Perception of intoxication in a field study of the night-time economy: Blood alcohol concentration, patron characteristics, and event-level predictors

OBJECTIVE

Determine the relationship of subjective intoxication to blood alcohol concentration (BAC) and examine whether patron and event-level characteristics modify the relationship of BAC to subjective intoxication.

METHODS

An in-situ systematic random sample of alcohol consumers attending night-time entertainment districts between 10pm and 3am on Friday and Saturday nights in five Australian cities completed a brief interview (n=4628). Participants reported age, sex, and pre-drinking, energy drink, tobacco, illicit stimulant and other illicit drug use that night, and their subjective intoxication and BAC were assessed.

RESULTS

Male and female drinkers displayed equally low sensitivity to the impact of alcohol consumption when self-assessing their intoxication (BAC only explained 19% of variance). The marginal effect of BAC was not constant. At low BAC, participants were somewhat sensitive to increases in alcohol consumption, but at higher BAC levels that modest sensitivity dissipated (actual BAC had less impact on self-assessed intoxication). The slope ultimately leveled out to be non-responsive to additional alcohol intake. Staying out late, pre-drinking, and being young introduced biases resulting in higher self-assessed intoxication regardless of actual BAC. Further, both energy drinks and stimulant use modified the association between BAC and perceived intoxication, resulting in more compressed changes in self-assessment as BAC varies up or down, indicating less ability to perceive differences in BAC level.

CONCLUSIONS

The ability of intoxicated patrons to detect further intoxication is impaired. Co-consumption of energy drinks and/or stimulant drugs is associated with impaired intoxication judgment, creating an additional challenge for the responsible service and consumption of alcohol.

The location of late night bars and alcohol-related crashes in Houston, Texas

A study in the City of Houston, Texas, related the location of establishments primarily serving alcohol ("bars") after midnight to late night alcohol-related motor vehicle crashes. There were three data sets for 2007-09: 1) 764bars that were open after midnight; 2) 1660 alcohol-related crashes that occurred within the City of Houston between midnight and 6 am; and 3) 4689 modeling network road segments to which bars and alcohol-related crashes were assigned. Forty-five percent of the late night alcohol-related crashes were within a quarter mile of a late night bar. The bars were highly concentrated in 17 small bar clusters. Using the modeling network, Poisson-Gamma-CAR and Poisson-Lognormal-CAR spatial regression models showed a positive exponential relationship between late night alcohol-related crashes and the number of late nights bars and bar clusters, and a negative exponential relationship to distance to the nearest late night bar controlling for the type of road segment (freeway, principal arterial, minor arterial). A more general model dropped the bar cluster variable. Further, the Poisson-Gamma-CAR model appeared to produce a better representation than the Poisson-Lognormal-CAR model though the errors were different. The general Poisson-Gamma-CAR model showed that each late night bar increased the frequency of alcohol-related crashes on a segment by approximately 190%. For each mile closer a segment was to a late night bar, the likelihood increased by 42%.

Context-Specific Drinking Risks Among Young People

BACKGROUND

Limited research suggests the context in which drinking occurs may contribute to specific alcohol-related consequences. Therefore the aims are to (i) determine whether the use of drinking contexts affects risks for several drinking consequences among young people in the general population and (ii) assess the degree to which additional risks are associated with greater levels of drinking in those contexts.

METHODS

A New Zealand survey of 16- to 29-year-olds asked about context-specific drinking and incidence of alcohol-related consequences grouped as follows: total, alcohol-related disorderly behavior, symptoms of dependence, effects of heavier drinking, and felt effects the next day. A context-specific dose-response model separated the effects of frequency (i.e., how often someone consumes 1 drink in each context) and context-specific quantity (i.e., the count of each successive drink consumed above the first), and these were estimated as predictors of consequences. Demographic covariates were included.

RESULTS

Exposure (number of visits): Increased exposure to drinking at bars/nightclubs, even at a very low level of consumption, that is, 1 drink, was independently related to the experience of greater consequences, including alcohol-related disorderly behavior. Risks for alcohol-related consequences were more strongly related to exposure to bars/nightclubs than they were to heavier drinking in that context. Greater use of private motor vehicles and outdoor public places was also associated with greater consequences (independently of the heavier drinking in these contexts). Quantity: Risk of consequences associated with others' home, restaurants, and own home depended primarily on quantity consumed.

CONCLUSIONS

Bars/nightclubs are inherently risky contexts for drinking by young people and improved controls are required. Drinking at others' home, private motor vehicles, and outdoor public places were also associated with consequences; prevention efforts increasing the price and reducing the availability of takeaway alcohol should work to reduce consequences at these contexts. Innovative context-specific interventions may be useful.

Can Obviously Intoxicated Patrons Still Easily Buy Alcohol at On-Premise Establishments?

BACKGROUND

Excessive alcohol consumption at licensed alcohol establishments (i.e., bars and restaurants) has been directly linked to alcohol-related problems such as traffic crashes and violence. Historically, alcohol establishments have had a high likelihood of selling alcohol to obviously intoxicated patrons (also referred to as "overservice") despite laws prohibiting these sales. Given the risks associated with overservice and the need for up-to-date data, it is critical that we monitor the likelihood of sales to obviously intoxicated patrons.

METHODS

To assess the current likelihood of a licensed alcohol establishment selling alcohol to an obviously intoxicated patron, we conducted pseudo-intoxicated purchase attempts (i.e., actors attempt to purchase alcohol while acting out obvious signs of intoxication) at 340 establishments in 1 Midwestern metropolitan area. We also measured characteristics of the establishments, the pseudo-intoxicated patrons, the servers, the managers, and the neighborhoods to assess whether these characteristics were associated with likelihood of sales of obviously intoxicated patrons. We assessed these associations with bivariate and multivariate regression models.

RESULTS

Pseudo-intoxicated buyers were able to purchase alcohol at 82% of the establishments. In the fully adjusted multivariate regression model, only 1 of the characteristics we assessed was significantly associated with likelihood of selling to intoxicated patrons-establishments owned by a corporate entity had 3.6 greater odds of selling alcohol to a pseudo-intoxicated buyer compared to independently owned establishments.

CONCLUSIONS

Given the risks associated with overservice of alcohol, more resources should be devoted first to identify effective interventions for decreasing overservice of alcohol and then to educate practitioners who are working in their communities to address this public health problem.

Disentangling contributions of bar attendance, drinking, and other factors to elevated acute alcohol problems on the U.S.-Mexico border

BACKGROUND

Levels of drinking are unusually elevated among young adults on the U.S.-Mexico border, and this elevation can be largely explained by young border residents' unusually high frequency of bar attendance. However, this explanation complicates interpretation of high alcohol problem rates that have also been observed in this group. Because bar environments can lower the threshold for many types of problems, the extent to which elevated alcohol problems among young border residents can be attributed to drinking per se-versus this common drinking context-is not clear.

METHODS

Data were collected from multistage cluster samples of adult Mexican Americans on and off the U.S.-Mexico border (current drinker N = 1,351). After developing structural models of acute alcohol problems, estimates were subjected to path decompositions to disentangle the common and distinct contributions of drinking and bar attendance to problem disparities on and off the border. Additionally, models were estimated under varying degrees of adjustment to gauge the sensitivity of the results to sociodemographic, social-cognitive, and environmental sources of confounding.

RESULTS

Consistent with previous findings for both drinking and other problem measures, acute alcohol problems were particularly elevated among young adults on the border. This elevation was entirely explained by a single common pathway involving bar attendance frequency and drinking. Bar attendance did not predict acute alcohol problems independently of drinking, and its effect was not moderated by border proximity or age. The common indirect effect and its component effects (of border youth on bar attendance, of bar attendance on drinking, and of drinking on problems) were surprisingly robust to adjustment for confounding in all parts of the model (e.g., fully adjusted indirect effect: b = 0.11, SE = 0.04, p < 0.01).

CONCLUSIONS

Bar attendance and associated increases in drinking play a key, unique role in the high levels of acute alcohol problems among the border's young adult population that cannot be entirely explained by sociodemographic or social-cognitive characteristics of young border residents, by contextual effects of bars on problems, or by broader neighborhood factors. Bar attendance in particular may represent an early modifiable risk factor that can be targeted to reduce alcohol problem disparities in the region.

Cross-border policy effects on alcohol outcomes: drinking without thinking on the u.s.-Mexico border?

BACKGROUND

Rates of alcohol-related outcomes are sensitive to policy differences in politically distinct, adjacent territories. Factors that shape these cross-border effects, particularly when the policy differences are longstanding, remain poorly understood. We compared the ability of 2 classes of variables with theoretical relevance to the U.S.-Mexico border context-bar attendance and alcohol-related social-cognitive variables-to explain elevated drinking on the U.S. side of the border relative to other areas of the United States.

METHODS

Data were collected from multistage cluster samples of adult Mexican Americans on and off the U.S.-Mexico border (current drinker N = 1,351). Structural equation models were used to test drinking context (frequency of bar attendance) and 6 different social-cognitive variables (including alcohol-related attitudes, norms, motives, and beliefs) as mediators of border effects on a composite drinking index.

RESULTS

The border effect on drinking varied by age (with younger adults showing a stronger effect), consistent with previous findings and known risk factors in the region. Contrary to theoretical expectations, 6 different social-cognitive variables-despite relating strongly with drinking-were comparable in border and nonborder areas (within and across age) and played no role in elevated drinking on the border. Conversely, elevated drinking among border youth was mediated by bar attendance. This mediated moderation effect held after adjusting for potential sociodemographic and neighborhood-level confounders.

CONCLUSIONS

Increased drinking among U.S.-Mexico border youth is explained by patterns of bar attendance, but not by more permissive alcohol-related social-cognitive variables in border areas: Border youth attend bars and drink more than their nonborder counterparts, despite having comparable alcohol-related beliefs, attitudes, norms, and motives for use. Alcohol's heightened availability and visibility on both sides of the border may create opportunities for border youth to drink that otherwise would not be considered.

Systematic review and meta-analysis of the economic impact of smoking bans in restaurants and bars

AIMS

To review systematically the literature on the economic impact of smoking bans in bars and restaurants and provide an estimate of the impact size using meta-analysis.

METHODS

Studies were identified by systematic database searches and screening references of reviews and relevant studies. Google and web-pages of tobacco control agencies were also searched. The review identified 56 studies using absolute sales, sales ratio or employment data and employing regression methods to evaluate the impact of smoking bans in the United States, Australia or in countries in South America or Europe. The meta-analysis included 39 comparable studies, with 129 cases identified based on the outcome measure, scope of the ban, type of establishment and geographical location. Methodological quality was assessed based on four pre-determined criteria. Study and case selection and data extraction were conducted independently by two researchers.

RESULTS

Random-effects meta-analysis of all cases showed no associations between smoking bans and changes in absolute sales or employment. An increase in the share of bar and restaurant sector sales in total retail sales was associated with smoking bans [0.23 percentage-points; 95% confidence interval (CI) 0.08-0.375]. When cases were separated by business type (bars or restaurants or wider hospitality including bars and restaurants), some differential impacts emerged.

CONCLUSIONS

Meta-analysis of the economic impact of smoking bans in hospitality sector showed overall no substantial economic gains or losses. Differential impacts were observed across individual business types and outcome variable, but at aggregate level these appear to balance out.