Empowerment Evaluation: Grantee Perspective

SHOWCASE OF EVIDENCE-BASED ENVIRONMENTAL STRATEGIESPresented by: Workgroup on Evidence-Based Practice (WEB)Presented for CASTDate: January 26, 2011

AgendaBrief history/goals of WEB groupDefinitions of evidence-basedLogic models for preventing DUI and underage drinkingOverview of enforcement strategiesLunchReview of additional environmental strategiesQuestion and AnswersNext StepsBackground on WEBWEB (Workgroup on Evidence-Based) began in January 2010 as condition of SPF-SIG.Wanted the Cohort 4 states to learn from previous states about what works.Wanted continued update of the literature.WEB should work to compile literature that is customize for each states priorities.

Who is on the WEB?Co-chairpersons: Drs. Pam Imm and Abby FaganCommunity and state-level expertsSee handouts of presenters/agenciesCoaches attend WEB meetingsStaffed by PIRE and other DAODAS staffReport to the Executive Committee and to the Governors Council

Goals of WEB Compile literature on the evidence-based practices for the states priorities. Ensure the use of EBP in the countiesCurrent Roles: Compile literature on EBP for CASTProvide training on EBP for CASTProvide recommendations for SC ToolkitProvide recommendations to Governors Council about the county strategic plans

Format for ShowcaseOverview of strategyKey terms/definitionsRelation to logic model and needs/conditionsNeeds assessment data sources to reviewHow do we know it is evidence-based? Current status in South CarolinaWhat are the key elements of implementation?

WEB MEMBERS Dr. Pam Imm, Chair LRADAC Dr. Abigail Fagan, Co-Chair University of South Carolina Barbara BrownClemson University Ann CrawleyCommunity Initiatives, Inc.Regina CreechRegion 4 Capacity Coach, Ernest E.Kennedy Center Rhonda DiNovoWest Columbia Police Dept.Dawn HancockRegion 3 Capacity Coach, Circle ParkBehavioral Health Services

WEB MEMBERS (cont.) Donna HerchekCounseling Services of LancasterLou Anne JohnsonRegion 1 Capacity Coach, The Phoenix Center Beth MackinemSC Dept. of EducationPam RushAxis 1 Center of BarnwellCurtis ReeceThe Phoenix Center Eunika SimonsRichland School District 2Kim SmithSC Dept. of EducationKristy StoneburnerRegion 2 Capacity Coach, LRADAC Lorene WelchSC PTA

WEB STAFFSteven BurrittPIREMichael GeorgePIRECrystal GordonDAODASKerry McLoughlinDAODASElaine Dowdy Melvin PIREMichelle Nienhius DAODAS Brenda PowellDAODAS

Overview of Evidence-Based StrategiesDr. Abigail Fagan, University of South Carolina Dr. Pam Imm, Lexington/Richland Alcohol and Drug Abuse CouncilPrepared for CAST: Jan 26, 2011 What Does Evidence-Based Mean?OVER THE LAST THREE YEARS, OVER 220 COMMUNITIES HAVE STARTED NEW D.A.R.E. PROGRAMS!Even little ones can think and respond when guided with Love and Logic." -Linda, Anderson, CAGrandparentThe Community Trials Intervention produced significant results, including: decreased alcohol sales to youth and decreased binge drinking. Program EvaluationAsk two questions:Does it work?How do you know it works?On the one hand.On the other hand

Does it Work?Yes (Pretty good evidence)There are meaningful changes in the outcomes you are interested in for participants or communities who received the intervention Look for actual statements regarding changes (e.g., statistics and graphs)There are no harmful effects on participants

Effects of the Life Skills Training Program on Adolescent Alcohol UseSource: Botvin, Baker, Dusenbury, Botvin, & Diaz, 1995

12.15.00KLO 1-14Weekly alcohol use rates were: 29% for control group, 26.5% for full group (NS vs. control) and 22% for high fidelity group (sig) Does it Work?YES! (the Best evidence)Effects were sustained over timeEffects were replicated in multiple studies And were shown for a variety of populationsAnd were assessed by independent evaluators

How do you know it works?Effects were found during a strong, carefully conducted study One group, pre/post test design: the most common type of study; results may not be as valid Quasi-experimental design: participants are non-randomly assigned to intervention and comparison groupsExperimental research design: participants are randomly assigned to receive the intervention or not (i.e., involves a control group)

Why have a comparison group?Guards against falsely concluding that an effective program didnt workGuards against falsely concluding that an ineffective program did workHelps rule out other possible explanations for the change

How do you know it works?Other important questions to ask:How many participants were involved in the study?How many participants dropped out of the research project (why?)?What happened to participants in the control group?

How is this relevant for your work?The WEB group has reviewed the evidence and will summarize what works regarding environmental strategiesIts still important to look at the details of how well and for whom these strategies are effective. Fortunately, much of the research has been done for you and the WEB has consolidated the research for you.

What is meant by environmental strategies?Looks to change the conditions in the environment.Individual change:Focus: Individual behaviorGoal: Personal control of alcoholTools: Education, treatment, small group activitiesWho: Professional and client; educator and studentWhat is meant by environmental strategies? (cont.)Move from individual to environmentalEnvironmental changeFocus: policy, laws, normsGoal: Community control of alcoholTools: Media and policy advocacy, social pressureWho: Coalitions, stakeholders, community organizersFoundation of Key PrinciplesSubstance use is a public health challenge requiring a public health approach.

Select Sources: IOM, 2004; SAMHSA/CSAP, SPF Grants, 2004 -Host (individual)Agent(ATOD)Environment(social, physical, other contexts of use)Influence host through interventions targeting individualsInfluence agent (ATOD) through controls on supplyInfluence environment by changing social, physical, other factors at family, community, state, national levels 22Foundation of Key Principles (Cont.)A complex system of factors produces substance use and related problems.

Select Sources: Birckmayer et al., 2004; IOM, 2004

Multiple points of intervention Varied levels of influenceAssessmentThen comprehensive and synergistic approach

23Foundation of Key Principles (Cont.)Prevention requires a shift from select an intervention to prevention by design for widespread impactFrom intervention-based approach focused on individuals To a diagnostic approach focused on population-level change

Select Sources: SAMHSA/CSAP, SPF Grants, 2004 - ; Green & Kreuter, 1999Intervening Variables, R/P Factors

SCIENTIFIC KNOWLEDGE ABOUT PREVENTION STRATEGIESSUBSTANCE USE and RELATED CONSEQUENCES

Existing Products, Research, and TAExamples of Advances in the Last Five YearsEpidemiology Workgroup ToolkitAssessing The Fidelity SPF Cross-Site 2006200520082010Reducing Underage DrinkingEnvironmental Strategies GuideThe Surgeon Generals Call To ActionGetting To Outcomes: SPFTask Force on Prevention Services FindingsLogic Model on Underage Drinking20072009$s and Cents Cost Benefit AnalysesTrends in Underage Drinking NIAAAIOM Report on Preventing DisordersAssessing Drug Abuse NIDA / CEWGUnderage Drinking/DUIWhat do we know?Economic availability Strong evidence that PRICE reduces use and associated harmsRetail availability Strong evidence that physical and commercial access reduces use and associated harms Minimum purchase age lawsOutlet density restrictionsProhibition of minors from barsControls on who can sell and whenInternet monitoringEnforcement is directly related to policies strong evidence that threat of and actual enforcement deters use and reduces associated harms

Social availability and access (intervention evidence is limited yet evolving)Minor in possession lawsPenalizing adult procurement for youthInterventions evolve as sources evolveMedia/Promotion most effective when supporting specific policies or enforcement effortsBy itself, little effect on behaviorSome lessons to be learned from tobaccoNorms are related to policies and behavior, but temporal relationship less clearUnderage Drinking/DUIWhat do we know? (Cont.)What types of environmental strategies work to reduce underage drinking and DUI?Enforcement (compliance checks, traffic safety checkpoints)Happy Hour restrictionsRestricting sales at Public EventsResponsible Beverage ServiceSocial Host LawsGraduated Drivers License LawsKeg RegistrationReducing Alcohol Outlet DensityIncreasing Taxes on Sales of Alcohol

How do I know which to pick?Pull out logic models (DUI/underage drinking)You are to create a strategic plan (it will never be one strategy)Pick your strategies based on the data collected from needs/resource assessmentShould be a match between what needs assessment data are telling you and what environmental strategies you choose.Examples of good match and not so goodEunika SimonsReconnecting Richland 2INCREASING TAXES ON SALES OF ALCOHOLIncreasing Taxes on Sales of AlcoholOverview: The overall price of alcohol affects how much people will consume, which in turn, affects the level of alcohol-related problems. The primary way to make alcohol more expensive is through increasing taxes on the sale of alcohol.Research indicates that higher taxes lead to a reduction in the levels and frequency of drinking and heavy drinking among youth, lower traffic fatality rates and reduced incidence of some types of crime.TermsAdjusting taxes to the rate of inflation: One way to raise taxes is to catch up the current tax rate to what it should be after accounting for inflation and then index the alcohol taxes to increase with inflation for future years.

Alcoholic Beverage Control States: Certain states have a state monopoly over the wholesale and/or retail pricing and distribution of some or all categories of alcoholic beverages. (Southeastern control states: Alabama, North Carolina, Mississippi)How does it work?Decreasing access/availability of alcohol by raising prices through tax increases.Current Status in SCSouth Carolina RatesAverage National RatesNational RankSpirits Tax$5.42$5.9421stTable Wine Tax$1.08$0.7911thBeer Tax$0.77$0.274thSouth Carolina Alcohol Sales Tax Rates (per gallon) January 2009

In short, South Carolina has close to an average sales tax on spirits, a high tax on wine, and a very high tax on beer.Key Elements of ImplementationDetermine what the current tax rate is for your state/community.Learn what the exact rate is in your state.Conduct analysis on what tax rate should be raised to.Key Elements of Implementation (cont.)Compile data and evidence that supports alcohol tax increases.Begin building community support for this strategy from lawmakers, key stakeholders and the public at large.Identify immediate, intermediate and long-term outcomes of the strategy.Relation to Logic ModelKey Risk FactorsSocial norms favorable toward useEasy retail/social accessLow or discount pricing

Data SourcesEnvironmental ScanCommunity/Key Leader SurveysDepartment of RevenueAlcohol CommissionAlcohol Tax IncreasesImplemented at state and federal levelsAre beverage-specificBased on the amount of beverage purchasedNot on the sales priceEffects erode over time InflationIndustry promotionsPrice reductions to offset taxesNeed to adjust tax amountSupport based on 73 studiesReductions in consumption and harmsControlling Alcohol Outlet Density and LocationOverview: Geographic areas with increased alcohol outlet density have increased levels of heavy drinking and alcohol-related problems, including violence, crime, alcohol-related traffic crashes and injuries. Geographic buffers between alcohol establishments and youth-related areas (schools, parks) help reduce accessibility by making it less prevalent in their immediate environment.Definitions/TermsAlcohol licensee: Paid $ to receive a license to serve alcohol on premise or off-premise (or both) from Department of Revenue (DOR).Alcohol outlet density: Number of outlets that can sell alcohol within a given geographic areaGeographic densityEconomic densityPopulation density Relation to Logic ModelKey risk factors:Social norms favorable toward useEasy retail/social accessInsufficient enforcementData sources:Youth surveys (CTC)Environmental scanCommunity/key leader surveysCrash data

How do we know it is evidence-based?Higher density contributes to increased alcohol-related problems including sales to minors. Both Off and On premise outlet density is positively related to frequency of underage driving after drinking and riding with drinking drivers among 16-20 year old youth.Outlet density related to drinking and drinking- related problems among college students.Evidence (continued)The CDC Task Force on Community Preventive Services recommends the use of regulatory authority (e.g., through licensing and zoning) to limit alcohol outlet density on the basis of sufficient evidence of a positive association between outlet density and excessive alcohol consumption and related harms.

ResourcesCampbell CA, Hahn RA, Elder R, Brewer R, Chattopadhyay S, Fielding J, Naimi TS, Toomey T, Briana Lawrence B, Middleton JC, Task Force on Community Preventive Services. The effectiveness of limiting alcohol outlet density as a means of reducing excessive alcohol consumption and alcohol-related harms. Am J Prev Med 2009;37(6):556-9.Task Force on Community Preventive Services. Recommendations for reducing excessive alcohol consumption and alcohol-related harms by limiting alcohol outlet density. Am J Prev Med 2009;37(6):570-1.

Application for License/PermitPublic notification of intention to sell alcohol (e.g., newspaper)Who is applying and address of location To object, written protest must be notified by (date) including:Name, address, and telephone number of person filingSpecific reasons why the application should be deniedThat the person protesting is willing to attend a hearing (if requested by the applicant)That the person resides in the same county where the proposed place of business is located or within five miles of the business, and name/address of applicant and location

AddressProtests must be mailed to Department of RevenueAttn: ABLP O Box 125Columbia, SC 29214Fax: 803-898-5899Key elements of implementationDetermine law (local and state)Get champions on your sideEnsure a geographic buffer zone of about 1000 feet between outlet and schools, playgrounds, residential neighborhoods, etcWork to restrict these outletsConsider conditional permitsIncrease communitys awareness/knowledge that they can protest issuance (newspaper)MediaMedia is a powerful resource but is NOT EFFECTIVE on its own.Couple media efforts with other activities; publicize the activities of other activities (e.g., compliance check activities, merchants who dont sell, school TV stations, sobriety checkpoints).Combined with multi-component community efforts /variety of new media optionsDeterrent effect increase perceived risk of detection

Take-Away MessagesA complex system [still] produces substance usePrevention is more than packaged programs and strategies it is a strategic, comprehensive design process of planning, implementation, and evaluationNo single program component or strategy can prevent multiple and complex risk behaviors, reduce related harms, and achieve widespread and lasting change.Need individual and population-based approaches that target high risk situations and use in general

49Take-Away Messages Cont.Education programs (alone, small, limited effects) should be used within broader environmental approaches to address availability of alcoholPolicies need to target both underage drinkers AND the general populationHelp eliminate adult suppliers and role modelsReduce social acceptability of adult provisionResearchers, policymakers, and practitioners all have important perspectives. We can advance the field by working and learning together!

50Questions and AnswersLets talk!!

Please complete evaluation forms

Use the technical assistance providers available to you.

KEG REGISTRATION Beth MackinemSC Department of Education Keg RegistrationOverview of the Keg Registration Law: Requires kegs of beer to be tagged with an identification number and information to be recorded about the purchaser; Sometimes a deposit is required as an incentive to keep the keg properly tagged; and Easier to track the whereabouts of kegs and the individuals using them including underage youth and the adults who provided the keg for them.Definition/TermsSouth Carolina terms:Keg means a container of beer with a capacity of 5.16 gallons or more that is designed to dispense beer directly from the container in an off-premises location.Retail licensee means the holder of a retail beer or wine license issued by the South Carolina Department of Revenue.

Relation to Logic ModelKey Risk Factors:Easy social access;Social Norms encouraging use; Insufficient enforcement of laws; andEasy retail access

How do we know it is evidence based?According to the Community Anti-Drug Coalitions for America (CADCA), keg registration reduces the overall rates of traffic deaths among the general population. Keg registration enhances the control of youth access to alcohol outside of licensed establishments.

Keg registration allows retailers to keep track of when a keg is purchased and who purchased the keg. Keg registration also gives law enforcement information needed to determine the responsible party for the purchase.

How do you know it works?Adults may be dissuaded from purchasing a keg for a group of underage youth if that purchase will be able to be tracked back to them. Anyone who purchases a keg must sign paperwork that states that they cannot provide alcohol to anyone under the age of 21 and that the beer in the keg will not be consumed by anyone under the age of 21.

A retail licensee cannot sell a keg of beer without gathering the purchasers information and verifying the accuracy of the information by obtaining drivers license information from the purchaser. A retailer can lose their beer or wine license for violation of this law.

A paper compiled by the Illinois Higher Education Center for Alcohol, Other Drug and Violence Prevention indicates that there is not sufficient data on the effectiveness of keg registration, however advocates indicate that it decreases the supply which in turn decrease consumption.Current Status in South CarolinaSouth Carolina has a keg legislation law that wentinto effect January 1, 2008.The Alcohol Beverage License (ABL) holder must attach a Keg Identification Tag to the kegMust complete the State-approved Keg Registration Form. The license holder must keep the Keg Identification Tag and the Keg Registration Form, for a period of not less than 90 days from the date the keg was sold to the consumer.Current Status in South Carolina (cont.)The SC Department of Revenue will furnish the Keg Identification Tag to any license holder upon written request and proper proof of licensure. The Keg Identification Tag is furnished without cost to the license holder. The license holder must furnish his/her ABL license number and acknowledge receipt of the numbered Keg Identification Tag(s). Any SC Department of Revenue office can furnish the license holder a limited number of Keg Identification Tags.Current Status in South Carolina (cont.)About the Keg Identification Tag Designed by the SC Department of Revenue Is approximately 4x 5, and is a 2-color water-resistant and tear-resistant poly film tag, bearing consecutive numbers and the State of South Carolina image. Contains certain relevant statutory portions advising the license holder on how to attach the tag Has a warning to the public that it is unlawful to remove, alter or obliterate the Keg Identification Tag, punishable by a fine of up to $500 and/or imprisonment of not more than 30 days. Has blank lines for the license holder to record his name, address and ABL License Number.

Key elements of implementationThe license holder, before making any keg sale to a consumer,must record and keep the following information on the Keg Registration Form:The date of the sale and the Keg Identification Number.The name, address and birth date of the purchaser.The driver's license or identification card number furnished by the purchaser.A statement by the purchaser attesting that the information furnished to the license holder is accurate and acknowledging that unless authorized by law, it is unlawful to transfer beer to a person under the age of twenty-one.The date the keg was returned to the license holder and whether the Keg Identification Tag was returned with the tag properly affixed.The Keg Registration Form must be available for inspection by the Department of Revenue or law enforcement agencies during normal business hours.ResourcesIllinois Higher Education Center for Alcohol, Other Drug and Violence Prevention, Spring 2005, Statewide Mandatory Keg Registrationhttp://www.eiu.edu/~ihec/documents_pdf/rb_link_keg_registration.doc , accessed on January 18, 2011. Imm, Pamela , Matthew Chinman, Abraham Wandersman, David Rosenbloom, Sarah Guckenburg and Roberta Leis. Preventing Underage Drinking: Using Getting To Outcomes with the SAMHSA Strategic Prevention Framework to Achieve Results. Santa Monica, CA: RAND Corporation, 2007. http://www.rand.org/pubs/technical_reports/TR403

South Carolina Department of Revenue website for the keg registration instructions and required forms, http://www.sctax.org/Forms+and+Instructions/default.htm

The Evidence for Environmental Strategies Drug Free Communities New Grantee Meeting, Washington, DC December 7, 2010, http://www.preventionworksinseattle.org/uploads/Evidence-4-EnvironmentalStrategies-CD-12-2010.pdf , accessed on January 18, 2011.

RESPONSIBLE BEVERAGE SERVICE

Barbara Brown Clemson University64Responsible Alcohol Sales (RAS) & Beverage Service (RBS) StrategyOverview of strategy Responsible Alcohol Sales training (RAS) and Responsible Beverage Service (RBS) training helps employees and managers understand state laws and corporate social responsibility policies and procedures. It is a good best line of liability defense for alcohol sales and service by educating on strategies to avoid illegally selling to underage youth and intoxicated patrons.

Key Definitions/TermsAlcohol licensee: Paid $ to receive a license to serve alcohol on premise or off-premise (or both) from Department of Revenue._ Alcohol Licensee_ On-premise Licensee_ Off-premise Licensee_ On/Off-premise LicenseeCorporate Social Responsibility: The concept of an organization taking responsibility for its impact on society and the environment. (www.science.org.au/NOVA/034/034glo.htm)Protect, Respect, and Remedya United Nations framework(www.reports-and-materials.org/Ruggie-UN-draft-business-principals)

RESPONSIBLE SALES AND SERVICE TRAININGAlcohol Sales and Service trainings aim to reduce alcohol related harm.Be aware of social aspects organizations of the alcohol industry who may provide research, training and provide policy recommendations.Three programs approved by State Department of Revenue:Palmetto Retailers Education Program (PREP) www.prepmerchant.orgServSafe (on-premise alcohol sales & food safety) www.servsafe.comTIPS (on & off-premise alcohol sales www.gettips.com

RAS & RBS Training on Responsible Policies & Procedures Information about: laws and penaltiesthe importance of avoiding sales to minors to protect the health and well-being of everyone in the community how to recognize false IDs how to refuse a sale safely proper management techniques and policies to encourage compliance with the law(From: Pacific Institute for Research and Evaluation)

Relation to Logic ModelKey risk factors: Easy retail/social accessData sources:Environmental scanCommunity/key leader surveysState Licensee DataCompliance Check DataWhere else?

How do we know it is evidence-based?These types of programs (RBS training) help reduce alcohol sales to underage youth. Also, they help protect licensees and their employees as well.Nearly all evaluations in training bar staff in responsible beverage service when backed up with enforcement have demonstrated improved knowledge and attitudes among participants. (Anderson & Baumberg, 2006)Evidence There is growing evidence for the impact of strategies that alter the drinking context in reducing the harm done by alcohol. These strategies are primarily applicable to drinking in bars and restaurants, and their effectiveness relies on adequate enforcement. Passing a minimum drinking age law, for instance, will have little effect if it is not backed up with a credible threat to remove the licenses of outlets that repeatedly sell to the under-aged.Such strategies are also more effective when backed up by community based prevention programs

Anderson, P., and Baumberg, B. (June 2006), Alcohol in Europe A Public Health Perspective A Report for the European Commission, Institute for Alcohol Studies, U.K.

EffectivenessIntensive, high quality, face to face server training, when accompanied by strong and active management support, is effective in reducing the level of intoxication in patrons, (Shults, 2001).

An Oregon study showed that a server training program reduced single-vehicle nighttime injury crashes by 23% (Jones and Lacey, 2001).

http://www.nhtsa.gov/people/injury/airbags/countermeasures/pages/Chapt1/5p1RespBevSe

EffectivenessA rigorous server 18-hour RST program for management and staff and the revision of establishment policies and job descriptions at a US Navy Base resulted in customer intoxication being cut in half (Saltz,1987).

University of Minnesota, (2009) Alcohol Epidemiology Program, Responsible Beverage Server Training, Retrieved from:http://www.epi.umn.edu/alcohol/policy/rbst.shtm

NeedFood and beverage industry forecast that consumers are expected to increase their purchases of alcohol in bars and restaurants in 2011 by 1.9%, from Business Wire Technomic news release, December 8, 2010.

Current Status in SCServer training is only required of an individual if they are convicted of selling to youth

Alcohol liability insurers often offer discounts for having all staff trained

1,671 participants trained in PREP in FY10 (dropped 2 straight years)

Current Status in SC (cont.)Only 11% of clerks ticketed for underage sales in FY10 indicated they had taken a merchant education class

DAODAS & CAST recommend PREP, a rigorous delivery and monitoring system is in place which includes pre & post surveys and tracking

Many establishment (like grocery stores) say they do their own training

Key Elements of Implementation The alcohol industry can provide server training and monitoring to: insure adherence to the law; and reduce risk of harmful consequences of intoxication, harmful patterns of drinking, and the risk of drinking and driving.

Resources Alcohol Epidemiology Program, Responsible Beverage Service Training http://www.epi.umn.edu/alcohol/policy/rbst.shtmAlcohol Policy http://www.alcoholpolicy.niaaa.nih.govFACE, 105 West Fourth St., Clare, MI 48617, 1-800-822-3223, http://www.facecatalog.orgImn, P., Chinman, M., Wendersman, A., Rosenblum, D., Guchenberg, S., Leis, R. (2007), Preventing Underage Drinking Using Getting To Outcomes with SAMHSA Strategic Prevention Framework to Achieve Results, A Rand Health Technical Report supported by the Substance Abuse and Mental Health Service Administration, Santa Monica, CA: Rand Corporation,Retrieved from: http://www.rand.org/content/dam/rand/pubs/technical_reports/2007/RAND_TR403.pdfPacific Institute for Research and Evaluation, http://www.pire.orgUnderage Drinking Enforcement Training Center, http://www.udetc.org/documents/responsible_sales.pdf

ENFORCEMENT STRATEGIESSteven Burritt Michael George Pacific Institute for Research and Evaluation (PIRE) Compliance ChecksOverview: When retail outlets intentionally or unintentionally sell alcohol to those under 21, it increases the availability to youth. SC high school surveys reveal direct retail purchase is the most common access method for @ 10% of them.

Key Definitions/TermsOn-Premise: Place where the alcohol is consumed where it is bought (Bar, restaurant, hotel, etc.)Off-Premise: Place where alcohol is sold but not consumed (store)Administrative Violation: Ticket written against license holder rather than clerk; must have state powers to writeUCI: Underage Cooperating Individual (the youth)Relation to Logic ModelKey risk factors:Social norms favorable toward useEasy retail accessInsufficient enforcement of lawsData sources:AET Compliance DataYRBSSC CTC

How do we know it is evidence-based?Numerous PIRE/OJJDP publications identify compliance checks as evidence-based, when appropriately coupled with merchant awareness and application of sanctionsDirect connection between youth use and rate of illegal sales (Oregon study; Dent, Grube, & Biglan, 2005)Dozens of studies and examples of reductions in youth access (including SC)

ResourcesPIRE/OJJDP. Guide to Conducting Alcohol Purchase Surveys. (www.udetc.org)DAODAS/PIRE. Compliance Check Instructions. (http://chweb.pire.org/scdocuments/)DAODAS/PIRE. SC Compliance Check Planning Guide. (http://chweb.pire.org/scdocuments/)Regional AET TrainingsCurrent status in SCAETs did 6,438 checks in FY 10Buy rate: 14.5%Steady drop from 20.3% in FY 07Almost every county has conducted through AETsSLED now does relatively few; complaint-drivenSee much more on compliance data in Prevention Outcomes Annual Reports (Chapter 5) found at (http://chweb.pire.org/scdocuments/)

Key elements of implementationDo not neglect merchant notificationlet them know you are coming! (vaguely)Couple with offering merchant education, to violators and non-violatorsPartner w/ SLED when possible so administrative violations are writtenPublic Safety CheckpointsOverview: There is substantial and consistent evidence from research that highly publicized, highly visible, and frequent sobriety checkpoints in the United States reduce impaired driving fatal crashes by 18% to 24% (Fell, Lacey, & Voas, 2004). Checkpoints are used in South Carolina by state and local law enforcement agencies working in communities to deter drink driving motorists.Key Definitions/TermsLow staffing checkpoints: These checkpoints involve 4-5 officers, are highly mobile, and typically short in duration (45 minutes to 1 hr). This type of checkpoint important for agencies with lower resources in personnel, yet want to affect impaired driving in their community.Full scale checkpoints: These checkpoints can involve 10-12 officers. Depending on the location for the checkpoint, this strategy may involve more officers, especially if it is a multi-jurisdictional checkpoint.High visibility enforcement: Strict enforcement combined with a strong public message from either earned or paid mediaRelation to Logic ModelKey risk factors:Social norms favorable toward useInsufficient enforcement of lawsData sources:AET/LEN checkpoint dataCrash data provided from Office of Highway Safety through CASTYRBS/SC CTCInformation obtained from impaired drivers about last place of drinking

How do we know it is evidence-based?Many studies point to the effectiveness of checkpoints for reducing drink-driving crashes, when conducted in manner consistent with high visibility enforcement practices (Lacey, et al., 2006; Fell, et al., 2004; Clapp, et al., 2005). ResourcesRegional AET TrainingsLaw Enforcement Networks (www.sclen.org)AET Public Safety Checkpoint videoNHTSA Public Safety Checkpoint Guidelines

Current status in SCIn 2010, there were about 4,600 checkpoints conducted in South Carolina (source is SCDPS)Also in 2010, SC law enforcement made 24,430 arrests for DUI (not just at checkpoints-source is SCDPS)Averages to one checkpoint conducted every 3 days in every county in South CarolinaExisting partnership through SCLEN (www.sclen.org), SCHP, and local law enforcement to conduct public safety checkpointsSome AETs & LENs conduct checkpoints and compliance checks at same timeKey elements of implementationUtilize data sources, such as crash and arrest data to determine checkpoint locationsEnroll state and local law enforcement agencies to conduct checkpointsConduct earned media events publicizing checkpointsInform public why and where checkpoints are being held to increase perception of likelihood that impaired driving motorists will be apprehended.Once checkpoints are held, inform public of results

ReferencesBabor, T. (2010). Alcohol : no ordinary commodity : research and public policy (pp. xv, 360 p.). Oxford ; New York: Oxford University Press.Beck, K. H., & Moser, M. L. (2006). Does the Type of Exposure to a Roadside Sobriety Checkpoint Influence Driver Perceptions Regarding Drunk Driving? [Article]. American Journal of Health Behavior, 30(3), 268-277. Clapp, J. D., Johnson, M., Voas, R. B., Lange, J. E., Shillington, A., & Russell, C. (2005). Reducing DUI among US college students: results of an environmental prevention trial. Addiction, 100(3), 327-334. Fell, J. C., Ferguson, S. A., Williams, A. F., & Fields, M. (2003). Why are sobriety checkpoints not widely adopted as an enforcement strategy in the United States? [doi: DOI: 10.1016/S0001-4575(02)00097-0]. Accident Analysis & Prevention, 35(6), 897-902. ReferencesFell, J. C., Lacey, J. H., & Voas, R. B. (2004). Sobriety Checkpoints: Evidence of Effectiveness Is Strong, but Use Is Limited. [Article]. Traffic Injury Prevention, 5(3), 220-227. doi: 10.1080/15389580490465247Lacey, J. H., Ferguson, S. A., Kelley-Baker, T., & Rider, R. P. (2006) Low-Manpower Checkpoints: Can They Provide Effective DUI Enforcement in Small Communities? [Article]. Traffic Injury Prevention, 7(3), 213-218. doi: 10.1080/15389580600696686National Highway Traffic Safety Administration. (2006, April). Low-Staffing Sobriety Checkpoints. (DOT HS 810 590). Washington, DC: Retrieved from http://www.nhtsa.dot.gov/people/injury/enforce/LowStaffing_Checkpoints/images/LowStaffing.pdf.Ross, H. L. (1992). Reasons for Nonuse of Sobriety Checkpoints. [Legislative Materials]. Police Chief, 59(11), 58-63. Party Patrols/Controlled Party DisperalsOverview: Youth usually consume alcohol in groups (parties). Safely dispersing a party means many young drunk drivers off the road, lots of underage drinking prevented, and youth getting appropriate sanctions that could alter their behavior. Also, party dispersals are one of the few approaches that can lead to identifying social providers, the main source of alcohol for youth.Key Definitions/TermsControlled Dispersal: A systematic enforcement response to a party that is zero-tolerance and efficiently and safely ends the partyParty Patrols: Proactive efforts to identify underage drinking partiesRelation to Logic ModelKey risk factors:Social norms favorable toward useEasy social accessInsufficient enforcement of lawsData sources:AET Party Patrol DataYRBSSC CTC

How do we know it is evidence-based?Promise of effectiveness in PIRE/OJJDPs Strategies to Reduce Underage Alcohol Use

ResourcesPIRE/OJJDP. Preventing and Dispersing Underage Drinking Parties. (www.udetc.org)NEW!: Party Patrols: Best Practice Guidelines for College Communities. (www.udetc.org)Regional AET TrainingsCurrent status in SCAETs did 150 dispersals in FY 10952 tickets written; 705 underage drinking, 68 transfer

AETs reported 140 parties prevented in FY 10Down from 231 in FY 09

Key elements of implementationOfficers can be trained in operational best practicesCommunities can help by generating public support, sending in tips about parties, perhaps even volunteer assisting in dispersals Source investigation is important component

Shoulder TapsOverview: A compliance check for potential adult providers of alcohol to youth, usually strangers. A cooperating youth asks adults entering a retail establishment to buy alcohol for them. Those who do are ticketed. SC CTC data show 2% of youth indicated this was their preferred method of getting alcohol.Key Definitions/TermsThird-party Transaction: Another term for a shoulder tap:UCIs: Underage Cooperating IndividualRelation to Logic ModelKey risk factors:Social norms favorable toward useEasy social accessInsufficient enforcement of lawsData sources:AET Shoulder Tap DataSC CTC

How do we know it is evidence-based?Included in PIRE/OJJDPs Strategies to Reduce Underage Alcohol Use though noted as less well researched

ResourcesPIRE/OJJDP. Reducing Third-Party Transactions of Alcohol. (www.udetc.org)Regional AET TrainingsCurrent status in SCAETs did 55 shoulder tap operations in FY 1010 counties573 adults approached; 33 purchased6% violation rateDown from 10% in FY 09

Key elements of implementationMust clear with local prosecutors firstYouth security is paramountThose who sell often have past offensesShould target hot spots based on other information, complaints

Fake ID ChecksOverview: Fake IDs are highly prevalent among underage college students, and are strongly associated with heavy drinking. In one study of 1,098 students, approximately 21% admitted to possessing a fake id at one time. Understanding how underage youth obtain fake ids could aid law enforcement and school personnel in their enforcement responsibilities, and might further elucidate the extent and means by which students make ethical compromises to gain illegal access to alcohol. Key Definitions/TermsFake IDs false identification used by underage youth to obtain access to alcohol. Fake ID covers the use of an actual counterfeit or forged identification card or the use of a bona fide identification. Fake ID includes state issued drivers license, non-driver identification, student identification card or any similar item.

Relation to Logic ModelKey risk factors:Social norms favorable toward useInsufficient enforcement of lawsEasy retail accessData sources:AET data

How do we know it is evidence-based?Though it is difficult to assess whether strict enforcement of possessing of false ID curtails continued attempts to gain another false ID, research indicated possessing false ID predicted heavy drinking. The research further indicated that server training, including confiscation of fake IDs, and refusal to serve, reduced the use of fake ID. Enforcement of false ID laws is part of the environmental strategies meant to curtail possession and use of alcohol by underage youth (Martinez, Rutledge, & Sher, 2007). ResourcesRegional AET TrainingsUDETC Law Enforcement Guide to False IdentificationSouth Carolina Department of Motor Vehicles, Office of Integrity and Accountability ReferencesMartinez, J. A., Rutledge, P. C., & Sher, K. J. (2007). Fake ID ownership and heavy drinking in underage college students: Prospective findings. Psychology of Addictive Behaviors, 21(2), 226-232. doi: 10.1037/0893-164x.21.2.226Martinez, J. A., & Sher, K. J. (2010). Methods of fake ID obtainment and use in underage college students. [Article]. Addictive Behaviors, 35(7), 738-740. doi: 10.1016/j.addbeh.2010.03.014Pacific Institute for Research and Evaluation. (2009). Law Enforcement Guide of False Identification. Beltsville, MD: Underage Drinking Enforcement Training Center Retrieved from http://www.udetc.org.Current status in SCUnclear about current status but nationally the use of fake & fraudulent IDs is challengingAnecdotal information from South Carolina law enforcement indicates this is a problem here, too. SCDMV conducts fake ID training & it is a module within Regional 2-Day AET trainingTraining involving national UDETC trainers is being planned for late March 2011Training will build capacity for SC Instructors to hold regional classes

Key elements of implementationProvide merchant training that includes the process of the discovery of false or fake identification commonly possessed by underage youthEnsure law enforcement officers know methods for determining false or fake identification cardsSOCIAL HOST LIABILITY LAWSAnn Crawley Community Initiatives, Inc. Hold adults accountable for serving or providing alcohol to minorsHold adults responsible for underage drinking that happens on property they own, lease, or controlVary from state to state; may provide criminal and civil penalties; may be covered under dram shop laws that normally cover commercial services onlyOVERVIEWDram shop laws and social host liability laws through legislative actionSection 61-4-90: transfer of beer/wine for underage persons consumptionSection 61-4-50: Sales of beer/wine to underage personsSection 61-6-4070: transfer of liquor to underage personsSection 61-6-4080: sales of liquor to underage personsSOUTH CAROLINACommon Law Decisions: criminal, civil, administrative penalties-monetary fines & jail sentencesNegligence Liability: Criminal misdemeanor for selling or serving alcohol to minor or intoxicated personsDram Shop Law: Holds servers responsible for harm that intoxicated or underage patrons cause other persons or themselvesKEY TERMSNational data show Social Host Laws are a strong deterrent if providers believe they will be sued if injury or death occurs as a result of their provision of alcohol to minors or intoxicated personsResearch shows Social Hosts Laws to be effective: an analysis of data from all 50 states reveals Social Hosts Laws were associated with reductions in drinking and driving incidents and with reduction of heavy drinking among youth 16-25 and in older adultsEVIDENCE-BASEDDAODAS provides public information and education, CAST will provide programs/projects addressing social hosting-related problemsDrug Free Communities Support grantee coalitions provide public information & education and engage communities in public policy issues and environmental strategies Local, county, and state law enforcement endorsed new, stronger Social Host Laws and enforce the lawsCant stop now!WHAT IS HAPPENING IN SOUTH CAROLINA?Review recent data in your area of concern that show youth are accessing alcohol from their homes or from adults (include data on other means of accessibility as baseline)Determine the link of this data to other ATOD problems in your areaDevelop case that shows how Social Host Laws could limit access and availability of alcohol to youth and reduce ATOD-related problems in your areaKEY ELEMENTS OF IMPLEMENTATIONObtain and strengthen community support for your strategy (youth, parents, merchants, law enforcement, elected officials, gatekeepers, etc.)Increase public awareness of problemIdentify any gaps that may exist within current law and draft statement to enhance/strengthen legislationHold meetings with those in key positions to affect change in existing lawsWork with law enforcement to ensure only current laws are being enforcedIdentify immediate, intermediate, & long-term outcomes of this strategy & continue to monitor & evaluate programKEY ELEMENTS (cont.)SOCIAL NORMS ACCEPTING AND/OR ENCOURAGING USEEASY SOCIAL ACCESSINSUFFICIENT ENFORCEMENT OF LAWSINSUFFICIENT LAWS AND POLICIESAny ideas for strategies? Lets hear them!RELATIONSHIP TO LOGIC MODEL& NEEDS/CONDITIONSSocial Host Liability, 2010 FACE27 Laws to Lose By, South Carolina DAODASSC Code of Laws Title 61, Chapters 4 & 6Throwing a Party? Are You Protected from Law?: www.thatmoney.comSocial Host Liability/Underage Drinking: Clemson UniversitySocial host liability for minors and underage drunk-driving accidents: Journal of Health Economics 29 (2010) 241-249SC law regarding liability for alcohol at parties, host liability: www/avvo.com/legal-answers/sc-law-regarding-liability-for-alcohol-at-parties-9381Impacting Community Norms: http://drugfreeactionalliance.org/occe_strat1.php

SOURCESOverview of Strategy:Happy Hour RestrictionsHappy Hour Restrictions:Limits or bans placed on events that promote over-consumption or binge drinking: happy hours, ladies night, all-you-can-drink specials or unlimited beverages at a fixed price for a fixed period of time are examples.Key terms/definitionsCover charge: Entry fees imposed on the consumer for the purpose of recovering financial losses incurred because of reduced drink prices.Drink Contests: Contests that involve drinking and award alcoholic beverages as prizes to the winners.Two-for-Ones: Discounted alcoholic beverages in which the consumer receives two drinks for the price of one drink.Relation to logic model and needs/conditionsLow or discounted pricingMore drinkingRelated to higher binge-drinking rates

How do we know it is evidence based (resources)Research shows that as the price of alcohol decreases, alcohol consumption, intoxication and drinking/driving increases, especially among minors. (Chaloupka, et al., 2002)Promotions such as happy hours, drinking contests and all you can drink specials encourage over-consumption by reducing prices. These promotions lead to tragic circumstances. Restricting them can prevent negative outcomes. (Grossman, et al., 1998)The Harvard School of Public Health conducted a study in 2001 that demonstrated a significant correlation between lower drink prices and higher binge drinking rates among colleges across the US. The study also demonstrated a reduction in self-reported drinking and driving rates when laws limited underage access to alcohol. The reduction was even greater when these laws were actively enforced. (Wechsler, et al., 2003; NHTSA, 2002; NHTSA, 2004)Current Status in South CarolinaProhibits two for ones, free beverages.Regular drink prices may be reduced between 4:00p.m.-8:00p.m. only.All on-premise spirits sales must be containers of 1.75 oz. or less (mini-bottles) No minimum age to sell if alcohol is sold in sealed containers.Must be 21 to pour or mix.Must be 18 to serve.No law preventing a patron from removing the open container from a restaurant.Open containers are permitted in the trunk or luggage compartment of a vehicle.Off-premise: may serve alcohol Monday through Saturday, 24 hours, cease at midnight. Prohibited on Sundays.On-premise: may serve Monday through Saturday, beer and wine 10a.m.-2:00a.m., for liquor cease at midnight on Saturdays. Local option, election day sales are prohibited.Key elements of implementationDemonstrate a direct link between Happy Hour promotions and alcohol problems and costs in the community.Determine the type of Happy Hour restrictions already in place.Determine the degree to which the current policies are being enforced.Determine if the evidence you have collected warrants actions to develop or change existing policies.Begin to develop new or enhanced regulation or policy that addresses the gaps you have identified.Increase the communitys awareness and understanding of the issue. Gather community support.Educate key people about the data. Make sure key people have two or three talking points on alcohol-related problems related to happy hour promotions.Provide examples to the community on suggested new or revised happy hour regulations.Meet with city council members. Work with law enforcement.Identify immediate, intermediate, and long-term outcomes for the strategy.Monitor and evaluate progress.Overview of StrategyRestricting Alcohol Sales at Public Events and FestivalsRestricting Alcohol Sales at Public Events and Festivals:Policies that control the availability and use of alcohol at public venues, such as concerts, street fairs, community festivals, and sporting events.Restrictions can be implemented voluntarily by event coordinators or through local legislation.Alcohol restrictions can range from a total ban on alcohol consumption to the posting of warning posters that detail risks of alcohol consumption.Key terms/definitionsAlcohol sponsorship: The alcohol industry utilizes community events to market its brands and products. Relation to logic model and needs/conditionsSocial Norms accepting and/or encouraging useEasy social accessHow do we know it is evidence based (resources)Research shows that the propensity for illegal alcohol sales at festivals is very highHowever, the effectiveness of this strategy has not been thoroughly evaluatedCurrent Status in South Carolina: Five PointsKey elements of implementationDetermine your communitys ordinances/restrictions related to the sale of alcohol at public events.Use the information you have gathered regarding problems as a basis to create change.Write letters to event organizers or sponsors of public events describing the problems caused by unrestricted sales of alcohol. Explain how restrictions can help with these problems.Ensure that key informants are available to educate the community about the data.Strengthen community support from event organizers, law enforcement, and other key officials.Assist event organizers with getting training for servers.Identify immediate, intermediate, and long-term outcomes of the strategy.Monitor and evaluate progress.