Observable characteristics associated with alcohol intoxication within licensed entertainment venues in Australia

BackgroundThe aim of the current study was to assess correlates of intoxication in licensed venues in Australia.MethodsCovert observations of licensed venues and venue patron in night-time entertainment districts of five Australian cities were conducted. In total, 828 unique cross-sectional observations were completed across 62 bars, nightclubs, and large mainstream pubs. Venues were selected from the main entertainment district of smaller cities and the busiest entertainment districts of larger cities. Outcomes were the estimated percentage of patrons showing any signs of alcohol intoxication and the overall level of intoxication (‘high’ versus ‘none to medium’). Seven predictors of patron intoxication were examined: hour of observation; estimated percentage of male patrons; estimated percentage of patrons <25 years old; venue crowding; presence of observable alcohol promotions; type of alcoholic beverage consumed by the majority of patrons; and, venue type.ResultsTime of night (coefficient = 11.71, p < .001; OR = 9.61, p < .001), percentage of patrons aged <25 (coefficient = 0.14, p < .001; OR = 1.01, p = .031), and venue crowding (coefficient = 4.40, p < .001; OR = 1.39, p = .009) had significant positive associations with both signs of intoxication and high levels of intoxication. Nightclubs had a lower percentage of signs of intoxication compared to pubs (coefficient = −10.73, p = .021). Increased percentage of male patrons was associated with increased odds of high-level intoxication (OR = 1.05, p = .020).ConclusionTime of night and proportion of younger patrons had a strong association with patron intoxication adding further support for the strong body of evidence that ceasing service of alcohol earlier in the evening will reduce intoxication levels.     

Off the rails—Evaluating the nightlife impact of Melbourne,Australia’s 24-h public transport trial

BackgroundThis paper evaluates the impact of the AU$83 million introduction of 24-h public transport (PT) in Melbourne, Australia on Friday and Saturday nights on a sample of nightlife venues and venue patrons. This sample was selected because a primary reason for the introduction of 24 h PT was to provide a safe means of travel home for nightlife attendees.MethodsCovert venue observations (pre-post) and a convenience sample of nightlife patron interviews (post-only) were conducted to measure the impact of 24-h PT on venues and venue patrons. Specifically, the impact of 24-h PT on the proportion of people observed within venues (as rated on a 0–100% scale of venue capacity), patrons in venues showing any sign of intoxication, those who were observed to be too intoxicated to remain in the venue, patron drinking or drug taking behavior, train use, and the time and money spent in the night time economy were assessed.ResultsAfter 24-h PT was introduced there were no significant differences overall in the proportion of people observed within venues, or significant associations with the proportion of patrons showing any sign of intoxication or proportions who were observed to be too intoxicated to remain in the venue. However, when accounting for seasonality (matching-months), observed patron intoxication increased significantly after the introduction of 24-h PT. The majority of nightlife patrons did not report a change in their pre-drinking or drug taking behavior after 24-public transport, but 44% indicated spending more time in the night time economy, 27% reported spending more money, and 56% reported increasing their train use.ConclusionPatron reports suggest that 24-h public transport has increased the amount of time people spend in nightlife settings without obviously impacting on drinking behavior. However, supplying 24-h public transport has resulted in greater self-reported use of public transport.     

Environmental contexts of combined alcohol and energy drink use: Associations with intoxication in licensed venues

BackgroundEnvironmental factors inside licensed venues have been found to influence the intoxication levels and consumption practices of patrons. The consumption of alcohol mixed with energy drinks (AmED) occurs primarily at or prior to attending licensed venues, however there is a lack of in situ research investigating AmED use in these contexts. Given that AmED use has been linked with increased alcohol consumption, intoxication, illicit substance use, and risk taking behaviours, this paper explores the environmental correlates and levels of intoxication associated with AmED use in licensed venues.MethodsStructured observations were undertaken in five Australian cities on Friday and Saturday nights. Covert teams spent 4–5 h in venues and recorded hourly observations on patron, venue, and staff characteristics, alcohol, illicit drug and AmED consumption patterns and intoxication levels.Results898 hourly observations were recorded across 68 venues. All but one venue served energy drinks, and patron AmED use was observed during 34.9% of hourly records. AmED use was more prevalent after 12am and in nightclub venues compared to bars and pubs, and was positively associated with high intoxication levels, illicit drug use, and younger crowds. After controlling for environmental factors (i.e. venue crowding, service practices, venue characteristics, patron demographics and behaviour) AmED use did not predict high intoxication at a venue level in multivariable models.ConclusionAmED consumption is ubiquitous in the licensed venues of Australian night-time entertainment districts, particularly busy nightclub venues where intoxication and risky consumption are heightened. However, AmED use was not associated with high patron intoxication when environmental factors were considered.     

Indicators of Club Management Practices and Biological Measurements of Patrons’ Drug and Alcohol Use

Background: Electronic music and dance events in nightclubs attract patrons with heavy alcohol/drug use. Public health concerns are raised from risks related to these behaviors. Practices associated with increased risk in these club settings need to be identified. Objectives: The relationship between club management practices and biological measures of patrons’ alcohol/drug use is examined. Methods: Observational data from 25 events across six urban clubs were integrated with survey data (N = 738 patrons, 42.8% female) from patrons exiting these events, 2010–2012. Five indicators of club management practices were examined using mixed model regressions: club security, bar crowding, safety signs, serving intoxicated patrons, and isolation. Results: Analyses revealed that serving intoxicated patrons and safety signs were related to substance use. Specifically, serving intoxicated patrons was related to heavy alcohol and drug use at exit, while safety signs were marginally related to less exit drug use. Conclusions/Importance: Findings indicate observable measures in nightclubs provide important indicators for alcohol/drug use, suggesting practices to target. Study strengths include the use of biological measures of substance use on a relatively large scale. Limitations and future directions are discussed.     

Perception of intoxication in a field study of the night-time economy: Blood alcohol concentration,patron characteristics,and event-level predictors

ObjectiveDetermine the relationship of subjective intoxication to blood alcohol concentration (BAC) and examine whether patron and event-level characteristics modify the relationship of BAC to subjective intoxication.MethodsAn in-situ systematic random sample of alcohol consumers attending night-time entertainment districts between 10 pm and 3 am on Friday and Saturday nights in five Australian cities completed a brief interview (n = 4628). Participants reported age, sex, and pre-drinking, energy drink, tobacco, illicit stimulant and other illicit drug use that night, and their subjective intoxication and BAC were assessed.ResultsMale and female drinkers displayed equally low sensitivity to the impact of alcohol consumption when self-assessing their intoxication (BAC only explained 19% of variance). The marginal effect of BAC was not constant. At low BAC, participants were somewhat sensitive to increases in alcohol consumption, but at higher BAC levels that modest sensitivity dissipated (actual BAC had less impact on self-assessed intoxication). The slope ultimately leveled out to be non-responsive to additional alcohol intake. Staying out late, pre-drinking, and being young introduced biases resulting in higher self-assessed intoxication regardless of actual BAC. Further, both energy drinks and stimulant use modified the association between BAC and perceived intoxication, resulting in more compressed changes in self-assessment as BAC varies up or down, indicating less ability to perceive differences in BAC level.ConclusionsThe ability of intoxicated patrons to detect further intoxication is impaired. Co-consumption of energy drinks and/or stimulant drugs is associated with impaired intoxication judgment, creating an additional challenge for the responsible service and consumption of alcohol.     

Designing drunkenness: How pubs,bars and nightclubs increase alcohol sales

Using ethnographic data, this paper investigates the techniques used inside pubs, bars and nightclubs to solicit and sustain alcohol consumption among patrons. Focus is on venues with the majority of patrons belonging to the age group of approximately 15–35 years. The paper identifies a number of techniques, both overt and covert, including: alcohol advertising; special offers (e.g. ‘Happy Hours’ and ‘all you can drink’ specials); bartenders’ use of strategic intimacy, flirtation, and encouragements to buy more; speed drinking devices (e.g. shot glasses, ‘beer bongs’ and large pitchers); and architectural features that hamper moderate drinking while accelerating the purchase and intake of alcohol. These techniques were used most extensively in low-priced venues with the youngest patrons (e.g. themed chain pubs) and less so in more expensive venues with more adult patrons (e.g. craft beer bars). The paper argues that youth-oriented drinking venues may be conceived as staged atmospheres of consumption where individuals are seduced and compelled into purchasing alcohol. A team of 12 researchers collected the data through interviews and observations in pubs, bars and nightclubs in four cities across Denmark.     

Typology of Nightclubs in São Paulo,Brazil: Alcohol and Illegal Drug Consumption,Sexual Behavior and Violence in the Venues

Background: Nightclubs are venues in which excessive alcohol use and illegal drug consumption occur in addition to other high-risk behaviors, such as violence and sexual risk behaviors. Environmental factors common in nightclubs and the personal characteristics of patrons might increase the risk of these events. To better understand the relationship between these factors, typologies were formulated that clustered nightclubs according to definite profiles to identify differences to be taken into consideration in preventive interventions. Objectives: The present study aim was to construct a typology of nightclubs in São Paulo, Brazil. Methods: This typology was constructed using mixed methods research through the triangulation of several data sources as follows: 307 hours of ethnographic observation at 31 nightclubs, 8 focus group sessions with nightclub patrons (n = 34) and 30 semi-structured interviews with nightclub employees. Content analysis and qualitative typology were used. Results: Four nightclub types were defined based on four analyzed thematic axes (Intoxicating, Violent, Dancing and Highly Sexualized nightclubs). Excessive alcohol use was detected in almost all of the investigated nightclubs, and drug use was observed in approximately one-third of them. Triangulation of the data revealed a relationship among environmental factors (especially alcohol sales strategies and promotion and the availability of areas for sex) and a more considerable presence of high-risk behaviors. Conclusions: The study shows that nightclubs are settings in which high-risk behaviors are potentiated by facilitating environmental factors as well as by the lack of laws restricting excessive alcohol use stimulated by the promotion strategies applied at these venues.     

Large drinks are no mistake: Glass size,not shape,affects alcoholic beverage drink pours

Introduction and Aims. Alcohol content in drinks has been shown to be variable. This study evaluates claims regarding the effects of glass size and glass shape on the amount of alcohol served in on‐premise drinks. Design and Methods. Wine and spirits drinks were purchased and measured in 80 on‐premise establishments in 10 Northern California Counties. Alcohol content was measured as the liquid volume of the drink multiplied by the percentage alcohol by volume of given brands or from analysis of mixed drink and wine samples. Results. Spirits drinks were classified as either straight shots or mixed drinks. Mixed drinks poured in short wide glasses were not found to contain more alcohol than those poured in tall thin glasses. Straight shots and mixed drinks served in the relatively large pint glass and variable ‘other’ glass type were found to contain more alcohol than drinks served in a short wide glass. No other significant differences were found between glass types. Analyses of establishment characteristics found that bars with mostly black patrons serve spirits drinks with more alcohol than bars with other patron types. Discussion and Conclusions. Glass shape does not affect actual drink pours in the USA but glass size does in some cases. Consumer education programs should foster awareness of the relatively high alcohol content of on‐premise wine and mixed spirits drinks. More research is needed to evaluate potential differences in drink pours by patron race and ethnicity.[Kerr WC, Patterson D, Koenen MA, Greenfield TK. Large drinks are no mistake: Glass size, not shape, affects alcoholic beverage drink pours. Drug Alcohol Rev 2009;28:360–365]     

Associations of Early Age of First Intoxication with Past Year Drinking Contexts and Problems

Background: Mechanisms underlying associations between early drinking and problems are largely unknown. Objectives: We investigated (a) associations between early age of first intoxication (≤15?years) and past year drinking in different contexts and (b) whether early age of first intoxication is differentially associated with problems in these contexts. Methods: We used survey data collected in 2013–2014 from 405 past-year adolescent drinkers in 24 midsized California cities. Data included demographics; drinking behaviors; age of first intoxication; frequency of being at and drinking at restaurants, bars/nightclubs, outdoor places, and home; and problems. We used multilevel logistic and negative binomial models to account for the clustering of adolescents within cities. Probabilities were corrected to maintain family-wise error rates. Results: Early age of first intoxication was associated with a 120% increase in the odds of drinking at outdoor settings (OR = 2.20, p_c < .05). Early age of first intoxication was associated with increased numbers of problems related to drinking in restaurants (IRR = 5.72, p_c < .001), outdoor settings (IRR = 3.40, p_c < .001), and homes (IRR = 2.84, p_c < .001). Later intoxication (≥16?years) was not significantly associated with increased drinking or problems in any of these contexts. Conclusions: Results suggest that underage drinkers who report early intoxication are more likely to drink at outdoor settings, but not other contexts. However, they may differentially experience drinking problems across contexts. To target youths who have experienced intoxication at an early age and to reduce problems, prevention interventions should focus on outdoor settings.     

Intoxication by drinking location: a web-based diary study in a New Zealand university community

Drinking to intoxication is a modifiable risk factor for various health, social, and legal problems. The objective was to estimate the relative risk of intoxication by type of drinking location. Participants were 1614 university students (mean age 19.0 years) in residential halls who completed a web survey (67% response). Respondents reported their drinking for each day of the preceding week, in residential halls, pubs/bars/nightclubs, student flats/houses, and 'other' locations. An estimated blood alcohol concentration (EBAC) was computed and intoxication was defined as EBAC>0.08%. Pubs/bars/nightclubs accounted for 51% of all alcohol consumed, followed by residential halls (34%), student flats/houses (9%), and other locations (6%). Episodes resulting in intoxication comprised 61% of all drinking episodes in pubs/bars/nightclubs, 55% in student flats/houses, 53% in residential halls, and 37% in other locations. Multi-level analyses revealed positive associations between the first three location types (relative to 'other') and intoxication among women. Drinking in pubs/bars/nightclubs was associated with intoxication among men. Other significant predictors included hazardous drinking in the respondent's residential hall, pre-university drinking, and first-year status. Student intoxication is commonplace in licensed premises and residential halls. These environments are amenable to interventions to reduce the incidence of intoxication.     

To what extent is intoxication associated with aggression in bars? A multilevel analysis

OBJECTIVE: The purpose of this study was to assess the relationship between level of intoxication and the frequency and severity of aggression at the person, incident, visit, and bar level for aggressive incidents observed in bars or clubs. METHOD: Hierarchical Linear Modeling (HLM) analysis of 1025 incidents of aggression documented by trained observers during 1334 nights of observation in 118 bars and clubs in Toronto, Canada, was conducted. RESULTS: Both level of intoxication of the crowd during the visit as well as mean level of intoxication at the bar level significantly predicted frequency of aggression. There was a positive association between level of intoxication and severity of aggression at both the incident and person level except for the highest level of intoxication at the person level, where severity of aggression was less than for moderate intoxication. A person-incident level interaction between intoxication and severity of aggression was also found. CONCLUSIONS: These results suggest that prevention efforts should focus on both identifying bars that typically have more intoxicated patrons and reducing the intoxication levels of patrons across bars generally. The results also showed a strong positive relationship between level of intoxication and severity of aggression (except at the highest levels), indicating that intoxication increases risk in terms of both frequency and severity of aggression. The significant interaction between person- and visit-level intoxication suggests that greater attention needs to be paid to group dynamics in alcohol-related aggression.     

Event-level analyses of energy drink consumption and alcohol intoxication in bar patrons

Aim

To assess event-level associations between energy drink consumption, alcohol intoxication, and intention to drive a motor vehicle in patrons exiting bars at night.

Method

Alcohol field study. Data collected in a U.S. college bar district from 802 randomly selected and self-selected patrons. Anonymous interview and survey data were obtained as well as breath alcohol concentration (BrAC) readings.

Results

Results from logistic regression models revealed that patrons who had consumed alcohol mixed with energy drinks were at a 3-fold increased risk of leaving a bar highly intoxicated (BrAC ≥ 0.08 g/210 L), as well as a 4-fold increased risk of intending to drive upon leaving the bar district, compared to other drinking patrons who did not consume alcoholic beverages mixed with energy drinks.

Discussion

These event-level associations provide additional evidence that energy drink consumption by young adults at bars is a marker for elevated involvement in nighttime risk-taking behavior. Further field research is needed to develop sound regulatory policy on alcohol/energy drink sales practices of on-premise establishments.     

Playing it safe: Patron safety strategies and experience of violence in night‐time entertainment districts

Introduction and Aims. Incidences of violence are elevated in night‐time entertainment districts. Research suggests that safety‐related behavioural strategies adopted while drinking can reduce negative alcohol‐related outcomes. The current study investigates the use of safety strategies and its association with experiences of violence among patrons from the general population. Design and Methods. Patron interviews (N = 3949) were conducted in and around licenced venues in Newcastle (New South Wales) and Geelong (Victoria) during peak trading hours (Friday and Saturday, 21:00–01:00 h). Participants (mean age = 24.3, SD = 5.8; male 54.4%) were asked to report what measures, if any, they used to keep safe when drinking and whether they had been involved in a violent incident in the last 12 months. Results. After controlling for patron demographics and location, the use of multiple (more than one) safety strategies was significantly associated with reduced odds of involvement in a violent incident (odds ratio = 0.64, 95% confidence interval 0.49–0.85, P = 0.002). Significant gender differences were observed in the number and type of safety strategies reported. Discussion and Conclusions. Increasing the number of safety‐related behaviours during drinking occasions is associated with a small but significant reduction in experiencing alcohol‐related harms, such as violence. [Zhou J, Droste N, Curtis A, Zinkiewicz L, Miller P. Playing it safe: Patron safety strategies and experience of violence in night‐time entertainment districts.     

Smoking in outdoor areas of bars and cafés: Large differences between midday and evening prevalences

Aim: There have been only two studies of the smoking prevalence outside bars/cafés worldwide, both undertaken in Australia. The aim of this study was to further develop the assessment of the prevalence of smoking outside bars/cafés in a busy urban area. It is important for smokefree places policymaking to have baseline data on smoking visibility at these places, so as to be able to gauge the effects of policy changes that may alter levels of smoking.

Methods: Researchers observed smoking during eight 15-minute periods (during 12–1?pm and 7–8?pm) in April 2013 at 14?bar/café locations in central Wellington, New Zealand.

Results: Of 2600 people observed in the outdoor areas of bars/cafés, 15.8% were observed smoking (95% confidence interval (CI): 14.5%–17.5%); 18.5% in the evening (95% CI: 16.8%–20.4%) compared to 9.1% at midday (95% CI: 7.2%–11.4%).

Conclusion: Smoking was observed in the outdoor areas of the bars/cafés at a prevalence of double that found in the previous Australian studies. This may be accounted for by observation method or observation times, or may be due to a much wider range of premises in the Australian cities with outdoor areas, which are open later, or a much wider variety of patrons who used such areas, compared to in Wellington. We found twice the prevalence of smoking outside bars/cafés in evenings compared to midday. Such differences may be related to a greater consumption of alcohol in evenings or to a different patronage then. Smokefree policies covering these settings could help denormalize smoking.     

Making licensed venues safer for patrons: what environmental factors should be the focus of interventions?

The Queensland Safety Action Projects operationalized a problem-focused responsive regulatory model in order to make nightclubs and other venues safer. A problem-focused approach requires a careful analysis of the total environment of licensed venues, including drinking and its controls but also the social and physical environments, patron mix and management practices. We present new analyses of observational data collected in 1994 and 1996 in the north Queensland cities of Cairns, Townsville and Mackay. Major reductions in aggression and violence were observed, as well as improvements in many aspects of the venue environment and management practices. We do not argue in this paper that the interventions caused the environmental and management changes, although we believe this to be true. Rather, our assumption is that whatever caused them, some of the environmental and management changes were critical to the reductions in aggression. Regression techniques were used to identify those factors that best explained the declines in aggression. For reduced physical violence four key predictors were identified: improved comfort, availability of public transport, less overt sexual activity and fewer highly drunk men. For reduced non-physical aggression, four key predictors were: fewer Pacific Islander patrons, less male swearing, fewer intoxicated patrons requiring that management be called and more chairs with armrests. The analyses are consistent with the argument that the control of drinking is necessary but not sufficient to reduce aggression and violence.     

Assertive communication about others' smoking and vaping in public venues: Results from a National Survey of US adults

IntroductionThis study describes prevalence and correlates of US adults' intentions to engage in assertive communication (i.e., speak up) about others' smoking and vaping in public venues. Methods: Participants from a nationally representative online survey of 1551 US adults conducted October–December 2013 reported intentions to ask others not to smoke/vape in three types of public venues (restaurants, bars/casinos/nightclubs, and parks). We examined weighted prevalence of intentions and conducted weighted logistic regression. Results: Fifty-two percent of participants reported being likely to ask someone not to smoke in at least one venue compared with 19% for vaping. Assertive communication intentions for smoking in restaurants (48%), bars/casinos/nightclubs (35%), and parks (32%) were higher than for vaping (16%, 14%, and 12%, respectively). Significant correlates of assertive communication intentions in one or more venues were current smoking status, ever trying e-cigarettes, gender, age, health status, political ideology, and party identification. Conclusions: US adults were more willing to ask others not to smoke than vape. Intentions to speak up about smoking and vaping differed by venue, demographics, and cigarette/e-cigarette use. These findings help establish an evidence base to inform policymakers in developing strategies to promote compliance with smoke-free and vape-free laws.     

“How do online and offline sampling compare in a multinational study of drug use and nightlife behaviour?”

BackgroundOnline sampling is widely used to recruit hard to reach samples such as drug users at nightlife events. We conducted the first study comparing differences in demographics, drug use and nightlife behaviour between an online sample of young adults engaging with the European nightlife scene, and an offline sample recruited at nightclubs and festivals in Europe.MethodsOnline participants who attended at least six nightlife events in the past 12 months were recruited using social media advertising (May-November 2017). Offline participants were recruited at nightclubs and festivals using a random intercept method (May-November 2017). Samples were compared with respect to age, gender, past year use of alcohol, cannabis, cocaine, ecstasy/MDMA and amphetamines, and past year attendance at nightclubs, licensed festivals, illegal festivals, pubs and house-parties.Results6153 online and 3529 offline participants were recruited. When adjusting for differences in age and gender, online participants were less likely to have used each drug and to have attended illegal festivals, pubs and house-parties in the past 12 months. The online sample also used each drug and attended each venue, with the exception of nightclubs, less frequently on average than offline participants. Adjusted odds ratios (range 0.37 to 1.39) and regression coefficients (range -0.84 to 0.07) indicate that the majority of observed differences between the samples were of a small effect size.ConclusionsEstimates of drug use and nightlife engagement are more conservative when using online sampling compared to venue based sampling. Observed differences were generally small in effect, indicating good overall representativeness when using online sampling in the European nightlife scene.     

Alcohol and Club Drug Use Among Same-Sex Attracted Young People: Associations With Frequenting the Lesbian and Gay Scene and Other Bars and Nightclubs

This study aimed to determine whether the lesbian and gay “scene” of bars and nightclubs is a more common site for club drug use than other bars and clubs. A cross-sectional, online survey was conducted with 254 same-sex attracted women and 318 men aged 18–25 in Sydney, Australia. Drug use was more likely in those who attended any venue type more frequently. Men, but not women, were more likely to report drug use in lesbian and gay venues than other venues. Club drug use may be more normalized within the lesbian and gay scene than elsewhere, particularly among young men. The study's limitations are noted.     

Late night environments: Bar “morphing” increases risky alcohol sales in on-premise outlets

Niche theory proposes that in areas of high alcohol availability, alcohol sales outlets will compete for patrons by diversifying their operating characteristics to provide a diversity of drinking contexts. We aimed to characterize features of outlet operations that contribute to increased risk of alcohol problems across communities. We conducted ethnographic observations in 97 on-premise outlets across six California cities and interviewed staff and patrons in a subsample of these. We observed outlet managers deliberately altering the environments in 17.5% of establishments. These modifications aimed to increase bar/nightclub effects, enabling venues to “morph” (i.e. alter operating conditions from restaurant to bar, or from bar to club) and display environmental characteristics associated with over-service and alcohol-related problems (e.g. more young male patrons, crowding and dancing). Late night morphing was observed in some outlets in most cities and included outlets operating with restaurant licences. Staff and patrons identified morphing as a strategy to increase alcohol sales in late night hours. Competition for late night customers may encourage business practices that increase the number of alcohol sales establishments operating under risky circumstances. Community alcohol policies and practices should attend to the potential expansion of risky alcohol sales niches in night-time economies.