Increasing designated driving with a program of prompts and incentives

Preventive Interventions for On-Premise Drinking: A Promising but Underresearched Area of Prevention

Evidence is reviewed regarding the effectiveness of eight different approaches to the prevention of drinking driving, aggression, and other problems associated with drinking in licensed premises. Some evidence of positive effects was found for Responsible Beverage Service training (including mandatory training), laws holding servers liable for negative consequences due to intoxicated patrons, increased enforcement, ride services, and, to a lesser extent, designated-driver programs and community interventions broadly focused on on-premise drinking. House policies, risk assessments, and proactive policing showed promise but remain unproved in terms of direct effects on the prevention of problems. Codes of practice and patron education appear unlikely to be effective unless combined with enforcement or other interventions. Overall there has been an abundance of local and more extensive interventions to reduce problems in bars, but few have been rigorously evaluated. There is a need in future evaluations for strategically targeting and combining interventions according to a systematic analysis of the nature of the problem and hypothesized contributing factors.

Effectiveness of three contingency-nonspecific stimuli on bathroom graffiti prevention in a college setting

An A-B-A design was adopted to test the effectiveness of different types of contingency-nonspecific stimuli in the prevention of bathroom graffiti in a college setting. The three stimuli examined in this study have been frequently used to prevent bathroom graffiti in South Korea and they were: (a) "Please do not write, draw, or mark on these walls;" (b) a mirror; and (c) "Courteous people keep public places clean." No graffiti was observed when the first and second stimuli were presented. In contrast, a notable increase in bathroom graffiti was observed when the third sign was presented. The results suggest that a contingency non-specific stimuli posting intervention can be effective in the prevention of bathroom graffiti only when appropriate stimuli are used. The practical implications, including cost-effectiveness, are discussed.

An analysis of a contingency program on designated drivers at a college bar

The present study evaluated the effects of prompts and incentives on designated drivers in a bar. We defined the dependent variable as the percentage of customers either functioning as or riding with a designated driver. We used an ABCA design to evaluate the effectiveness of prompts and incentives on the dependent variable. Results indicated that the intervention was successful at increasing the ratio of safe to unsafe passengers in a bar.

Interventions in the alcohol server setting for preventing injuries

BACKGROUND

Injuries are a significant public health burden and alcohol intoxication is recognised as a risk factor for injuries. There is increasing attention on supply-side interventions, which aim to modify the environment and context within which alcohol is supplied and consumed.

OBJECTIVES

To quantify the effectiveness of interventions implemented in the server setting for reducing injuries.

SEARCH STRATEGY

We searched the Cochrane Injuries Group Specialised Register (September 2004), Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2004), MEDLINE (January 1966 to September 2004), EMBASE (1980 to 2004, wk 36), other specialised databases and reference lists of articles. We also contacted experts in the field.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and non-randomised controlled studies (NRS) of the effectiveness of interventions administered in the server setting which attempted to modify the conditions under which alcohol is served and consumed, to facilitate sensible alcohol consumption and reduce the occurrence of alcohol-related harm.

DATA COLLECTION AND ANALYSIS

Two authors independently screened search results and assessed the full texts of potentially relevant studies for inclusion. Data were extracted and methodological quality was examined. Due to variability in the intervention types investigated, a pooled analysis was not appropriate.

MAIN RESULTS

Twenty studies met the inclusion criteria. Overall methodological quality was poor. Five studies used an injury outcome measure; only one of these studies was randomised. The studies were grouped into broad categories according to intervention type. One NRS investigated server training and estimated a reduction of 23% in single vehicle night-time crashes in the experimental area (controlled for crashes in the control area). Another NRS examined the impact of a drink driving service, and reported a reduction in injury road crashes of 15% in the experimental area, with no change in the control; no difference was found for fatal crashes. One NRS investigating the impact of a policy intervention, reported that pre-intervention the serious assault rate in the experimental area was 52% higher than the rate in the control area. After intervention, the serious assault rate in the experimental area was 37% lower than in the control. The only RCT targeting the server setting environment with an injury outcome compared toughened glassware (experimental) to annealed glassware (control) on number of bar staff injuries; a greater number of injuries were detected in the experimental group (relative risk 1.72, 95% CI 1.15 to 2.59). A NRS investigating the impact of a intervention aiming to reduce crime experienced by drinking premises; found a lower rate of all crime in the experimental premises (rate ratio 4.6, 95% CI 1.7 to 12, P = 0.01), no difference was found for injury (rate ratio 1.1. 95% CI 0.1 to 10, P = 0.093). The effectiveness of the interventions on patron alcohol consumption is inconclusive. One randomised trial found a statistically significant reduction in observed severe aggression exhibited by patrons. There is some indication of improved server behaviour but it is difficult to predict what effect this might have on injury risk.

AUTHORS' CONCLUSIONS

There is no reliable evidence that interventions in the alcohol server setting are effective in reducing injury. Compliance with interventions appears to be a problem; hence mandated interventions may be more likely to show an effect. Randomised controlled trials, with adequate allocation concealment and blinding are required to improve the evidence base. Further well conducted non-randomised trials are also needed, when random allocation is not feasible.

Interventions in the alcohol server setting for preventing injuries

BACKGROUND

Injuries are a significant public health burden and alcohol intoxication is recognised as a risk factor for injuries. There is increasing attention on supply-side interventions, which aim to modify the environment and context within which alcohol is supplied and consumed.

OBJECTIVES

To quantify the effectiveness of interventions implemented in the server setting for reducing injuries.

SEARCH STRATEGY

We searched the Cochrane Injuries Group Specialised Register (September 2004), Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2004), MEDLINE (January 1966 to September 2004), EMBASE (1980 to 2004, wk 36), other specialised databases and reference lists of articles. We also contacted experts in the field.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and non-randomised controlled studies (NRS) of the effectiveness of interventions administered in the server setting which attempted to modify the conditions under which alcohol is served and consumed, to facilitate sensible alcohol consumption and reduce the occurrence of alcohol-related harm.

DATA COLLECTION AND ANALYSIS

Two authors independently screened search results and assessed the full texts of potentially relevant studies for inclusion. Data were extracted and methodological quality was examined. Due to variability in the intervention types investigated, a pooled analysis was not appropriate.

MAIN RESULTS

Twenty studies met the inclusion criteria. Overall methodological quality was poor. Five studies used an injury outcome measure; only one of these studies was randomised. The studies were grouped into broad categories according to intervention type. One NRS investigated server training and estimated a reduction of 23% in single vehicle night-time crashes in the experimental area (controlled for crashes in the control area). Another NRS examined the impact of a drink driving service, and reported a reduction in injury road crashes of 15% in the experimental area, with no change in the control; no difference was found for fatal crashes. One NRS investigating the impact of a policy intervention, reported that pre-intervention the serious assault rate in the experimental area was 52% higher than the rate in the control area. After intervention, the serious assault rate in the experimental area was 37% lower than in the control. The only RCT targeting the server setting environment with an injury outcome compared toughened glassware (experimental) to annealed glassware (control) on number of bar staff injuries; a greater number of injuries were detected in the experimental group (relative risk 1.72, 95% CI 1.15 to 2.59). A NRS investigating the impact of a intervention aiming to reduce crime experienced by drinking premises; found a lower rate of all crime in the experimental premises (rate ratio 4.6, 95% CI 1.7 to 12, P = 0.01), no difference was found for injury (rate ratio 1.1. 95% CI 0.1 to 10, P = 0.093). The effectiveness of the interventions on patron alcohol consumption is inconclusive. One randomised trial found a statistically significant reduction in observed severe aggression exhibited by patrons. There is some indication of improved server behaviour but it is difficult to predict what effect this might have on injury risk.

AUTHORS' CONCLUSIONS

There is no reliable evidence that interventions in the alcohol server setting are effective in reducing injury. Compliance with interventions appears to be a problem; hence mandated interventions may be more likely to show an effect. Randomised controlled trials, with adequate allocation concealment and blinding are required to improve the evidence base. Further well conducted non-randomised trials are also needed, when random allocation is not feasible.

A prompt plus delayed contingency procedure for reducing bathroom graffiti

This study assessed the effectiveness of posting signs for reducing graffiti in three men's restrooms on a college campus using a multiple baseline across settings design. During baseline, graffiti increased almost daily in each of the three settings. Immediately following the intervention, no marks were made on any of the three walls. Results were maintained at 3-month follow-up. A possible explanation for the results is that the signs specified an altruistic contingency.