Does a Place of Last Drink (POLD) Initiative Affect Alcohol Serving Staff Attitudes and Perceptions Related to Overservice of Alcohol?

Background: One enforcement strategy used to address illegal sales of alcohol to intoxicated patrons (i.e., overservice) is Place of Last Drink (POLD). When law enforcement responds to an alcohol-related incident, they ask persons involved in the incident where they had their last drink; POLD data can then be used to track patterns of overservice.Methods: We evaluated potential effects of a POLD initiative in one state (USA) on the attitudes and perceptions of serving staff (i.e., bartenders and servers) about their experiences in refusing sales to intoxicated customers. We conducted interviews with 44 serving staff across 24 communities (14 communities that participated in the POLD initiative and 10 comparison communities). We analyzed the interview transcripts using a qualitative matrix to identify major themes.Results: We found few differences across the two study conditions, with interview participants having no apparent awareness of POLD and many stating that overservice occurs frequently without law enforcement getting involved. One difference we identified was serving staff from communities in the POLD initiative reporting generally positive experiences with their managers when refusing sales to intoxicated patrons, whereas serving staff in comparison communities more commonly saying they were overruled by their managers. It is possible that these differences are the result of the POLD initiative; however, more research is needed.Conclusions: In general, serving staff across communities share many similar perceptions and attitudes around overservice. These findings can inform future implementation of POLD and other strategies to reduce overservice of alcohol.

Strategies Used by Local Law Enforcement Agencies to Prevent Overservice of Alcohol in the United States.

Overservice of alcohol, defined as commercial provision of alcohol to an individual who is obviously intoxicated, is illegal in most states and contributes to motor vehicle crashes and violence. Law enforcement agencies use various strategies that aim to reduce overservice at licensed alcohol establishments (e.g., bars, restaurants). Place of Last Drink (POLD) data collection is an emerging overservice enforcement strategy. POLD identifies patterns of overservice, which can provide support for targeted interventions to prevent overservice at offending establishments. We describe the prevalence of POLD and other overservice enforcement strategies and associations with agency characteristics, which has important implications for public health and safety. We conducted a national survey of 1024 municipal (e.g., town, city) and county law enforcement agencies in 2019 (response rate = 73%). We assessed the use of overservice enforcement strategies conducted by the agencies over the past year. We examined associations of each type of overservice enforcement strategy with agency and jurisdiction characteristics using regression models. 27% of responding agencies reported conducting overservice enforcement and 7% conducted POLD data collection specifically. Municipal (vs. county) agencies and agencies with an officer assigned primarily to alcohol enforcement activities were significantly more likely to conduct overservice enforcement generally but not POLD data collection specifically. Overservice enforcement in general, and POLD data collection specifically, are not widely conducted. Prevention of overservice has the potential to reduce harms related to excessive alcohol consumption. Increased evaluation of overservice enforcement strategies should be prioritized.

Effects of Sunday Liquor Sales Legalization on Alcohol Policy Attitudes and Alcohol Purchasing Behavior.

We examined how legalization of Sunday alcohol sales relates to attitudes towards Sunday sales, and how both attitudes and alcohol consumption patterns relate to Sunday alcohol purchasing. A total of 1,384 adults of legal drinking age completed a survey one year post-legalization of Sunday sales. A majority of respondents (51%) were supportive of Sunday sales legalization both before and after legalization. People were more likely to support Sunday sales legalization if they reported binge drinking (PR: 2.19; CI: 1.51 3.18). Following Sunday sales legalization, 59% of participants reported purchasing alcohol in Minnesota on Sunday. Binge drinking (PR: 1.39; CI: 1.27, 1.52) or supporting Sunday sales legalization (PR: 1.85; CI: 1.56, 2.17) were associated with higher likelihood of purchasing alcohol on Sunday. Legalizing Sunday sales may have increased access to alcohol for people with more unhealthy drinking behaviors.

Housing mobility protects against alcohol use for children with socioemotional health vulnerabilities: An experimental design.

PURPOSE: Neighborhood context may influence alcohol use, but effects may be heterogeneous, and prior evidence is threatened by confounding. We leveraged a housing voucher experiment to test whether housing vouchers' effects on alcohol use differed for families of children with and without socioemotional health or socioeconomic vulnerabilities. TRIAL DESIGN: In the Moving to Opportunity (MTO) study, low-income families in public housing in five US cities were randomized in 1994 to 1998 to receive one of three treatments: (1) a housing voucher redeemable in a low-poverty neighborhood plus housing counseling, (2) a housing voucher without locational restriction, or (3) no voucher (control). Alcohol use was assessed 10 to 15 years later (2008 to 2010) in youth ages 13 to 20, N = 4600, and their mothers, N = 3200. METHODS: Using intention-to-treat covariate-adjusted regression models, we interacted MTO treatment with baseline socioemotional health vulnerabilities, testing modifiers of treatment on alcohol use. RESULTS: We found treatment effect modification by socioemotional factors. For youth, MTO voucher treatment, compared with controls, reduced the odds of ever drinking alcohol if youth had behavior problems (OR = 0.26, 95% CI [0.09, 0.72]) or problems at school (OR = 0.46, [0.26, 0.82]). MTO low-poverty treatment (vs. controls) also reduced the number of drinks if their health required special medicine/equipment (OR = 0.50 [0.32, 0.80]). Yet treatment effects were nonsignificant among youth without socioemotional vulnerabilities. Among mothers of children with learning problems, MTO voucher treatment (vs. controls) reduced past-month drinking (OR = 0.69 [0.47, 0.99]), but was harmful otherwise (OR = 1.22 [0.99, 1.45]). CONCLUSIONS: For low-income adolescents with special needs/socioemotional problems, housing vouchers protect against alcohol use.

Do Alcohol Outlets Mediate the Effects of the Moving to Opportunity Experiment on Adolescent Excessive Drinking? A Secondary Analysis of a Randomized Controlled Trial.

Background: Housing mobility impacts adolescent alcohol use, and the neighborhood built environment may impact this relationship. Methods: Moving to Opportunity (MTO) was a multi-site, three-arm, household-level experiment. MTO randomly assigned one of three treatment arms (1994-1997) allowing families living in public housing to (1) receive a voucher to be redeemed any neighborhood (2) receive a voucher to be redeemed in a neighborhood with less than 10% poverty (3) remain in public housing (control). MTO decreased girls' alcohol use, but increased boys' alcohol use. Treatment groups were pooled because they are similar conceptually and statistically on our primary outcome. Among youth aged 12-19 in 2001-2002 (N = 2829), we estimated controlled direct effects mediation of MTO treatment effects on youth with housing vouchers (N = 1950) vs. controls (N = 879) on past 30-day number of drinks per day on days drank, using gender-stratified Poisson regression. Mediators were density of on- and off-premises alcohol outlets per square mile at the families' census tract of residence in 1997. Results: Treatment group youth were randomized to live in 1997 census tracts with lower off-premises, but higher on-premises, outlet density. MTO treatment (vs. controls) decreased drinking for girls via alcohol outlet density, but only at higher levels of outlet density. Treatment was 18% more beneficial when girls moved to high density neighborhoods, compared to controls who stayed living in public housing in high density neighborhoods. Conclusion: Additional social processes unmeasured in the current study may play an important role in the alcohol use and other health risks for girls.

The Effectiveness of Alcohol Impact Areas in Reducing Crime in Washington Neighborhoods.

BACKGROUND: We evaluated the effectiveness of Alcohol Impact Areas (AIA) in reducing crime around off-premise alcohol outlets in 3 AIAs in Spokane and Tacoma, Washington, using an interrupted time series design with comparison groups. AIAs only exist in Washington and include designated areas in a city where specific brands of malt liquor are restricted. We hypothesized that mandatory restrictions on malt liquor sales in AIAs would be significantly associated with decreases in crime, especially less-serious crime. METHODS: In Spokane and Tacoma, targets were 3 AIAs and 3 comparison areas with demographically similar neighborhoods without malt liquor restrictions in the same respective city. Nine different crime outcomes were evaluated: Part I selected crimes, Part II selected crimes (further split into nuisance crimes and other Part II crimes), assaults, vandalism, narcotics, disorderly conduct, and all selected crimes combined. Crime was typically compared 3 years prior to and 3 years following policy adoption using time series and negative-binomial modeling. Separate models were run for each area and each crime. RESULTS: Study hypotheses were partially supported. Malt liquor restrictions in AIAs were associated with significant decreases in crime, particularly certain Part II crimes and assaults (simple and aggravated) in 12 of the 23 models. The strength of the observed associations varied by AIA. Average monthly crime counts across all crime categories decreased more in the Tacoma AIA than in Spokane AIAs, and average monthly crime decreased more in Spokane AIA 2 (East Central) than in AIA 1 (Downtown Core). Malt liquor restrictions were significantly associated with increases in disorderly conduct in the Tacoma AIA; the increase, however, was small. CONCLUSIONS: Findings suggest that malt liquor policies such as AIAs may be one of a number of tools local officials can use to reduce alcohol-related crime in cities, especially less-serious crime.

Effects of Restricting High Alcohol Content Beverages on Crime in California.

Background: Policy restrictions on malt liquor sales have been adopted in several cities throughout the United States in an effort to reduce crime around off-premise alcohol outlets. Although California has implemented the most restrictions on malt liquor sales, no studies in the published literature have evaluated the effects of these policies on reducing crime. Objectives: We evaluated the effectiveness of malt liquor restrictions on reducing crime around off-premise alcohol outlets in six California cities. We hypothesized that adoption of malt liquor policies would be significantly associated with decreases in crime within areas surrounding targeted outlets. Methods: We used an interrupted time-series design with control areas to examine the relationship between malt liquor policies and crime reduction. We compared crime rates three years prior and following adoption of malt liquor policies. Results: Malt liquor policies were associated with modest decreases in crime, largely Part II or less serious crimes such as simple assaults. The effectiveness of malt liquor policies varied by city, with reductions in crime greatest in Sacramento where policies were more restrictive than in other cities. Malt liquor policies were also associated with small increases in nuisance crime, especially in San Francisco. Conclusion: Results suggest that malt liquor policies may have modest effects on reducing crime when they include strong restrictions on the sale of malt liquor products. Results may be informative to other cities considering whether to maintain or change their malt liquor policies as well as cities considering placing restrictions on other high content beverages.

Evidence-based policies on school nutrition and physical education: Associations with state-level collaboration, obesity, and socio-economic indicators.

Despite calls for more cross-sector collaboration on obesity prevention, little is known about the role of collaborative partnerships, or groups of organizations from different sectors working together toward a shared goal, in state policy activities. This study examined associations between competitive food/beverage and physical education policies and state-level collaboration and state characteristics (obesity, socioeconomic indicators, public health funding levels) for all 50 states and the District of Columbia, USA, in 2012. We examined cross-sectional associations between evidence-based competitive food/beverage and physical education policies from the Classification of Laws Associated with School Students and state characteristics from the School Health Policies and Practices Study and other national data sources using prevalence ratios and generalized linear models. Analyses were conducted in 2016. Cross-sector collaboration (i.e., state staff reports of working together on school nutrition or physical education activities) between state-level nutrition and physical education staff and ten types of organizations was not significantly associated with having state policies. Childhood obesity (RR=1.78, 95% CI[1.11,2.85]), high-school non-completion (RR=2.35, 95% CI[1.36,4.06]), poverty (RR=1.89, 95% CI[1.16,3.09]) and proportion non-white or Hispanic residents (RR=1.75, 95% CI[1.07, 2.85]) were positively associated with the presence of elementary school competitive food/beverage policies. Fewer indicators were associated with policies for middle and high schools. The large investment of time and resources required for cross-sector collaboration demands greater research evidence on how to structure and manage collaborative partnerships for the greatest impact.

The Impact of Single-Container Malt Liquor Sales Restrictions on Urban Crime.

Many US cities have adopted legal restrictions on high-alcohol malt liquor sales in response to reports of crime and nuisance behaviors around retail alcohol outlets. We assessed whether these policies are effective in reducing crime in urban areas. We used a rigorous interrupted time-series design with comparison groups to examine monthly crime rates in areas surrounding alcohol outlets in the 3 years before and after adoption of malt liquor sales restrictions in two US cities. Crime rates in matched comparison areas not subject to restrictions served as covariates. Novel methods for matching target and comparison areas using virtual neighborhood audits conducted in Google Street View are described. In Minneapolis, Minnesota, sales of single containers of 16 oz or less were prohibited in individual liquor stores (n = 6). In Washington, D.C., the sale of single containers of any size were prohibited in all retail alcohol outlets within full or partial wards (n = 6). Policy adoption was associated with modest reductions in crime, particularly assaults and vandalism, in both cities. All significant outcomes were in the hypothesized direction. Our results provide evidence that retail malt liquor sales restrictions, even relatively weak ones, can have modest effects on a range of crimes. Policy success may depend on community support and concurrent restrictions on malt liquor substitutes.

Attitudes and Practices Regarding Responsible Beverage Service: Focus Group Discussions With Bar and Restaurant Management and Staff.

Staff and management of bars and restaurants are the key players in assuring responsible beverage service (RBS) and preventing the overservice of alcohol to intoxicated patrons. We conducted six focus group discussions ( N = 42) with management and staff from bars and restaurants about RBS. We compared findings from these current discussions to results of focus group discussions conducted in the 1990s. In comparison to the earlier focus group discussions, we found that many managers and staff members had experience with RBS training programs, establishments generally had written alcohol service policies, and managers and staff members perceived greater likelihood of facing consequences from law enforcement for serving underage youth. Managers and servers also expressed greater concern about overservice of alcohol but did not report greater concern about potential legal consequences for overservice of alcohol than participants from the 1990s focus groups. Results of this study can inform training and enforcement approaches to addressing overservice of alcohol.

Can Obviously Intoxicated Patrons Still Easily Buy Alcohol at On-Premise Establishments?

BACKGROUND: Excessive alcohol consumption at licensed alcohol establishments (i.e., bars and restaurants) has been directly linked to alcohol-related problems such as traffic crashes and violence. Historically, alcohol establishments have had a high likelihood of selling alcohol to obviously intoxicated patrons (also referred to as "overservice") despite laws prohibiting these sales. Given the risks associated with overservice and the need for up-to-date data, it is critical that we monitor the likelihood of sales to obviously intoxicated patrons. METHODS: To assess the current likelihood of a licensed alcohol establishment selling alcohol to an obviously intoxicated patron, we conducted pseudo-intoxicated purchase attempts (i.e., actors attempt to purchase alcohol while acting out obvious signs of intoxication) at 340 establishments in 1 Midwestern metropolitan area. We also measured characteristics of the establishments, the pseudo-intoxicated patrons, the servers, the managers, and the neighborhoods to assess whether these characteristics were associated with likelihood of sales of obviously intoxicated patrons. We assessed these associations with bivariate and multivariate regression models. RESULTS: Pseudo-intoxicated buyers were able to purchase alcohol at 82% of the establishments. In the fully adjusted multivariate regression model, only 1 of the characteristics we assessed was significantly associated with likelihood of selling to intoxicated patrons-establishments owned by a corporate entity had 3.6 greater odds of selling alcohol to a pseudo-intoxicated buyer compared to independently owned establishments. CONCLUSIONS: Given the risks associated with overservice of alcohol, more resources should be devoted first to identify effective interventions for decreasing overservice of alcohol and then to educate practitioners who are working in their communities to address this public health problem.

State-Level Trends and Correlates for Cross-Sector Collaboration on School Nutrition and Physical Education Activities, 2000-2012.

INTRODUCTION: Cross-sector collaboration on child obesity prevention is common, yet little research has examined the context of collaboration at the state level. This study describes secular trends in collaboration between state agency staff responsible for school nutrition and physical education activities and other organizations from 2000 to 2012. METHODS: Data from the School Health Policies and Practices Study were used to describe collaboration between state agency staff and 13 types of public, private, and nonprofit organizations. Breadth of collaboration in 2012 was examined across political, social, and economic conditions. RESULTS: Collaboration between state agency staff and other organization types increased from 2000 to 2006 and decreased or stabilized from 2006 to 2012. Breadth of collaboration was greater in states with a physical education coordinator, higher levels of poverty, higher prevalence of childhood obesity, and more public health funding. Breadth was similar across states by census region, political party of governor, majority party in state legislature, percentage non-Hispanic white population, high school graduation rate, and unemployment rate. CONCLUSION: Cross-sector collaboration on school nutrition and physical education was widespread and did not vary substantially across most political, social, and economic measures. Expanded monitoring and surveillance of state-level collaboration would assist efforts to understand how state agencies work across sectors and whether this collaboration affects the support they provide to schools.

Problematic Drinking Among Postgraduate Students: Binge Drinking, Prepartying, and Mixing Alcohol With Energy Drinks.

BACKGROUND: Although problematic alcohol use has been studied extensively in undergraduate students, little is known about problematic drinking among postgraduate students. OBJECTIVES: This study examined binge drinking, prepartying, and mixing alcohol with energy drinks to determine: (1) the extent to which postgraduate students engage in these drinking behaviors, (2) how postgraduate students differ from undergraduate students in these behaviors, and (3) the demographic risk factors for these behaviors in postgraduate (and undergraduate) students. METHODS: This study utilized data from n = 695 students (n = 298 postgraduate; n = 397 undergraduate) who participated in the Healthy Minds Study at a large, public university in the Midwestern US. RESULTS: Past-two-week binge drinking, past-year and past-30-day prepartying, and past-30-day mixing alcohol with energy drinks were reported by 26.2%, 28.6%, 14.9%, and 8.1% of postgraduate students, respectively. Multivariate analyses indicated that postgraduate status was a significant negative predictor of binge drinking and prepartying, and that status interacted with age in predicting prepartying such that the effect of age on prepartying was negative for postgraduate students and nonsignificant for undergraduates. Age was a significant negative predictor of mixing alcohol with energy drinks for all students. CONCLUSIONS/IMPORTANCE: This study makes a unique contribution to the literature by providing information on problematic drinking in postgraduate students. Although there was evidence of "maturing out," a substantial number of postgraduate students were found to engage in binge drinking and prepartying, and a not insubstantial number of them were found to mix alcohol with energy drinks.

Alcohol Service Practices: A Survey of Bar and Restaurant Managers.

Excessive alcohol consumption can result from illegal sales to intoxicated patrons at bars and restaurants. We surveyed bar/restaurant managers about their practices in reducing illegal sales to intoxicated patrons. We found that managers were confident that they could refuse service to intoxicated customers but were less likely to have communicated necessary information to their staff on how to refuse such sales. Managers who agreed that a business in their community would be cited for overservice were more likely to be confident that they could handle customers who had been cut off from alcohol service. Our study suggests that bar/restaurant managers may need training to improve their communication with staff and that increased enforcement may lead to an increase in manager confidence in handling intoxicated patrons.

The alcohol policy environment and policy subgroups as predictors of binge drinking measures among US adults.

OBJECTIVES: We examined the relationships of the state-level alcohol policy environment and policy subgroups with individual-level binge drinking measures. METHODS: We used generalized estimating equations regression models to relate the alcohol policy environment based on data from 29 policies in US states from 2004 to 2009 to 3 binge drinking measures in adults from the 2005 to 2010 Behavioral Risk Factor Surveillance System surveys. RESULTS: A 10 percentage point higher alcohol policy environment score, which reflected increased policy effectiveness and implementation, was associated with an 8% lower adjusted odds of binge drinking and binge drinking 5 or more times, and a 10% lower adjusted odds of consuming 10 or more drinks. Policies that targeted the general population rather than the underage population, alcohol consumption rather than impaired driving, and raising the price or reducing the availability of alcohol had the strongest independent associations with reduced binge drinking. Alcohol taxes and outlet density accounted for approximately half of the effect magnitude observed for all policies. CONCLUSIONS: A small number of policies that raised alcohol prices and reduced its availability appeared to affect binge drinking.

Targeting adults who provide alcohol to underage youth: results from a national survey of local law enforcement agencies.

We investigated what local enforcement agencies are doing to target adults who provide alcohol to underage youth; what types of enforcement activities are being conducted to target adult providers; and factors that encourage enforcement activities that target adult providers. We surveyed 1,056 local law enforcement agencies in the US and measured whether or not the agency conducted enforcement activities that target adults who provide alcohol to underage youth. We also measured whether certain agency and jurisdiction characteristics were associated with enforcement activities that target adults who provide alcohol to underage youth. Less than half (42%) of local enforcement agencies conducted enforcement efforts targeting adults who provide alcohol to underage youth. Agencies that conducted the enforcement activities targeting adult providers were significantly more likely to have a full time officer specific to alcohol enforcement, a division specific to alcohol enforcement, a social host law, and to perceive underage drinking was very common. Results suggest that targeting social providers (i.e., adults over 21 years of age) will require greater law enforcement resources, implementation of underage drinking laws (e.g., social host policies), and changing perceptions among law enforcement regarding underage drinking. Future studies are needed to identify the most effective enforcement efforts and to examine how enforcement efforts are prospectively linked to alcohol consumption.

Developing Internet-based health interventions: a guide for public health researchers and practitioners.

BACKGROUND: Researchers and practitioners interested in developing online health interventions most often rely on Web-based and print resources to guide them through the process of online intervention development. Although useful for understanding many aspects of best practices for website development, missing from these resources are concrete examples of experiences in online intervention development for health apps from the perspective of those conducting online health interventions. OBJECTIVE: This study aims to serve as a series of case studies in the development of online health interventions to provide insights for researchers and practitioners who are considering technology-based interventional or programmatic approaches. METHODS: A convenience sample of six study coordinators and five principal investigators at a large, US-based land grant university were interviewed about the process of developing online interventions in the areas of alcohol policy, adolescent health, medication adherence, and human immunodeficiency virus prevention in transgender persons and in men who have sex with men. Participants were asked questions that broadly addressed each of the four phases of the User-Centered Design Process Map from the US Department of Health and Human Services' Research-Based Web Design & Usability Guidelines. Interviews were audio recorded and transcribed. Qualitative codes were developed using line-by-line open coding for all transcripts, and all transcripts were coded independently by at least 2 authors. Differences among coders were resolved with discussion. RESULTS: We identified the following seven themes: (1) hire a strong (or at least the right) research team, (2) take time to plan before beginning the design process, (3) recognize that vendors and researchers have differing values, objectives, and language, (4) develop a detailed contract, (5) document all decisions and development activities, (6) use a content management system, and (7) allow extra time for testing and debugging your intervention. Each of these areas is discussed in detail, with supporting quotations from principal investigators and study coordinators. CONCLUSIONS: The values held by members of each participating organization involved in the development of the online intervention or program, as well as the objectives that are trying to be met with the website, must be considered. These defined values and objectives should prompt an open and explicit discussion about the scope of work, budget, and other needs from the perspectives of each organization. Because of the complexity of developing online interventions, researchers and practitioners should become familiar with the process and how it may differ from the development and implementation of in-person interventions or programs. To assist with this, the intervention team should consider expanding the team to include experts in computer science or learning technologies, as well as taking advantage of institutional resources that will be needed for successful completion of the project. Finally, we describe the tradeoff between funds available for online intervention or program development and the complexity of the project.

A cost analysis of web-enhanced training to reduce alcohol sales to intoxicated bar patrons.

OBJECTIVE: The purpose of this study was to document the development and testing costs of the Enhanced Alcohol Risk Management (eARM) intervention, a web enhanced training program to prevent alcohol sales to intoxicated bar patrons and to estimate its implementation costs in a "real world", non-research setting. METHODS: Data for this study were obtained retrospectively from a randomized controlled trial of the eARM intervention, which was conducted across 15 communities in a Midwestern metropolitan area. Inputs and their costs were obtained from records maintained during the randomized controlled trial. Total development and testing costs were computed, and implementation costs were estimated with input from the research team. The average implementation cost per establishment was calculated by dividing the total estimated implementation cost by the number of establishments that participated in the study. This provides an estimate of the resources needed to support a broader dissemination of interventions such as eARM. RESULTS: Direct development and testing costs were $484,904. Including the University's overhead cost rate of 51 percent, total development and testing costs were $732,205. Total estimated implementation costs were $179,999 over a 12 month period. The average cost per establishment was $1,588. CONCLUSIONS: Given the large damage liability awards faced by establishments that serve alcohol to drunk drivers, establishments or their insurance companies may be willing to pay the $1,588 estimated implementation cost in order to limit their exposure to these large damage awards. Therefore, making interventions such as eARM available could be an effective and sustainable policy for reducing alcohol-related incidents.

College law enforcement and security department responses to alcohol-related incidents: a national study.

BACKGROUND: Campus police and security personnel are often the first to respond to alcohol-related incidents on campus. The purpose of this study is to examine how campus law enforcement and security respond to alcohol-related incidents, and how consequences and communication differ based on characteristics of the incident. METHODS: Directors of campus police/security from 343 colleges across the United States completed a survey regarding usual practice following serious, underage, and less serious alcohol incidents on and off campus. RESULTS: Campus law enforcement and security most commonly reported contacting campus officials. A minority reported issuing citations and referring students to the health center. Enforcement actions were more commonly reported for serious and underage incidents than for less serious incidents. Large (vs. small) colleges, public (vs. private) colleges, and those located in small (vs. large) towns more consistently reported taking actions against drinkers. CONCLUSIONS: Understanding how campus police and security respond to alcohol-related incidents is essential for reducing alcohol-related problems on college campuses.

Current use of underage alcohol compliance checks by enforcement agencies in the United States.

BACKGROUND: Compliance checks conducted by law enforcement agents can significantly reduce the likelihood of illegal alcohol sales to underage individuals, but these checks need to be conducted using optimal methods to maintain effectiveness. METHODS: We conducted a national survey of local and state enforcement agencies from 2010 to 2011 to assess: (i) how many agencies are currently conducting underage alcohol compliance checks, (ii) how many agencies that conduct compliance checks use optimal methods-including checking all establishments in the jurisdiction, conducting checks at least 3 to 4 times per year, conducting follow-up checks within 3 months, and penalizing the licensee (not only the server/clerk) for failing a compliance check, and (iii) characteristics of the agencies that conduct compliance checks. RESULTS: Just over one-third of local law enforcement agencies and over two-thirds of state agencies reported conducting compliance checks. However, only a small percentage of the agencies (4 to 6%) reported using all of the optimal methods to maximize effectiveness of these compliance checks. Local law enforcement agencies with an alcohol-related division, those with at least 1 full-time officer assigned to work on alcohol, and those in larger communities were significantly more likely to conduct compliance checks. State agencies with more full-time agents and those located in states where the state agency or both state and local enforcement agencies have primary responsibility (vs. only the local law agency) for enforcing alcohol retail laws were also more likely to conduct compliance checks; however, these agency characteristics did not remain statistically significant in the multivariate analyses. CONCLUSIONS: Continued effort is needed to increase the number of local and state agencies conducting compliance checks using optimal methods to reduce youth access to alcohol.