brad s. krevor, ph.d. bill dejong, ph.d. joel grube, ph.d. brandeis university boston university...
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Brad S. Krevor, Ph.D. Bill DeJong, Ph.D. Joel Grube, Ph.D. Brandeis University Boston University PIRE
Reducing youth access to alcohol:
the state-of-the-art in preventing underage sales and use of age-restricted products
April 18, 2006
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Background
RR Forum as outgrowth of Attorney General Consumer Protection Initiative: CP Authority as alternative legal theory for underage sales Agreements with national chains
National CDC-sponsored meeting (March 2000)
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CSAP Report
Report on Best Practices for RR
Innovations of CSAP Report: Identified components of RR
Emphasis upon management systems
Role of public agencies: enforce and assist licensees identify and implement Best Practices for RR
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Paradox of Enforcement
Enforcement is the sine qua non of compliance…
1) But public agencies have inadequate resources to inspection frequently
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Paradox of Enforcement
1. Inadequate enforcement resources
2. “Educate into compliance”: … but not when turnover rates > enforcement frequency
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Paradox of Enforcement
1. Inadequate enforcement resources2. “Educate into compliance”
3. Wagenaar study (2005): pedagogic effects short-lived
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Paradox of Enforcement
1. Inadequate enforcement resources
2. “Educate into compliance”
3. Pedagogic effects short-lived
4. Deterrent effect is undermined by the uncertainty of how to avoid risk:
Policies do not translate into consistent clerk (or manager) performance
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Integrated Responsible Retailing Model
a continuous system supported by the efforts of retailers, agencies, and other public and private stakeholders
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Protocols for age verification/ sales declination
Point-of-sales aids:
Signage
Specialty calendars
ID scanning
Hiring, Supervision,
Training
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A “Community Policing” model employs a “problem-solving” approach to underage access and use.
Identify and address actual sources of age-restricted products in the community
An involved, concerned community is decisive in motivating public agencies, which in turn can engage—and assist—retailers.
“Retailers as Active Partners”
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Responsible Retailing
Policies
• Laws and Regulations
• Enforcement protocols
• Penalties
• Affirmative Defense
• FundingWhat Policies will encourage adoption of effective RR practices?
Public PolicyPublic Policy
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RR Systems Project
1st RR Forum: March 2003, Orlando, FL Staffed by Brandeis and FSU support from Diageo / Diageo Foundation
1st priority recommendation:Demonstrate and evaluate the integrated RR systems model.
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RR Systems ProjectDeveloping an operational model 1. Business analogue for implementing BPs:
ExxonMobil Assurance of Voluntary Compliance• Adoption of many Best Practices in CSAP Report• Continual monitoring• Remedial response to age-verification failures• Company-wide commitment
How would one replicate the ExxonMobil model at the level of community?
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RR Systems Project
Developing an operational model 2. Health care analogue:
Best Practices = Clinical Guidelines
How to implement clinical guidelines in medical practice sites?
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RR Systems Project
Developing an operational modelWhy primary care physicians don’t adopt guidelines:
[note similarity to explanations for not checking IDs]
Unfamiliarity Time constraints: too busy Inability to overcome inertia of prior practice Doubts regarding effectiveness Doubts regarding self-efficacy (for tobacco) Aversion to confrontation
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Public Health model
Medical Practice SitePatient—Doctor
Community Resources:•Quit lines•Counselors•Cessation classes
State Stakeholder:•Health Depts.•Medical societies•Insurers
•Planning Guide •Pharmacology•Self-help Materials•Tech. Assistance
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Community Resources:•Clerk / Server Training•Mystery Shoppers•Coalitions
Public Health model applied to retailing
Retail EstablishmentCustomer—Clerk / Server
State Stakeholder:•Regulators•Health Depts. •Trade ass’ns
Planning Guide RR materials
Tech Ass’t
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RR Systems Project
Phase 1 (Sept 2003 – May 2005):
Focus upon Tier 1: Retail-level Objective: Develop tools to assist retailers and implementation strategies
Study Sites: Birmingham, AL Springfield, MO Santa Fe, NM Des Moines, IA
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RR Systems Project
Assistance to retailers:1. Develop “A Planning Tool for [Iowa] Retailers”
a quality improvement tool to assess current practices identifies absent Best Practices Promoted and supported by state Regulatory / Enforcement
agency: R / E Agency is engine that drives the model
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RR Systems Project
Assistance to retailers:2. Monitoring / Feedback
Multiple inspections by young adults Reports to retailers on individual inspections
Feedback—not penalties! Will include inspections by pseudo-intoxicated
customers
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RR Systems Project
Lessons from Phase 1: Variability of retailers
Chains Owner-operatedhigh Number of employees low “ Turnover “ “ Need for Systems “ “ Level of technology “ “ Explicit policies “ no Manager is change agent? yes
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RR Systems Project
Lessons from Phase 1: Stakeholders face challenge in engaging retailers regulatory / enforcement agencies are feared independent retailers don’t belong to trade
associations
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RR Systems Project
Phase 2 (beginning Sept 2005): Community roll-out of “enforcement + assistance” model
Study sites:
Albuquerque, NMMontgomery, AL Iowa City, AL
Waukesha, WI Gettysburg, PA
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RR Systems Project
Phase 2
Focus: Community context (2nd tier of model)
Objectives:
1) Engage retailers in quality improvement model
2) Employ community policing principles to identify actual sources of alcohol (both commercial and social) in the community
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RR Systems Project
Phase 3 (begin 2007/08):
Focus: 3rd tier: system-level RR
Objective: conduct a multi-state community trial to evaluate the effectiveness of the “enforcement + assistance” model at the level of county, with study arms that employ various implementation strategies to engage retailers.
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Insights derived from RR Research
The problems that we face are in the domain of public health . . .
. . . but the solutions are in the domain of organizational behavior
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Insights derived from RR Research
Electronic Age Verification (EAV) device Field effectiveness study:
Study sites: Tallahassee, FL; Iowa City, IA
Primary findings: attitudes; utilization
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Insights derived from RR Research
Electronic Age Verification (EAV) device study
TobaccoInspections
Baseline 1Compliance
Baseline 2Compliance
CompliantB1 & B2
Florida 81% 86% 66%
Iowa 43% 51% 33%
Overestimation of compliance
Variability of “compliance”
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Insights derived from RR Research Electronic Age Verification (EAV) device study
Variability of clerks:Clerk is an important determinant of whether the
store is found to be compliant
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Insights derived from RR Research
Who makes underage sales?No profilelength of time predictive of complianceunderage sales a “crime of inattention”