1. Stewart: Lifesavers 2008 What Communities Can Do to Prevent Alcohol Service Problems: New and Ongoing Research Kathryn Stewart Prevention Research Center of the Pacific Institute for Research and Evaluation Safety and Policy Analysis International

2. Stewart: Lifesavers 2008 Strategies Coordinating Community Policy and Enforcement Preventing alcohol related problems at the US/Mexico Border Preventing alcohol related problems at the US/Mexico Border Controlling alcohol outlet density to prevent alcohol problems Controlling alcohol outlet density to prevent alcohol problems Using policy and enforcement to prevent alcohol problems in college communities Using policy and enforcement to prevent alcohol problems in college communities Using community awareness and enforcement to reduce sales to minors Using community awareness and enforcement to reduce sales to minors

3. Stewart: Lifesavers 2008 The Border Project Preventing alcohol-related problems at the US/Mexico Border

4. Stewart: Lifesavers 2008 Current sites San Diego -Tijuana San Diego -Tijuana El Paso – Juarez El Paso – Juarez Laredo –Nuevo Laredo Laredo –Nuevo Laredo Brownsville - Matamoros Brownsville - Matamoros

5. Stewart: Lifesavers 2008 The Problem Mexico’s drinking age is 18 Mexico’s drinking age is 18 Some border towns provided plentiful, cheap sources of alcohol Some border towns provided plentiful, cheap sources of alcohol

6. Stewart: Lifesavers 2008

9. The Problem Mexico’s drinking age is 18 Mexico’s drinking age is 18 Some border towns provided plentiful, cheap sources of alcohol Some border towns provided plentiful, cheap sources of alcohol Young people traveled to Mexico to drink Young people traveled to Mexico to drink Beverage service not always “responsible” Beverage service not always “responsible”

10. Stewart: Lifesavers 2008

12. The Problem Mexico’s drinking age is 18 Mexico’s drinking age is 18 Some border towns provided plentiful, cheap sources of alcohol Some border towns provided plentiful, cheap sources of alcohol Young people traveled to Mexico to drink Young people traveled to Mexico to drink Beverage service not always “responsible” Beverage service not always “responsible” Heavy drinking occurred Heavy drinking occurred Sometimes resulted in problems in Mexico Sometimes resulted in problems in Mexico

13. Stewart: Lifesavers 2008

14. The Problem Mexico’s drinking age is 18 Mexico’s drinking age is 18 Some border towns provided plentiful, cheap sources of alcohol Some border towns provided plentiful, cheap sources of alcohol Young people traveled to Mexico to drink Young people traveled to Mexico to drink Beverage service not always “responsible” Beverage service not always “responsible” Heavy drinking occurred Heavy drinking occurred Sometimes resulted in problems in Mexico Sometimes resulted in problems in Mexico Impaired young people drove home Impaired young people drove home

15. Stewart: Lifesavers 2008

16. The Research Strategy PIRE studied drinking behavior of young US residents crossing into Mexico PIRE studied drinking behavior of young US residents crossing into Mexico Documented the extent of heavy drinking Documented the extent of heavy drinking Shed light on motivations and behavior of border crossers Shed light on motivations and behavior of border crossers

17. Stewart: Lifesavers 2008 The Implementation Strategy The nature and scope of the problem were explained to groups and agencies on both sides of the border The nature and scope of the problem were explained to groups and agencies on both sides of the border Media advocacy brought the problem to the attention of the public through compelling news coverage Media advocacy brought the problem to the attention of the public through compelling news coverage

18. Stewart: Lifesavers 2008 The Change Strategies Earlier bar closings Earlier bar closings Stepped up DUI enforcement efforts on the US side of the border Stepped up DUI enforcement efforts on the US side of the border Highly publicized enforcement of laws against crossing by youth under 18 Highly publicized enforcement of laws against crossing by youth under 18 New restrictions on Marines from Camp Pendleton New restrictions on Marines from Camp Pendleton

19. Stewart: Lifesavers 2008 The Results Dramatic decline in number of nighttime crossings by young people Dramatic decline in number of nighttime crossings by young people Reduction in nighttime crashes involving drivers under 18 Reduction in nighttime crashes involving drivers under 18 90% reduction in number of Marines driving back from the border 90% reduction in number of Marines driving back from the border

20. Stewart: Lifesavers 2008 Alcohol Outlet Density and Alcohol Problems Making Enforcement More Effective through Alcohol Policy

21. Stewart: Lifesavers 2008

22. The Problem Neighborhoods where bars, restaurants and liquor and other stores that sell alcohol are close together suffer more frequent incidences of violence and other alcohol-related problems. Neighborhoods where bars, restaurants and liquor and other stores that sell alcohol are close together suffer more frequent incidences of violence and other alcohol-related problems.

23. Stewart: Lifesavers 2008 Problems include Impaired driving Property crime Violent crime Child abuse and neglect Underage drinking

24. Stewart: Lifesavers 2008

25. The Implementation Strategy Make communities aware of the problems created by alcohol outlets Make communities aware of the problems created by alcohol outlets Make communities aware of the policy strategies that can control outlet location and density Make communities aware of the policy strategies that can control outlet location and density Licensing policies Licensing policies Land use policies Land use policies

26. Stewart: Lifesavers 2008 The Results Communities can: Set minimum distances between alcohol outlets Set minimum distances between alcohol outlets Limit new licenses for areas that already have outlets too close together; Limit new licenses for areas that already have outlets too close together; Not issue a new license when an outlet goes out of business Not issue a new license when an outlet goes out of business Permanently close outlets that repeatedly violate liquor laws Permanently close outlets that repeatedly violate liquor laws

27. Stewart: Lifesavers 2008 The Follow-up Policy changes can permanently change the environment Policy changes can permanently change the environment Reductions in alcohol problems can be sustained Reductions in alcohol problems can be sustained Communities are empowered to take control of the alcohol environment Communities are empowered to take control of the alcohol environment

28. Stewart: Lifesavers 2008 Safer California Universities Project Goal To evaluate the efficacy of a “Risk Management” approach to alcohol problem prevention NIAAA grant #R01 AA12516 with support from CSAP/SAMHSA.

29. Stewart: Lifesavers 2008 Why Care About College Student Drinking? Over 1,700 deaths among 18-24 year old college students Over 1,700 deaths among 18-24 year old college students 590,000 unintentionally injured under the influence of alcohol 590,000 unintentionally injured under the influence of alcohol More than 690,000 assaulted by another student who has been drinking More than 690,000 assaulted by another student who has been drinking More than 97,000 are victims of alcohol-related sexual assault or date rape More than 97,000 are victims of alcohol-related sexual assault or date rape About 25 percent of college students report academic consequences of their drinking including missing class, falling behind, doing poorly on exams or papers, and receiving lower grades overall About 25 percent of college students report academic consequences of their drinking including missing class, falling behind, doing poorly on exams or papers, and receiving lower grades overall

30. Stewart: Lifesavers 2008 What are we trying to prevent? Intoxication Harm related to intoxication

31. Stewart: Lifesavers 2008 Random Assignment Intervention Sites  CSU Chico  Sacramento State  CSU Long Beach  UC Berkeley  UC Davis  UC Riverside  UC Santa Cruz Comparison Sites  Cal Poly SLO  San Jose State  CSU Fullerton  UC Irvine  UC Los Angeles  UC San Diego  UC Santa Barbara

32. Stewart: Lifesavers 2008 How is risk management a unique approach? Targets times and places instead of individuals Targets times and places instead of individuals Focus on intoxication Focus on intoxication Data driven and directive Data driven and directive Tied to continuous monitoring and improvement - emphasis on “control” rather than “one shot” interventions Tied to continuous monitoring and improvement - emphasis on “control” rather than “one shot” interventions

33. Stewart: Lifesavers 2008 Strategies for Implementation Focused on one (at most two) settings Focused on one (at most two) settings Focused on beginning of academic year Focused on beginning of academic year Highly-specified planning and implementation process Highly-specified planning and implementation process Minimal attention to motivation Minimal attention to motivation Maximum attention to tasks and implementation per se Maximum attention to tasks and implementation per se

34. Stewart: Lifesavers 2008 Integrated Intervention Strategies for Off-Campus Parties A Social Host Safe Party Campaign A Social Host Safe Party Campaign Compliance Checks Compliance Checks DUI Check Points DUI Check Points Party Patrols Party Patrols Pass Social Host “Response Cost” Ordinance Pass Social Host “Response Cost” Ordinance

35. Stewart: Lifesavers 2008 Outcomes Likelihood of getting drunk at bars or restaurants much less. Likelihood of getting drunk at bars or restaurants much less. Likelihood of getting drunk at off campus parties much less. Likelihood of getting drunk at off campus parties much less. Overall likelihood of getting drunk at any location much less. Overall likelihood of getting drunk at any location much less.

36. Stewart: Lifesavers 2008

39. In addition… No Displacement

40. Stewart: Lifesavers 2008 In Sum… We have the ability to create environments that help teens and young adults make healthy decisions about alcohol consumption We have the ability to create environments that help teens and young adults make healthy decisions about alcohol consumption We have ample evidence that these strategies are effective We have ample evidence that these strategies are effective Our greatest impact will come from adopting mutually-reinforcing policies and practices Our greatest impact will come from adopting mutually-reinforcing policies and practices

41. Stewart: Lifesavers 2008 Reducing Youth Access to Alcohol: A Randomized Trial Purpose of Study: Evaluate five combined environmental strategies to reduce youth access to alcohol and underage drinking

42. Stewart: Lifesavers 2008 Reducing Youth Access to Alcohol: A Randomized Trial Study Design 36 Oregon communities 36 Oregon communities 18 randomly assigned to intervention 18 randomly assigned to intervention Interventions staggered, ~6 communities every two years Interventions staggered, ~6 communities every two years Now in second intervention year with 1 st and 2 nd intervention community cohorts Now in second intervention year with 1 st and 2 nd intervention community cohorts

43. Stewart: Lifesavers 2008 Reducing Youth Access to Alcohol: A Randomized Trial Environmental Strategies Reward and Reminder Program Reward and Reminder Program Minor Decoy Operations Minor Decoy Operations Shoulder Tap Operations Shoulder Tap Operations Party Patrols Party Patrols Traffic Surveillance Traffic Surveillance Media Advocacy Media Advocacy

44. Stewart: Lifesavers 2008 Community Interventions Mobilization Mobilization Reward & Reminder Reward & Reminder Media Media

45. Stewart: Lifesavers 2008 Reward & Reminder

46. Stewart: Lifesavers 2008

47. Reward & Reminder Total number of communities: 13 Total number of communities: 13 Total number of stores visited: 104 Total number of stores visited: 104 Total number of visits: 184 Total number of visits: 184 Total number of rewards given: 104 Total number of rewards given: 104

48. Stewart: Lifesavers 2008 Media Topics: Topics: The problem of underage drinking The problem of underage drinking The details of the project The details of the project Endorsed proclamation Endorsed proclamation Reward & Reminder results Reward & Reminder results Alcohol and the teenage brain Alcohol and the teenage brain Prom and Graduation Prom and Graduation Parents who host parties Parents who host parties Law enforcement activities in the community Law enforcement activities in the community

49. Stewart: Lifesavers 2008 Alcohol Sources Among Oregon 8 th and 11 th Graders, 2006

50. Stewart: Lifesavers 2008

57. Reducing Youth Access to Alcohol: A Randomized Trial Summary Preliminary evidence of intervention effects in 1 st community cohort Preliminary evidence of intervention effects in 1 st community cohort Stronger evidence if similar effects are observed in subsequent cohorts with support for intervening processes Stronger evidence if similar effects are observed in subsequent cohorts with support for intervening processes

58. Stewart: Lifesavers 2008 Conclusions Communities can create environments that reduce alcohol related problems through Communities can create environments that reduce alcohol related problems through Development of appropriate policies Development of appropriate policies Strategic use of law enforcement resources Strategic use of law enforcement resources Strategic use of community awareness Strategic use of community awareness

59. Stewart: Lifesavers 2008 www.resources.prev.org