Sales to Apparently Intoxicated Customers in Three States With Different Histories of Responsible Beverage Service Training.

OBJECTIVE: Most states prohibit sales of alcohol to customers who are apparently intoxicated, and many require training in responsible beverage service (RBS), with the aim of reducing driving while intoxicated (DWI) and other harms. Sales to apparently intoxicated patrons were assessed in onsite alcohol sales establishments and compared across three states. METHOD: A sample of 180 licensed onsite alcohol establishments was selected in California (n = 60), New Mexico (n = 60), and Washington State (n = 60). States had different RBS training histories, content, and procedures. Research confederates, trained to feign cues of intoxication, visited each establishment twice. The pseudo-intoxicated patron (PP) ordered an alcoholic beverage while displaying intoxication cues. Sale of alcohol was the primary outcome. RESULTS: At 179 establishments assessed, PPs were served alcohol during 56.5% of 356 visits (35.6% of establishments served and 22.6% did not serve at both visits). Alcohol sales were less frequent in New Mexico (47.9% of visits; odds ratio [OR] = 0.374, p = .008) and Washington State (49.6%; OR = 0.387, p = .012) than in California (72.0%). Servers less consistently refused service at both visits (6.8%) in California than New Mexico (33.9%) or Washington (27.1%), χ2(4, n = 177) = 16.72, p = .002. Alcohol sales were higher when intoxication cues were less obvious (p < .001). CONCLUSIONS: Overservice of alcohol to apparently intoxicated customers was frequent and likely elevated risk of DWI and other harms. The lower sales in New Mexico and Washington than California may show that a policy approach prohibiting sales to intoxicated customers combined with well-established RBS training can reduce overservice. Further efforts are needed to reduce overservice.

Pseudo-Underage Assessment of Compliance With Identification Regulations at Retail Marijuana Outlets in Colorado.

OBJECTIVE: Four states are creating a regulated industry for the retail sale of cannabis products. This pilot study assessed refusal rates of sales to underage-appearing individuals without valid identification (ID) at retail outlets in Colorado. METHOD: State-licensed retail marijuana outlets (n = 20) in Colorado were included in the sample. Pseudo-underage assessment teams of a buyer and an observer visited each retail outlet once between 11 A.M. and 5 P.M. on four weekdays in August 2015. The observer entered first, performed an unobtrusive environmental scan, and recorded the outcome of the purchase attempt. The buyer attempted to enter the outlet and purchase a cannabis product. If asked for an ID, they did not present one. Once inside, if the clerk offered to sell cannabis, the buyer declined, saying they had insufficient cash, and departed. RESULTS: Most outlets sold both retail and medical marijuana (75%). All outlets (100%) asked the buyer to show an ID. Only one outlet was willing to sell marijuana to the pseudo-underage buyer after the buyer did not provide an ID (95% refusal rate). All outlets (100%) had posted signs stating that an ID was required for entry; approximately half had signs that only individuals 21 years of age or older could enter (55%) and how to properly use marijuana edibles (50%). CONCLUSIONS: Compliance with laws restricting marijuana sales to individuals age 21 years or older with a valid ID was extremely high and possibly higher than compliance with restrictions on alcohol sales. The retail market at present may not be a direct source of marijuana for underage individuals, but future research should investigate indirect sales.

An applied test of the social learning theory of deviance to college alcohol use.

Several hypotheses about influences on college drinking derived from the social learning theory of deviance were tested and confirmed. The effect of ethnicity on alcohol use was completely mediated by differential association and differential reinforcement, whereas the effect of biological sex on alcohol use was partially mediated. Higher net positive reinforcements to costs for alcohol use predicted increased general use, more underage use, and more frequent binge drinking. Two unexpected finding were the negative relationship between negative expectations and negative experiences, and the substantive difference between nondrinkers and general drinkers compared with illegal or binge drinkers. The discussion considers implications for future campaigns based on Akers's deterrence theory.

Alcohol risk management in college settings: the safer California universities randomized trial.

CONTEXT: Potentially effective environmental strategies have been recommended to reduce heavy alcohol use among college students. However, studies to date on environmental prevention strategies are few in number and have been limited by their nonexperimental designs, inadequate sample sizes, and lack of attention to settings where the majority of heavy drinking events occur. PURPOSE: To determine whether environmental prevention strategies targeting off-campus settings would reduce the likelihood and incidence of student intoxication at those settings. DESIGN: The Safer California Universities study involved 14 large public universities, half of which were assigned randomly to the Safer intervention condition after baseline data collection in 2003. Environmental interventions took place in 2005 and 2006 after 1 year of planning with seven Safer intervention universities. Random cross-sectional samples of undergraduates completed online surveys in four consecutive fall semesters (2003-2006). SETTING/PARTICIPANTS: Campuses and communities surrounding eight campuses of the University of California and six in the California State University system were utilized. The study used random samples of undergraduates (∼500-1000 per campus per year) attending the 14 public California universities. INTERVENTION: Safer environmental interventions included nuisance party enforcement operations, minor decoy operations, driving-under-the-influence checkpoints, social host ordinances, and use of campus and local media to increase the visibility of environmental strategies. MAIN OUTCOME MEASURES: Proportion of drinking occasions in which students drank to intoxication at six different settings during the fall semester (residence hall party, campus event, fraternity or sorority party, party at off-campus apartment or house, bar/restaurant, outdoor setting), any intoxication at each setting during the semester, and whether students drank to intoxication the last time they went to each setting. RESULTS: Significant reductions in the incidence and likelihood of intoxication at off-campus parties and bars/restaurants were observed for Safer intervention universities compared to controls. A lower likelihood of intoxication was observed also for Safer intervention universities the last time students drank at an off-campus party (OR=0.81, 95% CI=0.68, 0.97); a bar or restaurant (OR=0.76, 95% CI=0.62, 0.94); or any setting (OR=0.80, 95% CI=0.65, 0.97). No increase in intoxication (e.g., displacement) appeared in other settings. Further, stronger intervention effects were achieved at Safer universities with the highest level of implementation. CONCLUSIONS: Environmental prevention strategies targeting settings where the majority of heavy drinking events occur appear to be effective in reducing the incidence and likelihood of intoxication among college students.

Understanding college drinking: assessing dose response from survey self-reports.

OBJECTIVE: One of the most difficult challenges confronting alcohol researchers is the assessment of specific risks associated with specific drinking levels (one, two or three or more drinks). In this article, a model-based method is presented that provides specific measures of dose, exposures and risks related to drinking and enables adequate assessment of dose-response relationships using survey data. METHOD: Survey data collected from 2,102 college students on drinking patterns and related problems were analyzed using a mathematical model that extracts separable measures of dose (number of drinks consumed per occasion) and exposures (numbers of occasions) for every respondent. A constrained class of quadratic risk models was estimated that relates units of exposure at each dose (e.g., number of occasions drinking five drinks) to problem outcomes (e.g., number of hangovers). The resulting dose-response functions provided an estimate of the rate of problems produced on each occasion of drinking at a given drinking level. Population risks were estimated by reintegrating dose response with the population distribution of drinking exposures. RESULTS: The distribution of drinking exposures among college drinkers was markedly peaked at a modal dose of two drinks, with variations in light and heavy drinking between demographic groups. Multivariate analyses showed relative rates of heavier drinking were greatest among white male freshmen and unrelated to residential settings. Most drinking problems showed a marked dose-response relationship to drinking levels. Population risks, however, were typically unimodal, with many problems reported at moderate drinking levels (two or three drinks). CONCLUSIONS: Distributed across a large number of drinkers and drinking occasions, problems reported by students occurred most often at moderate drinking levels (two to three drinks). Nevertheless, heavier drinking remained substantively related to many drinking problems. These observations encourage aview of college drinking that supports interventions related to both moderate and heavy drinking.

Drinking to extremes: theoretical and empiricalanalyses of peak drinking levels among college students.

OBJECTIVE: Heavy drinking among college students continues to be a substantial problem on campuses across the United States. Attempts to predict these drinking events have been restricted to assessments of the correlates of heavy drinking (measured at 4 or 5 drinks) and have not examined the peak drinking levels that can be fatal to students. This article presents a theoretical analysis of college drinking patterns that provides a basis for estimating peak drinking levels and predicts future risks related to peak drinking events. METHOD: Survey data were collected on sociodemographics and drinking patterns of 2,102 college students from two college campuses in California. A mathematical model of drinking patterns was used to characterize the stochastic distribution of drinking events among 1,273 students who drank five or more times and consumed more than one drink on some occasion since the beginning of the school year. An application of extreme value theory enabled the estimation of peak drinking levels for every college drinker. These estimates were related to self-reported maximum drinking levels and sociodemographic characteristics of respondents. RESULTS: Among these drinkers, the distribution of self-reported maximum drinking levels ranged from 2 to 43 drinks per occasion. Estimated peak drinking levels ranged from 3 to 49. Maximum drinking levels were well characterized by peak drinking estimates (R2 = 0.503). Variations in peak drinking levels were large and specifically related to particular sociodemographic groups (i.e., white male freshmen). CONCLUSIONS: The theoretical model of peak drinking events effectively characterizes maximum drinking levels among college students. High levels of peak drinking are to be expected among specific sociodemographic subgroups. These risks can be assessed on an individual basis. At the population level, risks for harm related to peak drinking events are predictable.