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.

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: 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.

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.

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.

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.