Evidence-based Evidence-based Strategies to ReduceStrategies to Reduce

Alcohol-related InjuriesAlcohol-related Injuries

A REVIEW OF THE SCIENCEA REVIEW OF THE SCIENCE

Brenda Rooney, PhD,Brenda Rooney, PhD,

Epidemiologist, Epidemiologist,

Gundersen LutheranGundersen Lutheran

What are What are “evidence-based strategies”?“evidence-based strategies”?

Strategies that Strategies that based on databased on data have been shown to have been shown to reduce risk in a community. Usually these have been reduce risk in a community. Usually these have been studied through studied through tightlytightly controlled research studies. controlled research studies.

Strategies can include education, media campaigns, or Strategies can include education, media campaigns, or alcohol control policies.alcohol control policies.

Policies can affect how beverages are manufactured, Policies can affect how beverages are manufactured, packaged, distributed, sold and consumed. packaged, distributed, sold and consumed.

Policies can alter dimensions of the environment that Policies can alter dimensions of the environment that promotes overall consumption as well as hazardous promotes overall consumption as well as hazardous patterns of use.patterns of use.

Why should we consider Why should we consider evidence-based strategies?evidence-based strategies?

They will help us focus our energy on They will help us focus our energy on those strategies that have been shown those strategies that have been shown to work in other communitiesto work in other communities..

Can we consider other Can we consider other strategies too?strategies too?

CertainlyCertainly!!

Every community is unique. Strategies Every community is unique. Strategies need to be based on the unique assets need to be based on the unique assets and problems within and problems within ourour community. community.

Population/Host(Age, Gender,

Race/Ethnicity)

Agent/Vehicle(Content, Packaging

Warning Labels)

Environment(Pricing/Taxation,

Regulations, Media)

Applying the Public Health Model

Beer Keg RegistrationBeer Keg RegistrationWhat is it?What is it?

Beer kegs are marked with unique identification Beer kegs are marked with unique identification numbersnumbers

The keg id number is recorded along with the The keg id number is recorded along with the purchaser’s informationpurchaser’s information

When a keg from which underage youth drink When a keg from which underage youth drink alcohol is confiscated by the police, the alcohol is confiscated by the police, the purchaser is fined for supplying alcohol to purchaser is fined for supplying alcohol to underage persons.underage persons.

Keg purchasers sign a statement promising not Keg purchasers sign a statement promising not to sell to underage persons.to sell to underage persons.

Beer Keg RegistrationBeer Keg RegistrationWhy it’s importantWhy it’s important

Kegs are often a main source of alcohol at teenage Kegs are often a main source of alcohol at teenage parties. Kegs may encourage drinking greater quantities parties. Kegs may encourage drinking greater quantities of beer.of beer.

When police arrive at a party, people scatter. Without When police arrive at a party, people scatter. Without keg tagging, there is no way to trace who purchased the keg tagging, there is no way to trace who purchased the keg.keg.

Adults who provide alcohol to underage youth may be Adults who provide alcohol to underage youth may be deterred only if they believe they will face legal or deterred only if they believe they will face legal or financial consequences.financial consequences.

Keg registration works best if it covers a Keg registration works best if it covers a wide wide geographic area.geographic area.

Alcohol Warning PostersAlcohol Warning Posters- What is it?- What is it?

Notices or signs located in alcohol establishments that provide information Notices or signs located in alcohol establishments that provide information related to the legal, social, and health consequences of alcohol use.related to the legal, social, and health consequences of alcohol use.

They may include:They may include:

Penalties and consequences of providing/selling alcohol to underage or Penalties and consequences of providing/selling alcohol to underage or intoxicated personsintoxicated persons

The legal penalties of underage possession and consumptionThe legal penalties of underage possession and consumption

The establishment’s policies on checking IDs and refusing sales to intoxicated The establishment’s policies on checking IDs and refusing sales to intoxicated personspersons

Risks of consuming alcohol while taking certain medications or before drivingRisks of consuming alcohol while taking certain medications or before driving

A study in Arizona in 1992 one year after a state ordinance was passed, A study in Arizona in 1992 one year after a state ordinance was passed, showed that awareness of the sign and memory of the warning message showed that awareness of the sign and memory of the warning message increased.increased. Fenaughty 1993Fenaughty 1993

Drink specials restrictionsDrink specials restrictions

Promotional drink specials may encourage Promotional drink specials may encourage customers to consume a high volume of alcohol customers to consume a high volume of alcohol in a short period of time.in a short period of time.

ResearchResearch 3% decline in alcohol consumption after banning 3% decline in alcohol consumption after banning

happy hour in pubs in Ireland in 2003happy hour in pubs in Ireland in 2003 Numerous studies have shown that consumption Numerous studies have shown that consumption

increases because of drink specials.increases because of drink specials.

Recent challenge in MadisonRecent challenge in Madison

Price control/taxPrice control/tax Many studies have clearly established that Many studies have clearly established that

increases in alcohol taxes and increases in the increases in alcohol taxes and increases in the retail price of alcoholic beverages are retail price of alcoholic beverages are associated with:associated with: Decreases in alcohol consumptionDecreases in alcohol consumption Decreases in alcohol-related traffic crashesDecreases in alcohol-related traffic crashes Decreases in violent crimeDecreases in violent crime

Youth are especially sensitive to changes in Youth are especially sensitive to changes in price, which means that when prices rise, there price, which means that when prices rise, there are greater reductions in consumption and are greater reductions in consumption and alcohol-related problems among youth than the alcohol-related problems among youth than the general adult population. general adult population. Toomey 1999, Chaloupka 1993, Grossman, 1994.Toomey 1999, Chaloupka 1993, Grossman, 1994.

Price control/taxPrice control/tax States tax the sale of alcoholic beverages in one States tax the sale of alcoholic beverages in one

of two ways. of two ways. Most states apply an excise tax on alcohol called Most states apply an excise tax on alcohol called

“gallonage taxes” that are based on the quantity of “gallonage taxes” that are based on the quantity of beverage sold.beverage sold.

Some states apply a “percentage tax”, a tax based on Some states apply a “percentage tax”, a tax based on a percentage of the selling price.a percentage of the selling price.

3 basic taxes3 basic taxes Beer tax - $2/barrel (31 gallons)Beer tax - $2/barrel (31 gallons) Spirit tax - $3.36/gallonSpirit tax - $3.36/gallon Wine tax - $0.12-0.45/literWine tax - $0.12-0.45/liter

Price control/taxPrice control/tax

33rdrd lowest beer tax in the nation lowest beer tax in the nation Beer tax hasn’t increase since 1969Beer tax hasn’t increase since 1969 Special allowances for brewersSpecial allowances for brewers

WI beer exported elsewhere is exempt from the WI WI beer exported elsewhere is exempt from the WI beer taxbeer tax

Producers that brew less and 300,000 barrels pay Producers that brew less and 300,000 barrels pay only half of the tax on the first 50,000 barrelsonly half of the tax on the first 50,000 barrels

44thth highest per capita beer consumption in the highest per capita beer consumption in the nationnation

Population/Host(Age, Gender,

Race/Ethnicity)

Agent/Vehicle(Content, Packaging

Warning Labels)

Environment(Pricing/Taxation,

Regulations, Media)

Applying the Public Health Model

Alcohol Use Restrictions Alcohol Use Restrictions on Public Property - on Public Property - What is it?What is it?

Alcohol restrictions on public property control the Alcohol restrictions on public property control the availability and use of alcohol at parks, beaches and availability and use of alcohol at parks, beaches and other public spaces.other public spaces.

Total banTotal ban Restricted times or placesRestricted times or places

A range of polices may be implemented that:A range of polices may be implemented that: Prohibit possession of an open containerProhibit possession of an open container Establish standard procedures for dealing with intoxicated Establish standard procedures for dealing with intoxicated

persons in public areaspersons in public areas Require regular monitoring of public areasRequire regular monitoring of public areas Require responsible serving practices at special events in park Require responsible serving practices at special events in park

shelters for special events (e.g. weddings)shelters for special events (e.g. weddings) Establish standard enforcement proceduresEstablish standard enforcement procedures

Alcohol Use Restrictions Alcohol Use Restrictions on Public Property – on Public Property – Why it’s importantWhy it’s important

Underage drinking may occur in a variety of Underage drinking may occur in a variety of unsupervised places including parks, beaches, unsupervised places including parks, beaches, cemeteries or parking lots. It is easier to break up parties cemeteries or parking lots. It is easier to break up parties in public areas if the community has a policy.in public areas if the community has a policy.

Alcohol consumption in unsupervised places may be Alcohol consumption in unsupervised places may be related to problems such as fighting, vandalism and related to problems such as fighting, vandalism and public disturbances.public disturbances.

Creating the policy is not enough. It must be enforced.Creating the policy is not enough. It must be enforced.

Its important to identify where the alcohol was purchased Its important to identify where the alcohol was purchased so adult or commercial sources can also be targeted and so adult or commercial sources can also be targeted and punished.punished.

Alcohol Use Restrictions Alcohol Use Restrictions on Public Property – on Public Property – The evidenceThe evidence

Communities that have increased Communities that have increased enforcement of existing public alcohol use enforcement of existing public alcohol use policies report a reduction in alcohol-policies report a reduction in alcohol-related problems. related problems. Source: Cassady D, et al. Alcohol use at community Source: Cassady D, et al. Alcohol use at community

events: creating policies to prevent problems. San Diego events: creating policies to prevent problems. San Diego

County Alcohol Program and Applied Communication County Alcohol Program and Applied Communication

Technology, 1987. Technology, 1987.

Alcohol Restrictions Alcohol Restrictions at Community Events - at Community Events - What is it?What is it?

Include policies that control the availability and Include policies that control the availability and use of alcohol at public venues, such as use of alcohol at public venues, such as concerts, street fairs and sporting events. Such concerts, street fairs and sporting events. Such restrictions can be implemented voluntarily by restrictions can be implemented voluntarily by event organizers or through local legislation.event organizers or through local legislation.

Restrictions at these events can range from a Restrictions at these events can range from a total ban on alcohol consumption to the posting total ban on alcohol consumption to the posting of warning posters that detail the risks of warning posters that detail the risks associated with consuming alcohol.associated with consuming alcohol.

Alcohol Restrictions Alcohol Restrictions at Community Events - at Community Events - What is it?What is it?

A wide variety of restrictions can be considered at community A wide variety of restrictions can be considered at community events:events:

Establish non-drinking areas for families and youthEstablish non-drinking areas for families and youth Establish designated drinking areas where underage youth are not Establish designated drinking areas where underage youth are not

allowed; prohibit people from leaving these areas with alcoholic allowed; prohibit people from leaving these areas with alcoholic beveragesbeverages

Limit alcohol sponsorshipLimit alcohol sponsorship Have alcohol-free days/nightsHave alcohol-free days/nights Establish enforcement procedures for all policiesEstablish enforcement procedures for all policies Require responsible beverage service training for alcohol sellers and Require responsible beverage service training for alcohol sellers and

event coordinatorsevent coordinators Require alcohol sellers to be at least 21 years oldRequire alcohol sellers to be at least 21 years old Require a manager to be on duty at the alcohol booth at all timesRequire a manager to be on duty at the alcohol booth at all times Establish age identification checking proceduresEstablish age identification checking procedures Prohibit drinking by serversProhibit drinking by servers Require signs indicating the illegality of providing alcohol to minors and Require signs indicating the illegality of providing alcohol to minors and

obviously intoxicated persons.obviously intoxicated persons.

Alcohol Restrictions Alcohol Restrictions at Community Events - at Community Events - What is it?What is it?

A wide variety of restrictions can be considered at A wide variety of restrictions can be considered at community events:community events:

Establish procedures for handling intoxicated drinkersEstablish procedures for handling intoxicated drinkers Require that security staff be adequately trainedRequire that security staff be adequately trained Ban alcohol consumption in parking lots and monitor the lotsBan alcohol consumption in parking lots and monitor the lots Limit cup size to 12 ouncesLimit cup size to 12 ounces Use cups for alcoholic beverages that are easily distinguishable Use cups for alcoholic beverages that are easily distinguishable

from non-alcoholic beverage cupsfrom non-alcoholic beverage cups Limit number of servings per person per purchase to one or two Limit number of servings per person per purchase to one or two

at a time.at a time. Stop serving alcohol at least one hour before closingStop serving alcohol at least one hour before closing Sell food and non-alcoholic drinks and provide free water.Sell food and non-alcoholic drinks and provide free water.

Alcohol Restrictions Alcohol Restrictions at Community Events – at Community Events –

Why it’s importantWhy it’s important Underage youth may easily get alcohol by buying it or by having Underage youth may easily get alcohol by buying it or by having

friends over 21 buy it for them.friends over 21 buy it for them. Individuals who are already intoxicated may easily get alcohol at Individuals who are already intoxicated may easily get alcohol at

festivals and sporting events.festivals and sporting events. Alcohol use may fuel outbreaks of fighting and other forms of Alcohol use may fuel outbreaks of fighting and other forms of

disruptive behavior.disruptive behavior. Policies such as discontinuing alcohol sales during the last half or final Policies such as discontinuing alcohol sales during the last half or final

hour of the event or limiting the number of servings per person can hour of the event or limiting the number of servings per person can reduce alcohol-related problems. Stadiums can prohibit the sale of reduce alcohol-related problems. Stadiums can prohibit the sale of alcohol in the stands.alcohol in the stands.

Alcohol consumption at community events may cause other types of Alcohol consumption at community events may cause other types of disturbance within the community (noise, traffic, litter, parking, disturbance within the community (noise, traffic, litter, parking, property damage and vandalism.)property damage and vandalism.)

Alcohol consumption at a community event increases the chances Alcohol consumption at a community event increases the chances of drinking and driving.of drinking and driving.

Alcohol Restrictions Alcohol Restrictions at Community Events – at Community Events – The evidenceThe evidence

One study showed that youth were able to One study showed that youth were able to purchase alcohol in 50% of attempts at purchase alcohol in 50% of attempts at community festivals.community festivals.

This same study showed that at 50 This same study showed that at 50 different festivals, individuals appearing different festivals, individuals appearing obviously intoxicated were able to buy obviously intoxicated were able to buy alcohol in 89% of attempts. alcohol in 89% of attempts.

Source: Toomey TL et al. Illegal alcohol sales and use of alcohol Source: Toomey TL et al. Illegal alcohol sales and use of alcohol control policies at community festivals. Public Health Reports, control policies at community festivals. Public Health Reports, 120:33-27, 2000120:33-27, 2000

Public Intoxication PoliciesPublic Intoxication Policies The law allows police officers to cite intoxicated people The law allows police officers to cite intoxicated people

whom they believe constitute a danger or a public whom they believe constitute a danger or a public nuisance.nuisance.

Fines of up to $222 can be imposed, but those fines are Fines of up to $222 can be imposed, but those fines are waived for first-time offenders if they complete a class waived for first-time offenders if they complete a class about binge drinking.about binge drinking.

Disorderly conduct laws are less focused on education, nor does Disorderly conduct laws are less focused on education, nor does it allow for warnings.it allow for warnings.

By Dec. 31, police had issued 156 warnings and 89 public By Dec. 31, police had issued 156 warnings and 89 public intoxication citations. Of the 156 people warned, 78 completed intoxication citations. Of the 156 people warned, 78 completed the two-hour class.the two-hour class.

Renewed for another year 4/1/08-3/31/08 at the 3/11/08 Renewed for another year 4/1/08-3/31/08 at the 3/11/08 city council meeting.city council meeting.

Issues outside of La Crosse?Issues outside of La Crosse?

Social Host LiabilitySocial Host Liability What is it?What is it?

Adults who serve or provide alcohol to minors or persons Adults who serve or provide alcohol to minors or persons who are obviously intoxicated can be held liable if the who are obviously intoxicated can be held liable if the person who was provided alcohol is killed or injured or person who was provided alcohol is killed or injured or kills or injures another person.kills or injures another person.

In some states, social host liability is covered under In some states, social host liability is covered under dram shop law.dram shop law.

Dram shop liability refers to a drinking establishment’s potential Dram shop liability refers to a drinking establishment’s potential financial liability for serving alcohol to an intoxicated or underage financial liability for serving alcohol to an intoxicated or underage person who later causes injury to a third party. (Dram shop law person who later causes injury to a third party. (Dram shop law normally covers commercial service and not private parties.)normally covers commercial service and not private parties.)

Social Host LiabilitySocial Host Liability Why it’s importantWhy it’s important

Social host liability laws deter parents and other adults Social host liability laws deter parents and other adults from hosting underage parties and purchasing/providing from hosting underage parties and purchasing/providing alcohol for underage youth.alcohol for underage youth.

Social host liability laws send a clear message to adults Social host liability laws send a clear message to adults that providing alcohol to underage youth is not that providing alcohol to underage youth is not acceptable.acceptable.

Social host liability laws may act as a strong deterrent if Social host liability laws may act as a strong deterrent if providers believe that they will be sued if injury or death providers believe that they will be sued if injury or death occurs as a result of the provision of alcohol to an occurs as a result of the provision of alcohol to an obviously intoxicated personobviously intoxicated person

Social Host LiabilitySocial Host Liability The evidenceThe evidence

In an analysis of all 50 states, social host laws were In an analysis of all 50 states, social host laws were associated with reductions in drinking-driving and heavy associated with reductions in drinking-driving and heavy drinking. drinking.

Source: Goldberg. Social host liability for serving alcohol. Trial. March 31-33, Source: Goldberg. Social host liability for serving alcohol. Trial. March 31-33, 19921992

As of 2002, 32 states in the US had social host liability As of 2002, 32 states in the US had social host liability laws in place. In states that do not have host liability laws in place. In states that do not have host liability laws, cities and communities have passed social host laws, cities and communities have passed social host liability ordinances. 18 cities in San Diego County in liability ordinances. 18 cities in San Diego County in California passed social host ordinances in 2004.California passed social host ordinances in 2004.

Source: www.madd.orgSource: www.madd.org

Minimum Age of Seller Minimum Age of Seller Requirements – Requirements – What is it?What is it?

Policies that require the server or clerks at Policies that require the server or clerks at alcohol establishments be of a minimum age in alcohol establishments be of a minimum age in order to serve or sell alcohol. order to serve or sell alcohol. In most states it is 18. It can be controlled at the local In most states it is 18. It can be controlled at the local

level.level. Younger employees may be allowed to stock coolers Younger employees may be allowed to stock coolers

with alcohol or clear beverages from tables.with alcohol or clear beverages from tables.

Younger employees are more likely to sell to Younger employees are more likely to sell to underage youth and intoxicated patrons than underage youth and intoxicated patrons than older employees.older employees.

Responsible Beverage Service Responsible Beverage Service Training (Server Training)Training (Server Training)

- What is it?- What is it? Education of owners, managers, servers, and sellers at alcohol Education of owners, managers, servers, and sellers at alcohol

establishments about strategies to avoid illegally selling alcohol to establishments about strategies to avoid illegally selling alcohol to youth or intoxicated patrons.youth or intoxicated patrons.

Helps managers and servers/sellers understand policies and the Helps managers and servers/sellers understand policies and the consequences for failing to complyconsequences for failing to comply

Provides the necessary skills to comply with these policiesProvides the necessary skills to comply with these policies The importance of checking age id of customersThe importance of checking age id of customers How to identify fake IDs and what to do if a fake ID is confiscatedHow to identify fake IDs and what to do if a fake ID is confiscated How to recognize situations in which adults are buying alcohol for How to recognize situations in which adults are buying alcohol for

underage youthunderage youth How to refuse sales to individuals who may supply alcohol to underage How to refuse sales to individuals who may supply alcohol to underage

youthyouth How to identify intoxicated customersHow to identify intoxicated customers How to refuse service to underage youth and intoxicated customers.How to refuse service to underage youth and intoxicated customers. Offer food with drinksOffer food with drinks Delay service to rapid drinkersDelay service to rapid drinkers Discourage intoxicated patrons from drivingDiscourage intoxicated patrons from driving

Responsible Beverage Service Responsible Beverage Service Training (Server Training)Training (Server Training)

- The evidence- The evidence Research in Minnesota shows that server and Research in Minnesota shows that server and

management training reduced sales to youth by 11.5% management training reduced sales to youth by 11.5% and to intoxicated buyers by 46%. and to intoxicated buyers by 46%. Sources: Toomey 2001, Wagenaar 2005Sources: Toomey 2001, Wagenaar 2005

In California, sales to intoxicated customers was cut in In California, sales to intoxicated customers was cut in half. half. Source: Salz, 1987.Source: Salz, 1987.

Due to high staff turnover in many establishments, Due to high staff turnover in many establishments, owners and managers need to develop an on-going owners and managers need to develop an on-going system to train new employeessystem to train new employees

Requires good quality, face-to-face training with strong Requires good quality, face-to-face training with strong and active management support.and active management support.

Checking Age IdentificationChecking Age Identification-What is it?-What is it?

Age identification policies are written guidelines at stores, bars and Age identification policies are written guidelines at stores, bars and restaurants that provide employees instructions on checking IDs of restaurants that provide employees instructions on checking IDs of customers attempting to buy alcohol.customers attempting to buy alcohol.

Although studies show that less than 15% of youth use fake IDs, Although studies show that less than 15% of youth use fake IDs, there are several sources of fake IDs including:there are several sources of fake IDs including:

Alteration of one’s own IDAlteration of one’s own ID Use of someone else’s IDUse of someone else’s ID Applying for another person’s ID using stolen informationApplying for another person’s ID using stolen information Creating one’s own fake IDCreating one’s own fake ID Purchasing an ID from professional counterfeitersPurchasing an ID from professional counterfeiters

Checking IDs decreases the potential liability a server or seller could Checking IDs decreases the potential liability a server or seller could face for selling alcohol to an underage person.face for selling alcohol to an underage person.

ExampleExample

Identification Seizure – Newport, RIIdentification Seizure – Newport, RI When an establishment employee suspects an id When an establishment employee suspects an id

might be fake, he or she asks that person to wait until might be fake, he or she asks that person to wait until a police officer arrives to investigate. Usually the a police officer arrives to investigate. Usually the patron will abandon the fake ID and flee. If the patron will abandon the fake ID and flee. If the customer does wait the officer issues a citation and customer does wait the officer issues a citation and the fine is up to $500.the fine is up to $500.

In the first 3 months more than 400 fake IDs were In the first 3 months more than 400 fake IDs were collected from 5 bars.collected from 5 bars.

Compliance ChecksCompliance Checks What is it?What is it?

A compliance check is a tool to identify alcohol A compliance check is a tool to identify alcohol establishments that sell alcohol to underage establishments that sell alcohol to underage youth.youth.

The practice of compliance checks can be:The practice of compliance checks can be: Mandated by a local ordinanceMandated by a local ordinance Voluntarily implemented by law enforcement or Voluntarily implemented by law enforcement or

licensing authoritieslicensing authorities Compliance checks can be used for:Compliance checks can be used for:

EnforcementEnforcement EducationEducation

Compliance ChecksCompliance ChecksWhy it’s importantWhy it’s important

Alcohol licensees are informed that compliance checks Alcohol licensees are informed that compliance checks will occur at various times throughout the year and about will occur at various times throughout the year and about potential penalties for selling alcohol to underage youth.potential penalties for selling alcohol to underage youth.

While an enforcement agent waits outside the premises, While an enforcement agent waits outside the premises, a person under age 21 attempts to purchase or order an a person under age 21 attempts to purchase or order an alcoholic beverage.alcoholic beverage.

If the alcohol establishment sells alcohol to the young If the alcohol establishment sells alcohol to the young person, the enforcement agent issues a citation to the person, the enforcement agent issues a citation to the seller/server or the establishmentseller/server or the establishment

Because compliance checks can be used to hold the Because compliance checks can be used to hold the owner and seller accountable, it encourages the licensee owner and seller accountable, it encourages the licensee to adequately train, supervise and back up their to adequately train, supervise and back up their employee.employee.

Compliance ChecksCompliance ChecksThe evidenceThe evidence

Several studies show that in communities where there is Several studies show that in communities where there is little or no enforcement, youth can buy alcohol without little or no enforcement, youth can buy alcohol without showing their IDs in 45-50% of their attempted showing their IDs in 45-50% of their attempted purchases. purchases. Forster 1994Forster 1994

Two studies from the mid 1990’s found that after Two studies from the mid 1990’s found that after compliance checks were conducted, sales to underage compliance checks were conducted, sales to underage patrons reduced from 60-80% to 25-30%.patrons reduced from 60-80% to 25-30%. Lewis 1996, Preusser, 1994 Lewis 1996, Preusser, 1994

In a large study in Minnesota, sales to youth were In a large study in Minnesota, sales to youth were reduced immediately by 17% in alcohol establishments reduced immediately by 17% in alcohol establishments that experienced a check. that experienced a check. Wagenaar, 2005Wagenaar, 2005

Nationally, 66% of adults are in favor of compliance Nationally, 66% of adults are in favor of compliance check policies. check policies. Wagenaar, 2000Wagenaar, 2000

• Operational January 2005

• Three officers assigned

• Hours of operation 7pm – 3am

•Focused enforcement on alcohol violations

• Developed SOP’s on large party containment and dispersal & compliance checks

•Dual purpose: (1) Aggressive enforcement of alcohol related violations (2) Provide alcohol education

A.C.E.

Compliant rate:

2005 – 64%

2006 – 71%

2007 – 79%

Covert Compliance Checks

149 establishments were checked in June 2007;

118 passed.

Responsible Responsible Beverage ServingBeverage Serving

La Crosse Police La Crosse Police DepartmentDepartment

Identifying ID’s License Requirements Signs of Intoxication

Quantifiable results from aggressive enforcement:

Year Underage Citations Issued 10+ @ one location

2005 1,350 18

2006 1,186 11

2007 (Jan – July) 654 (1,116 projected)

Summary Report:

38% reduction in underage citations issued

12% reduction in incidents where 10 or more citation were issued at one location

Alcohol Sponsorship RestrictionsAlcohol Sponsorship Restrictions

Control of alcohol-related sponsors at community events.Control of alcohol-related sponsors at community events.

Sponsors provide financial support for the event in return Sponsors provide financial support for the event in return for promotions and advertisements at the event.for promotions and advertisements at the event.

Restrictions can be by a local ordinance, state law or can Restrictions can be by a local ordinance, state law or can be implemented voluntarily by a business, event or be implemented voluntarily by a business, event or organization.organization.

Promotions may send the message that alcohol is Promotions may send the message that alcohol is needed to have fun or to excel in athleticsneeded to have fun or to excel in athletics

Alcohol Sponsorship RestrictionsAlcohol Sponsorship Restrictions-An Example-An Example

In Oakland, California, the annual Cinco In Oakland, California, the annual Cinco de Mayo festival was not previously de Mayo festival was not previously associated with drinking, but in the 1980s associated with drinking, but in the 1980s there was an onslaught of nationwide there was an onslaught of nationwide advertising. A group in Oakland called advertising. A group in Oakland called Hispanos Unidos organized people in the Hispanos Unidos organized people in the community to find non-alcohol sponsors community to find non-alcohol sponsors for their festival.for their festival.

Sobriety CheckpointsSobriety Checkpoints The US uses selective breath testing checkpoints in The US uses selective breath testing checkpoints in

which law enforcement official must have reason to which law enforcement official must have reason to suspect that a driver who is stopped has been drinking suspect that a driver who is stopped has been drinking before a breath test can be administeredbefore a breath test can be administered

Some European countries use random breath testing in Some European countries use random breath testing in which all drivers are stopped and given breath tests.which all drivers are stopped and given breath tests.

Use of sobriety checkpoints have been determined to be Use of sobriety checkpoints have been determined to be legal by the US Supreme Courtlegal by the US Supreme Court

The research:The research: Based on 11 studies Based on 11 studies (Guide to Community Preventive Services, 2004)(Guide to Community Preventive Services, 2004)

Selective breath testing checkpoints are effective in reducing Selective breath testing checkpoints are effective in reducing fatal and non-fatal injury crashes by 20%fatal and non-fatal injury crashes by 20%

$6 - $23 Return on Investment$6 - $23 Return on Investment

Decrease the number Decrease the number of outlets per capita of outlets per capita

Alcohol outlet density refers to the number of alcohol Alcohol outlet density refers to the number of alcohol merchants available to a particular population or in a merchants available to a particular population or in a particular areaparticular area

Affects the availability of alcohol, its presence as part of Affects the availability of alcohol, its presence as part of the community culture, and the strain on local the community culture, and the strain on local enforcement agencies.enforcement agencies.

Several studies found the more outlets, the higher Several studies found the more outlets, the higher drinking and driving and riding with impaired drivers, and drinking and driving and riding with impaired drivers, and higher alcohol-related fatalities.higher alcohol-related fatalities.

La Crosse liquor license per capita as a county isn’t as La Crosse liquor license per capita as a county isn’t as high as some counties, but issue may be the high as some counties, but issue may be the concentration of liquor licenses in certain areas concentration of liquor licenses in certain areas (downtown)(downtown)

Community statistics from census:Community statistics from census:

Population/Host(Age, Gender,

Race/Ethnicity)

Agent/Vehicle(Content, Packaging

Warning Labels)

Environment(Pricing/Taxation,

Regulations, Media)

Applying the Public Health Model

Blood Alcohol Concentration LawsBlood Alcohol Concentration Laws

As of July 2004, all states have passed a As of July 2004, all states have passed a 0.08 BAC which established the legal level 0.08 BAC which established the legal level of intoxication for drunk drivingof intoxication for drunk driving

The research: The research: A review of 9 studies A review of 9 studies (Guide to Community Preventive Services, 2004)(Guide to Community Preventive Services, 2004)

Following implementation of the laws, the Following implementation of the laws, the median decrease in fatal alcohol-related median decrease in fatal alcohol-related motor vehicle crashes was 7%motor vehicle crashes was 7%

Estimates of the number of lives that could be Estimates of the number of lives that could be saved ranged from 400 to 600 lives per year.saved ranged from 400 to 600 lives per year.

Minimum drinking ageMinimum drinking age

Minimum legal drinking age laws specify an age Minimum legal drinking age laws specify an age below which the purchase of public consumption below which the purchase of public consumption of alcoholic beverages is illegal. In all states in of alcoholic beverages is illegal. In all states in the US the legal age is 21.the US the legal age is 21.

Minimum bar entry age in WI?Minimum bar entry age in WI? The Research: The Research:

A Review of 33 studies A Review of 33 studies (Guide to Community Preventive Services, 2004)(Guide to Community Preventive Services, 2004)

Raising the drinking age was effective at reducing the Raising the drinking age was effective at reducing the fatal injury crashes by 17% and fatal and non-fatal fatal injury crashes by 17% and fatal and non-fatal injury crashes combined by 15%.injury crashes combined by 15%.

Mass Media CampaignsMass Media Campaigns

Typically carried out in conjunction with other Typically carried out in conjunction with other programs and policiesprograms and policies

Where adequate local resources can support a Where adequate local resources can support a mass media campaign that is carefully planned, mass media campaign that is carefully planned, well executed and attains adequate audience well executed and attains adequate audience exposure, and is supported by other prevention exposure, and is supported by other prevention activities, mass media campaigns can be activities, mass media campaigns can be effective in reducing alcohol-impaired driving.effective in reducing alcohol-impaired driving.

Research:Research: 8 studies 8 studies (Guide to Community Preventive Services, 2004)(Guide to Community Preventive Services, 2004)

13% reduction in crashes13% reduction in crashes

Restriction on AdvertisementRestriction on Advertisement Includes any policies that limit advertising of alcoholic Includes any policies that limit advertising of alcoholic

beverages particularly advertising that exposes young beverages particularly advertising that exposes young people to alcohol messages. Can include:people to alcohol messages. Can include:

Banning ads on buses, billboards, supermarket carts, bus Banning ads on buses, billboards, supermarket carts, bus shelters, schoolsshelters, schools

Banning or limiting advertising and sponsorship at community Banning or limiting advertising and sponsorship at community events such as festivals, parties, concerts and sporting eventsevents such as festivals, parties, concerts and sporting events

Restricting alcohol advertising in newspapers, TV, or radioRestricting alcohol advertising in newspapers, TV, or radio

Restricting the size and placement of window advertisements in Restricting the size and placement of window advertisements in liquor and convenience storesliquor and convenience stores

Setting a maximum for the percentage of total advertising space Setting a maximum for the percentage of total advertising space that alcohol ads can coverthat alcohol ads can cover

Restriction on AdvertisementRestriction on AdvertisementAn ExampleAn Example

Oakland, California adopted a strict Oakland, California adopted a strict ordinance prohibiting alcohol ads on ordinance prohibiting alcohol ads on billboards in residential areas and near billboards in residential areas and near schools. The ordinance also banned schools. The ordinance also banned alcohol advertising within 3 blocks of rec alcohol advertising within 3 blocks of rec centers, churches, and licensed day care centers, churches, and licensed day care facilities.facilities.

Alcohol Education to YouthAlcohol Education to Youth

Peer-to-peerPeer-to-peer Expert ledExpert led Middle schoolMiddle school High schoolHigh school CollegeCollege

Alcohol Education to YouthAlcohol Education to Youth

School-based instructional programsSchool-based instructional programs Peer organizationsPeer organizations Social “norming” campaignsSocial “norming” campaigns

School-based instructional School-based instructional programsprograms

Many school-based programs exist- teach about Many school-based programs exist- teach about the health consequences of alcohol use and role the health consequences of alcohol use and role model how to avoid behaviormodel how to avoid behavior

Only a few are evidence-based.Only a few are evidence-based. E.g., Project NorthlandE.g., Project Northland

Research:Research: 5 studies on school-based intervention effectiveness 5 studies on school-based intervention effectiveness

suggest small benefits for preventing drinking and suggest small benefits for preventing drinking and drivingdriving

4 studies suggest small benefits to decreased 4 studies suggest small benefits to decreased likelihood of riding with drinking drivers.likelihood of riding with drinking drivers.

Peer-based programsPeer-based programs

Many peer-based programs exist Many peer-based programs exist E.g., Students Against Destructive DecisionsE.g., Students Against Destructive Decisions

Research:Research: 2 studies on peer-led programs have produced some 2 studies on peer-led programs have produced some

beneficial effects, but neither study found that their beneficial effects, but neither study found that their presence was associated with a significant decrease presence was associated with a significant decrease in drinking and driving or riding with drinking drivers.in drinking and driving or riding with drinking drivers.

Too much variability in programs to easily studyToo much variability in programs to easily study Community/culture specificCommunity/culture specific

Social Norming programsSocial Norming programs Social norming campaigns attempt to correct Social norming campaigns attempt to correct

students’ tendencies to overestimate the alcohol students’ tendencies to overestimate the alcohol consumption of peers, thus reducing the consumption of peers, thus reducing the perceived pressures to consume excessive perceived pressures to consume excessive quantities of alcohol.quantities of alcohol.

Research:Research: 2 studies on social norming. 2 studies on social norming. One found at 25% reduction in the number of drivers One found at 25% reduction in the number of drivers

with a positive BAC and 50% reduction in BAC with a positive BAC and 50% reduction in BAC about .08%about .08%

One found a self-reported increase in use of One found a self-reported increase in use of designated drivers and decrease in drinking and designated drivers and decrease in drinking and driving.driving.

Social Norms Approach Relies on hopeful tactics Relies on hopeful tactics Highlights protective behaviorsHighlights protective behaviors Uses media to expose solutionsUses media to expose solutions Uses policy to reward behavior changeUses policy to reward behavior change Results in partnerships working Results in partnerships working

effectively for health and safety.effectively for health and safety.

Protective practices, policies, and places are norms of the population and are reinforced with methods derived from the population.

Michael Haines, Northern Ill Univ

When asked, “When asked, “HowHow do you protect do you protect yourself and others when drinking at a yourself and others when drinking at a

party or social event?” Students party or social event?” Students replied:replied:

• Set a limit and stick to itSet a limit and stick to it• Avoid drinking gamesAvoid drinking games• Abstain for the nightAbstain for the night• Count your drinksCount your drinks• Pace yourself to one drink per hourPace yourself to one drink per hour• Drink a look-alike drinkDrink a look-alike drink

Results of Social Norms: Reductions in Heavy Drinking at

Universities 44% Northern Illinois University 40% Hobart and Wm Smith Colleges 28% University of Arizona 23% Florida State University 23% Rowan State University 20% Western Washington University 20% University of Virginia 18% Michigan State University

© Michael Haines 2006

Increasing the penalty Increasing the penalty for underage drinkersfor underage drinkers

Limited research/evidence with increased Limited research/evidence with increased penaltiespenalties

May achieve the same results by applying May achieve the same results by applying restrictions on licensingrestrictions on licensing Graduated drivers’ license lawsGraduated drivers’ license laws

Increasing the penalty/loweringIncreasing the penalty/loweringthethe BAC limits for BAC limits for

Young or inexperienced driversYoung or inexperienced drivers

In the US, the lower BAC laws apply to all In the US, the lower BAC laws apply to all drivers under the age of 21. The illegal BAC drivers under the age of 21. The illegal BAC level varies by state from any BAC to 0.02% (WI level varies by state from any BAC to 0.02% (WI is 0.00)is 0.00)

The Research:The Research: 6 studies have reviewed the impact of a lower BAC 6 studies have reviewed the impact of a lower BAC

level for young or inexperienced drivers: level for young or inexperienced drivers: (Guide to Community (Guide to Community

Preventive Services, 2004)Preventive Services, 2004)

Fatal crashes declined by 9-24%Fatal crashes declined by 9-24% Injury crashes declined by 4-17%Injury crashes declined by 4-17%

Alternate activities for youthAlternate activities for youth

Makes intuitive senseMakes intuitive sense Alternative activity needs to be seen to Alternative activity needs to be seen to

youth as a “true alternative.”youth as a “true alternative.” Research needed on the effectiveness of Research needed on the effectiveness of

alternative activities.alternative activities.

Designated Driver Promotion Designated Driver Promotion ProgramsPrograms

Programs use mass media and other communication Programs use mass media and other communication channels to promote designated driver usechannels to promote designated driver use

May commonly use incentives like free soft drinks, food May commonly use incentives like free soft drinks, food or free admission.or free admission.

Most commonly inform customers with a display in a bar.Most commonly inform customers with a display in a bar. Research:Research:

13% increase in “always” selecting a designated driver but not 13% increase in “always” selecting a designated driver but not change in self-reported alcohol impaired driving or riding with an change in self-reported alcohol impaired driving or riding with an alcohol-impaired driver.alcohol-impaired driver.

Incentive program increased the number of designated drivers Incentive program increased the number of designated drivers per night (+0.9)per night (+0.9)

6% decrease in self-reported drinking and driving6% decrease in self-reported drinking and driving

In the 1st six years of the program, over 280,000 people have utilized the “Safe Ride” program. The program was developed by the University of Wisconsin – La Crosse Student Association in cooperation with the City’s Mass Transit Authority. The program is currently administered by the La Crosse Tri-Campus Group and financed through student tuition fees. The program has been a model for other college communities throughout the state.

Operation River Watch is a grass roots

initiative utilizing community volunteers

to patrol Riverside Park, creating a safer

environment and increasing public awareness on the dangers of binge

drinking.