Comparing Statewide Alcohol Server Training Systems

Transcription

1 Comparing Statewide Alcohol Server Training Systems Dresser, J. Oregon Research Institute 1715 Franklin Blvd. Eugene, Oregon United States Keywords: Alcohol, server training, DUI, DWI, risk reduction, harm reduction Abstract This study examines the effectiveness of alcohol server training legislation to prevent DUI, comparing state-mandated training in two states, training encouraged by laws providing license protection incentives for participating establishments in two states, and two states with no formal statewide system. Dependent variables measuring both implementation and effectiveness include: percent of alcohol servers trained; knowledge, attitudes, and self-reported practices of servers; observed server adherence to responsible practices; estimates of exiting customer intoxication; and time series analyses of DUI crash data. Survey and field data comparing mandatory, incentive, and free market states are presented. We have completed four years of a five-year study. Mail survey data collection has been completed in six states. Observational, pseudo-patron and interview data collection is completed in Texas and Washington, and is in progress in Alabama, South Carolina, Oregon and New Mexico. Results include: management attitudes are more positive among those who have experienced server training; significantly more servers are trained under mandatory systems than either incentive or free market systems; fewer visibly intoxicated patrons were observed in states with mandatory training; appropriate responses to pseudo-patrons simulating intoxication was somewhat superior in mandatory states but was disappointingly infrequent in all states irrespective of server training systems; and patrons interviewed displayed fewer visible signs of intoxication in mandatory and incentive states than a free market state (Washington) Introduction Some 15-20,000 Americans die annually in DUI crashes, which represents almost 40% of total traffic fatalities in the US (NHTSA, 1998). Roadside survey and arrest data indicate that a third to half of DUI incidents in the U.S. originate in alcohol serving establishments (O'Donnell, 1984; Council of Economic Advisors, 1987; NHTSA, 1997). Moreover, the highest BACs among drinking drivers are obtained from this population (Palmer, 1988). Thus, alcohol servers might prevent crashes by discouraging overconsumption, and alcohol server training has developed as a DUI countermeasure. This shifts emphasis from traditional offender-focused models to one of environmental prevention.

2 Comprehensive training at the establishment level attempts to modify both management policies and alcohol serving practices. Alcohol servers are provided skills and incentives to slow the rate of consumption or refuse service before intoxication levels are reached. The potential value of such training was established by an experimental program developed, implemented and evaluated at a U.S. Navy Enlisted Club in San Diego (Saltz, 1987, 1988). Findings from the Navy study showed that intensive management and server training reduced by half the probability of patrons exceeding the legal intoxication limit (.10 in California at that time). Other research confirms the potential importance of the alcohol-serving environment and serving policies in affecting patron drinking behavior (Single & Storm, 1985). Although available evidence suggests a role for server training in society's approach to DUI reduction as well as liability reduction for alcohol servers, hospitality industry support has been inconsistent and server training is used irregularly throughout the country. Server training is currently mandated in a handful of states, counties, and municipalities, is encouraged by incentives in three states, and is used voluntarily by many alcohol-serving establishments which view it as ethical or useful for liability protection. However, we found widespread disinterest in server training offered without cost to establishments during a previous study in Southern California (Dresser & Molof, 1993), and there has been particular industry resistance to mandated programs. Incentive systems have been suggested by the alcohol industry as an alternative to the threat of mandated training. Alcohol industry ambivalence has not been substantially resolved or clarified by the research evidence to date. The effectiveness of server education remains largely undemonstrated. Saltz' Naval Club training was much more intensive and comprehensive than many or most real-world trainings. After 6-hour trainings in an 8-state study, McKnight (1991) found only a 20% intervention rate, and a 7% termination of service rate, among servers responding to pseudopatrons simulating intoxication, and trained servers outperformed controls in only five of the eight states. Gliksman et al. (1993) found "less inappropriate" server responses to pseudopatrons following training; although significantly better than untrained controls, their typical responses were less than optimal. More promising, Russ and Geller (1987) found a decrease from mean pseudopatron BAC from.096 to.059 among TIPS-trained servers, with more numerous appropriate interventions compared with untrained servers. However, the posttraining data in these studies were collected within a few weeks of training; does decay of effects occur over time? Also, there is frequent turnover among waitstaff at many establishments, and server training this month may be inconsequential next month unless management policy requires it for all new employees and supports staff interventions. In order to establish sound management policies and to establish consistent server training standards, some political jurisdictions have mandated and others created formal incentives to encourage server training following uniform curriculum standards. Oregon was the first state to mandate server training, and Texas the first state to establish an incentive system, both in More recently, New Mexico has virtually duplicated the Oregon legislation in more ethnically diverse environments. Alabama's "Certified Responsible Vendor" program is four years old and resembles the Texas system: both provide immunity from loss of liquor license to owners who train their servers. Washington had no system through January 1, 1997, when a new mandatory system took effect and before which our data was collected. The current study is a "natural experiment" to evaluate these systems, comparing server training: (1) mandated by law in Oregon and New Mexico; (2) encouraged by laws providing license protection for participating

3 establishments in Texas and Alabama; and (3) available on a "free market" basis serving the selfperceived business interests of licensees in Washington and South Carolina. Studies of this type typically relate a legislative event to distal outcome variables (crashes), which fail to account for important mediating variables. For example, legislation may not be well or widely implemented, or training standards may vary resulting in uneven effectiveness. Our dependent variables therefore include measures of both implementation and effectiveness. Materials and Methods Our design includes both implementation and effectiveness measures in a causal model linking the following variables: Independent variable: Mandatory system vs. incentive system vs. free market system Degree of Implementation: (1) Percent of establishments requiring servers to be trained, and (2) ratio of total to trained servers, managers, and owners. These are assessed through surveys of a random sample of 1,500 establishments in each state. Effectiveness of Implementation: Number of visibly intoxicated customers, and servers' responses to these customers, observed during two 45-minute visits. Number of young-looking customers admitted without ID check during same two 45- minute visits. Server responses to a 4-part "pseudopatron" scenario which tests: (1) Admission and service with a young-looking patron needing ID check. (2) Over-service to a possibly intoxicated person. (3) Service to a visibly intoxicated person. (4) Response to a visibly intoxicated person preparing to drive. Blood alcohol levels of exiting patrons, estimated from interview data, self-estimated, and measured by breathalyzer. Visible signs of intoxication among exiting patrons interviewed. Interview data regarding alcohol service, usual drinking patterns, and driving intentions from exiting patrons. Knowledge of responsible alcohol service among servers, determined by test. Management policies and attitudes toward alcohol service and server training as determined by interviews with owners and managers. DUI Outcomes: Time series analyses of alcohol-related crash data: Fatal Injury Property damage Results

4 Survey research Survey data comparing the mandatory system states of Oregon and New Mexico, the incentive system states of Alabama and Texas, and the free market states of Washington and South Carolina have been completed. Findings include: (1) Mail surveys to Washington and New Mexico bars achieved response rates of 65-70%, but response rates were under 50% in Alabama, Oregon, Texas and South Carolina. Our method combined (a) an introductory letter from the state hospitality association prior to the survey mailout, (b) a cover letter with each survey from a hospitality association representative, (c) a 50- cent coin with each survey to add attention-getting weight to the envelope and provide a small courtesy incentive, (d) a mailback postcard to tell us they had responded without identifying their individual questionnaires which were completed anonymously, (e) a follow-up reminder with a second copy of the questionnaire, and (f) telephone follow-ups to continuing non-respondents, which has substantially increased the response rate as well as yielding valuable qualitative data. (2) There are substantial differences in percent of servers trained and establishments which require training under the different systems. In the mandatory states of Oregon and New Mexico, of course, virtually 100% of establishments require their waitstaff to be trained and 85-90% of servers have been trained. Under the incentive systems of Texas and Alabama, 61% and 44% of establishments require waitstaff training. Under free-market systems, 44% of Washington and 29% of South Carolina establishments required waitstaff training The difference between state systems in percent requiring training is significant (p <.000). (3) Management attitudes were generally favorable in all states. Most training topics were rated as "useful to our business" by about 95% of respondents. Server training was judged "good for" owners, managers and servers by about half of management respondents, but as "good for" customers and society by only a third. Statements rejecting the training were generally confined to less than 20% of respondents. There were interesting differences between states, with management opinion significantly more favorable in New Mexico under a mandatory system. Unfavorable opinions were least frequent in South Carolina, where training is entirely voluntary, and most frequent in Washington where they were anticipating an impending mandatory system. These findings are counter-intuitive, since the incentive system would seem more appealing to owners. Perhaps server training, once mandated and universally implemented, is recognized as valuable through experience, and it is the coercion rather than the training to which owners object. The consistently positive management views in New Mexico suggest that familiarity with server training breeds respect. Fears of business loss are unconfirmed. Among respondents who used server training in all states, negligible effects were reported on their business volume, with only 3.5% reporting that it has reduced business and 7.5% reporting that it has increased business. (4) In reported frequency of service refusal or limitation to intoxicated customers, significant differences (p <.000) were found between systems differing in emphasis on management training. Management training is mandated in Oregon and was included in nearly half of Alabama trainings. In contrast, management training was included in less than 15% of trainings

5 in Washington and New Mexico. In Oregon and Alabama, one or more service refusals weekly were reported by only 30% and 23% of establishments, respectively. In Washington and New Mexico, these figures were 52% and 45%, respectively. This may reflect policies and procedures which prevent intoxication from occurring when management is trained. (5) As we anticipated, training standards differed between systems. Management training, which we consider very important for establishing and supporting responsible policies and procedures, was included by nearly half of Alabama trainings but less than 15% of trainings in Washington and New Mexico. Use of a live trainer, which we also consider of value, occurred in 75% of New Mexico trainings but only 40% and 28% of trainings in Alabama and Washington, respectively. Role playing, a third important component, was utilized in almost one-fourth of trainings in Alabama and New Mexico, but in only 10% of Washington trainings. Generally, trainings under the voluntary systems were more likely to lack important elements. There were few differences in curriculum content. Field research Naturalistic observation is complete in Oregon, Washington, Texas and Alabama. Pseudopatron procedures have been completed in Washington, Texas and Alabama, and are nearly completed in New Mexico and Oregon. Both procedures are half-completed in South Carolina. (1) In Oregon, responsible serving practices were observed in most establishments, but effectiveness varied widely between establishments of different types and different clientele. We found significant differences in mean number of visibly intoxicated persons observed per hour, ranging from.29 in Oregon to 2.93 in Washington (p <.000). Mean number per hour of uncarded young-looking patrons also differed significantly, ranging from.67 in Washington to 1.17 in Oregon (p <.000). This appears to reflect ABC enforcement priorities. (2) Significant differences were also found in server responses to the pseudopatron scenario. Identification of the young-looking researcher was carefully checked in 51% of Washington establishments but only 19% in Texas and New Mexico (p <.000). Service was appropriately denied or delayed in response to the "excessive ordering" act in 17-18% of mandatory state establishments, 14% of incentive state establishments, and 12% of free-market state establishments. In response to the "intoxicated ordering" scenario, service was denied or delayed in 11% of free-market establishments, 6% of incentive state establishments, and 13% of mandatory establishments. In response to the "intoxicated driving" scenario, some intervention effort was recorded in 6% of free-market establishments, 5% of incentive state establishments, and 9% of mandatory state establishments. Most noteworthy was the widespread indifference of servers everywhere, with only about 10% denying or delaying service to a clearly intoxicated patron, and only about 6% attempting to prevent the pseudopatron from leaving alone with an expressed intention to drive. (3) Patron Interviews have been completed in Washington and Texas and are half completed in Alabama, New Mexico and South Carolina. The absolute numbers are more interesting than the comparisons, which reveal no clear pattern of differences between systems in measured or estimated BAC. Mean BAC across states was about.06, with 21-33% exiting with BACs at or above the legal limit of.08. A marked lack of congruence between self-assessed and measured degrees of intoxication, suggests that patrons are poor judges of their own levels of impairment.

6 Visible signs are the criteria upon which servers are trained to depend. These were significantly greater in the Washington sample, where 27% of exiting patrons showed conspicuous signs of intoxication. Elsewhere, 8-12% showed such signs. This finding would be consistent with a server training effect. Discussion Although field data indicate a slight advantage favoring mandatory systems, several of our findings are counter-intuitive. The lower incidence of visibly intoxicated patrons in the states which mandate server training suggests the value of this system, but why the higher incidence of uncarded service to young-looking patrons in Oregon? Also, carding of young-looking pseudopatrons was more common in voluntary Washington than mandatory New Mexico. Interviews with bar management suggests that differential ABC enforcement is an important variable, and service-to-minors violations are not targeted uniformly across states. During interviews with Washington bar management, we were told of "sting" operations by the ABC using underage decoys, but no such concerns were expressed by management in Oregon. On the other hand, Oregon's server training curriculum places heavy emphasis on recognition and avoidance of customer intoxication. The differences in management attitudes across states is interesting and encouraging. Management attitudes toward server training were substantially more positive in the state with an established mandatory system than the state anticipating such a system. This suggests that management acceptance increases through direct experience of server training and its effects. In particular, the loss of revenue which many owners fear appears to rarely occur. Qualitative data also suggests that many owners feel safer from liability and more confident in "hiring someone off the street" when the new hire has a server permit. The incentive system in Alabama does not appear to produce more employers requiring training or servers trained than the voluntary system in Washington. There are several possible factors contributing to this: over a third of respondents in Alabama were unaware of the system; some were aware but pessimistic, reporting that it "didn't work" for them or others they knew; the "Responsible Vendor" certification protects only against service-to-minors violations; and the benefits of certification reported by some owners seem largely unknown to others. Acknowledgments The author wishes to express his appreciation to Louis Gliksman, Ph.D., co-investigator, James Schaefer, Ph.D., field research supervisor, and the National Institute on Alcohol Abuse and Alcoholism, which is funding the study under Grant RO1-AA