Does a place of last drink initiative affect the likelihood of alcohol sales to obviously intoxicated patrons?

BACKGROUND: Although the sale of alcohol to obviously intoxicated patrons (i.e., overservice) is illegal in 48 U.S. states, the likelihood of overservice at bars and restaurants has exceeded 80% across multiple studies, states, and decades. Place of last drink (POLD) enforcement is one proposed strategy to address alcohol overservice. When law enforcement agents respond to an alcohol-related incident, they ask the individuals involved where they had their last alcoholic beverage. POLD information is recorded and ideally systematically reviewed to identify locations that are frequently places of last drink. Law enforcement or other agencies may follow up with or penalize the alcohol license holder at these locations. We compared the likelihood of overservice in communities conducting POLD with communities that did not conduct POLD in Minnesota. METHODS: Pseudo-intoxicated patrons acted out signs of obvious intoxication while attempting to purchase alcohol at 396 bars and restaurants in 26 communities conducting POLD and 26 comparison communities. We calculated rates of alcohol sales to the pseudo-intoxicated patrons overall and in POLD communities versus comparison communities. RESULTS: The overall sales rate to the pseudo-intoxicated buyers was 98%. Rates of sales were 99% at establishments in POLD jurisdictions and 97% in comparison jurisdictions. There were no common characteristics, such as perceived gender/age of the server/bartender or crowdedness of the establishment, among the seven establishments that refused alcohol service. CONCLUSIONS: Our study shows that, as currently implemented in Minnesota, POLD does not reduce the overservice of alcohol at a jurisdiction level. More research is needed to identify interventions that yield sustained reductions in the overservice of alcohol.

The Interplay of Local- and State-Level Alcohol Policies in the US.

OBJECTIVE: Most research on alcohol control policies in the U.S. has focused on the state-level. In this study, we assessed both local and state policy prevalence and restrictiveness in a nationwide sample of cities. METHODS: We conducted original legal research to asses prevalence of local-level policies across 374 cities (48 states) in 2019 for seven policy areas: (1) Drink specials; (2) Beverage service training; (3) Minimum age for on-premise servers and bartenders; (4) Minimum age for off-premise sellers; (5) Prohibitions against hosting underage drinking parties (i.e., social host provisions); (6) Bans on off-premise Sunday sales; and (7) Keg registration. We obtained parallel state-level policies from the Alcohol Policy Information System. We assessed restrictiveness of existing policies and how these compared across local and state levels. RESULTS: We found that for six of the seven policy areas, the majority of cities (53% to 83%) had only a state-level policy. Few cities (0% to 8% across policy areas) had only a local-level policy. The percentage of cities that had an alcohol policy at both the local and state-level ranged from <1% to 19% across policy areas, and the policies were mostly equally restrictive at both levels. DISCUSSION: The lack of local policies may point to areas where these localities could strengthen their alcohol policy environments. More research is needed to understand how the prevalence and restrictiveness of local and state policies are associated with public health harms such as traffic crashes.

Does a Place of Last Drink (POLD) Initiative Affect Alcohol Serving Staff Attitudes and Perceptions Related to Overservice of Alcohol?

Background: One enforcement strategy used to address illegal sales of alcohol to intoxicated patrons (i.e., overservice) is Place of Last Drink (POLD). When law enforcement responds to an alcohol-related incident, they ask persons involved in the incident where they had their last drink; POLD data can then be used to track patterns of overservice.Methods: We evaluated potential effects of a POLD initiative in one state (USA) on the attitudes and perceptions of serving staff (i.e., bartenders and servers) about their experiences in refusing sales to intoxicated customers. We conducted interviews with 44 serving staff across 24 communities (14 communities that participated in the POLD initiative and 10 comparison communities). We analyzed the interview transcripts using a qualitative matrix to identify major themes.Results: We found few differences across the two study conditions, with interview participants having no apparent awareness of POLD and many stating that overservice occurs frequently without law enforcement getting involved. One difference we identified was serving staff from communities in the POLD initiative reporting generally positive experiences with their managers when refusing sales to intoxicated patrons, whereas serving staff in comparison communities more commonly saying they were overruled by their managers. It is possible that these differences are the result of the POLD initiative; however, more research is needed.Conclusions: In general, serving staff across communities share many similar perceptions and attitudes around overservice. These findings can inform future implementation of POLD and other strategies to reduce overservice of alcohol.

Alcohol Enforcement in the United States From 2010 to 2019.

OBJECTIVE: Despite the important role of enforcement in reducing alcohol-related harms, few studies have assessed alcohol enforcement efforts, particularly over time. We assessed the prevalence of alcohol law enforcement strategies at two time points. METHOD: Of a random sample of U.S. local law enforcement agencies (i.e., police, sheriff) surveyed in 2010, 1,028 were resurveyed in 2019 (742/1,028 [72%] response rate). We assessed changes in alcohol enforcement strategies and priorities within three domains: (a) alcohol-impaired driving, (b) alcohol sales to obviously intoxicated patrons (i.e., overservice), and (c) underage drinking. RESULTS: Agencies reported placing higher priority on enforcement of alcohol-impaired driving and overservice in 2019 versus 2010. For alcohol-impaired driving enforcement strategies, we found increases over time in use of saturation patrols and in enforcing laws prohibiting open containers of alcohol in motor vehicles, but not in use of sobriety checkpoints. Approximately 25% of agencies conducted overservice enforcement in both years. For all strategies directed at underage drinking, enforcement decreased over time with more agencies using strategies aimed at underage drinkers versus alcohol suppliers (alcohol outlets, adults) in both years. CONCLUSIONS: Agencies reported continued low levels or declines in enforcement across most strategies despite reported increases in prioritizing alcohol enforcement. More agencies could adopt alcohol control enforcement strategies, including an increased focus on suppliers of alcohol to youth rather than on underage drinkers, and increased awareness and enforcement of selling alcohol to obviously intoxicated patrons. Use of these strategies has the potential to reduce health and safety consequences of excessive alcohol use.

Place of last drink enforcement: Effects on alcohol-related traffic crashes.

BACKGROUND: Binge drinking can result in various types of harms including traffic crashes. Bars and restaurants that serve alcohol to patrons who are obviously intoxicated (i.e., overservice) contribute to these crashes. One strategy to address overservice is place of last drink (POLD) where law enforcement officers responding to alcohol-related incidents inquire about where the individuals last drank alcohol. This information may then be used to identify bars and restaurants that frequently overserve alcohol. There is limited evaluation of the effectiveness of POLD in reducing overservice, traffic crashes, and other harms. METHODS: We evaluated the effects of a POLD initiative, developed by some law enforcement agencies in Minnesota (USA), on alcohol-related traffic crashes from 2010 to 2019. Among 89 intervention (POLD) vs. comparison communities, we fit regression models with participation in POLD as the predictor. As secondary analyses, we fit models with POLD implementation level as the predictor (implementation levels were assessed via a survey of law enforcement agencies). We controlled for relevant community and agency characteristics. RESULTS: In the model with participation in POLD as a predictor, there was little difference in the rate of total alcohol-related crashes (rate ratio [RR] = 1.07, 95% CI: 0.85-1.34). In the model with level of implementation as a predictor, the rate of total alcohol-related crashes was comparable between communities with high implementation and those with no implementation (RR = 0.89; 95% CI: 0.71-1.10). Similar results were seen for alcohol-related crashes with nonfatal injury and property damage outcomes. CONCLUSIONS: This study found little evidence that the POLD initiative, as currently implemented, was associated with reductions in traffic crashes across communities in Minnesota. Further research could explore whether specific characteristics of POLD are particularly important and whether POLD could be combined with other strategies to reduce traffic crashes and other alcohol-related harms.

Alcohol-impaired driving enforcement priorities and strategies in a nationwide sample of U.S. law enforcement agencies.

OBJECTIVE: Excessive alcohol consumption leads to a range of public health problems and social and financial burdens. Traffic crashes resulting from alcohol-involved driving are a major contributor to the overall health consequences of alcohol. Various laws and enforcement strategies aim to prevent alcohol-involved driving. The extent to which law enforcement agencies prioritize enforcement of alcohol-impaired driving laws can help to reduce alcohol-impaired driving. Among law enforcement agencies in the US, we examined prioritization of alcohol-impaired driving enforcement and how it is associated with use of specific enforcement strategies, as well as agency and community characteristics. METHODS: We conducted a survey of a national sample of 1,024 US police and sheriff agencies in 2019. We assessed prioritization of alcohol-impaired driving enforcement, use of specific enforcement strategies (saturation patrols, sobriety checkpoints, open container law enforcement, training field officers to identify driving impairment), and agency and jurisdiction characteristics. We assessed how priority of enforcement (high vs. low) was associated with use of specific strategies, and agency and jurisdiction characteristics using regression models that accounted for agencies nesting within states. RESULTS: A majority of agencies (68%) placed a high priority on alcohol-impaired driving enforcement. Almost all agencies (93%) reported performing at least one alcohol-impaired driving enforcement strategy and the most common strategy used was saturation patrols. Agencies that prioritized alcohol-impaired driving enforcement were more likely to use sobriety checkpoints and saturation patrols, conduct enforcement of open container laws and train field officers in identifying driving impairment (p < 0.05). They were also more likely to have an officer assigned primarily to alcohol enforcement, have an alcohol division, and serve jurisdictions that had fewer Black residents (p < 0.05). CONCLUSIONS: Many law enforcement agencies utilize strategies to address alcohol-impaired driving, however, some strategies are underutilized and an opportunity exists for agencies to incorporate additional strategies to help prevent alcohol-impaired driving. Agencies that made alcohol-impaired driving enforcement a priority were more likely to conduct related enforcement strategies. Encouraging police and sheriff agencies to prioritize alcohol-impaired driving enforcement may be an effective approach for preventing alcohol-related harms.

Strategies Used by Local Law Enforcement Agencies to Prevent Overservice of Alcohol in the United States.

Overservice of alcohol, defined as commercial provision of alcohol to an individual who is obviously intoxicated, is illegal in most states and contributes to motor vehicle crashes and violence. Law enforcement agencies use various strategies that aim to reduce overservice at licensed alcohol establishments (e.g., bars, restaurants). Place of Last Drink (POLD) data collection is an emerging overservice enforcement strategy. POLD identifies patterns of overservice, which can provide support for targeted interventions to prevent overservice at offending establishments. We describe the prevalence of POLD and other overservice enforcement strategies and associations with agency characteristics, which has important implications for public health and safety. We conducted a national survey of 1024 municipal (e.g., town, city) and county law enforcement agencies in 2019 (response rate = 73%). We assessed the use of overservice enforcement strategies conducted by the agencies over the past year. We examined associations of each type of overservice enforcement strategy with agency and jurisdiction characteristics using regression models. 27% of responding agencies reported conducting overservice enforcement and 7% conducted POLD data collection specifically. Municipal (vs. county) agencies and agencies with an officer assigned primarily to alcohol enforcement activities were significantly more likely to conduct overservice enforcement generally but not POLD data collection specifically. Overservice enforcement in general, and POLD data collection specifically, are not widely conducted. Prevention of overservice has the potential to reduce harms related to excessive alcohol consumption. Increased evaluation of overservice enforcement strategies should be prioritized.

An examination of how alcohol enforcement strategies by sheriff and police agencies are associated with alcohol-impaired-driving fatal traffic crashes.

Objective: Over 10,000 people die in alcohol-impaired-driving traffic crashes every year in the U.S. Approximately half of alcohol-impaired drivers report their last drink was at a bar or restaurant, and most bars and restaurants serve alcohol to patrons who are already intoxicated, known as overservice. Law enforcement agencies use various strategies to address alcohol-impaired driving and overservice but research on the effectiveness of these strategies is limited. Our objective was to assess whether law enforcement efforts focusing on alcohol-impaired driving and alcohol overservice were associated with alcohol-impaired-driving fatal traffic crashes.Methods: We conducted a survey of police and sheriff agencies in 1,082 communities across the U.S. in 2010 regarding their alcohol enforcement practices. We assessed whether the agency conducted: (1) alcohol overservice enforcement and (2) alcohol-impaired driving enforcement (sobriety checkpoints, saturation patrols, open container, overall alcohol-impaired driving enforcement). From the Fatality Analysis Reporting System (2009-2013), we obtained counts of alcohol-impaired-driving fatal traffic crashes (at least one driver had blood alcohol content ≥ 0.08) within the agency's jurisdiction boundary and within a 10-mile buffer. Using multi-level regression, we assessed whether each enforcement type was associated with alcohol-impaired-driving fatal crashes (per 100,000 population). For both the jurisdiction boundary and 10-mile buffer, we ran stratified models based on community/agency type: (1) small town/rural police; (2) urban/suburban police and (3) sheriffs.Results: In jurisdiction boundary models, urban/suburban communities where police conducted overservice enforcement (compared to those that did not) had fewer alcohol-impaired-driving fatal crashes (5.0 vs. 6.6; p = 0.01). For the 10-mile buffer, small town/rural communities where police agencies conducted overservice enforcement (compared to those that did not) had fewer alcohol-impaired-driving fatal crashes (16.9 vs. 21.2; p = 0.01); we found similar results for small town/rural communities where police used saturation patrols (18.7 vs. 22.1; p = 0.05) and had overall high alcohol-impaired driving enforcement (18.7 vs. 22.1; p = 0.05). The direction and the size of the effects for other types of enforcement and agencies were similar, but not statistically significant.Conclusions: Alcohol enforcement strategies among police agencies in small town/rural communities may be particularly effective in reducing alcohol-impaired fatal traffic crashes. Results varied by enforcement, agency and community type.

Global assessment of national mandatory vaccination policies and consequences of non-compliance.

BACKGROUND: Declining vaccination coverage and increasing hesitancy is a worldwide concern. Many countries have implemented mandatory vaccination policies to promote vaccination. However, mandatory vaccination policies differ significantly by country. Beyond case studies, no comprehensive study has compared these policies or the penalties for non-compliance on a global scale. METHODS: We conducted extensive keyword, policy, and literature searches to identify mandatory national vaccination policies globally and develop a comprehensive database. A mandatory national vaccination policy was defined as a policy from a national authority that requires individuals to receive at least one vaccination based on age or to access a service. Two reviewers independently evaluated evidence for a mandate and whether non-compliance penalties were incorporated. We categorized penalties into four types, based on the nature of the penalty. These penalties impact an individual's financial, parental rights, educational (i.e., child's school entry and access), and liberty status. We rated the severity within each category. RESULTS: Of 193 countries investigated, 54% (n = 105) had evidence of a nationwide mandate as of December 2018. The frequency, types, and severity of penalties varied widely across all regions. We found that 59% (n = 62) of countries with national mandates defined at least one penalty for non-compliance with a vaccine mandate. Among those, educational penalties (i.e., limiting a child's entry or ongoing access to school) were the most common (69%; n = 43), with most countries with educational penalties refusing school enrollment until vaccination requirements are met (81%; n = 35). CONCLUSION: We undertook a comprehensive assessment of national mandatory vaccination policies and identified a diversity of penalties in place to promote compliance. Our results highlight the need to critically evaluate the implementation of non-compliance penalties in order to determine their effectiveness and to define best practices for sustaining high vaccination uptake worldwide.

What Affects College Students' Decision to Intervene or Not Intervene When Someone Is Drinking Too Much?

OBJECTIVE: Medical amnesty policies aim to encourage individuals to help their peers who have been drinking too much by providing immunity for alcohol policy violations. We examined college students' decisions to intervene or not intervene when someone was drinking too much and reasons for not intervening. METHOD: We conducted secondary analyses using data from college students ages 18-25 who participated in the Healthy Minds Study, a national survey of mental health and substance use (N = 30,785; 65% female). We examined the prevalence of reasons for not intervening and estimated a multilevel multinomial logistic regression to answer our research questions. RESULTS: Nearly half (46.5%) of students reported being in at least one situation in the past year when someone was drinking too much. Among these students, 46.7% consistently intervened, 27.7% inconsistently intervened, and 25.6% did not intervene in these situations. The most common reasons for not intervening were: "I felt it was none of my business" and "I didn't know what to do." "I was afraid I'd get in trouble" was the least common reason for not intervening. Intervening differed by student characteristics, including age, gender, race/ethnicity, residence, international student status, and binge drinking. CONCLUSIONS: Fear of getting in trouble, the basis for amnesty policies, was not a major barrier preventing intervention behavior in our study. Our findings suggest that implementing amnesty policies may not lead to intervention behavior. Strategies that empower and compel students to help their peers and provide them with skills needed to help may lead to more intervention behavior.

NIAAA's College Alcohol Intervention Matrix.

The College Alcohol Intervention Matrix (CollegeAIM) is a user-friendly, interactive decision tool based on a synthesis of the substantial and growing literature on campus alcohol use prevention. It includes strategies targeted at both the individual and environmental levels. Commissioned by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), CollegeAIM reflects the collective knowledge of 16 separate experts in the field, which makes it unique relative to other summaries of the science. CollegeAIM is designed to help college stakeholders compare and contrast different evidence-based prevention strategies to select a mix of individual and environmental strategies that will work best on and around their campuses. CollegeAIM is a living document, which will be updated to keep pace with the science. Colleges are therefore encouraged to ensure that evaluations of individual- or environmental-focused strategies on their campuses or in their communities make it into the published literature.

Changes in alcohol policies and practices in bars and restaurants after completion of manager-focused responsible service training.

INTRODUCTION AND AIMS: Irresponsible and illegal serving practices at bars and restaurants, such as sales to obviously intoxicated patrons, can lead to various public health harms. Training managers of bars and restaurants in the development and promotion of responsible alcohol policies may help prevent risky and illegal alcohol serving practices. DESIGN AND METHODS: We implemented a training program for managers of bars/restaurants designed to establish and promote responsible beverage service policies/practices. The program included online and in-person components. Bars/restaurants were randomised to intervention (n = 171) and control (n = 163) groups. To assess changes in policies/practices, we surveyed managers prior to and at 1 and 6 months post-training. Logistic regression models assessed changes in policies/practices across time points. RESULTS: The proportion in the intervention group that had written alcohol policies increased from 62% to 95% by 6 months post-training while the control group increased from 65% to 79% (P < 0.05). Similarly, by 6 months post-training 70% of managers in the intervention group reported they had communicated to their staff how to cut off intoxicated patrons, a significant increase from baseline (37%) and from the change observed in the control group (43%-56%). Prevalence of other policies/practices also increased post-training but differences between intervention and control groups were not statistically significant. DISCUSSION AND CONCLUSIONS: Our training program appears to have led to implementation of some policies/practices. Additional studies are needed to determine how training can be combined with other strategies to further improve establishment policies and ultimately reduce alcohol-related harms.

Effects of a Hybrid Online and In-Person Training Program Designed to Reduce Alcohol Sales to Obviously Intoxicated Patrons.

OBJECTIVE: Overservice of alcohol (i.e., selling alcohol to intoxicated patrons) continues to be a problem at bars and restaurants, contributing to serious consequences such as traffic crashes and violence. We developed a training program for managers of bars and restaurants, eARM™, focusing on preventing overservice of alcohol. The program included online and face-to-face components to help create and implement establishment-specific policies. METHOD: We conducted a large, randomized controlled trial in bars and restaurants in one metropolitan area in the midwestern United States to evaluate effects of the eARM program on the likelihood of selling alcohol to obviously intoxicated patrons. Our outcome measure was pseudo-intoxicated purchase attempts-buyers acted out signs of intoxication while attempting to purchase alcohol-conducted at baseline and then at 1 month, 3 months, and 6 months after training. We conducted intention-to-treat analyses on changes in purchase attempts in intervention (n = 171) versus control (n = 163) bars/restaurants using a Time × Condition interaction, as well as planned contrasts between baseline and follow-up purchase attempts. RESULTS: The overall Time × Condition interaction was not statistically significant. At 1 month after training, we observed a 6% relative reduction in likelihood of selling to obviously intoxicated patrons in intervention versus control bars/restaurants. At 3 months after training, this difference widened to a 12% relative reduction; however, at 6 months this difference dissipated. None of these specific contrasts were statistically significant (p = .05). CONCLUSIONS: The observed effects of this enhanced training program are consistent with prior research showing modest initial effects followed by a decay within 6 months of the core training. Unless better training methods are identified, training programs are inadequate as the sole approach to reduce overservice of alcohol.

Attitudes and Practices Regarding Responsible Beverage Service: Focus Group Discussions With Bar and Restaurant Management and Staff.

Staff and management of bars and restaurants are the key players in assuring responsible beverage service (RBS) and preventing the overservice of alcohol to intoxicated patrons. We conducted six focus group discussions ( N = 42) with management and staff from bars and restaurants about RBS. We compared findings from these current discussions to results of focus group discussions conducted in the 1990s. In comparison to the earlier focus group discussions, we found that many managers and staff members had experience with RBS training programs, establishments generally had written alcohol service policies, and managers and staff members perceived greater likelihood of facing consequences from law enforcement for serving underage youth. Managers and servers also expressed greater concern about overservice of alcohol but did not report greater concern about potential legal consequences for overservice of alcohol than participants from the 1990s focus groups. Results of this study can inform training and enforcement approaches to addressing overservice of alcohol.

Alcohol Electronic Screening and Brief Intervention: A Community Guide Systematic Review.

CONTEXT: Excessive drinking is responsible for one in ten deaths among working-age adults in the U.S. annually. Alcohol screening and brief intervention is an effective but underutilized intervention for reducing excessive drinking among adults. Electronic screening and brief intervention (e-SBI) uses electronic devices to deliver key elements of alcohol screening and brief intervention, with the potential to expand population reach. EVIDENCE ACQUISITION: Using Community Guide methods, a systematic review of the scientific literature on the effectiveness of e-SBI for reducing excessive alcohol consumption and related harms was conducted. The search covered studies published from 1967 to October 2011. A total of 31 studies with 36 study arms met quality criteria and were included in the review. Analyses were conducted in 2012. EVIDENCE SYNTHESIS: Twenty-four studies (28 study arms) provided results for excessive drinkers only and seven studies (eight study arms) reported results for all drinkers. Nearly all studies found that e-SBI reduced excessive alcohol consumption and related harms: nine study arms reported a median 23.9% reduction in binge-drinking intensity (maximum drinks/binge episode) and nine study arms reported a median 16.5% reduction in binge-drinking frequency. Reductions in drinking measures were sustained for up to 12 months. CONCLUSIONS: According to Community Guide rules of evidence, e-SBI is an effective method for reducing excessive alcohol consumption and related harms among intervention participants. Implementation of e-SBI could complement population-level strategies previously recommended by the Community Preventive Services Task Force for reducing excessive drinking (e.g., increasing alcohol taxes and regulating alcohol outlet density).

Sobriety checkpoint and open container laws in the United States: Associations with reported drinking-driving.

OBJECTIVE: The objective of this study was to assess how 2 types of drinking-driving laws-permitting sobriety checkpoints and prohibiting open containers of alcohol in motor vehicles-are associated with drinking-driving and how enforcement efforts may affect these associations. METHODS: We obtained 2010 data on state-level drinking-driving laws and individual-level self-reported drinking-driving from archival sources (Alcohol Policy Information System, NHTSA, and Behavioral Risk Factor Surveillance System). We measured enforcement of the laws via a 2009 survey of state patrol agencies. We computed multilevel regression models (separate models for each type of law) that first examined how having the state law predicted drinking-driving, controlling for various state- and individual-level covariates; we then added the corresponding enforcement measure as another potential predictor. RESULTS: We found that states with a sobriety checkpoint law, compared with those without a law, had 18.2% lower drinking-driving; states that conducted sobriety checks at least monthly (vs. not conducting checks) had 40.6% lower drinking-driving (the state law variable was not significant when enforcement was added). We found no significant association between having an open container law and drinking-driving, but states that conducted open container enforcement, regardless of having a law, had 17.6% less drinking-driving. CONCLUSION: Our results suggest that having a sobriety checkpoint law and conducting checkpoints as well as enforcement of open containers laws may be effective strategies for addressing drinking-driving.

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.

The alcohol policy environment, enforcement and consumption in the United States.

INTRODUCTION AND AIMS: Many studies of alcohol policies examine the presence or absence of a single policy without considering policy strength or enforcement. We developed measures for the strength of 18 policies (from Alcohol Policy Information System) and levels of enforcement of those policies for the 50 US states, and examined their associations with alcohol consumption. DESIGN AND METHODS: We grouped policies into four domains (underage alcohol use, provision of alcohol to underage, alcohol serving, general availability) and used latent class analysis to assign states to one of four classes based on the configuration of policies-weak except serving policies (6 states), average (29 states), strong for underage use (11 states) and strong policies overall (4 states). We surveyed 1082 local enforcement agencies regarding alcohol enforcement across five domains. We used multilevel latent class analysis to assign states to classes in each domain and assigned each state to an overall low (15 states), moderate (19 states) or high (16 states) enforcement group. Consumption outcomes (past month, binge and heavy) came from the Behavioral Risk Factor Surveillance System. RESULTS: Regression models show inverse associations between alcohol consumption and policy class, with past month alcohol consumption at 54% in the weakest policy class and 34% in the strongest. In adjusted models, the strong underage use policy class was consistently associated with lower consumption. Enforcement group did not affect the policy class and consumption associations. DISCUSSION AND CONCLUSIONS: Results suggest strong alcohol policies, particularly underage use policies, may help to reduce alcohol consumption and related consequences. [Erickson DJ, Lenk KM, Toomey TL, Nelson TF, Jones-Webb R. The alcohol policy environment, enforcement, and consumption in the United States. Drug Alcohol Rev 2015;●●:●●-●●].

Associations between Responsible Beverage Service Laws and Binge Drinking and Alcohol-Impaired Driving.

We explored potential associations between the strength of state Responsible Beverage Service (RBS) laws and self-reported binge drinking and alcohol-impaired driving in the U.S. A multilevel logistic mixed-effects model was used, adjusting for potential confounders. Analyses were conducted on the overall BRFSS sample and drinkers only. Seven percent of BRFSS respondents lived in states with the strongest RBS laws, 15% reported binge drinking and 2% reported driving after having too much to drink at least once in the past 30 days. There was no evidence of a significant association between RBS law strength and self-reported binge drinking or alcohol-impaired driving. Future studies should include additional information about RBS laws and use a prospective research design.