Despite progress in reducing impaired driving, drivers 21 to 34 years old remain a particularly high-risk group for involvement in impaired-driving-related crashes. In 2014, 21- to 34-year-olds accounted for 42 percent of the impaired drivers (i.e., those with a blood alcohol concentration [BAC] of .08 grams per deciliter [g/dL] or greater) of all ages in fatal crashes and 30 percent of all drivers (drinking or not drinking) in fatal crashes. The proportion of drivers in fatal crashes in 2014 with BACs of .08 or greater for drivers 21 to 24 was 30 percent, followed by drivers 25 to 34 at 29 percent. Kennedy, Isaac, and Graham (1996) found that 70 percent of fatally injured male drinking drivers in the Fatality Analysis Reporting System (FARS) were 21 to 39 years, with 65 percent of them having a BAC of .15 or greater. In response to the overall problem of impaired driving, a variety of public health efforts have been undertaken including media campaigns, enforcement initiatives, and legal and policy efforts (e.g., reducing the illegal BAC limit to .08). Strong enforcement of impaired-driving laws can be effective in reducing impaired-driving-related crashes involving drivers 21 to 34. However, other programs aimed at reducing excessive drinking can work to prevent driving after drinking, ultimately reducing not only injuries, but also the costs of driving-while-intoxicated (DWI) convictions for alcohol-impaired drivers of all ages. Such programs, which change the environment that promotes risky drinking-driving behaviour, are of particular interest to the National Highway Traffic Safety Administration and other safety researchers and advocates. Several studies have revealed that approximately half of intoxicated drivers had their last drink at a licensed bar or restaurant. Stockwell, Lang, and Rydon (1993) studied risk factors associated with drinking that led to a wide range of harmful incidents (violence, injury, and illness) and concluded, “the most significant risk factors were the amount of alcohol consumed and whether obviously intoxicated customers continue to be served.” Except in a few jurisdictions, the service of alcohol to intoxicated patrons is prohibited by State or local law, as well as by liquor control regulation. In addition, Dram Shop laws in most States allow injured third parties to recover damages from licensed establishments when the crash resulted from the service of alcohol to intoxicated patrons. Given the high proportion of alcohol-impaired drivers who come from licensed establishments, it is evident that these legal measures have not prevented intoxicated patrons from being served or from leaving licensed establishments in an intoxicated condition. In recent years, restricting alcohol at the point of sale has increased in an effort to reduce impaired-driving-related motor-vehicle crashes and other negative consequences of alcohol abuse. In a systematic review of interventions designed to reduce alcohol use and related harms in drinking, effects of server intervention programs on patrons’ alcohol consumption were mixed. However, one study of state-wide mandated server training showed that such training had a statistically significant effect on single-vehicle night-time crashes. Another study found that an intervention designed to reduce aggression among bar patrons had a modest influence on severe and moderate patron aggression. Following introduction of an experimental alcohol service enforcement effort in one Michigan county, denial of service to pseudo-patrons (individuals recruited by the researcher to pose as patrons, according to protocols established by the researcher) simulating signs of intoxication rose from 18 percent to 54 percent of visits to licensed establishments, a threefold increase. Simultaneously, the proportion of arrested drinking drivers coming from bars and restaurants declined from 32 percent to 23 percent, a decrease of more than 25 percent. The results of these studies show that responsible beverage service (RBS) training and follow-up enforcement and/or monitoring can be a tool in lowering the rates of high-risk alcohol consumption and impaired driving. Some of these results suggest that RBS training can be effectively implemented as one aspect of a multicomponent intervention. To test the effectiveness of a multicomponent intervention with RBS to reduce impaired driving among 21- to 34-year-olds, NHTSA funded two demonstration projects and their evaluations. In the summer of 2007, two communities were selected–Monroe County, New York (through the Monroe County STOP-DWI Program), and Cleveland (through University Hospitals Case Medical Center)–in which the RBS and enhanced alcohol enforcement intervention would be conducted and the data for the evaluation would be collected. The overall goal of the RBS/enforcement program was to reduce over-service practices and the frequency of serving to obviously intoxicated individuals in bars and restaurants in each community through training and enforcement. The long-term goal of the program was to reduce DWI arrests and impaired-driving-related traffic crashes in the 21- to 34-year-old age group. Within the two treatment communities, we compared 10 intervention and 10 control bars to gauge the effects of the RBS/enforcement program on serving practices. Specifically, we measured the changes in the frequency of service to and intervention with visibly intoxicated pseudo-patrons, the reductions in the frequency of place-of-last-drink (POLD) mentions of RBS-trained establishments among drivers arrested for DWI, and patrons’ drinking behaviour (e.g., changes in the frequency of high-BAC patrons leaving intervention establishments). Contrasts between the two treatment communities (Monroe County and Cleveland) and their respective comparison communities (Onondaga County, New York, and Toledo, Ohio) were used to examine broader changes beyond those affecting only bars and their patrons. These comparisons investigated changes from pre- to post-intervention in public attitudes and reports of driving while impaired, DWI arrests, and the ratio of impaired-driving-related crashes to non-impaired-driving-related crashes. The two communities participating in the demonstration and evaluation agreed to implement an intervention that integrated outreach and RBS training, targeted enforcement, and as necessary, implemented corrective actions by the enforcement agency to a random sample of identified problem bars. In addition, the sites agreed to collect the data necessary to conduct the evaluation. The community intervention included four activities: (a) the collection of data on the POLD for drivers arrested for impaired-driving-related offenses to determine problem establishments, (b) letter writing and bar assessments by alcohol beverage control (ABC) officers to raise awareness and cooperation among selected problem bars, (c) RBS training, and (d) stepped-up alcohol law enforcement. While the RBS training included parts on preventing service to underage patrons, the emphasis in this program was in preventing over-service practices to adults, particularly those 21 to 34. The basic design for the evaluation involved implementing the RBS/enhanced enforcement program at a random sample of problem establishments. In each treatment community, problem establishments were identified based on indicators of over-service problems, such as POLD mentions by drivers arrested for DWI and calls-for-service provided by the law enforcement agencies. We randomly assigned 10 establishments to receive the intervention and roughly matched those establishments with 10 control bars that did not receive the server training and the stepped-up enforcement. The intervention occurred from January through October 2009. Data were collected at three points: (a) Wave 1 or Baseline (before initiation of the RBS/enforcement strategy); (b) Post 1 (following the RBS training and one enforcement visit approximately 6 months after intervention start-up); and (c) Post 2 (1 to 2 months following the third and final enforcement visit approximately a year after the intervention start-up). Eight data-collection activities were conducted for the evaluation: (a) pseudo-patron assessments to determine over-service to obviously intoxicated patrons in each bar; (b) bar observations by ABC officials for over-service violations; (c) bar patron breath tests at each bar to determine proportion at high BACs; (d) self-reported driving behaviour by drivers at the Department of Motor Vehicles or Bureau of Motor Vehicles offices in each community (conducted independently by the jurisdictions); (e) calls-for-service near the intervention and control bars; (f) POLD data for drivers arrested for DWI; (g) DWI arrests of 21- to 34-year-old drivers; and (h) police-reported alcohol involvement in crashes in each of the four communities. We used these data to compare either between intervention and control bars in each treatment community or between treatment communities and their comparison communities. These comparisons at different levels were necessary as intervention activities were expected to have effects at multiple levels. For example, RBS training and enforcement were implemented in order to have direct effects on the serving practices of alcohol establishments targeted for intervention (bar-level effects), changes in bar patrons’ drinking and drinking-driving behaviour (patron-level effects), and ultimately, changes in traffic crashes and other problem outcomes associated with excessive drinking, such as DWI arrests and reported driving after drinking too much (community-level effects). We expected no changes in the comparison communities (Onondaga County and Toledo) on these measures as no similar program was being administered in either community during the intervention period. (Author/publisher)
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