Responsible beverage service : Effects of a community action project

Sammanfattning: Alcohol consumption at licensed premises is associated with various problems, such as violence. In 1996, a community action program was initiated in Stockholm targeting licensed premises. An action group consisting of representatives of authorities and the hospitality industry developed training in responsible beverage service (RBS) for restaurant owners, servers, and doormen. Authorities also developed new routines for monitoring of alcohol service. The objective of this thesis was to study the effects of the community action program on problems related to alcohol consumption at licensed premises. The thesis is based on five papers. The first two papers study the refusal rate of alcohol service to intoxicated and underage patrons at licensed premises. Actors portraying intoxicated persons and adolescents visited licensed premises, ordering beer. A pre- and posttest design was used in both studies, with the northern part of central Stockholm as project area, and the southern part of central Stockholm as control area. Paper three is a study of public support for strategies to reduce intoxication and violence at licensed premises. A random sample of 1000 inhabitants (1865 years) from Stockholm County was selected for the questionnaire study. The fourth paper analyzes policereported violent crimes for the time period January 1994 to September 2000. A times-series quasiexperimental design was used, with the same study areas as in the first two papers. In the last paper, the level of institutionalization of the community action program is analyzed. An institutionalization scale was developed based on five key factors: adoption, sustainability, key leader support, structural changes, and compliance. The results from the first two papers show a statistically significant increase in the refusal rate of alcohol service over time. At baseline in 1996, 5% refused alcohol service to intoxicated patrons, compared with 47% at follow-up in 1999. The refusal rate for alcohol service to underage patrons was 55% at baseline in 1996, 59% in 1998 (follow-up I), and 68% in 2001 (follow-up 11). There were no statistically significant differences between the project and control area. Public opinion in Stockholm is supportive of strategies focusing on the responsibility of the licensed premises to prevent intoxication and violence. 86% supported the notion that licensed premises should lose their license if they serve intoxicated or underage patrons. 60% supported RBS training of servers. Public opinion did not support strategies to reduce number of licensed premises, reduce opening hours, or increase the price of alcoholic beverages. Men, young people (<30 years), and frequent visitors to licensed premises were less supportive of the strategies. Time-series analyses (ARIMA modeling) of monthly changes in police-reported violence showed a reduction of 29% in the project area during the project period, when controlled for the development in the control area. The analyses of the key factors in the last paper indicate a high degree of institutionalization (score 13 on a scale 5-15). Key leaders, authorities and organizations accept and sustain the activities. All members of the action group have signed a written agreement ensuring a permanent organization for RBS within Stockholm. A combination of activities (community mobilization, RBS-training, policy initiatives, and efficient monitoring) has probably contributed to the decrease in alcohol-related problems at licensed premises in Stockholm. A high level of institutionalization of the program increases the likelihood of long-term effects on problem levels.