Prevention Enhancement Protocols System
(PEPS) Preventing Problems Related to Alcohol
Availability: Environmental Approaches Practitioners' Guide
Third in the PEPS Series Prakash L.
Grover, Ph.D., Executive Editor
Department of
Health and Human Services Substance Abuse and Mental Health Services
Administration Center for Substance Abuse Prevention DHHS
Publication No. (SMA)99-3298.
The Prevention Enhancement Protocols System (PEPS) Series, initiated by the
Substance Abuse and Mental Health Services Administration's Center for Substance
Abuse Prevention (SAMHSA/CSAP), exists for three reasons. PEPS guides strive to
systematically evaluate research and practice evidence on substance abuse
prevention,
make recommendations for field use by those who implement intervention
programs, and
maximize the prevention efforts of State substance abuse prevention
agencies, practitioners, and local communities.
Prakash L. Grover, Ph.D., M.P.H., is the Program Director of PEPS and the
Executive Editor of the Guideline series for CSAP. Robert Bozzo serves as Team
Leader for the PEPS. Friedner D. Wittman, Ph.D., M.Arch., Chair of the Expert
Panel, played a major role in writing the Reference Guide. He contributed to the
volume beyond reasonable expectations from a Panel Chair. For this, CSAP and the
Executive Editor are deeply grateful. Several other members of the Expert Panel
also helped write the Reference Guide: Norman Giesbrecht, Ph.D.; Katherine
Kessler, M.S., L.M.F.C.C.; Michael Sparks; Ralph Hingson, Ph.D.; and Karen Bass.
From the PEPS staff, Mim Landry and Prakash Grover wrote the core sections on
analysis of evidence and recommendations for practice. Cheryl Droffner provided
the indispensable research assistance that serves as a foundation of such
documents. Donna Dean helped refine the Reference Guide and developed the
Practitioner's Guide and the Community Guide. Betsy Earp and Chip Moore, with
assistance from Sara Davidson, edited the document.
Exhaustive review of the documents was conducted by Robert W. Denniston, Mark
Weber, Tom Vischi, and Christine Quinn. Their comments vastly improved the
document.
The deliberations and recommendations of the Expert Panel in this guide do
not necessarily reflect the opinions, official policy, or position of
SAMHSA/CSAP, or the U.S. Department of Health and Human Services.
This publication was prepared for SAMHSA/CSAP, with substantial assistance
from Birch & Davis Associates, Inc. (Contract No. 277-92-1011). Lee Wilson
served as the Government Project Officer of the Prevention Technical Assistance
to States project under which this publication was produced.
For single copies of this document, contact SAMHSA' s National Clearinghouse
for Alcohol and Drug Information (NCADI), P.O. Box 2345, Rockville, MD
20847-2345, 1-800-729-6686, 301-468-2600, or TDD 1-800-487-4889; or visit the
website at http://ncadi.samhsa.gov/. The
documents are also available electronically from the National Institutes of
Health at http://text.nlm.nih.gov/ftrs/dbaccess/csap.
The Substance Abuse and Mental Health Services Administration's Center for
Substance Abuse Prevention, (SAMHSA/CSAP), is committed to enhancing a broad
range of effective prevention strategies that are planned and implemented by
State agencies as well as community-based organizations across the Nation.The
Prevention Enhancement Protocols System (PEPS) generates science-based documents
that can substantially improve planning and management of prevention programs,
consolidate and focus prevention interventions, and serve as the foundation for
potential prevention studies.
CSAP selected this topic, Preventing Problems Related to Alcohol
Availability: Environmental Approaches, because alcohol problems affect many
individuals and groups in our communities, and there is an emerging body of
evidence that these approaches can be highly effective. In fact, research and
practice strongly suggest that carefully planned management of alcohol
availability can reduce alcohol problems and enhance the quality of life for all
members of the community.
But many communities neglect to manage alcohol availability problems through
the State and local government entities that exist for that very purpose.
Through these PEPS documents, CSAP is providing State and local governments with
a strong foundation for addressing alcohol problems that affect the well-being
of communities, using balanced approaches involving education, regulation, and
local resources for managing alcohol availability, consistent with the norms and
values of the community.
PEPS designed this guide for broad use by State substance abuse agencies as
well as national, State, and local organizations that try to manage the problems
related to the availability of alcohol. It is intended as a practical guide for
those whose responsibility it is to consider the strengths and limitations of
specific interventions and to plan prevention initiatives. Using this Guide in
combination with other ongoing community efforts can result in a balanced,
effective program to addressing alcohol problems.
Nelba Chavez, Ph.D. Administrator Substance Abuse
and Mental Health Services Administration
Karol Kumpfer, Ph.D. Director Center for Substance
Abuse Prevention Substance Abuse and Mental Health Services
Administration
This guide focuses on research and practice evidence for key environmental
approaches to the prevention of problems related to alcohol availability. It
evaluates the following six approaches:
Preventing Availability to Underage Youth
Raising Alcohol Taxes and Prices
Responsible Beverage Service
Changing the Conditions of Availability
Changing Hours and Days of Sale
Community-Based Prevention Approach
This practitioner's guide is intended to be brief and simple. It summarizes
much of the information in its parent document, Preventing Problems Related
to Alcohol Availability: Environmental Approaches-Reference Guide, and
highlights information that will be most useful to those directly involved in
planning and implementing prevention programs.
For much greater detail concerning the six prevention approaches, the
research and practice evidence for each approach, recommendations for practice,
and guides for program development, implementation, and evaluation, please see
the Reference Guide.
A separate brochure-length publication, Preventing Problems Related to
Alcohol Availability: Environmental Approaches-Community Guide, provides a
brief overview of substance abuse problems, outlines courses of action for
concerned citizens, and offers tips for becoming involved in community-centered
prevention.
Before developing guidelines for practitioners, the evidence that comes from
research and practice must be weighed. Several criteria are central to
determining whether information is strong enough to serve as the basis for
making recommendations.
The term research evidence refers to the research-based body of
knowledge for a specific prevention approach. This information is gathered from
scientific investigations that adopt various research designs but are all
rigorously conducted. When natural experiments are reviewed as evidence, it is
ensured that they are properly documented and analyzed.
design — an outline of the procedures to be followed in
scientific experimentation in order to reach valid conclusions.
The term practice evidence describes information gained from
prevention practice cases, which is generally presented in the form of
well-designed and -executed case studies that include documentation on program
implementation and procedures, as well as on process evaluation
effect — establishing, through comparison, a logical
relationship between conditions with and without the program or
intervention.
In each of the prevention approaches described in "Environmental Prevention
Strategies — What Works?," shaded boxes present information on levels of
evidence for the effect of intervention approaches. These boxes highlight the
consensus of the Expert Panel, whose members summarized the conclusions that can
reasonably be drawn after analyzing the evidence for each approach. The boxes
also indicate the strength of the level of cumulative evidence supporting the
conclusions.
The criteria for assigning levels of evidence are shown in the following
boxes. The first three categories apply to varying degrees of confirmation of
positive effect. The fourth category applies to evidence that a prevention
approach is ineffective.
1. Strong Level of Evidence
Application.
Practitioners can use the approach with the most assurance that the
approach can produce the effect specified in the evidence statement.
Here are the criteria for including evidence in this
category:
Consistent positive results of strong or medium effect from a series
of studies, including:
— At least three well-executed studies of experimental or
quasi-experimental design
OR
— Two well-executed
studies of experimental or quasi-experimental design and consistent
results from at least three case studies
The use of at least two different methodologies
Unambiguous time ordering of intervention and results
A plausible conceptual model ruling out or controlling for
alternative causal paths or explanations
2. Medium Level of Evidence
Application.
Although the number or rigor of the studies reviewed is limited, there is
substantial support for the approach's ability to produce the effect
specified in the evidence statement. Practitioners should exercise
discretion in applying the approach and in assessing the process and
outcomes.
Here are the criteria for including evidence in
this category:
Consistent positive results from a series of studies, including:
— At least two well-executed studies with experimental or
quasi-experimental designs
OR
— At least one
well-executed study and three prevention case studies showing
statistically significant or qualitatively clear effects
The use of at least two different methodologies
Unambiguous time ordering of intervention and results when so
measured
A plausible conceptual model, whether or not competing explanations
have been ruled out
3. Suggestive but Insufficient Evidence
Application. The approach has shown promise for the effect
specified, but it is not well documented. Practitioners should be cautious
about using this approach. However, if the approach fits the local
situation, practitioners may use it, paying special attention to its
systematic testing and documentation.
This category is
used to describe research and/or practice evidence that (1) is based on a
plausible conceptual model or on previous research and (2) is being
demonstrated in rigorous evaluation studies or appropriate intervention
programs currently in process.
Here are the conditions that lead
evidence to be included in this category:
The evidence, although limited, appears to support a conclusion, but
additional research is needed to fully support the conclusion.
This condition often applies to areas in which there has been little
study, such as those that are impractical to research or new areas of
study.
OR
The evidence is associated with equivocal results.
Effectiveness of the approach is supported in some studies but is not
supported in others.
4. Substantial Evidence of Ineffectiveness
Application. The approach has not demonstrated the intended
results or has shown negative findings for the effects specified.
Practitioners are advised not to use this approach at this time.
This category describes research and practice evidence
demonstrating that a prevention approach is not effective.
Here
are the conditions that lead evidence to be included in this category:
The absence of a statistically significant effect in a
majority of well-executed studies, including at least two quantitative
studies with sample sizes sufficient to test for the significance of the
effect
OR
The absence of a statistically significant negative effect in
a majority of well-executed studies, including at least two quantitative
studies with sample sizes sufficient to test for the significance of the
effect
All communities endure adverse health and social consequences related to
alcohol use and abuse. Many of these consequences are severe and expensive, such
as automobile-related injuries and fatalities, homicides and suicides, and
chronic health problems such as cirrhosis. Some of the most promising strategies
for these problems are community-based prevention activities that use
environmental approaches.
Reaching a single conclusion about a particular approach is difficult. No two
research studies or practice cases are the same, as they differ in the subjects
of evaluation and in the methods used. Conclusions from a single prevention
approach may justify more than one evidence statement since the approach may
have more than one desired result. Furthermore, evidence for a specific desired
result may show a complex pattern. For instance, studies may show that a
prevention approach has strong evidence for attaining a desired effect in
the short term but suggestive but insufficient evidence for sustaining
that effect over time.
Practitioners should evaluate the prevention approaches in this guide in
light of local circumstances; it may not be feasible to implement only
approaches with a strong level of evidence. In developing a program,
practitioners must consider local needs, interests, resources, and abilities —
as well as the level of evidence for a particular approach.
It takes prevention practitioners with great skill and dedication to develop
strong community-based programs. Despite the difficulty and complexity of the
challenges practitioners face, a growing body of research and practice evidence
has documented successful strategies that can change the social, political, and
economic contexts supporting alcohol availability.
The effective management of alcohol availability is a community
problem. The more available alcohol is in the environment, the more likely
it is that the community will have a higher alcohol consumption rate. A high
alcohol consumption rate has been found to be related to an increased number of
problems, such as the following:
Automobile-related injuries and deaths — Alcohol is a factor in 41
percent of traffic fatalities. Alcohol-related car crashes are the number one
killer of teens.
Homicides, manslaughters, and suicides — Alcohol is a factor in
more than 50 percent of homicides, 68 percent of manslaughters, and 33 percent
of suicides.
Head injuries — More than 50 percent of those who sustain head
injuries are drinking alcohol when injured.
Domestic accidents — Alcohol is a factor in 21 to 47 percent of
drownings, 35 to 63 percent of deaths due to falls, and 12 to 61 percent of
deaths due to fire.
High costs — In 1990, alcohol-related problems cost the Nation
$98.6 billion! That is a 40 percent rise between 1985 and 1990. Estimates for
the total lifetime cost for an individual with a severe head injury are as
high as $4.6 million.
Unprotected sex — Teens who drink are less likely to use condoms or
other methods to prevent pregnancy and sexually transmitted diseases.
These costly problems may strain community resources, including fire, police,
and ambulance crews; emergency department personnel and facilities; and the
court system. Therefore, prevention involves many community systems: health,
education, transportation, law, engineering, architecture, and public safety. It
takes the concerted effort of concerned citizens, community groups, businesses,
and officials from local and State agencies to develop and implement effective
strategies.
Although communities can largely manage these problems through State and
local government entities, many do not.
Efforts that focus solely on individual problem drinkers or on individual
outlets are not sufficient. Public health strategies must also prevent or reduce
problems related to availability through local laws, policies, and programs.
In practical terms, this means placing reasonable limitations on the retail
distribution of alcohol, on the operation of alcohol outlets, and on the
management of events at which alcohol is sold. This practitioner's guide
describes six prevention approaches that focus on limiting the availability of
alcohol in the community in order to help reduce alcohol-related
problems.
Communities that want to make an impact on the availability of alcohol
need to understand how alcohol is sold (made available) in the community; the
relationships between alcohol outlets and alcohol-related problems; and the
systems for managing alcohol availability.
Three forms of alcohol availability are of particular interest.
Retail availability — Commercial availability. Dimensions of
control include price, density of outlets, types of outlets, serving
practices, hours and days of sale, and one-day and short-term licenses. The
relationship between retail availability, consumption, and public health and
safety problems is the primary focus of this practitioner's guide.
Public availability — Public events and places. Public availability
is usually controlled by local jurisdictions, but the State Alcohol Beverage
Control (ABC) board may control availability at State-sponsored events or
locations.
Social availability — Social customs and traditions related to
alcohol use. Social availability is the product of community history, beliefs,
and cultures that shape the norms for drinking and social host practices at
private events. (This type of availability is not a direct focus of this
guide, but it does affect other forms of availability.)
To make an impact on alcohol availability, practitioners and community
leaders should have a common understanding of a few terms, the most important
of which are defined below. A full glossary is provided in appendix B.
Alcohol outlet — A place that sells alcoholic beverages to the
public or a select membership. Outlets vary throughout the United States
because of differences in State regulations and types of retail alcohol
licenses. Licenses are issued to applicants to sell alcohol for consumption
on, off, or both on and off their premises.
Alcohol outlet capacity — The serving capacity of one outlet or of
all outlets in a given area. On-sale capacity is calculated by the number of
seats in the outlet or the outlet's square footage. Off-sale capacity is
calculated by the number of linear feet of shelves devoted to alcohol sales or
the outlet's square footage.
Alcohol outlet density — The number of outlets licensed to sell
alcohol within a given geographic area.
On- or off-sale outlet — An on-sale outlet is licensed to sell
alcohol for consumption within, but not outside of, its establishment.
Examples include bars, taverns, clubs, and some restaurants. An off-sale
outlet is licensed to sell alcohol for consumption outside of, but not within,
its establishment. Examples include liquor stores, supermarkets, wine shops,
gas stations, and minimarkets.
Changes in alcohol control systems and in the availability of alcohol can
have a significant impact on the patterns and problems of alcohol consumption.
The key environmental factors that influence where, when, and how much people
drink are types of regulations, enforcement practices, outlet density, hours and
days of sale, and forms of retail outlet availability.
Today, management of alcohol availability is based on a system of State ABC
boards. State laws regarding the oversight of alcoholic beverages preempt those
of cities and counties. However, since the late 1970's, the States have
delegated varying degrees of power to local governments for retail licensing and
local enforcement.
alcohol management — ways in which a State plays a role
visà-vis the local authorities in controlling the distribution and marketing
of alcohol.
The ways in which States approach alcohol management can be divided roughly
into four categories: (1) Some States prohibit local control of alcohol
availability and marketing in virtually all circumstances. They are called
"control States." (2) Many States place primary authority at the State level but
allow local control through zoning ordinances and local police enforcement of
alcohol laws. (3) Some States provide concurrent State and local authority. (4)
Many States give primary authority to local jurisdictions, with only limited
State involvement. They are called "license
States."
Most local jurisdictions do not fully use their powers to prevent problems
related to alcohol availability. But this picture is changing as communities
begin to recognize the negative impact alcohol outlets can have. Communities
that might once have taken action only after problems arose are now taking
action to prevent problems from arising.
Cities and counties are beginning to put "alcohol elements" into their master
plans. They are also beginning to take stronger measures, such as these:
Writing zoning ordinances specifically to manage retail alcohol outlets.
These ordinances address such concerns as public decorum, litter, noise,
traffic, loitering, harassment, sale of alcohol to minors, underage drinking,
driving under the influence, alcohol-related crime and violence, and public
inebriation.
Imposing conditions on the sale and use of alcohol in public places and at
public events.
Setting policies regarding drinking at official public agencies'
activities and functions.
Enacting local ordinances (other than those tied to planning and zoning
ordinances) specifying how far away alcohol outlets must be from churches and
schools.
In an environmental prevention model, the focus on solving alcohol-related
problems shifts from an individual focus to an environmental focus.The logic is
that reducing alcohol availability will reduce alcohol consumption or modify the
conditions under which it is consumed, which will in turn reduce alcohol-related
problems such as violence, traffic injuries, and alcohol consumption by
minors.
Individual focus
Environmental focus
Individual behaviors
The relationship between the individual
Short-term program development
Individual participation in problem-solving
Policy and policy changes
The social, political, and economic and alcohol-related problems
contexts of alcohol-related problems
Long-term policy development
Collective action
As the PEPS Expert Panel evaluated research studies and practice cases, it
grouped the evidence into six prevention approaches. Each approach is presented
here in terms of its concept, the activities of the studies reviewed by PEPS,
the strength of the evidence supporting the approach, lessons learned from the
evidence, and recommendations for practice.
How do minors get their hands on alcohol? They get it from friends and family
members, they shoplift, and despite a minimum legal drinking age of 21 they buy
it directly from retail outlets such as convenience and grocery stores, service
stations, and minimarts. Enacting and enforcing laws prohibiting alcohol sales
to underage youth should reduce the likelihood that merchants will sell alcohol
to minors, who will in turn be less likely to try to buy it.
Merchants and minors often ignore the laws restricting alcohol sales to
minors. Community-based prevention efforts can educate and publicly support
merchants who comply with drinking age laws.
Levels of Evidence: Availability to
Youth
The research and practice evidence reviewed
indicates that it is possible to implement and enforce laws designed to
prevent alcohol availability to minors.
There is strong evidence that increasing the minimum
drinking age results in a decrease in traffic casualties.
There
is medium evidence that increasing the minimum drinking age
results in a decrease in consumption of alcohol and consequent alcohol
problems other than traffic casualties.
There is strong
evidence that there are substantial sales to minors and that there
is considerable potential for reduction of such sales.
There is
medium evidence that the level of enforcement affects the rates
of underage purchasing.
Most Americans who drink alcohol begin
in their early teens. Occasional intoxication for many begins during the
mid-teen years. Recurrent drinking to intoxication is quite common among
college students. It is clear that enforcement of minimum drinking age
laws decreases but does not eliminate underage drinking.
The
enforcement efforts with the greatest immediate public health
significance are those that break the link between drinking and driving.
All the prevention approaches presented in this guide should
be considered in view of their suggested application in the Evidence Boxes
(pp. 2-3). However, local needs, interests, resources, and abilities — as well
as the level of evidence — must all be considered as practitioners develop
their programs.
Enhance enforcement. Laws that increase the minimum drinking age help
to decrease alcohol consumption, traffic casualties, and alcohol problems.
However, these laws are not uniformly enforced and are often poorly enforced.
Therefore, practitioners should focus on enforcement. Efforts can include
creating linkages among several groups: the State ABC board, the local police,
college administrations, and others that promote community values and support
strict enforcement of drinking-age laws.
Unite efforts. A high minimum drinking age is more effective when it
is complemented by adjunctive efforts such as implementing land use laws
consistent with the enforcement of drinking-age laws.
Be consistent. The enforcement of minimum drinking-age laws differs
among communities and is affected by many factors, such as the police
department's service level or workload, community priorities, and availability
of funds. Community laws and enforcement policies should be consistent with
local prevention messages.
Anticipate crises. The enforcement of minimum drinking-age laws is
often driven by tragedies and crises. Anticipate crises that could occur during
special events such as rock concerts, high school and college activities, and
holidays. Many fraternities and sororities have activities that revolve around
drinking alcohol. These activities often escape the scrutiny of community and
university law enforcement agencies and university administrations until a
tragedy occurs. Work to prevent such tragedies by gaining the support of
fraternities and sororities to change norms that promote heavy drinking. If the
local chapters will not cooperate, enlist the support of their national
organizations and their insurance companies.
Educate underage youth. Most young people harbor false beliefs about
alcohol and driving impairment. Many think it would take several alcoholic
drinks or many beers to impair their driving. Research shows that one or two
alcoholic drinks or four or five beers often produce blood alcohol
concentrations in excess of the legal limit. Even with low to moderate blood
alcohol concentrations, younger people are more likely to be in traffic crashes
when drinking alcohol. This message needs to be brought home to
teenagers.
When States add new taxes that raise the price of alcohol, researchers have
the chance to study how the increased cost affects purchase and consumption
rates. The assumption is that significant increases in price will make alcohol
less accessible, especially to youth. On the other hand, "two for the price of
one" or other happy-hour promotions are thought to increase the likelihood of
overconsumption.
Most of the studies reviewed in this approach were not planned interventions
developed by public health practitioners but, rather, the observations of
"natural experiments." Natural experiments are changes — such as new State taxes
on alcohol — that offer researchers an opportunity to compare behaviors before
and after the changes take effect. Some of the factors that researchers examined
in this prevention approach are changes in State and local taxes on alcohol;
minimum legal drinking age; retail prices of wine, beer, and distilled spirits;
and happy-hour drink discount policies.
Increased alcohol taxes are associated with a moderate decrease in alcohol
consumption, as well as alcohol-related problems, and can be an important aspect
of a prevention campaign. Some research even revealed that, among underage
youth, taxes that increased price were more effective in reducing consumption
than a minimum legal drinking age.
Levy local taxes. Where State laws allow, local taxes such as a
"nickel-a-drink" tax for on-site purchases may be an effective way of both
financing local alcohol prevention initiatives and dissuading purchase. Local
license fees may also be employed to increase alcohol prices.
default State taxes. Because the benefits of price increases resulting
from State alcohol taxes are likely to diminish as inflation erodes the real
value of the tax increase, the taxes can be defaulted so that the nominal tax
rates rise in step with prices. defaulting alcohol taxes to the consumer price
default is an effective way to maintain the public health gains of higher
taxes.
Seek allies in neighboring jurisdictions. Practitioners who are
considering promoting alcohol taxes should initiate discussions and possible
collaboration with neighboring jurisdictions. The benefits of State alcohol
taxes erode when the strategy is out of step with that of neighboring
jurisdictions. Cross-border shopping, cross-border drinking and driving, theft,
and black-market sales may result. When neighboring jurisdictions adopt
equivalent regulations, such problems greatly diminish.
Levels of Evidence:Taxes & Prices
The
research evidence reviewed indicates the following:
There is strong evidence that increases in alcohol
taxes result in a moderate decrease in alcohol consumption.
There is strong evidence that increases in alcohol taxes
result in a moderate decrease in alcohol-related problems such as
automobile crashes, cirrhosis mortality, and driving under the
influence.
There is medium evidence that increases in
alcohol taxes result in roughly equivalent reductions in consumption of
alcoholic beverages among all drinkers.
There is suggestive
but insufficient evidence that increases in alcohol taxes have a
strong effect on drinking initiation among youngsters.
There is
suggestive but insufficient evidence that happy-hour promotions
increase alcohol consumption.
The behavior of people who serve alcohol and the policies of drinking
establishments can influence the behavior of the patrons. For example, servers
may encourage heavy drinking; allow heavy drinking to continue ignored,
promoting intoxication; or foster problems associated with intoxication, such as
disruptive behavior, fights and resulting injuries, or driving while intoxicated
(DWI). Training servers and management to watch for and recognize the warning
signs of intoxication can help reduce the risk that patrons will become
intoxicated and harm themselves or others. It may be necessary to modify
management policies to discourage an atmosphere of "anything goes."
Establishing a State law requiring responsible server training
Enforcing a county law prohibiting alcohol service to intoxicated patrons
Establishing a State Liquor Control Board with comprehensive prevention
activities
Establishing a coalition of representatives from the hospitality industry
and the prevention field to promote and ensure responsible beverage service
Levels of Evidence: Responsible Beverage
Service
The research and practice evidence reviewed
indicates that it is possible to implement responsible beverage server
interventions:
There is strong evidence that server training and
policy interventions are effective in curbing illegal sales to
intoxicated and underage individuals when these interventions are
combined with enforcement activities.
There is medium
evidence that server training and policy interventions are effective
in improving some forms of server behavior, at least in the short term.
There is medium evidence that server training can lead to
more responsible service practices and management policies.
Server training programs differ in type, intensity, length, and focus.
There is no evidence that certain server training program characteristics are
associated with greater or lesser effectiveness.
Server training programs are more likely to exist when stakeholders
(people with a special interest in the problem) offer support, organization,
and interest.
States, counties, and other local jurisdictions are appropriate vehicles
for establishing server training programs.
Responsible beverage service programs are most likely to succeed when
servers and managers know that the law will be enforced or realize that they
assume significant liability if they serve intoxicated or underage
individuals.
Enforce the law. All States and most local jurisdictions have laws
regarding the sale of alcohol to underage and intoxicated individuals. These
laws should be enforced strictly and uniformly.
Target trouble spots. Focus on high-risk establishments and training
their staffs. High-risk establishments include the locations where arrested
drunk drivers purchased their last drink. Much of the information for such
training can be collected by police during arrests, by counselors during
hearings, or by those training drivers convicted of DWI.
Keep the legal burden on owners. The strongest incentive to stop
owners from serving intoxicated or underage individuals in their establishments
appears to be revocation of the establishment's alcohol license. Owners are also
concerned with preventing injuries for which they might have civil liability. In
a few States, this liability has, unfortunately, shifted from owner to server.
States and jurisdictions should try to keep — or even increase — the burden of
legal responsibility on the owners, not their employees.
Provide incentives. Drinking establishments often need incentives to
participate in responsible beverage service activities. Prevention approaches
should include incentives regarding license retention, legal liability,
reputation, etc. Practitioners can highlight such incentives through persuasive
statements such as these:
"You don't have to worry about losing your license to sell alcohol
if you never sell it to intoxicated or underage individuals."
"You
protect yourself from legal liability arising from the behavior of impaired
patrons if you never serve anyone to the point of intoxication."
"You'll be known as an establishment with a good reputation if you
help keep the community safe and healthy by doing your part to prevent alcohol
abuse, addiction, and alcohol-related problems."
Intervene early. Early intervention (to revoke alcohol licenses) is
more effective than waiting until the problems associated with a drinking
establishment have progressed to a late stage.
Close license loopholes. When the State or jurisdiction revokes a
license, the license should not be allowed to transfer to a new owner — often a
friend or relative. Potential new owners should have to apply formally for a new
license.
Avoid grandfather exceptions. Licenses should not transfer to a new
owner unless all restrictions that apply to new licenses apply to the purchase
of the existing business.
Help establish standards for beverage service activities. At this
point, there are no clear national standards. Certain national organizations and
State agencies are working to define what components are essential, optimal, and
effective. Server training should be understood as one component of responsible
hospitality, which encompasses the following actions:
Developing community norms on the principles and practices of responsible
hospitality
Instituting professional development programs that train management and
service staff in responsible hospitality
Providing information and training for organizers and volunteers at
community events
Developing guidelines for employers and social hosts
Consistently enforcing regulations governing the sale and serving of
alcoholic beverages
Creating positive incentives to recognize and reward businesses and events
that practice responsible hospitality
Be sure alternatives to alcohol are offered. Managers of sales
establishments often see food and nonalcoholic drinks as less desirable because
they are less profitable. Responsible beverage service programs should encourage
managers and servers to provide these products. Such services encourage the use
of designated sober drivers and reduce intoxication.
Provide continuous server training. There is significant turnover
among alcohol servers. As a result, continuous server training should be offered
for entrants into the business as well as for experienced servers, who can
benefit from refresher sessions.
Alcohol availability is associated with social, civic, and health problems
and can be modified through government and community actions. These actions
include two distinct dimensions:
Controlling outlet density and restricting days and hours of alcohol sales
Restricting availability of alcohol at sporting and recreational events,
as well as at special locations such as parks and other publicly owned
facilities
While both aspects of this prevention approach are important, substantially
more research is needed on the second (i.e., restricting availability at special
events and locations).
The studies reviewed in this approach evaluated outcomes of "natural
experiments," including changes in legislation regarding alcohol sales
restrictions and regional differences in laws that allowed comparison between
regions. Some of the changes involved the following activities:
Eliminating State and provincial monopolies and privatizing retail alcohol
sales and wholesale alcohol sales and distribution
Changing a State law to remove off-sale restrictions on the sale of wine
and beer near campuses
Comparing differences in county-level prohibitions and State and local
laws, regulations, and policies pertaining to: liquor sales, distribution
methods, minimum legal age for purchase, and licensing of off- and on-premises
alcohol outlets
Comparing differences in county and city ordinances that range from
liberal to rigid control over outlet density
Instituting a law permitting grocery stores to sell table wine products
The following activities were examined in studies and practice cases
concerning alcohol availability at special events and locations:
Provincial regulations permitting the sale of beer at sporting events
Use of alcohol at city-owned recreational properties
Municipal policies regulating alcohol sales at specially licensed social
and recreational events in city-owned or -managed facilities
Community policies that establish alcohol rationing, prohibit public
drinking, and disallow congregating at parking lots and campgrounds
Levels of Evidence: Conditions of
Availability
The research evidence reviewed indicates
that it is possible to implement efforts that result in changes in alcohol
availability.
There is medium evidence that an increase in the
number of outlets per capita increases rates of alcohol consumption and
alcohol-related problems.
The research and practice evidence
reviewed indicates that it is possible to pass legislation regulating the
sale and consumption of alcohol at special events and locations.
There is suggestive but insufficient evidence that
controlling alcohol availability and training servers in sporting arenas
and at special events reduces the number of intoxicated persons and the
rate of abusive incidents involving intoxication.
Alcohol consumption levels and the rates of alcohol-related problems tend
to increase when a greater density of outlets and increased hours of sale
increase the availability of alcohol.
Although there is a clear relationship among alcohol outlets, high poverty
rates, and violence, the location and density of outlets are themselves
related to community power. For example, zoning laws often keep liquor stores
and high-risk businesses out of affluent neighborhoods.
The following lessons pertain to the regulation of alcohol availability at
special events and locations:
A wide range of restrictions can be placed on special events, including
restrictions on operating hours, noise levels, general location of event,
location of alcohol sales or places of consumption (such as beer gardens),
advertising of alcohol, alcohol sponsors, age of servers, quantity of sales,
size of containers, and condition of the customers.
Alcohol sales can be discontinued before an event is over, giving patrons
some time between their last drink and driving home. For example, alcohol
sales can be discontinued at the end of the third quarter of a football game.
Sales of food and nonalcoholic beverages can be required during and after
alcohol sales are cut off.
The following recommendations of the Expert Panel address general issues such
as geographic spacing of outlets and community compatibility.
Collect data on outlet density. When communities perceive problems
related to outlet density, it is important that they initiate a data
collection effort using individuals with skills in data collection and
analysis. Important information that should be gathered includes police
activities, citizen complaints, and State licensing complaints.
Become aware of licensing laws and processes. Community prevention
groups should become involved in issues such as density and spacing. They also
need to become aware of licensing laws and ways in which citizens can become
involved in the law-changing process. Laws are not changed unless there is
involvement and activity on the part of those who are affected; often, it is
the community that makes the difference.
Consider neighborhood compatibility. A specific outlet may be
incompatible with the surrounding area. For instance, an outlet may be
incompatible with other businesses or local residents — perhaps due to
late-night entertainment or hours of closing. The Expert Panel recommends that
all new applicants be interviewed by representatives of local residents and
businesses and be able to demonstrate to the city or licensing body that the
immediate neighborhood does not object to the business.
The following Expert Panel recommendations regarding regulations at special
events and locations address general issues such as alcohol control activities
at community events.
Plan ahead. Introduce discussions about alcohol control activities,
providing nonalcoholic beverages, and alcohol safety provisions early in the
planning stages of community-sponsored festivals, street fairs, and other
special events.
Train servers. Make sure that the people who will serve alcoholic
beverages at special events receive server training, understand relevant laws
and policies, and know the guidelines for resolving problems.
Disseminate rules. Develop simple guidelines for alcohol activities
before special events and publicize them through signs, brochures, and
printing of rules on tickets.
Use physical visual aids to separate drinking adults from nondrinking
ones. Providing nondrinking "family areas" decreases alcohol-related
incidents. This approach also attracts family customers who may otherwise stop
attending functions because they object to incidents of drunken rowdiness.
Hand-stamping adults or giving them identification bands as they enter special
events helps to enforce no-sales-to-minors laws.
Educate promoters. Alcohol-related problems at sporting events,
rock concerts, and other large special events can be categorized into two
types. The first type includes unpleasant behavior, rowdiness, fights, and
personal and property damage that occurs at the site before and during the
event. The second type includes arrests for DWI, driving casualties, street
fights, and other incidents that occur after and away from the event site,
often on the way home. Promoters are more likely to pay attention to the first
type. Fewer promoters adequately address the second type. Prevention
practitioners can sensitize promoters to the second type of problems and the
promoters' potential contribution in reducing them.
Address the need for a balance of interests. Permitting and
controlling alcohol use at sporting and special events involves balancing
several needs and concerns. Alcohol sales are a substantial source of profit
for stadium owners, sports teams, and catering companies. If alcohol-related
problems become numerous and severe, however, attendance may suffer and
liability issues can arise. Community interests can influence private profit
interests, helping all concerned to work together to achieve an acceptable
balance.
Level of Evidence: Hours and Days of
Sale
The research evidence reviewed indicates that, in
relation to changes in the days and hours of alcohol sales:
There is medium evidence that expanding the hours or
days of alcohol sales increases the rates of alcohol consumption and
alcohol-related problems.
Governments often influence the availability of alcohol by specifying the
hours of sale at specific sites and by allowing sales only on certain days.
Although seldom designed for prevention purposes, such changes are natural
experiments that provide opportunities to examine the effects on overall alcohol
sales and patterns of consumption.
The studies reviewed evaluated outcomes of natural experiments resulting from
changed alcohol sales laws. These changes included the following:
Increasing, decreasing, or shifting the hours during which taverns can
sell alcohol
Prohibiting Saturday sales at wine and spirits shops
Most of the research in this area reflects recent experience with extending
rather than reducing hours or days of sale and is based on research conducted
outside the United States.
Alcohol consumption levels and rates of alcohol-related problems tend to
increase when the hours and days of sale increase.
Reducing availability is difficult in an era when consumer convenience is
such a high priority. Even though one experiment (in Norway) demonstrated
clear positive results from Saturday closing, the political support was
lacking to continue or extend the closing.
Know the law. It's important for communities to be familiar with State
and local laws regarding hours and days of operation.
Be alert for chances to make the case for limited availability.
Knowing the law will enable communities to recognize and take advantage of
opportunities to exercise control.
Be alert to seemingly minor or innocuous changes in availability.
Proposals to extend hours or days of sale should be evaluated in light of the
fact that it is nearly impossible to reverse such changes.
Community-based initiatives to change local laws, regulations, or policies
offer a powerful resource for decreasing alcohol availability and the
accompanying alcohol-related problems. (This approach combines the most
promising elements of the other five approaches.)
Launching a comprehensive prevention program that included mass media
programming, a school-based education program, parent education, community
organizing, and health policy development components
Developing a community coalition of merchants, police officers, and
community organizations
Organizing a public education campaign led by a local council on
alcoholism and drug abuse in concert with the hospitality industry and
community-based prevention groups
Setting up a coalition that included a city planning committee, the city
council, and other city agencies working in concert with a university-based
prevention institute
The following are lessons learned and conclusions that can be drawn from the
research and practice evidence reviewed for this approach.
Community-based activities to control alcohol availability can lead to the
development of other alcohol-related prevention activities.
Community-based activities to control alcohol availability can be used to
enhance the effectiveness of prevention programs aimed at reducing drinking by
individuals.
Ad hoc coalitions can result in the establishment of permanent entities
for maintaining policy changes on alcohol availability and developing other
prevention activities.
Community organizing initiatives can be combined with mass media campaigns
to increase coverage of and debate on alcohol availability issues and proposed
changes in local laws, regulations, or policies.
Levels of Evidence: Community-Based
Approach
The research and practice evidence reviewed
indicates that community-based approaches can produce coalitions that
include multiple partners and address diverse issues:
There is strong evidence that community-based
prevention activities can result in decreases in alcohol consumption.
There is suggestive but insufficient evidence that these
programs can diminish driving after drinking, traffic death and injury,
and speeding.
community based prevention — a prevention approach that
relies on several interventions in concert, involving various sections of the
community, drawing on multiple local resources to address a community
problem.
It is important to note that, to be effective, coalitions need the
participation of the retail and wholesale beverage industries.
Use multiple, integrated strategies. Multicomponent,
community-based strategies are more effective than single-component
strategies. The individual components of a multicomponent strategy strengthen,
complement, and support one another. Multicomponent strategies create an
additive effect that is greater than the sum of the individual components.
Also, in the undesirable event of one component having to be eliminated, the
remaining components may continue to exert a significant preventive effect.
For example, in the area of responsible beverage service, a
multicomponent strategy could include mass media promotion, server training,
drinking establishment management policy and procedure development, community
monitoring to observe whether outlets serve intoxicated patrons and card
youthful patrons, and collaboration with law enforcement to take action
against offenders.
Develop ongoing support for change. Supporting change is just as
important as initiating it. Community coalitions that focus only on the
implementation of a policy or regulation will often see their gains diminish
unless they pay attention to sustaining the policy changes and related
prevention activities.
Continuously cultivate membership. Prevention practitioners need to
engage in ongoing efforts to recruit new members, maintain existing members,
and respond to new requests. Community coalitions should remain involved and
continue to monitor the community so that they are ready to take action as new
issues of alcohol availability arise.
Encourage communities to utilize practitioners. Prevention
practitioners are an important source of information, guidance, and resources
for community coalitions. When staff changes occur, it is important for new
practitioners to introduce themselves to the community and work to establish a
trusting relationship.
Organize mindfully. The success of community coalitions depends on
the participation and collaboration of local community groups, public
agencies, and organizers. Grassroots community members in coalitions should
have authority over the direction of the prevention efforts equal to that of
service providers, city officials, and other professional participants. Some
agencies and groups are good partners in certain coalitions but not in others,
depending on the issues. For example, the police are good coalition partners
for public safety issues. As public employees, however, their need to remain
impartial would prohibit them from being coalition partners for other, more
politicized, issues.
Identify, secure, and organize data to document your case. In
preparation for community coalition interventions, collect baseline data to
demonstrate the relationship between outlet density and problems. In many
cases, public agencies such as health and welfare departments, ABC's, police,
and education departments have such data in public records. Pay special
attention to finding innovative ways of visually presenting the information.
Action on both the State and community levels is necessary to implement
environmental approaches for reducing availability-related problems. The
community must establish — through local legislative bodies — public policies
that apply specific public health and safety standards to alcohol
availability.The community must then apply the standards, on a case-by-case
basis, to alcohol outlets.
Local planning and zoning ordinances offer a powerful opportunity to manage
retail availability. Community members should be actively involved in developing
these ordinances. Zoning ordinances can place the following limits on alcohol
outlets:
On-sale and off-sale outlets can be limited to certain
zones or disallowed altogether.
Density restrictions can limit
the number of alcohol outlets per unit of population, for a geographic area,
or as a percentage of all retail alcohol outlets in a given commercial area.
Spacing restrictions can specify the distance between alcohol
outlets or between alcohol outlets and schools, churches, residences, parks,
and playgrounds.
Hours of operation can be limited.
Conditions of design and operation can be established to ensure
that the premises are maintained safely and securely and that appropriate
practices are followed to prevent sales to underage youth, inebriates,
drinking drivers, and others.
Localities can make active or passive use of their zoning ordinances.
Active use involves a conditional use permit review of each application.
The review is conducted through a public hearing that gives neighbors and public
agencies an opportunity to identify high-risk features of the application.
Passive use involves using conformance to published zoning requirements
as the basis for granting a use permit.
To take action on alcohol availability problems, community members must work
with police, planning, community development, and parks and recreation
departments, and city attorney offices. Coordination and mutual support on
alcohol guidelines can improve policy formation, enhance policy implementation,
and provide clear signals and expectations for the public regarding the
reduction of availability-related problems.
The four steps outlined here can help localities use their existing powers to
become effective partners with the ABC authority in a joint effort to prevent
problems related to alcohol availability. Each step represents a "cluster" of
conceptually interrelated activities for implementing environmental approaches
in communities. The activities in these steps overlap and aren't always
sequential — early steps can be revisited as additional information becomes
available.
conditional use permit — a permit that is granted
pursuant to certain conditions, allowing the sale or consumption of
alcohol.
Local prevention initiatives must be based on a demonstrated link between
alcohol availability and community problems. Demonstrating this link helps
community members connect the problems they experience to their sources and
motivates them to get involved. It is also essential for the legal defense of
prevention policies and any conditions that affect the use of private
property.
To characterize availability-related problems, it is important to identify
and assess:
The nature of the problems
The physical location of the problems where the problems occur, such as at
public events, certain drinking establishments, fraternity parties, or high
school prom parties
Existing regulations and procedures concerning alcohol availability
Community attitudes about alcohol-related problems and the local history
of efforts to regulate availability
Knowing who will work with you (and who will not) is essential to developing
an effective strategy. Stakeholders are people with a special interest in the
problem. To identify them, ask,
Who has the power to effect change?
Who has access to that power?
Who is affected by problems such as drunken driving, violence,
difficulties in the workplace, loitering, and neighborhood blight?
Who has something to gain by ignoring the problems?
Particularly useful in this regard are the perspectives and duties of people
who live or work in the area; owners and managers of businesses (both
alcohol-related and others); and government officials and agencies, service
groups, and other interested parties.
Here are some ways to build a database from both informal and formal sources.
Data help demonstrate the link between alcohol availability and resulting
problems.
Collect data from the police, planning, and parks and
recreation departments, and the State ABC to establish the extent of
alcohol-related problems and incidents associated with various community
environments.
Use published and unpublished reports by local, State, and
Federal agencies as well as newspaper coverage of alcohol-related problems in
retail settings.
Talk with alcohol outlet patrons, servers, and members
of the general public.
Observe events or activities in or near alcohol
outlets.
Review literature on alcohol availability and its relationship
to public health and safety.
Communicate with agencies, organizations,
and individuals from other communities who have been active in addressing
alcohol-related problems in retail settings. Talking with them can save valuable
time. The very process of collecting this information can help focus energy in
your own community.
Use the technical assistance of individuals and
agencies with special expertise. Often, their expertise is available at little
or no cost. Consult some or all of the following:
State ABC's
The State substance abuse agency
Local police and planning departments
Foundations or publicly funded programs such as legal aid foundations or
health planning foundations
Federal agencies such as the Center for Substance Abuse Prevention (CSAP)
and the National Institute on Alcohol Abuse and Alcoholism
Well-organized groups can make significant changes in how, when, and where
alcohol is sold and served. To keep organizing efforts focused and effective,
all involved need to agree on the organizational approach and the role of
various participants.
The composition of the groups, the model of organizing, and the issues may
vary, but the underlying premise remains: Organizing the community is
fundamental to effecting change.
Community organizers need to understand the differences between mobilizing
for immediate action and organizing for long-term community improvement.
Immediate action may demand different membership than long-term improvement. The
approach also shapes how various other issues are handled. Issues of power,
control, community access, and goals are all colored by the choice of organizing
for immediate action or for the long haul.
Coalitions are made up of community-based organizations and smaller, less
formal grassroots groups that share common goals or concerns. Coalition-building
is an expanded form of community organizing. The more the coalition represents
the various facets of community that share a common goal, the more powerful and
respected it will be.
fortified wine — a wine that has had alcohol, usually in
the form of grape brandy, added to it either during or after fermentation.
Efforts that focus solely on individual problem outlets or drinkers have
proven inadequate. Broader prevention strategies are needed that set policies,
formulate ordinances, and affect the environments where alcohol is available —
especially high-risk environments.
High-risk outlets endanger public health, safety, and well-being. In general,
high-risk outlets engage in one or more of the following activities:
Allowing aggressive sales practices (sales with the intent to intoxicate)
Selling to underage youth
Selling to obviously intoxicated persons
Contributing to, or neglecting to address, drug trafficking on the
premises
Encouraging or allowing loitering near or on the premises
Neglecting to address on-site consumption of alcoholic beverages from open
containers in an off-sale outlet or on the premises
Not providing proper lighting or failing to institute other crime
prevention methods in known high-crime areas
Violating license restrictions on hours or days of sale
Marketing beverages such as fortified wines
Using promotions that encourage overconsumption, such as two drinks for
the price of one
Ignoring problematic patron behavior
Resisting working with the police and neighborhood groups to address
complaints
Organized pressure from the community can have an impact on high-risk outlets
that fail to comply with existing enforcement efforts. Community organizers can
try to meet with the owners of each high-risk outlet and remind them of the
stature they stand to gain by helping keep the community safe and of the license
they risk losing if they refuse to take corrective approaches.
Working with high-risk outlets in areas such as inner-city or high-poverty
neighborhoods, a collaboration of residents, churches, businesses, and social
and health service programs can bring about improved compliance and enforcement,
as well as the creation of stronger ordinances and public policies. Local groups
can also obtain relief through small claims court, by demanding vigorous
nuisance-abatement and code-enforcement activities, and by obtaining stronger
zoning laws for the regulation of alcohol availability.
problem outlet — a retail alcohol outlet that resists
cooperation with authorities or community groups in addressing high-risk
practices or community complaints.
Sometimes it takes a tragedy to motivate a community to take action.
Tragedy-based organizing occurs in communities that are frustrated by the
persistence of availability-related problems and the seemingly inadequate
official response to them. An excellent example is MADD, started by Candy
Lightener after her daughter was killed by a thrice-convicted drinking driver.
If a tragedy occurs, practitioners should use it to mobilize the
community.
The news media offer a very powerful tool for defining and publicizing needed
change. Media advocacy can make a significant impact on citizens' views about
alcohol-related problems and solutions. Media advocacy combines community
organizing, public policy support, and the use of several media sources (radio,
TV, newspaper) to promote specific prevention policies and to influence
policymakers to make changes.
Answer the following four questions to gauge the effectiveness of your
community organization effort:
Is the community selecting reduction of alcohol availability problems as a
concrete objective that everyone will work to support?
Has the community developed a productive planning process that achieves
results?
Is your group obtaining professional expertise and integrating your
program with public agencies in the community?
Does the group adequately explain the local community's problems to the
larger community, and does it take part in the larger community's political
process?
Taking action means bringing about changes to availability-related practices
and policies. Whatever their scope may be, all such changes will involve three
groups of stakeholders: the owners and managers, the occupants and neighbors,
and the officials and other interested parties. Each of these three stakeholder
groups exerts a particular kind of influence on activities associated with the
alcohol outlet(s) in question.
Owners and managers operate the alcohol environment. They determine who may
enter, and who may stay. They design the environment and manage the staff who
operate it. They set the rules for patron and guest behavior while in the
establishment or attending the event where alcohol is present. These rules
include provisions for the exit of staff, patrons, or guests if their behavior
is not acceptable. The owners and managers also are legally and financially
responsible for the environment.
Occupants and neighbors use the environment. Their uses of the setting and
behaviors at the event establish the kind of activities and quality of
experiences associated with the alcohol environment. Although the adult
occupants and neighbors are fully responsible for their individual behavior in
connection with these activities, they are also influenced strongly by the
behaviors of other occupants and neighbors and by the rules and expectations of
the facility's management.
Officials and other interested parties have particular obligations or
interests in controlling the environment. For example, State ABCand local police
officials are responsible for enforcement to protect public safety. Public
health officers and social service providers are responsible for guarding
against threats to public health and well-being posed by the environment. Banks
and insurance companies are concerned that the establishment's financial
operations are sound and legitimate.
Because the actions of these three stakeholder groups are so closely
connected in the local community, successful adoption of changes in alcohol
practices and policies for alcohol availability will require deliberate and
continuing efforts by the three stakeholder groups to work well with each
other.
It is important to move into action on specific alcohol problem environments
through the organized efforts of a community action group, as described in Step
2. The community prevention worker can provide coordinating and communication
assistance help to form a task force or working group dedicated to realizing the
prevention initiative that has been selected and specified through Steps 1 and
2. The community prevention worker can also help with special technical
assistance that may be needed. For example, a task force dedicated to
establishment of an effective Responsible Beverage Servicetraining program may
need a technical committee to identify the best training curriculum.
The community action group's other components are vital to help facilitate
the task force work upon which the three stakeholders are engaged. For example,
these other components of the community planning effort may include a Steering
Committee to help with liaisons to key agencies and organizations and with
monitoring and evaluation of prevention efforts, a Public Information Committee
to create press coverage and other community education activities, and a
Planning Committee to build a broad base of community support and understanding
for the initiative.
Maintain active participation. Stay involved in the policymaking and
monitoring process. The ongoing participation of concerned community groups and
organizations is critical to success.
Continue to learn about alcohol availability in your area. Help
document the pattern of problems at high-risk establishments and the impact of
alcohol availability on the health and safety of the community.
Provide critical support. Community organizations can provide
facilities, spread information, and recruit volunteers. Solicit the support of
the local business community.
Engage in self-monitoring. Businesses should monitor their compliance
with local policies. This process will enhance their credibility in the
community and will be extremely helpful in addressing problems created by
noncompliant outlets.
Help develop policy procedures. Owners and managers should meet
periodically with city agencies and community groups to jointly construct the
required steps and establish a timeline for compliance with local policies. This
approach brings businesses into the decision-making process.
Clarify standard review procedures. Local legislation and regulations
should be followed up quickly with instructions and guidelines that explain the
procedures for reviewing use permit applications from alcohol outlets. Trained
staff should be available to explain the procedures.
Monitor operations and reward compliance. Perform unannounced
compliance checks to determine whether outlets are selling to minors or
violating other restrictions specific to the community. The community also
should reward merchants who consistently comply with the law by acknowledging
and publicizing their efforts.
Train staff. Coordinate staff training at the various agencies that
implement alcohol policies.
Educate participants and support broad participation. Local public
agencies are responsible for educating community groups and explaining how to
participate in the review process. Planning and police departments should
educate alcohol retailers and guide them through the procedures for special-use
permits. Other efforts include introductory workshops for community groups,
retailers, and other organizations; pre-application and pre-enforcement
meetings; specialized briefings for those in high-risk areas; and building
community support through media advocacy.
Encourage responsiveness, promptness, and efficiency. The review
process should be a practical tool for preventing alcohol-related problems.
Protection of health and safety require prompt, efficient action. Implementation
of policies should include creative modifications of standard review procedures
to eliminate elements that have little preventive value or objectives that can
be accomplished by other means.
Collect local data. Most local data systems were not designed to
document problems related to alcohol availability. However, systems can be
redesigned to provide minimal but appropriate data to permit statistical
operations needed to demonstrate the prevalence of alcohol-related problems, as
well as to track progress over time.
Provide prompt and fair enforcement. The police often do not have
sufficient staff to effectively monitor and enforce compliance with availability
policies. However, several community actions can help, and the police can work
with community groups to identify and document problems. For example, the
community can set up a community-wide, user-friendly complaint system. Negotiate
with retailers before applying sanctions; apply sanctions firmly and promptly
when necessary.
Offer economic incentives. Local action to help retailers reduce their
dependence on alcohol sales will depend on the community's creativity and
economic conditions. For example, communities may encourage patronage of outlets
that shift away from the sale of high-risk alcoholic beverages. Local economic
development offices may be able to offer incentives that help retailers make
these shifts.
Work with other stakeholders. Inform insurance companies, national
owners of local chain outlets, investors and note holders, and other parties of
the community's alcohol availability policy and ask them to endorse it for their
operations in the community.
The following table presents examples of roles and responsibilities of local
public agencies in managing alcohol availability and related problems. In a
given setting, these roles and responsibilities will be determined by the
change-agent, the community, and the existing organizations and their commitment
and resources.
Institutionalization — occurs when a policy or program
is supported by the community and local or State governments and incorporated
in routine operations.
Institutionalizing a policy means incorporating it into an agency's or
community organization's routine operations. Alcohol availability policies
should be reviewed continually to determine whether they still address the
problems they were intended to solve. A policy should be responsive to changing
demographics and shifting business climates in its community.
Of the six prevention approaches presented in this guide, these four require
institutionalization activities:
Preventing Availability to Underage Youth
Responsible Beverage Service
Changing the Conditions of Availability
Community-Based Prevention Approaches
Institutionalizing local availability policies is challenging. Policies that
have been fully adopted and produce useful results are likely to gain
acceptance. Conversely, failure to diligently implement a local availability
policy can damage its credibility, even though it may be essentially sound. Even
after a policy is successfully implemented, people may lose sight of its
preventive value and begin to wonder why the community should bother to maintain
it. For all these reasons, it is critical to regularly review policies relating
to alcohol availability.
The review process should be driven by positive concerns for improving the
policy's effectiveness and efficacy. The ongoing review process involves the
following examinations:
Are administrators of an alcohol availability
policy responsive when availability problems are identified? Is there a
system to gather and analyze specific information related to alcohol problems
and then to distribute or make that information available to the appropriate
parties? Do official records accurately reflect and thoroughly note the nature
of community-based complaints about problem outlets? When problems are
identified, are managers made aware of them?
Is the policy fairly,
uniformly, and appropriately applied? Alcohol availability policies must be
administered to address real problems and must be applied in a nondiscriminatory
manner.
Is the policy easy to administer? Experience may show
that the original policy is difficult to implement or that it does not function
as intended. Changes in operating conditions and personnel in local
organizations and government bodies may also require adjustments. The search for
improvements in administration should be continuous. Modifications to the policy
should always be welcome when they make administration easier without
diminishing effectiveness.
Does the policy use recent research
findings regarding the link between public health and safety problems and
alcohol availability? Findings from this research should continue to flow
into local policymaking activities. The research should serve as one starting
point for continuing examinations of the policies currently in place.
Does the policy review process include community feedback?
Seeking comments and advice from the community makes for an informed and active
community. In such communities, it is more likely that local organizations and
private citizens will be able to speak clearly about the effect of availability
policies and in turn develop an ownership of these efforts.
Periodically convening a community group dedicated to the prevention of
availability-related problems will do much to renew the policymaking process
indefinitely. One way to stimulate the formation of such a group is to require
an annual or biannual report from the city manager to the city council. This
report should describe progress and outstanding issues and could serve as the
agenda for a community meeting.
Roles and Responsibilities of Local Public Agencies
Department or Agency
Chief Responsibility
Staff
Responsibilities
City attorney's office
Ensuring that procedures and practices apply applicable
laws at State and local level in ways that are most advantageous to the
locality.
Senior attorneys
Review interaction between State's and locality's
regulations of alcoholic beverages to provide basis for resisting legal
challenges to locality's authority to regulate land use where alcohol is
sold and (where permitted by the State) to regulate sale of alcoholic
beverages
Monitor legal issues and identify effective alcohol
ordinances in other localities
City/county manager's office
Coordination of contacts among all of the agencies and
reporting of their activities to the local legislature. Central planning
and review function helps ensure that all departments coordinate their
efforts and respond appropriately to retailers and concerned community
organizations regarding alcohol-related problems.
Senior management personnel
Coordinate work regarding alcohol availability across all
of the locality's departments
Establish task forces and alcohol
policy working groups.
Police or sheriff
Problem description and enforcement activities in relation
to all alcohol availability and drinking in public rights-of-way.
Patrol division Crime analysis unit Chief's office,
community-centered policing program, vice unit.
Report alcohol-related problems
Document link
between problems and availability
Work with State ABC, interpret
availability-related problem data, negotiate approvals and denials of
permit applications
Carry out proactive compliance and mitigation
activity such as decoy-buy operations, preventive visits to outlets and
neighborhood groups, consult with outlet operators and other agencies on
crime prevention and compliance issues
Planning and zoning
Approval and monitoring of distribution and operation of
retail outlets throughout the community
Line staff in zoning
Code enforcement staff
Long-range land use planning staff
Review department applications and make recommendations to
zoning approval boards Ensure compliance to conditions imposed by
approval process
code enforcement reviews and nuisance abatement
activities at outlets
Establish an "alcohol outlet desk" to focus
and coordinate activities and to respond rapidly to queries
Use
conditional use permits and other land-use measures to reduce high outlet
densities, facilitate case-by-case oversight, and establish preventive
conditions
Parks and recreation, community services
Sales of alcohol at special events and in public places (in
cooperation with sheriff's department)
Maintenance personnel
Program staff
Provide information about substance abuse in parks and
facilities
Review special-use permit requests for alcohol sales,
provide information to users of parks and facilities about alcohol use
policies, monitor events at which alcohol sales are permitted
Set
standards for alcohol use at public events
Housing and community services
Alcohol-related domestic violence
Key Staff
Work with landlords to develop policies to prevent problems
Assist police and social service domestic violence teams to work
with apartment management and residents
Agency for business licenses and permits
Collection of permit fees and use-permit application
fees
Key Staff
Community economic development agencies
Examine costs and benefits of alcohol outlets as
participants in community development projects
Key Staff
Establish fees levels for city services to reflect the
greater costs of alcohol outlets for police services and land-use
administration
Establishing "alcohol outlet elements" in
redevelopment plans
Prevention efforts do not end when a policy, law, or program goes into
effect. To ensure that alcohol availability problems are addressed, prevention
planners, practitioners, and community members need to answer two questions on
an ongoing basis: (1) Was the strategy properly implemented? and (2) Is the
strategy doing what it was intended to do?
To answer these questions, practitioners need to carefully plan — from the
beginning — what information will be collected and how it will be used. They
must collect baseline data on the community problems before intervention, data
on the intervention process itself, and data on the end results.
process evaluation — a descriptive and ongoing
evaluation that describes what happened as a program was started, implemented,
and completed.
Assessment involves two activities: documentation and evaluation.
Documentation entails keeping records, collecting data, and making
observations throughout the planning and implementation processes. Its key
purposes are to identify the problems, set the stage for planning and developing
prevention activities, and provide the information needed for evaluating the
activities. Evaluation is intended to assess the impact of prevention
activities, programs, or strategies.
Although the reasons for documenting and evaluating efforts to prevent or
limit alcohol availability vary according to the situation, the following
reasons are common to most efforts:
To better understand the
associations between retail alcohol systems and alcohol-related problems.
Studies may explore factors such as outlet density; rates of alcohol consumption
per adult; and alcohol-related problems such as drinking and driving, crime and
safety issues, and public drunkenness.
To justify, plan, or develop
prevention programming. Information can be gathered on alcohol availability
issues such as outlet density and capacity; licensing and enforcement practices;
land-use arrangements, zoning, and regulations; interaction of State and local
authority and management; and community retailing environments.
To
manage, operate, or administer activities. An alcohol retail system may be
monitored to determine whether it is being administered according to plan and
whether its arrangements and procedures are appropriate for the community.
To evaluate the impact of policies or programs. Studies may be
conducted to evaluate the effects of specific prevention activities. These
studies require both an intervention or "experimental" setting and a comparison
or "control" setting, with baseline and followup data for both settings.
Outlets, neighborhoods, and communities may be evaluated.
To guide
midcourse adjustments in prevention programming. Process or formative
evaluation of prevention interventions can be used to modify prevention programs
that are already under way. However, such midcourse corrections can create major
complications in attributing the effects to different components of the
intervention.
To interpret changes over time in retail system
arrangements, the role of prevention activities, and general trends in
society. Activities such as building coalitions or the very process used to
identify problems can be documented and evaluated to identify how prevention
efforts and prevailing popular trends affect alcohol availability policies and
procedures over time.
Experimental designs often exceed the needs and resources of local efforts
and are frequently nearly impossible to faithfully conduct at the community
level. Practitioners may wish to consider four nonexperimental evaluation
designs that are more feasible in terms of time and expense.
experimental design — a research design that included
random selection of study subjects, an intervention and a control group,
random assignment to the groups, and measurements of both groups.
Cross-sectional evaluation designs compare outlet density and rates of
alcohol-related problems for a given area. This method can be used to establish
the relationship between alcohol availability and alcohol problems, but it
cannot establish cause-and-effect relationships.
Pre-test/post-test evaluation designs can measure alcohol-related
problems and consumption before and after implementing the policy to evaluate
whether the policy achieved the intended effects. This method can suggest simple
cause-and-effect relationships. However, without a comparison group, you cannot
be certain that the change was due to the intervention and not some other
factor.
A time series pre-test/post-test design involves a group that is
tested at least once before a policy is implemented and is retested more than
once after the policy is implemented. These studies are costly and take a long
time to carry out; however, they offer greater confidence that changes result
from the policy, and that the measures are accurate. A stronger version of this
design is when a comparison community is studied at the same time intervals
without having received the intervention.
A natural study design uses both planned and unplanned changes in the
environment that — while not the direct result of a prevention intervention —
have an impact on alcohol availability. For example, the 1992 civil unrest in
Los Angeles destroyed 200 retail alcohol outlets. The effects of this sudden
decrease in outlets could then be examined. Planned natural experiments can also
be evaluated for their impact on consumption and alcohol-related problems. An
example of a planned natural experiment would be a State's decision to eliminate
its monopoly on retail alcohol sales and allow licensed retail sales. If
evaluators can respond quickly enough to such an opportunity, they may be able
to collect data both before and after policy changes take place.
Begin with an overview of the data that are readily available and a list of
the data you need. For example, you can use existing data from the community to
document the extent of the problem. However, special arrangements may be needed
to collect data for process assessment and outcome evaluations of prevention
interventions.
Data collection methods that can be used in studies of alcohol availability
include the following:
Literature reviews of alcohol availability and its associated public
health and safety aspects
Interview and questionnaire survey data obtained from patrons, servers,
and the general public
Contact with key informants and experts
Observational methods such as visual assessments of neighborhood
conditions or activities in or near licensed outlets
Archival data on alcohol sales, drinking-related problems, and numbers and
types of outlets
Special data collected by law enforcement officers and others concerned
with alcohol-related problems in the community
Contacts with other local agencies and organizations working on this
topic, as well as with State and Federal agencies, regarding the experiences
of model projects elsewhere
Legal, bureaucratic, and regulatory documents
Data on public and media reactions to availability issues
At the outset of a planning or evaluation process, devote a substantial
amount of time to outlining in detail the purposes and key questions or
objectives of the undertaking. Focusing on the information that is most critical
will help you avoid the pitfall of designing your evaluation around what data
you have, not what data you need.
Whenever possible, use several methods in combination. If feasible, use both
direct information — such as interviews or observations — and indirect
information — such as archival data on alcohol sales and police interventions —
to provide a broader data base.
Pay careful attention to the scope, coverage, validity, and reliability of
the data. Know how the data are collected, stored, and organized, as well as the
changes in protocols for data collection that have occurred over time that might
affect the quality or comparability of the data.
Recruit and train volunteers to collect and record data. In addition to
serving the needs of the evaluation, using volunteers will strengthen the
community organizing effort by actively engaging participants.
Set up a routine system for collecting data to inform planning and
evaluation. Setting up such a system is an effective use of resources and makes
it possible to use the same data for more than one project.
This Resource Guide compiles recommended resources for practitioners who
want to find out more about alcohol availability-related prevention
approaches.
The first section lists names and addresses of researchers and practitioners
whose work was considered as evidence in the evaluation of the research and
practice evidence for the prevention approaches. They are listed under the
approach they investigated. Because detailed descriptions of their program
planning and content is beyond the scope of this guide (and often is not fully
described in the published studies), CSAP felt that practitioners might want to
obtain more detailed information directly from these sources.
The second section lists the various Federal Government agencies and
nongovernment organizations that provide information, resources, and guidance
regarding alcohol availability-related interventions and programs. Some of these
have information clearinghouses.
alcohol management — ways in which a
State plays a role vis-á-vis the local authorities in controlling the
distribution and marketing of alcohol.
alcohol outlet — a place that sells
alcoholic beverages to the public or to a select membership for consumption on-
or off-premises. See also off-sale
outlet and on-sale
outlet.
commercial density — the percentage of
alcohol outlets in relation to the total number of other commercial (i.e.,
non-alcohol-related) outlets in a given planning area. See population
density.
community — a group of individuals who share
cultural and social experiences within a common geographic or political
jurisdiction.
community-based approach — a
prevention approach that relies on several interventions in concert, involving
various sections of the community, drawing on multiple local resources to
address a community problem. Programs that involve coordinated multiple
interventions are likely to be more effective in achieving the desired goals
than single-component programs and programs that involve multiple but
uncoordinated interventions. See also single-component
program.
community readiness — the degree of
support for or resistance to identifying substance use and abuse as significant
social problems in a community. Stages of community readiness for prevention
provide an appropriate framework for understanding prevention readiness at the
community and State levels.
conditional use permit — a permit
that is granted pursuant to certain conditions allowing the sale or consumption
of alcohol. It may be awarded on a temporary or permanent basis.
control system — a system in which the State
distributes and sells retail alcoholic beverages. See also license
system.
cross-sectional design — a research
design that involves the collection of data on a sample of the population at a
single point in time. When exposure and health status data are collected,
measures of associations between them are easily computed. However, because
health status and exposure are measured simultaneously, inferences cannot be
made that the exposure causes the health status.
data — information collected according to a
methodology using specific research methods and instruments.
data analysis — the process of examining
systematically collected information.
documentation (monitoring) —
entails keeping records, collecting data, and/or making observations in order to
obtain specific kinds of information; for instance, the rates of alcohol-related
problems, consumption, and sales.
effect — a result, impact, or outcome. In
evaluation research, attributing an effect to a program or intervention requires
establishing, through comparison, a logical relationship between conditions with
and without the program or intervention.
evaluation — entails analyzing the data
obtained through documentation in order to assess the operation or impact of the
service, program, or procedure.
experimental design — a research design
that includes random selection of study subjects, an intervention and a control
group, random assignment to the groups, and measurements of both groups.
Measurements are typically conducted before and always after the intervention.
The results obtained from these studies typically yield the most interpretable,
definitive, and defensible evidence of effectiveness.
fortified wine — a wine that has had
alcohol, usually in the form of grape brandy, added to it either during or after
fermentation.
geographic density — the density of
alcohol outlets per land area for a given geographic area, such as a planning
district, police reporting district, ZIP code, or census tract. See alcohol
outlet density.
happy hour — a promotional activity, usually
held during specific evening hours, in which bars and other on-site outlets
provide alcoholic beverages at a reduced price.
high-risk outlet — a retail alcohol outlet
that endangers the public health, safety, or well-being of the community. The
outlet may conduct high-risk promotional activities or contribute to excessive
noise, traffic, litter, loitering, or other problems. See also high-risk
setting and problem
outlet.
high-risk setting — denotes the location
of alcohol outlets where the threat to the health, safety, or well-being of the
community is escalated by other factors, such as high crime rates or dangerous
highways. See also high-risk
outlet.
institutionalization — occurs when a
program is supported by the community and local or State governments and
incorporated in routine operations. Although the program is accepted as a
routine and valuable practice at this stage, there is little perceived need for
change or expansion of the effort. See community
readiness.
intervention — a manipulation applied to a
group in order to change behavior. In substance abuse prevention, interventions
at the individual or environmental level may be used to prevent or lower the
rate of substance abuse or substance abuse-related problems.
lessons learned — in this guide,
conclusions that can be reached about a specific prevention approach based on
the research and practice evidence.
license system — system in which the State
licenses the private sector to distribute and sell retail alcoholic beverages.
See also control
system.
natural experiment — a change in a
situation, policy, or process, typically not initiated by researchers but which
can be evaluated. For example, the passage of a law that eliminates a State
monopoly and permits private retail alcohol sales may occur for reasons
unrelated to substance abuse prevention. However, researchers can evaluate the
effect of this natural experiment on alcohol consumption and alcohol-related
problems.
nonexperimental design — a type of
research design that does not include random assignment or a control group. With
such research designs, several factors prevent the attribution of an observed
effect to the intervention.
off-sale capacity — the linear feet of
shelves devoted to alcohol sales, or the square footage or floor space in a
retail alcohol outlet. See also on-sale
capacity.
off-sale outlet — a retail alcohol outlet
licensed to sell alcohol for consumption outside of, and not in, the licensed
establishment. See also alcohol
outlet and on-sale
outlet.
on-sale outlet — a retail alcohol outlet
licensed to sell alcohol for consumption within, but not outside of, the
licensed establishment. See also alcohol
outlet and off-sale
outlet.
outcome evaluation — an analysis that
focuses research questions on assessing the effects of interventions on intended
outcomes. See process
evaluation.
population density — in this guide, the
concentration of retail alcohol outlets per population unit, or the number of
outlets for a given population. See Commercial
Density.
practice evidence — in this guide,
information gained from prevention practice cases, generally compiled in the
form of case studies, which often include process evaluation information on
program implementation and procedures. See also research
evidence.
pre- and post-tests — in research design,
the collection of measurements before and after an intervention to assess its
effects.
problem outlet — a retail alcohol outlet
that resists cooperation with authorities or community groups in addressing
high-risk practices or community complaints. See also high-risk
outlet and high-risk
setting.
process evaluation — an assessment
designed to document and explain the dynamics of a new or continuing prevention
program. Broadly, a process evaluation describes what happened as a program was
started, implemented, and completed. A process evaluation is, by definition,
descriptive and ongoing. It may be used to the degree to which prevention
program procedures were conducted according to a written program plan. See outcome
evaluation.
qualitative data — generally constitute
contextual information in evaluation studies and usually describe participants
and interventions. The strength of qualitative data that often are presented as
text is their ability to illuminate evaluation findings derived from
quantitative methods. See also quantitative
data.
quantitative data — in evaluation
studies, measures that capture changes in targeted outcomes (e.g., substance
use) and intervening variables (e.g., attitudes toward substance use). The
strength of quantitative data is their use in testing hypotheses and determining
the strength and direction of effects. See qualitative
data.
quasi-experimental design — a
research design that includes intervention and comparison groups and
measurements of both groups, but assignment to the intervention and comparison
conditions is not done on a random basis. With such research designs,
attribution of an observed effect to the intervention is less certain than with
experimental designs.
questionnaire — research instrument that
consists of written questions, each with a limited set of possible
responses.
research — the systematic effort to discover or
confirm facts by scientific methods of observation and experimentation.
research evidence — in this guide,
information obtained from research studies conducted to evaluate the
effectiveness of an intervention and typically published in peer-reviewed
journals. The basis of this information is investigations whose designs range
from experimental to quasi-experimental to nonexperimental. See also practice
evidence.
single-component program — a
prevention approach using a single intervention or strategy to target one or
more problems. See also multicomponent program.
time-series design — a research design
that involves an intervention group evaluated at least once before the
intervention and more than once after the intervention. A time-series analysis
involves the examination of fluctuations in the rates of a condition over a long
period in relation to the rise and fall of a possible causative agent.
NOTE: This glossary is based partially on work performed by Westover
Consultants, Silver Spring, Maryland, and the Pacific Institute for Research and
Evaluation, Bethesda, Maryland, under other contracts with the Center for
Substance Abuse Prevention.
The Prevention Enhancement Protocols System (PEPS) is a process that
synthesizes a body of knowledge on specific prevention topics. It was created by
the Division of State and Community Systems Development of CSAP/SAMHSA primarily
to support and strengthen the efforts of State and Territorial agencies
responsible for substance abuse prevention activities. The PEPS program is
CSAP's response to the field's need to know "what works" and is an acceptance of
the responsibility for leading the field with current information supported by
the best scientific knowledge available.
This third guide in the PEPS series summarizes state-of-the-art approaches
and interventions designed to strengthen the role of communities in preventing
substance abuse and other alcohol-related problems. This topic was chosen in
response to the field's expressed need for direction and in recognition of the
important role of the environment as the first line of defense against the
dangerous, insidious, and addictive consequences of alcohol use.
The development of a PEPS guide begins with the deliberations of a Planning
Group of nationally known researchers and practitioners in the field of
substance abuse prevention. With input from their colleagues in the field, these
experts identify a topic area that meets preestablished criteria for developing
a guide. A Federal Resource Panel (FRP) with representatives from appropriate
Federal agencies then convenes to discuss the proposed content of the guide. The
FRP, taking into consideration recommendations from CSAP and the PEPS Planning
Group, identifies those experts in the field best suited to serve on an Expert
Panel for the chosen topic.
The Expert Panel meets to determine the scope of the problem to be addressed
in the guide. The PEPS staff conducts exhaustive searches for relevant research
and practice information, guided by the knowledge of the Expert Panel and its
chair. The studies and practice cases found are analyzed and their findings
compiled and presented in draft form according to the similarity of the
prevention approaches used.
A subpanel of selected Expert Panel members then meets to apply the PEPS
Rules of Evidence (described later in this section) to formulate summary
judgments on the quality of the research and practice evidence, by approach, and
to develop recommendations for the prevention field. This draft is reviewed by
the full panel. A revised version of the guide, including the revisions of the
Expert Panel, is distributed for review by the field. The critiques and analyses
received are used to further refine and increase the accuracy, readability, and
presentation of the guide.
The primary goal of PEPS is to develop a systematic and consistent process
for improving substance abuse prevention practice and research. Its objectives
are to
Synthesize research and practice evidence on selected topics
Present recommendations for effective substance abuse prevention
strategies in versions suitable for several target audiences
Ensure that PEPS products receive optimal dissemination among target
audiences
Monitor the usefulness and relevance of PEPS products
Although lessons from available science are distilled and specific
recommendations are made, this guide is not a "how-to" handbook, nor is it a
prescriptive prevention planning guide. Audiences for PEPS products include
State prevention agencies, other Federal and State authorities, and
community-based organizations addressing the problems of substance abuse or
serving high-risk populations. Therefore, targeted users of the PEPS guides
include policy analysts and decisionmakers, who need sound data to justify
funding for prevention planning; State agency and community-based administrators
and managers, who will find the series useful in allocating resources and
planning programs; researchers, who will receive guidance on the need for future
studies; and practitioners, who will find recommendations for programming
options that are most appropriate for the populations they
serve.
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