others have not. This leads us to consider issues of implementation and program effectiveness. In the current paper, a community-wide RBS program is described in some detail. The program was comprised by a larger comprehensive community intervention project in three sites across California and South Carolina. Process evaluation data, to track program implementation and proximal effects, provide early findings. Expressed support for RBS principles was high for both the public and the hospitality industry in all sites. A telephone survey of managers also suggests that prevention policies at bars and restaurants are beginning to show up, but a direct measure of server intervention with heavy drinkers does not yet demonstrate a program effect.

Summing up. Recommendations and experiences for evaluation of community-level prevention programs

This article provides recommendations and observations about evaluation of a locally based prevention project to reduce problems at a total community or aggregate level. The shift from targeting specific individuals or subpopulations to the overall structure and environment of a community is most demanding. Evaluation tools and analysis techniques have lagged behind program development because community-level interventions are not linked to a specific target group who can be separately studied. Thus assumptions about using random assignment and/or comparison communities as means to control for confounding variables are weakened when the unit of analysis is the community itself and dependent measures are subject to trending and the effects of history.

Evaluation design for a community prevention trial. An environmental approach to reduce alcohol-involved trauma

The Community Prevention Trial was 5-year effort to reduce alcohol-involved injuries and death through a comprehensive program of community awareness and policy activities. The three experimental communities were of approximately 100,000 population each (one in Northern California, one in Southern California, and one in South Carolina). Matched comparison communities were used for each experimental community. This article describes the evaluation approach used in a program that sought to change environmental factors not a specific population or target group. This approach demanded unique evaluation approaches for determining overall community aggregate effects, that is, distal outcomes, as well as changes in key mediating variables, that is, process effects. The problem of trending and lagged effects of community prevention programs are discussed.

Evaluating specific community structural changes. Examples from the assessment of responsible beverage service

Responsible Beverage Service (RBS) refers to the idea that bars and restaurants may be able to have a significant impact on the levels of deaths and injuries associated with alcohol consumption including, but not limited to alcohol-impaired driving. After a brief background on RBS as a prevention strategy, the authors review the different measures, protocols, and designs that have been employed in evaluations of responsible service programs with attention paid to the strengths and limitations accompanying each choice. This article concludes by describing the Prevention Research Center's Community Trials Project design as it relates to evaluating its RBS component, and some of the unique considerations that influenced the measures and protocols employed. In so doing, the authors discover how the larger project serves as an interesting case study in action research.

The impact of alcohol beverage container warning labels on alcohol-impaired drivers, drinking drivers and the general population in northern California

Using data collected in a random-digit dial telephone survey in a northern California county, an examination of the impact of alcohol beverage container warning labels was conducted. In a broadly conceived approach to the possible impact of warning labels, we examined recall and content as well as risk assessment and the use of warning labels as public policy to combat drunk driving. In a repeated measures pre- and post-design, respondents reported significantly higher recall of labels and their content in the post-introduction period. Evidence from a multivariate analysis of post-introduction data indicate that both drinking drivers and impaired drivers (based on self-reports) were more likely to recall the labels and their content, an indication that warning labels are reaching "at risk" individuals. In addition, increases in the perceived risk of driving and drinking are consistent with the notion that warning labels, as one part of a larger social movement, are helping to create an atmosphere in which drinking and driving is less acceptable. However, our findings also indicate that, at least among at risk drinking and impaired drivers, increased use of public policies such as warning labels in an effort to reduce the negative consequences of drinking and driving may generate a public opinion backlash.

Modeling social influences on public drinking

This article combines the qualitative tradition of naturalistic observations with quantitative multivariate methods to quantify the relationships between drinker characteristics, group composition, duration of the drinking period and alcohol consumption. Employing observational data on over 6,000 drinkers collected in six on-premise licensed establishments in California, structural equation regression methods were used to estimate the simultaneous effects of duration of the drinking period and total consumption on each other, controlling for patron characteristics and group composition. Results from all six establishments indicate that consumption is higher in larger groups because of longer drinking times at the establishment and not because of any direct effect of consumption on length of the drinking period. Group composition effects on consumption are also indicated since females in mixed drinking groups tend to reduce the alcohol consumption of males, but not the group as a whole.

The introduction of dram shop legislation in the United States and the advent of server training

This paper discusses the relationship of research to policy in the matter of dram shop liability and server training in the USA. The discussion is made difficult by the apparent lack of any such relationship. While research in the area has only just been published, dram shop liability in the USA actually dates to the nineteenth century, with its current form shaped by the repeal of prohibition in 1933. Because liability law and liability insurance vary from state to state, current movements for reform and server training arise somewhat spontaneously in different localities and with different emphases. Research constitutes only a minor influence among several others more salient to the political process of policy formation. The advent of mandatory server training in the state of Oregon is used to illustrate the somewhat capricious nature of progress in responsible beverage service.

The situational riskiness of alcoholic beverages

Using face-to-face interview data on a sample of young adults, this study investigates the perceived risk of alcohol consumption in drinking and driving, interactions with police and the probability of intoxication. Results show that beer is perceived as less risky than liquor in two risk situations, with men and drinkers in particular ranking beer as a lower risk beverage. When intoxication is considered, drinkers rank their preferred beverage as less risky than their alternative. Finally, an analysis of the relative riskiness of beer in comparison to liquor reveals that beer is perceived as less risky than liquor. This consensus does not vary significantly by sex or most other respondent characteristics.

Research needs and opportunities in server intervention programs

Prevention specialists have recently focused on ways to shape the drinking context and environment to reduce the risks of drinking and driving. Server intervention refers to a set of strategies to control drinking in service establishments through changes in management policies, serving practices, and by training servers and other employees to monitor and control patrons' alcohol consumption. Research on server intervention is mixed, but seems to indicate that some server intervention practices can reduce levels of alcohol intoxication by patrons. Further work is needed to determine how such effects can be enhanced. Topics for future research include optimal components of specific training curriculum, policies needed to support and extend server training, importance of "booster" sessions, and the relationship of server intervention to broader social and legal environments that discourage drinking and driving.