Illegal alcohol sales to obviously intoxicated patrons at licensed establishments

BACKGROUND: Early studies assessing propensity of alcohol sales to underage youth found that, before intervention, likelihood of licensed alcohol establishments selling alcohol to underage youth was 50% or higher across many communities. Community-wide interventions successfully lowered underage alcohol sales rates in several communities. Across studies assessing propensity for alcohol sales to obviously intoxicated patrons, sales rate estimates ranged from 58% to 85% for on-premise establishments (e.g., bars). No previous studies have assessed likelihood of alcohol sales to obviously intoxicated patrons in off-premise establishments (e.g., liquor stores). One goal of this study was to assess propensity for illegal alcohol sales to obviously intoxicated patrons at on- and off-premise establishments. Another goal was to assess whether server and/or establishment characteristics were related to the likelihood of illegal sales. Results may inform future interventions to reduce illegal alcohol sales at licensed alcohol establishments. METHODS: Trained actors attempted to purchase alcohol while acting out signs of obvious intoxication at a census of on- and off-premise alcohol establishments (n = 372) in 11 communities. The outcome variable was whether an establishment sold alcohol to a buyer. Independent variables included age and gender of server/clerk, type of establishment, area, exterior maintenance, type of license, and time of purchase attempt. Bivariate and multivariate analyses were conducted. RESULTS: Seventy-nine percent of the establishments sold alcohol to a buyer (83% and 76% at off- and on-premise establishments, respectively). Servers/clerks who appeared younger than age 31 and off-premise establishments were significantly more likely than older appearing servers and on-premise establishments to sell alcohol to buyers. CONCLUSIONS: The likelihood of alcohol sales to obviously intoxicated patrons in licensed alcohol establishments is very high. Interventions to reduce illegal alcohol sales to intoxicated patrons are needed.     

Propensity of alcohol establishments to sell to obviously intoxicated patrons

BACKGROUND: Although it is illegal to sell alcohol to an individual who appears obviously intoxicated, several recent studies show that the propensity of these types of sales is high. Our study further assesses the propensity of alcohol establishments to sell alcohol to obviously intoxicated patrons. In addition to providing more recent data (2001) on pseudo-intoxicated purchase attempts at Midwestern on-premise establishments, our study examines the association between establishment policies/practices and the likelihood of sales to intoxicated patrons. METHOD: We hired professional actors to feign intoxication while attempting to purchase alcohol (pseudo-intoxicated patrons) at 231 bars and restaurants, and we conducted a phone survey of owners/managers of each establishment. Our dependent variable was purchase attempt outcome (alcohol sold vs not sold). Our independent variables included policies/practices of establishments and characteristics of buyers/servers, establishments, and neighborhoods. RESULTS: Pseudo-intoxicated patrons were able to purchase alcohol in 65% of their attempts. Multivariate analyses showed the following: (1) compared with establishments with beer- and/or wine-only licenses, establishments with full liquor licenses were less likely to sell to intoxicated patrons; (2) establishments with average length of employment among managers of at least 1 year were more likely to sell to obviously intoxicated patrons; and (3) establishments that held staff meetings at least once a month were less likely to sell to obviously intoxicated patrons. Neighborhood characteristics were not associated with our outcome in multivariate analyses. CONCLUSIONS: Our findings provide increased evidence of the need to address the illegal sale of alcohol to intoxicated patrons, particularly given that increased intoxication levels among patrons resulting from these types of sales can lead to alcohol-related problems.     

A randomized trial to evaluate a management training program to prevent illegal alcohol sales

AIMS: 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. DESIGN: We assigned alcohol establishments randomly to intervention (full-ARM) and delayed-intervention/control (ARM Express) conditions. SETTING: One large metropolitan area in Midwestern United States. PARTICIPANTS: Owners and managers at 231 on-premise alcohol establishments (i.e. bars, restaurants). INTERVENTION: 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. MEASUREMENTS: 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. FINDINGS: 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. CONCLUSIONS: 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.     

Preventing youth access to alcohol: outcomes from a multi-community time-series trial*

AIMS/INTERVENTION: The Complying with the Minimum Drinking Age project (CMDA) is a community trial designed to test effects of two interventions designed to reduce alcohol sales to minors: (1) training for management of retail alcohol establishments and (2) enforcement checks of alcohol establishments. DESIGN: CMDA is a multi-community time-series quasi-experimental trial with a nested cohort design. SETTING/PARTICIPANTS: CMDA was implemented in 20 cities in four geographic areas in the US Midwest. MEASUREMENTS: The core outcome, propensity for alcohol sales to minors, was directly tested with research staff who attempted to purchase alcohol without showing age identification using a standardized protocol in 602 on-premise and 340 off-premise alcohol establishments. Data were collected every other week in all communities over 4 years. Mixed-model regression and Box-Jenkins time-series analyses were used to assess short- and long-term establishment-specific and general community-level effects of the two interventions. FINDINGS: Effects of the training intervention were mixed. Specific deterrent effects were observed for enforcement checks, with an immediate 17% reduction in likelihood of sales to minors. These effects decayed entirely within 3 months in off-premise establishments and to an 8.2% reduction in on-premise establishments. CONCLUSIONS: Enforcement checks prevent alcohol sales to minors. At the intensity levels tested, enforcement primarily affected specific establishments checked, with limited diffusion to the whole community. Finally, most of the enforcement effect decayed within 3 months, suggesting that a regular schedule of enforcement is necessary to maintain deterrence.     

Likelihood of illegal alcohol sales at professional sport stadiums

Background: Several studies have assessed the propensity for illegal alcohol sales at licensed alcohol establishments and community festivals, but no previous studies examined the propensity for these sales at professional sport stadiums. In this study, we assessed the likelihood of alcohol sales to both underage youth and obviously intoxicated patrons at professional sports stadiums across the United States, and assessed the factors related to likelihood of both types of alcohol sales. Methods: We conducted pseudo‐underage (i.e., persons age 21 or older who appear under 21) and pseudo‐intoxicated (i.e., persons feigning intoxication) alcohol purchase attempts at stadiums that house professional hockey, basketball, baseball, and football teams. We conducted the purchase attempts at 16 sport stadiums located in 5 states. We measured 2 outcome variables: pseudo‐underage sale (yes, no) and pseudo‐intoxicated sale (yes, no), and 3 types of independent variables: (1) seller characteristics, (2) purchase attempt characteristics, and (3) event characteristics. Following univariate and bivariate analyses, we a separate series of logistic generalized mixed regression models for each outcome variable. Results: The overall sales rates to the pseudo‐underage and pseudo‐intoxicated buyers were 18% and 74%, respectively. In the multivariate logistic analyses, we found that the odds of a sale to a pseudo‐underage buyer in the stands was 2.9 as large as the odds of a sale at the concession booths (30% vs. 13%; p = 0.01). The odds of a sale to an obviously intoxicated buyer in the stands was 2.9 as large as the odds of a sale at the concession booths (89% vs. 73%; p = 0.02). Conclusions: Similar to studies assessing illegal alcohol sales at licensed alcohol establishments and community festivals, findings from this study shows the need for interventions specifically focused on illegal alcohol sales at professional sporting events.     

The price of alcohol: a consideration of contextual factors

BACKGROUND: The current study considers the determinants of prices charged for alcoholic beverages by on-premise and off-premise outlets in Alaska. Alcohol outlet densities, a surrogate measure for local retail competition, are expected to be negatively associated with prices while costs associated with distribution are expected to be positively related to prices. Community demographic and economic characteristics may affect observed local prices via the level of demand, retail costs borne by retailers, or the quality of brands offered for sale. METHODS: The core data for these analyses came from a telephone survey of Alaskan retail establishments licensed to serve alcohol. This survey utilized computer-assisted telephone interviewing (CATI) techniques to collect alcohol-pricing information from on-premise (i.e., establishments where alcohol is consumed at the point of purchase such as bars and restaurants) and off-premise (i.e., establishments such as grocery stores and convenience markets where consumption occurs in other locations) alcohol retailers throughout the state of Alaska. Price estimates were developed for each beverage-type based on alcohol content. Separate regression analyses were used to model each of the 8 price indices (on-premise and off-premise measures for beer, spirits, wine, and the average price across beverage types). All regressions also controlled for a set of zip-code level indicators of community economic and demographic characteristics based on census data. RESULTS: Outlet density per roadway mile was unrelated to price for both on- and off-premise establishments, either across or between beverage types. In contrast, overall distribution costs did appear to be related to alcohol price. The demographic and economic variables, as a group, were significantly related to observed prices. CONCLUSIONS: More attention needs to be directed to the manner in which sellers and buyers behave relative to alcoholic beverages. Alcohol demand remains responsive to prices; yet, consumers have considerable latitude in determining the price that they pay for alcohol.     

Off-premise alcohol outlet characteristics and violence

Background: There is considerable evidence of an association between alcohol outlet density and violence. Although prior research reveals the importance of specific characteristics of bars on this association and that the relationship between bar density and violence may be moderated by these characteristics, there are few similar studies of the characteristics of off-premise outlets (e.g. liquor and convenience stores). Objectives: We examined whether immediate environment, business practice, staff, and patron characteristics of off-premise alcohol outlets are associated with simple and aggravated assault density. Methods: Cross-sectional design using aggregate data from 65 census block groups in a non-metropolitan college town, systematic social observation, and spatial modeling techniques. Results: We found limited effects of immediate environment, business practice, staff, and patron characteristics on simple assault density and no effect on aggravated assault density. Only two out of 17 characteristics were associated with simple assault density (i.e. nearby library and male patrons). Conclusion: This is the first study to examine the association between several off-premise alcohol outlet characteristics and assault. Our findings suggest that where the off-premise outlets are located, how well the immediate environment is maintained, what types of beverages the outlets sell, who visits them, and who works there matter little in their association with violence. This suggests the importance of outlet density itself as a primary driver of any association with violence. Public policies aimed at reducing alcohol outlet density or clustering may be useful for reducing violence.     

Alcohol Price and Intoxication in College Bars

Background:  Many population studies find that alcohol prices are inversely related to alcohol consumption and alcohol-related problems, including among college students and young adults. Yet, little is known about the "micro-level" effects of alcohol price on the behavior of individual consumers in natural drinking settings such as college bars. Therefore, we assessed patron's cost per gram of ethanol consumed at on-premise drinking establishments and its association with intoxication upon leaving an establishment.
Methods:  On 4 consecutive nights during April 2008, data were collected from 804 patrons exiting 7 on-premise establishments in a bar district located adjacent to a large university campus in the southeastern United States. Anonymous interview and survey data were collected as well as breath alcohol concentration (BrAC) readings. We calculated each patron's expenditures per unit of ethanol consumed based on self-reported information regarding the type, size, number, and cost of consumed drinks.
Results:  A multivariable model revealed that a 10-cent increase in cost per gram of ethanol at on-premise establishments was associated with a 30% reduction in the risk of exiting an establishment intoxicated (i.e., BrAC ≥ 0.08 g/210 l).
Conclusions:  The results are consistent with economic theory and population-level research regarding the price elasticity of alcoholic beverages, which show that increases in alcohol prices are accompanied by less alcohol consumption. These findings suggest that stricter regulation of the drink discounting practices of on-premise drinking establishments would be an effective strategy for reducing the intoxication levels of exiting patrons.     

Alcohol outlet policies and practices concerning sales to underage people

Little is known about the relationship between alcohol outlet policies and practices in the United States and the likelihood that outlets will sell alcoholic beverages to persons under the legal drinking age. This study assessed the prevalence of such outlet-level policies and practices, and analyzed the relationships between outlet variables and outlets' actual propensity to sell alcoholic beverages to youth. The sample consisted of all outlets licensed for off-premise and a 40% random sample of outlets licensed for on-premise sale of alcoholic beverages in 15 small to medium-sized communities in Minnesota and Wisconsin (USA). Data on outlet characteristics, policies and practices were collected by a telephone survey of the owner or manager of each outlet. In addition, alcohol purchase attempts were conducted at each outlet by youthful-appearing study confederates. Generally, policies and practices that may reduce the likelihood of sales to youth were reported by a minority of outlets. Purchase success was found to be associated with a number of outlet characteristics, policies and practices. The implications of these findings for policy and future research are discussed.     

Ecological models of alcohol outlets and violent assaults: crime potentials and geospatial analysis

AIMS: Empirical tests of relationships between alcohol outlets and violence are generally conducted with statistical controls for correlates related to characteristics of people and the places in which they live. Crime potentials theory asserts that certain subpopulations are disposed to participate in criminal activities (population potentials) and certain neighborhoods are more likely to be places where crimes occur (place potentials). The current study assesses the degree to which measures of the different geographic distributions of these potentials contribute to violent crime. DESIGN: Cross-sectional data on hospital discharges for violent assaults were obtained for residents of 1637 zip code areas in California. Assault rates were related to measures of population and place characteristics using spatial statistical models corrected for spatial autocorrelated error. FINDINGS: Rates of assault were related to population and place characteristics within zip code areas, and with characteristics of populations living in adjacent zip code areas. Assault rates were greater in densely populated, poor minority urban areas with greater residential instability. Assault rates were also greater in zip code areas adjacent to densely populated urban areas. Assault rates were related significantly to local densities of off-premise alcohol retail establishments, not bars. However, densities of bars moderated substantially effects related to local population characteristics. Bars were related significantly to violence in unstable poor minority areas and in rural middle-income areas of the state. CONCLUSION: Population and place characteristics are associated with rates of violence across spatial areas. Alcohol outlets directly affect and moderate potentials for violence associated with socio-demographic groups.     

Changes in per capita alcohol sales during the partial privatization of British Columbia's retail alcohol monopoly 2003–2008: a multi-level local area analysis

Aim   To investigate the independent effects on liquor sales of an increase in (a) the density of liquor outlets and (b) the proportion of liquor stores in private rather than government ownership in British Columbia between 2003/4 and 2007/8.
Design   The British Columbia Liquor Distribution Branch provided data on litres of ethanol sold through different types of outlets in 89 local health areas of the province by beverage type. Multi-level regression models were used to examine the relationship between per capita alcohol sales and outlet densities for different types of liquor outlet after adjusting for potential confounding social, economic and demographic factors as well as spatial and temporal autocorrelation.
Setting   Liquor outlets in 89 local health areas of British Columbia, Canada.
Findings   The number of private stores per 10 000 residents was associated significantly and positively with per capita sales of ethanol in beer, coolers, spirits and wine, while the reverse held for government liquor stores. Significant positive effects were also identified for the number of bars and restaurants per head of population. The percentage of liquor stores in private versus government ownership was also associated significantly with per capita alcohol sales when controlling for density of liquor stores and of on-premise outlets ( P  < 0.01).
Conclusion   The trend towards privatisation of liquor outlets between 2003/04 and 2007/08 in British Columbia has contributed to increased per capita sales of alcohol and hence possibly also to increased alcohol-related harm.     

Changes in outlet densities affect violence rates

BACKGROUND: Previous assessments of empirical relationships between alcohol outlets and rates of interpersonal violence have been conducted using cross-sectional spatial data, data collected across small geographic units such as Census Tracts and zip codes. These assessments demonstrate that the availability of alcohol, measured by the number and types of alcohol outlets, is related to violence. These analyses have examined many potential confounds of the outlets-violence connection (i.e., population and place characteristics) and statistically corrected for biases that arise in analyses of spatial data. The current study contributes the first observation of longitudinal relationships between alcohol outlets and violence. METHOD: The study examined longitudinal data from 581 consistently defined zip code areas represented in the California Index Locations Database, a geographic information system that coordinates population and ecological data with spatial attributes for areas across the state. Six years of data were collected on features of local populations (e.g., household size) and places (e.g., retail markets) thought to be related to 1 measure of violence (i.e., hospital discharges related to violent assaults). Assault rates were related to changes in population and place characteristics using random effects models with controls for spatial autocorrelation (n x t = 3,486 observations). Changes in population and place characteristics of bordering (spatial lagged) areas were also considered. RESULTS: Lower median household income and greater percentages of minorities (African American, Hispanic, and Asian) were related to increased rates of violence. Ten percent increases in numbers of off-premise outlets and bars were related to 1.67 and 2.06% increases in violence rates across local and lagged spatial areas. Every 6 outlets accounted for 1 additional violent assault that resulted in at least 1 overnight stay at hospital. These effects increased with larger male populations, doubling with every 3% increase in percent males. CONCLUSION: Assault rates were most strongly related to median household incomes and minority populations within zip code areas. Controlling for changes in assault rates related to these measures, greater numbers of licensed alcohol retail establishments, especially bars and off-premise outlets, were related to rates of assault. Failures to regulate the growth in numbers of bars will increase rates of violence, especially in urban areas.     

Alcohol Availability and Injury: The Role of Local Outlet Densities

BACKGROUND: We analyzed the relationship between alcohol availability and injury that occurred during the 6 months before survey administration. METHOD: The data examined were from a general population survey administered to 13,440 California respondents as part of a community-based project to reduce alcohol-involved injury and death. Two separate analyses were performed. The first considered individual local outlet densities (which included both on-premise establishments such as bars and restaurants and off-premise establishments such as liquor and grocery stores) as they affect individual phone survey respondents' self-reported injuries. To address potential spatially autocorrelated errors and geographically lagged effects, a second analysis considered aggregate outlet densities within geographic areas as they affect the proportion of survey respondents who reported injury. No spatial autocorrelation or significant lagged effects were found, which supported our individual-level analyses. RESULTS: Our analyses indicated an association between both on-premise and off-premise individual-level outlet densities and self-reported injuries. CONCLUSION: Alcohol availability seems to be related to self-reported injury. The mechanisms behind this relationship, however, are not clear, and further study is indicated.     

Effects of the elimination of a state monopoly on distilled spirits' retail sales: a time-series analysis of Iowa

Since the end of prohibition in the USA, only one slate, Iowa, has eliminated its state retail monopoly of distilled spirits sales for off-premise consumption. In March 1987 all slate retail stores were closed, and private establishments were licensed to sell distilled spirits. Interrupted time-series analyses of apparent spirits consumption in Iowa, controlling for nationwide sales trends over the past two decades, identified a statistically significant 9.5% increase in spirits sales following the policy change. While there was a corresponding 13.7% decline in wine sales, and no change in beer sales, privatization of spirits retail sales yielded a net increase in total alcohol consumption in Iowa. No changes were found in spirits sales in states bordering Iowa.     

Old enough for a beer? Compliance with minimum legal age for alcohol purchases in monopoly and other off‐premise outlets in Finland and Norway

AIM: To assess whether government monopoly outlets comply better with minimum legal age for purchase of alcohol compared to other off-premise outlets for alcohol sales. METHODS: Under-age-appearing 18-year-olds attempted to purchase alcohol in off-premise outlets applying identical procedures in Finland (n = 290) and Norway (n = 170). Outcomes were measured as whether or not the buyers were asked to present an identity (ID) card and whether or not they succeeded in purchasing alcohol. RESULTS The buyers were asked to present an ID card in slightly more than half the attempts, and they succeeded in purchasing alcohol in 48% of the cases. The buyers were more likely to be requested to present an ID card and less likely to succeed in purchasing alcohol in monopoly outlets compared to other types of outlets, and also when other outcome predictors, such as age and gender of salesperson and crowdedness in the outlet, were taken into account. CONCLUSION: Monopoly outlets may facilitate compliance with minimum legal age for purchase of alcohol.     

Alcohol sales to underage adolescents: an unobtrusive observational field study and evaluation of a police intervention

Aims. The aims of this study were to assess the ease with which adolescents in the United Kingdom are able to buy alcohol, to obtain information concerning vendors' perceptions of alcohol sales to adolescents, and to evaluate a police intervention intended to reduce underage alcohol sales. Design, setting, subjects. An unobtrusive naturalistic field study was conducted in two urban locations. Pairs of 13‐ and 16‐year‐old boys and girls were trained to attempt the purchase of different types of alcohol (alcopops, beer, cider, wine, spirits) from four different types of retail outlets (corner shops, off‐licence, public houses and supermarkets), under the supervision of a researcher and typically a parent. The assessment was repeated, with the omission of the 13‐year‐old boys, following a police intervention in one of the performance sites, consisting of warning letters and visits to vendors, and the issue of a small number of police cautions. A total of 62 underage confederates in all attempted 470 test purchases in phase 1 and 348 in phase 2. Between the two waves of test purchases a sample ( n= 95) of the same vendors was surveyed by telephone. Findings. In phase 1, sales resulted from 88.1% of purchase attempts by 16‐year‐old girls, 77% of attempts by 16‐year‐old boys, 41.6% of 13‐year‐old girls and 4.1% of 13‐year‐old boys. These figures were generally comparable across locations, alcohol types and outlet types. Refusals were more likely when another vendor was present. Eighty per cent of sales to 16‐year‐olds and 65% of sales to 13‐year‐old girls were made without challenge. 'Prove‐It' ID cards were requested in fewer than 12% of purchase attempts in both age groups. Overall, there was no evidence that the police intervention reduced sales of alcohol to 16‐year‐olds. There was a hint that the intervention may have caused a very short‐lasting decrease in sales to 13‐year‐old girls, but this was contained within an overall increase in sales to this group. Alcohol vendors reported that they rarely encountered underage customers or refused sale though 90% of vendors said that if they became suspicious, they would request ID. Only two vendors believed that they were likely to suffer adverse consequences if they sold alcohol to minors. Conclusions. These data suggest that 16‐year‐olds, and girls as young as 13, have little difficulty in purchasing alcohol, and that there is little difference between different types of outlets in their willingness to sell alcohol to minors. Vendors perceive little risk in selling alcohol to adolescents. The fact that the police intervention failed to decrease sales suggests that vendors do not change their behaviour in response to the threat of legal action.     

Routine Activities and Alcohol Use: Constraints on Outlet Utilization

Studies of consumers' use of alcohol beverage outlets have provided a basis for understanding drinking behaviors in different drinking environments. These studies have shown that drinking environments are related to both demographic and drinking pattern measures. Absent from these studies has been a theoretical basis on which to make predictions regarding drinking patterns and choices of drinking environments under the various social, economic, and environmental constraints typically confronting alcohol consumers. This study presents one such theoretical approach.
The approach assumes that, in the context of individual preferences for alcohol, drinking choices are constrained by consumers' economic and time-energy budgets for consumption. All other things being equal, it is suggested that greater budgets for consumption will be related to greater alcohol use, quality of beverages purchased, amenity values of purchase locations, or all three. Because on-premise drinking entails greater economic costs, greater drinking levels will be related to lower utilization of on-premise establishments.
The predictions of this approach were tested using data obtained from telephone surveys of consumers conducted in 1990 and 1991. The results showed that controlling for income, variables related to greater time-energy budgets for consumption (i.e., marital status and household composition) were related to greater consumption levels and greater utilization of on-premise establishments. Controlling for demographic measures, greater income was related to greater utilization of restaurants and increased beverage quality. Controlling for all other measures, frequencies of consumption were inversely related to consumption at on-premise establishments, reflecting the expected moderation in costs for heavier consumers on a limited alcohol budget.     

The geography of availability and driving after drinking

This paper reports on an analysis of geographically based data from four communities conducted to evaluate relationships between measures of the physical availability of alcohol and rates of driving after drinking. From a review of the literature, it was expected that rates of driving after dnnking would be directly related to the availability of alcohol at on-premise establishments. Based on theoretical arguments regarding the hfe activities which underlie drinking and driving it was expected that the effects of availability upon these outcomes would extend significantly beyond the local areas of outlets. Taking into account the geographic variations in environmental characteristics (road network density, traffic flow, population density), and socioeconomic (age, gender, race, marital status, income, employment) and drinking characteristics (rates of abstention, frequency and quantity of use) of resident populations, a spatial analysis of drinking driving and alcohol-related crashes was conducted. The results of the analysis showed that physical availability was unrelated to self-reports of driving after drinking and driving while intoxicated and significantly related to rates of single vehicle night-time crashes. In the latter case, physical availability affected both local and adjacent area rates of crashing.     

Alcohol retail sales licenses and sexually transmitted infections in Texas counties, 2008-2015

Background: Research suggests that reduced retail alcohol outlet density may be associated with lower prevalence of HIV and other sexually transmitted infections (STIs). On-premise sale of alcohol for immediate consumption is theorized as increasing social interactions that can lead to sexual encounters. Objective: We examined associations between on- and off-premise retail alcohol sales licenses and number of newly diagnosed HIV and STI cases in Texas counties. Methods: Retail alcohol sales license data were obtained from the Texas Alcoholic Beverage Commission. HIV and bacterial STI data were obtained from the Texas Department of State Health Services. Associations between retail alcohol sales licenses and STIs were estimated using spatial linear models and Poisson mixed effects models for over-dispersed count data. Results: Adjusting for county-specific confounders, there was no evidence of residual spatial correlation. In Poisson models, each additional on-premise (e.g., bar and restaurant) alcohol license per 10,000 population in a county was associated with a 1.5% increase (95% CI: 0.4%, 2.6%) in the rate of HIV and a 2.4% increase (95% CI: 1.9%, 3.0%) in the rate of bacterial STIs, adjusting for potential confounders. In contrast, number of off-premise licenses (e.g., take-out stores) was inversely associated with the incidence of STI and HIV, although the association with HIV was not statistically significant. Conclusions: This study adds to the limited literature on the association between retail alcohol availability and STIs. Additional research is needed on the role of alcohol availability (and policies affecting availability) in the spread of HIV and other STIs.     

A community prevention trial to reduce alcohol-involved accidental injury and death: overview

The 5-year “Preventing Alcohol Trauma: A Community Trial” project in the United States was designed to reduce alcohol-involved injuries and death in three experimental communities. The project consisted of five mutually reinforcing components: (1) Community Mobilization Component to develop community organization and support, (2) Responsible Beverage Service Component to establish standards for servers and owner/managers of on-premise alcohol outlets to reduce their risk of having intoxicated and/or underage customers in bars and restaurants, (3) Drinking and Driving Component to increase local DWI enforcement efficiency and to increase the actual and perceived risk that drinking drivers would be detected, (4) Underage Drinking Component to reduce retail availability of alcohol to minors, and (5) Alcohol Access Component to use local zoning powers and other municipal controls of outlet number and density to reduce the availability of alcohol. This paper gives an overview of the rationale and causal model, the research design and outline of each intervention component for the entire prevention trial.