Effectiveness of crime prevention through environmental design in reducing criminal activity in liquor stores: a pilot study. Effectiveness of toughened glassware in terms of reducing injury in bars: a randomised controlled trial. Too drunk for a beer? A study of overserving in Stockholm. Promotion of responsible drinking in hotels. The role of alcohol providers in prevention: an evaluation of a server intervention programme. Education of key personnel in student pubs leads to a decrease in alcohol consumption among the patrons: a randomized controlled trial. Can training bar staff in responsible serving practices reduce alcohol-related harm? A randomized trial to evaluate a management training program to prevent illegal alcohol sales. Project ARM: alcohol risk management to prevent sales to underage and intoxicated patrons. A community-wide Responsible Beverage Service program in three communities: early findings. Long-term effects of a community-wide alcohol server training intervention. Responsible alcohol service: a study of server, manager, and environmental impact. Training bar personnel to prevent drunken driving: a field evaluation. Mandated server training and reduced alcohol-involved traffic crashes: a time series analysis of the Oregon experience.
Liquor store employees experience disproportionately higher rates of workplace injury death than employees in any other retail setting. However, efforts to introduce workplace violence prevention programs into liquor stores have been minimal. This study examines the effectiveness of a Crime Prevention Through Environmental Design intervention in reducing criminal activity in Santa Monica, California liquor stores. Nine stores enrolling in the study received an individualized intervention safety plan; the remaining 13 served as a comparison group. Mixed-effects Poisson regression was used to examine intervention effectiveness. The largest reductions in criminal activity occurred for robbery and shoplifting outcomes. We conclude that the Crime Prevention Through Environmental Design program reduced crime and injury in liquor stores and educated small businesses about the risks associated with retail violence and the countermeasures that can be taken. To evaluate the effectiveness, in terms of injury prevention, of toughened pint glassware in bars.
                Randomised controlled trial.
                A random sample of 57 bars in South Wales, West Midlands, and West of England.
                A total of 1229 bar workers.
                Complete replacement of pint glasses with annealed (control) or toughened (intervention) glassware.
                Bar staff injuries recorded monthly: number, site, and severity (lifestyle impact; treatment need) of injuries.
                Ninety eight bar staff experienced 115 injuries: 43 in the control group, 72 in the intervention group. Adjusting for people at risk gave a relative risk (RR) of 1.48 (confidence interval (CI) 1.02 to 2.15). Similarly, adjusting for hours worked gave RR 1.57 (CI 1.08 to 2.29). Thus, injury rate was 60% higher in the intervention group (p<0.05), with no significant difference in severity. Most were hand injuries requiring first aid. Injuries tended to occur simultaneously in more than one body part in the intervention group, reportedly caused by spontaneous disintegration of toughened glassware. Impact resistance testing showed the energy required to break annealed glass (1.8 +/- 0.2 J) was greater than that for toughened glass (1.4 +/- 0.2 J), though the difference was not significant.
                Glass with lower impact resistance caused more injuries. "Toughened" glassware had lower impact resistance. Standards for toughening need to be developed. To evaluate the effects of a community alcohol prevention programme on the frequency of alcohol service to intoxicated patrons at licensed premises.
                Pretest (1996)-post-test (1999) design.
                Licensed premises in Stockholm, Sweden.
                The community alcohol prevention programme, including server training in responsible beverage service (RBS) and policy initiatives in the community, has been conducted since 1996.
                Actors were hired to enter licensed premises, enact a scene of severe intoxication and attempt to order a beer. At the baseline in 1996, actors visited 92 licensed premises, 47 from the central part of Stockholm and 45 from the southern part of Stockholm. At the follow-up in 1999, 103 licensed premises were visited, 61 from the central part of Stockholm and 42 from the southern part of Stockholm. Observers monitored each visit.
                At follow-up the actors were denied service of alcohol at 47% of the licensed premises, a statistically significant improvement compared to 5% in the baseline study.
                Licensed premises refused service of alcohol to intoxicated patrons to a much greater extent than in the baseline study. The improved results can probably be explained by a combination of policy initiatives in the community, changes in the overall enforcement environment and RBS training. This study reports on an intervention programme to promote responsible drinking in hotels. The licensees of eight hotels agreed to participate in a trial of measures designed to assist patrons to avoid drink-driving, and seven other hotels were used as controls. The interventions acceptable to licensees comprised commercial-quality promotional material with the theme "0.05 Know Your Limits", and a breath analysis machine and poster on its use. Patrons leaving the hotels on Thursday, Friday and Saturday nights were interviewed and breath-tested. Although the intervention material had been seen by one-third of patrons in the intervention hotels, there was no significant difference between them and control hotel patrons in either median BAC or the proportion who were going to drive with BAC over the legal limit. There was poor compliance by hotels with the intervention procedures, indicating that a major impediment to the implementation and evaluation of programmes to promote responsible drinking is a lack of motivation by many licensees, despite support by some licensees and the Australian Hotels Association. Server intervention is a relatively new approach in the attempt to reduce the incidence of drinking and driving. Although a number of evaluations have suggested that the approach may be effective, there have been few comprehensive evaluations of such programmes. The present study utilized process evaluation techniques to assess reactions to a programme developed by the Addiction Research Foundation, and a quasi-experimental design to determine the impact of the programme on the serving practices of servers. Actors portrayed behaviours often faced by servers, and observers rated the reactions of the servers, who were unaware of the simulations, to these situations. The programme appears to have been effective in changing behaviour, in that trained servers exhibited less inappropriate responses than did untrained servers. In addition the results suggested that the programme increased servers' knowledge about their obligations and potential strategies for dealing with these situations. The implications of these findings for future implementations of such programmes are discussed. To decrease alcohol consumption among patrons in student pubs by server-training programmes.
                Randomized controlled trial.
                University campus.
                A total of 1322 students visiting local student pubs during ordinary pub evenings.
                Educational programmes were given to bartenders (n = 40) in a randomized design in six of 12 pubs on a university campus. Bartenders in control pubs were not given the programme.
                Breath alcohol concentration (BAC), expressed in percentage, among the patrons and the reported social atmosphere in the pub ('high', 'cosy' and 'rowdy') measured on a visual analogue scale in the pub before and after the intervention programme was given.
                BACs of patrons in the intervention pubs were reduced by more than those of the patrons in the control pubs at a 1-month follow-up. The mean difference in BAC between intervention and control groups was -0.011% (95% confidence interval, 0.022-0.000). The intervention group also decreased more in reported level of 'rowdy' social atmosphere than did the control group. The mean difference was -6 points (95% confidence interval -11 to -1). No differences were found in reported 'cosy' and 'high' atmosphere.
                Alcohol levels among the patrons were decreased and the 'rowdy' social atmosphere reduced in the intervention group. Server-training programmes for personnel in student pubs could be a component in the prevention of alcohol problems in university student populations. A responsible service training programme aimed at reducing alcohol-related harm was implemented in a popular entertainment area over several months in 1992-93. Another popular entertainment area provided a control site. A number of evaluation measures were used: breath tests on 872 patrons from selected venues; drink driving data; risk assessments; the use of 'pseudo patrons'; and knowledge and attitude changes among trained bar staff (n = 88). Compared to control sites the intervention sites showed an immediate pre- to post-test reduction in patrons rated by researchers as extremely drunk and an eventual reduction from pre-test to follow-up in patrons with blood alcohol levels > = 0.08. There was also a small but significant increase in knowledge among bar staff. There was no significant reduction in patrons with blood alcohol levels > = 0.15 or in the number of drink driving offences from intervention sites during the study period. Pseudo drunk patrons were rarely refused service, identification was rarely checked and non-photographic identification was accepted on most occasions. The less than satisfactory outcome is attributed to poor implementation of the training and a lack of support among managers. The positive results from one venue, whose manager embraced the programme, served to highlight the importance of management support. It is suggested that mandatory training and routine enforcement of licensing laws are essential if the goals of responsible serving are to be met. To evaluate effects of a training program for owners/managers of alcohol establishments-Alcohol Risk Management (ARM)-on: (i) propensity to sell alcohol to obviously intoxicated patrons; and (ii) changing establishment-level policies/practices.
                We assigned alcohol establishments randomly to intervention (full-ARM) and delayed-intervention/control (ARM Express) conditions.
                One large metropolitan area in Midwestern United States.
                Owners and managers at 231 on-premise alcohol establishments (i.e. bars, restaurants).
                Training programs consisted of one-to-one sessions with the owner/manager at each establishment. The goal of training was to help owners/managers to select and implement alcohol control policies in their establishments. The full-ARM training consisted of four one-to-one sessions and the ARM Express was a single session.
                We measured intervention effects through baseline and follow-up pseudo-intoxicated alcohol purchase attempts (i.e. feigning intoxication while attempting to purchase alcohol) and telephone surveys of owners/managers at alcohol establishments.
                Sales rates to pseudo-intoxicated patrons reduced 23% (relative to delayed-intervention/control condition) at the first follow-up purchase attempt (P = 0.06) but returned to baseline levels 3 months later. On average, establishments selected 13 of 18 recommended policies, but in multivariate models we observed no significant differences at follow-up in reported policies/practices across establishments.
                Reliance on manager training to promote responsible establishment alcohol policies is not sufficient to prevent illegal alcohol sales to obviously intoxicated patrons and to reduce alcohol-related problems. Clear policies and expectations are key to increasing responsible service of alcohol in licensed establishments. Few training programs focus exclusively on owners and managers of alcohol establishments to reduce the risk of alcohol service. Project ARM: Alcohol Risk Management is a one-on-one consultation program for owners and managers. Participants received information on risk level, policies to prevent illegal sales, legal issues, and staff communication. This nonrandomized demonstration project was implemented in five diverse bars. Two waves of underage and pseudo-intoxicated purchase attempts were conducted pre- and postintervention in the five intervention bars and nine matched control bars. Underage sales decreased by 11.5%, and sales to pseudo-intoxicated buyers decreased by 46%. Results were in the hypothesized direction but not statistically significant. A one-on-one, outlet-specific training program for owners and managers is a promising way to reduce illegal alcohol sales, particularly to obviously intoxicated individuals. Evidence accumulating over the past 10 years or so suggests that commercial servers of alcoholic beverages will intervene to reduce levels of impairment among their patrons and will refuse service to intoxicated customers. While some Responsible Beverage Service (RBS) programs have had significant effects on server and patron behavior, others have not. This leads us to consider issues of implementation and program effectiveness. In the current paper, a community-wide RBS program is described in some detail. The program was comprised by a larger comprehensive community intervention project in three sites across California and South Carolina. Process evaluation data, to track program implementation and proximal effects, provide early findings. Expressed support for RBS principles was high for both the public and the hospitality industry in all sites. A telephone survey of managers also suggests that prevention policies at bars and restaurants are beginning to show up, but a direct measure of server intervention with heavy drinkers does not yet demonstrate a program effect. The Rhode Island Community Alcohol Abuse and Injury Prevention Project (CAAIPP), implemented from 1984 through 1989, employed the "community gatekeeper" approach to reduce alcohol-related injuries and deaths. Targeting alcohol servers rather than drinkers, community-wide interventions were designed and implemented to encourage responsible serving behaviors through the adoption of techniques of responsible service. The primary goal of the CAAIPP server intervention evaluation was to assess both short-term and long-term changes in behavior of alcohol beverage servers who were recipients of CAAIPP training.
                A 5-hour training curriculum on "Responsible Alcohol Service" was offered to all alcohol servers in a randomly selected study community. A prospective study design was used to evaluate long-term changes in the self-reported behavior of 321 trainees using three time-points over 5 years. A cross-sectional survey was conducted 4 years posttraining to compare rates of self-reported server behaviors in the intervention community (n = 106) with two comparison communities (nA = 56, nB = 49).
                Fifteen months after training, trainees reported significantly higher levels of desired serving behavior than nontrained servers. Though positive effects of server training diminished with time, responsible serving behavior 4 years posttraining remained higher than pretraining levels. The impact appeared greatest for servers with fewer years serving experience, wait-persons, younger servers and servers who worked in establishments without written policies regarding serving practices.
                The results with regard to modifying server behavior are positive and indicate that server interventions shown to be efficacious should be implemented. Training programs that target specific serving skills in repeat sessions may be most promising for improving server behavior, particularly among both young and new servers working in establishments without written policies regarding serving practices. A responsible alcohol-service training program was evaluated for its impact on changing beliefs, knowledge, and behavior in 97 servers and 43 managers and on changing establishment policies that encourage safer drinking environments. The training program had a significant impact on changing the beliefs and knowledge of both servers and managers. Observation 4 to 6 weeks after training showed no effects on server behavior, but there was a tendency toward more establishment policies compared with controls. The potential of a server intervention program to decrease the likelihood that a bar patron will leave a bar intoxicated was evaluated. Research assistants posing as regular patrons ("pseudopatrons") visited two bars where about half of the servers had received server intervention training. Pseudopatrons set the occasion for server intervention to occur by drinking six alcoholic beverages in two hours. The blood-alcohol concentration (BAC) of the pseudopatrons was measured after they left the bar. Results revealed that trained servers initiated more server interventions than did untrained personnel. Moreover, pseudopatrons served by trained personnel reached substantially lower BACs than those served by untrained servers. These results suggest that, if implemented on a large scale, server intervention programs have the potential of reducing drunken driving by helping to decrease the exit BACs of bar patrons. This paper reports the results from an evaluation of the first statewide mandated training for alcohol servers. The state of Oregon introduced training for all alcohol servers (and for one year all owners/managers) beginning in December 1986. Servers must complete training once over a five-year cycle; by December 1989, over 50% of servers and managers had been trained. We found statistically significant reductions in single-vehicle nighttime traffic crashes (those with high percentage of alcohol involvement) by the end of 1989 following the implementation of the compulsory server-training policy.
There is insufficient evidence from randomised controlled trials and well conducted controlled before and after studies to determine the effect of interventions administered in the alcohol server setting on injuries. Compliance with interventions appears to be a problem; hence mandated interventions may be more likely to show an effect. Randomised controlled trials, with adequate allocation concealment and blinding are required to improve the evidence base. Further well-conducted, non-randomised trials are also needed when random allocation is not feasible.