Texas SPF SIG Evaluators Meeting

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Texas SPF SIGEvaluators Meeting

Reducing Underage/Young Adult Binge Drinkingand
Alcohol-related Motor Vehicle CrashesMarch 29,
2007Johanna Birckmayer, PIRE
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Objectives

• Review the community level, outcomes based
  prevention approach of the SPF SIG
• Discuss key community level risk
  protective/causal factors to address the Texas
  priorities (binge drinking/ARMVC) and
  implications for strategies
• Discuss potential measures for risk
  protective/causal factors

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SPF SIG Goals

• Prevent onset and reduce the progression of
  substance use, including underage drinking
• Reduce substance-related problems in communities
• Build prevention capacities/infrastructure at
  State and community levels
• Extending our thinking and results
• from individuals to population-level change

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SPF SIG KEY PRINCIPLES

• PUBLIC HEALTH APPROACH
• (Population based)
• USING DATA TO DRIVE DECISIONS
• OUTCOMES-BASED PREVENTION

Substance-Related Consequences and Use
Risk Protective/ Causal Factors
Programs/ Policies/ Practices
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Where are we in the SPF SIG?
Epi Profile
Communities Implement SPF to assess RP/causal
factors and determine and implement strategies to
address priority(s)
Determine State Priority(s)
State Plan allocates SPF SIG dollars for
addressing priority(s)
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Binge Drinking

• Underage and Young Adult

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Logic Model for Binge Drinking
Substance-Related Consequences
Substance Use
Intervening Variables
Strategies (Examples)
Crash fatalities Violence Injuries High risk
sex School/work problems
Binge Drinking (underage/ young adult)
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Drinking patterns among U.S. Adults 12 and over
(past 30 day use), 2002
Source NHSDA
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Substance-Related Consequences
Substance Use
Intervening Variables
Alcohol Promotion
Binge Drinking
Retail Availability
Price
Social Availability
Enforcement Sales/Server Laws
Community Norms re. binge drinking
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Alcohol Related Motor Vehicle Crashes

• Underage and Young Adult

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Ex Logic Model for Alcohol-Related MVC, All Age
Substance-Related Consequences
Substance Use
Alcohol-related crash fatalities
Seatbelts (55 deaths no seatbelt Speeding 40
drivers in fatal crashes with BACgt.08 speeding
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Alcohol Related Motor Vehicle Crashes United
States

• 42,636 people killed 2,788,000 people injured
• 39 of crash fatalities alcohol related (16,696
  fatalities)
• Motor vehicle crashes are leading cause of death
  for ages 3-33 years

Source FARS, 2004
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Characteristics of Drinking Drivers in Fatal
Crashes, U.S.
Source FARS, 2003
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Binge Drinking and Fatal Crashes

• Drinking patterns among U.S. Adults 12 and over
  (past 30 day use), 2002

• Binge drinkers are over-represented in fatal
  crashes
• Self-reported non-bingers are at lower risk but
  still contribute to a significant number of fatal
  crashes (in part due to large number)

Source NHSDA
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Logic Model for Alcohol-Related MVC
Substance-Related Consequences
Substance Use
Intervening Variables
DUI Enforcement
Public Awareness of DUI Enforcement
Community Norms drinking/driving
Perceived risk of DUI Arrest
Alcohol Promotion
Alcohol-related crash fatalities
Binge Drinking
Drinking and Driving
Retail Availability
Price
Related risk factors Seatbelts (55 deaths no
seatbelt) Speeding (40 drivers in fatal crashes
with BACgt.08 speeding)
Social Availability
Enforcement Sales/Server Laws
Community Norms re. binge drinking
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Causal Factors vary by Consequence and/or
Consumption Variable

• Both Binge Drinking and Drinking and Driving are
  risk factors for Alcohol Related Motor Vehicle
  Crashes/Fatalities
• Only targeting Binge Drinking will have a limited
  effect on ARMVC (although it will have positive
  effects on negative consequences overall)
• Comprehensive efforts must target both Drinking
  and Driving and Binge Drinking to change both
  ARMVC and Binge Drinking

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Intervening Variables Targeting

• Our understanding of the relationship between
  intervening variables and drinking behaviors
  varies by intervening variable
• Research to date suggests some key levers
• Binge Drinking
• Retail availability
• Sales/Server Law Enforcement
• Price
• Drinking and Driving
• Perceptions of the Risk of DUI arrest
• DUI enforcement
• Public Awareness of DUI enforcement

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Prevention Strategies

• SPF SIG goal is to change population level
  outcomes
• No single strategy will produce community level,
  sustained effect
• Comprehensive approaches are needed

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Prevention Strategies (Examples)Designed to have
population effect

• Risk of DUI arrest/Public Awareness
• Lower BACs
• Zero tolerance for underage drinkers
• Graduated licensure
• Mass media campaigns re. risk of being caught
• Media Advocacy
• Designated driver programs
• DUI Enforcement
• Sobriety Checkpoints
• Evidence of effectiveness

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Prevention Strategies (Examples)Designed to have
population effect

• Retail Access
• Minimum drinking/purchase age
• Hours/Days of sales
• Density and location of outlets
• Responsible Beverage Service
• Liability for alcohol sales/service
• Enforcement (retail access)
• Retail Compliance Checks
• Sales to intoxicated compliance checks
• Evidence of effectiveness

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Prevention Strategies (Examples)Designed to have
population effect

• Social Availability
• Keg Registration
• Laws against adult provision (social host)
• Promoting alcohol free events
• Curfews for youth
• Enforcement (social availability)
• Party patrols
• Shoulder tap enforcement
• Evidence of effectiveness

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Prevention Strategies (Examples)Designed to have
population effect

• Price
• Taxes
• Limiting discounting prices (happy hour, etc.)
• Promotion
• Bans on advertising
• Restrictions on promotions
• Counter-advertising
• Community Norms
• Prohibiting consumption in public places
• Social norms campaigns
• Evidence of effectiveness

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State Role in Outcome Based Prevention
Implementation

• Determine priority problem(s) to be addressed
  based on consequence(s)/ consumption patterns
• Determine allocation approach for distributing
  funds to address the problem(s)
• Develop initial logic model identifying
• Consequence/consumption pattern(s) to be
  targeted,
• Factors that contribute to them, and
• Effective strategies to address intervening
  variables (NOTE these may be general classes of
  strategies)
• Support communities in process of local planning
  based on States initial logic model

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Community Role in Outcomes Based Prevention
Implementation

• Understand problem to be addressed
• Assess risk protective/causal factors for
  planning purposes
• Determine risk protective/causal factors for
  intervention
• Choose/implement strategies (effective and
  relevant) to address risk protective/causal
  factors
• Goal Develop outcomes-based logic models that
  outline a locally defined strategic response for
  addressing SPF SIG priorities

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Outcomes-Based Logic Models

• Represent complex systems of cause and effect
• Encourage planners and implementers to focus on
  the most important and strongest paths for
  creating change
• Must be constantly reviewed/revised to understand
  relationships, adapt to new circumstances, and
  accommodate success
• Adaptable for iterative assess/plan/evaluate/re-pl
  an
• SPF SIG process

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Measurement
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Consumption

• Drinking Driving
• Roadside BAC testing
• Survey questions on drinking and driving
• DUI arrest s (confounded by enforcement)
• Binge Drinking
• Surveys - 30 day use questions
• Bar/restaurant surveys (BAC tests outside
  establishments)

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DUI Enforcement

• Perceived Risk of DUI Arrest
• Survey
• DUI Enforcement
• Actual probability or risk of arrest in relation
  to the number of drinking driving instances
• Number of breath checks per vehicle miles
  traveled
• Number of checkpoints/arrests/BAC tests
• Man hours, budget spent, etc. on DUI enforcement
• Public Awareness of DUI Enforcement
• Survey (Have you seen DUI.)
• DUI coverage in local media

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Retail Availability

• Service
• Level of intoxication of customers (BAC at exit)
• Monitor over service using actors
• Survey server behavior Have you seen servers
  refuse sales? Have you been served or seen people
  served when you/they were already intoxicated?
  (less reliable)
• Track number/percent of trained servers
• Track implementation and monitoring of written
  policies to reinforce server behavior
• Sales to Under 21
• Compliance checks can people buy alcohol w/o
  showing ID (mostly off-premise)
• Surveys of Youth
• Hours/Days of Sales on premise/ off premise
• Density concentration of outlets in certain
  areas or per capita or distance b/w outlets

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Regulations and Enforcement

• Regulation
• Level of state/national/local regulation (hours
  of sale, happy hours, outlet placement, sales to
  minors, etc.)
• Regulation granting of business licenses
• Enforcement
• Probability of enforcement (citation or arrest)
  for over-selling
• Number of enforcement visits to licensed outlets
  per month/year (esp. b/w 8pm-2am on Fri/Sat)
• Number of arrests/citations for over-serving
• Number of convictions and sanctions (severity)

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PriceCommunity Norms

• Price
• State Excise Tax
• Retail Alcohol Prices
• State Monopoly Retail Prices
• /Type Happy Hours
• Community Norms
• Surveys
• Of acceptability of drinking driving
• Of policies such as regular BAC checks

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Social AvailabilityPromotion

• Social Availability
• Survey of sources
• Survey - Ease of access (relationship to behavior
  uncertain)
• Promotion
• /location billboards
• Signs on outlets
• Ads in local media
• /frequency price or other promotions

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Examples

• Community Trials

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Underage Drinking Activities
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Underage Alcohol Purchase Survey-Experimental
and Comparison Communities-
60
50
40
Percent Selling
30
20
10
0
Holder, et al., J. American Medical Association,
2000
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Responsible Beverage Service Policy Refuse
Service to Intoxicated Patrons
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(No Transcript)
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Monitoring

• Measuring changes in key intervening variables to
  determine if changes are going in the right
  direction
• Provides management information
• Determines strength of intervention
• Guides changes and improvement
• Determines what works and doesnt
• Some monitoring systems can act as intervention
  itself (e.g., compliance checks)

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Number One Rule in Monitoring and Evaluation

• KISS
• Keep It Simple, Stupid