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Sales of Alcohol to Apparently Intoxicated Customers in Three States

Sales of Alcohol to Apparently Intoxicated Customers in Three States

Most states prohibit sales of alcohol to customers who are apparently intoxicated. Many states require training in responsible beverage service, with the aim of reducing driving while intoxicated (DWI) and other harms.

Klein Buendel scientists and staff, along with a research collaborator from the Pacific Institute for Research and Evaluation, assessed alcohol sales to apparently intoxicated patrons across three states. Their findings were published in the Journal of Studies on Alcohol and Drugs.

A sample of 180 establishments licensed for on-site alcohol sales was selected in California (n=60), New Mexico (n=60), and Washington state (n=60). The three states had different RBS training histories, content, and procedures. Research confederates, trained to feign cues of alcohol intoxication, visited each establishment twice. The pseudo-intoxicated patron ordered an alcoholic beverage while displaying intoxication cues. Sale of alcohol was the primary outcome.

At 179 establishments assessed, the pseudo-intoxicated patrons were served alcohol during 56.5% of 356 visits (35.6% of establishments served and 22.6% did not serve at both visits). Alcohol sales were less frequent in New Mexico (47.9%) and Washington state (49.6%) than in California (72.0%). Servers less consistently refused service at both visits in California (6.8%) than New Mexico (33.9%) or Washington (27.1%). Alcohol sales were higher when intoxication cues were less obvious.

Over-service of alcohol to apparently intoxicated customers was frequent and likely elevated risk of DWI and other harms. The lower sales in New Mexico and Washington than California may show that a policy approach prohibiting sales to intoxicated customers combined with well-established RBS training can reduce over-service. The authors concluded that further efforts are needed to reduce over-service of alcohol to intoxicated patrons.

This research was supported by a grant to Klein Buendel from the National Institute on Alcohol Abuse and Alcoholism (AA029364; W. Gill Woodall and David Buller, Multiple Principal Investigators). Collaborating authors include Dr. Robert Saltz from the Pacific Institute for Research and Evaluation in Berkley, California, Dr. Gary Cutter from the University of Alabama, and Ms. Lila Martinez, Ms. Annelise Small, and Mr. Noah Chirico from Klein Buendel.

Professional Development to Improve Responsible Beverage Service Training 

Professional Development to Improve Responsible Beverage Service Training 

Research collaborators from Klein Buendel and the Prevention Research Center at the Pacific Institute for Research and Evaluation (PIRE) have published formative research results and a protocol for a randomized controlled trial in JMIR Research Protocols.  

The full trial will be evaluating an addition to a responsible beverage service (RBS) training because improved interventions are needed to reduce the rate of driving while intoxicated. RBS training has reduced service to intoxicated patrons in licensed premises in several studies. Its efficacy might be improved by increasing the proper application and continued use of RBS with a professional development program in the 3 to 5 years between the required RBS retraining. 

The formative research published in JMIR Research Protocols reports on the addition of a professional development component to an existing RBS training to improve the effectiveness of the web-based training alone. Semi-structured interviews with owners and managers of licensed establishments and focus groups and a survey with alcohol servers in New Mexico and Washington State were conducted to examine support for RBS and the need, feasibility, acceptability, and potential effectiveness of ongoing professional development. A prototype of a professional development component, WayToServe Plus, was produced and delivered in social media posts on advanced RBS skills, support from experienced servers, professionalism, and basic management training. The prototype included 50 social media posts. The prototype was evaluated in a usability survey and a field pilot study with alcohol servers in California, New Mexico, and Washington.  

Although owners and managers and alcohol servers were favorable toward RBS, they endorsed the need for ongoing support for RBS for servers and identified topics of interest. Servers felt that the professional development component was highly usable and appropriate for themselves and the premises in the usability survey (n=20) and field pilot test (n=110), with 85% and 78%, respectively, saying they would use it. Servers receiving the professional development component had higher self-efficacy and response efficacy for RBS compared with untreated controls. 

The article also includes a protocol for a planned randomized controlled trial. This phase of the project will include full production of the professional development component. It will be delivered in Facebook private groups over 12 months and evaluated with a sample of licensed premises (bars and restaurants) in California, New Mexico, and Washington (n=180) in a 2-group randomized field trial (WayToServe training only compared to WayToServe training and WayToServe Plus). Licensed establishments will be assessed for refusal of sales to apparently intoxicated pseudo-patrons at baseline and 12 months after the intervention commences. 

Owners, managers, and servers believed that an ongoing professional development component on RBS would benefit servers and licensed premises. Servers were interested in using such a program, a large majority engaged with a prototype, and servers receiving the prototype improved on theoretic mediators of RBS. The authors believe that the professional development component may improve RBS training and save lives. 

This research was supported by a grant to Klein Buendel from the National Institute on Alcohol Abuse and Alcoholism (AA029364; W. Gill Woodall and David Buller, Multiple Principal Investigators). Collaborating authors on the paper include Dr. Robert Saltz from the PIRE Prevention Research Center in Berkley, California, and Ms. Lila Martinez from Klein Buendel. 

Serving Alcohol to Obviously Intoxicated Patrons

Serving Alcohol to Obviously Intoxicated Patrons

Klein Buendel scientists and staff are co-authors on a new publication of research results with scientists from the Pacific Institute for Research and Evaluation (PIRE) in the Journal of Studies on Alcohol and Drugs (JSAD). The study, led by PIRE, examines alcohol over-service at bars, nightclubs, restaurants, etc. in California which is associated with driving while intoxicated, violence, and other problems.

Three hundred licensed bars, night clubs, restaurants, etc. were sampled in 2022 in nine counties representing the San Francisco Bay Area. Combination pseudo-patron and observer teams visited each on-premise establishment where the pseudo-patrons attempted to buy alcohol while displaying obvious signs of intoxication. The JSAD paper describes characteristics of the establishments, servers, pseudo-patrons, and time/date of purchase attempt that may be associated with the refusal of alcohol service.

In total, 21% of the establishments refused alcohol service to pseudo-patrons. Descriptive and regression analyses were conducted and are described in detail in the JSAD publication. According to the authors, “No establishment or server characteristics were significantly associated with service refusal in logistic regression analysis; nor were month, day, or time.” However, service refusal was significantly more likely for female pseudo-patrons and pseudo-patrons displaying obvious or very obvious signs of intoxication.

The authors assert that the study indicates that alcohol over-service to obviously intoxicated patrons remains common at licensed on-premises establishments. Mandatory responsible beverage service training of servers and enforcement of alcohol over-service laws was recently enacted in California, which may help to reduce over-service and its related problems.

This study is sponsored by a grant from the National Institute on Drug Abuse (AA028772; Dr. Robert Saltz, Principal Investigator, PIRE). Co-authors include Dr. Mallie Paschall and Dr. Sharon O’Hara from PIRE, and Dr. W. Gill Woodall, Dr. David Buller, and Ms. Lila Martinez from Klein Buendel.  

WayToServe Plus

WayToServe Plus

Among effective interventions to reduce driving while intoxicated (DWI) by alcohol, Responsible Beverage Service (RBS) training of alcohol servers has shown promise. RBS training is currently required or incentivized by 36 states and California will require it starting in 2022.

Klein Buendel and its research collaborators from the University of New Mexico and the Pacific  Institute for Research and Evaluation (PIRE) have shown that an online RBS training, named WayToServe®, was effective in two randomized research trials. WayToServe is currently commercially available in multiple states in English and Spanish.

Now, researchers from Klein Buendel and PIRE are launching a new research project funded by the National Institute on Alcohol Abuse and Alcoholism (AA029364) to develop and test an in-service professional development component for alcohol servers trained by WayToServe to enhance its effectiveness. It is intended to motivate servers to implement the RBS skills in the face of common barriers, provide support for RBS actions from a “community” of alcohol servers, and prevent natural degradation of skills over time. The in-service component – WayToServe Plus – will be delivered through the WayToServe Facebook page that currently is followed by over 20,000 alcohol servers trained by WayToServe.

The Fast-Track SBIR project will complete a 12-month Phase I feasibility study and a 2-year Phase II effectiveness trial in New Mexico and Washington State. The primary outcome will be the effect of WayToServe Plus on refusal of sales to pseudo-intoxicated patrons. The research will be led by Dr. David Buller and Dr. Gill Woodall (Multiple Principal Investigators) from Klein Buendel, and Dr. Robert Saltz from PIRE.

This research is innovative as WayToServe Plus will be the first continuous in-service professional development for RBS training and will increase the WayToServe training’s effectiveness and commercial advantage with alcohol servers and corporate clients.

New Study to Assess the Impact of California’s Mandatory Responsible Beverage Service Training Law

New Study to Assess the Impact of California’s Mandatory Responsible Beverage Service Training Law

Klein Buendel is collaborating with Dr. Robert Saltz and his team from the Pacific Institute for Research and Evaluation (PIRE) in California on a new research project to assess the impact of California’s new mandatory Responsible Beverage Service training law intended to prevent alcohol-involved motor vehicle crashes and other harms.  

Intoxicated driving continues to play a significant role in automobile accidents and fatalities. In response, California passed the Responsible Beverage Service Training Act of 2017. According to the California Department of Alcoholic Beverage Control, the law requires alcoholic beverage servers in California to attend responsible beverage service (RBS) training by July 1, 2022. Alcoholic beverage servers will be trained on the dangers of overserving alcohol to patrons in an effort to curb alcohol-related harm within local communities, particularly in regards to drunk driving and alcohol-related crimes. This change in law creates a new statewide mandate for licensees and a new training requirement for an estimated 1 million servers.

The new research study will examine whether there is a significant reduction in single nighttime motor vehicle injury crashes after implementation of the mandatory RBS training law, controlling for other factors in California that may influence this outcome, and the national trend in fatal alcohol-involved motor vehicle crashes. A second aim will address the question of whether the state mandate could have greater impact through wider use of high-quality evidence-based RBS training, or through RBS training supplemented by boosting management motivation to support the training objectives. The training program that will be implemented is the WayToServe® (WTS) online RBS training program developed and evaluated by PIRE, Klein Buendel, and the University of New Mexico. Currently, WTS is licensed to and sold by Wedge Communications LLC in multiple states.

A randomized controlled trial design will be used to examine the change in the refusal rate for alcohol service to pseudo-intoxicated patrons in a sample of 450 licensed on-premises bars and restaurants from 2020 (baseline) to 2024 (post-implementation of mandatory RBS training law). The evaluation will determine whether any change is more pronounced among bars that receive the original WTS RBS Training or the enhanced WTS Training Plus program. A significant feature of this design is that unlike previous evaluations of RBS training, this project will be able to document both short-term and long-term outcomes.  This is especially important for a statewide implementation where it cannot be known in advance how quickly or slowly servers will undertake the training, and how quickly, if at all, the training will have an effect on server behavior.

This research project will be funded by the National Institute on Drug Abuse (Dr. Robert Saltz, Principal Investigator). Collaborators include Dr. David Buller and Dr. W. Gill Woodall from Klein Buendel.

Way to Serve Sells 100,000 Trainings

Way to Serve Sells 100,000 Trainings

WayToServe®, an evidence-based online responsible alcohol server training program, has sold its 100,000th training!

WayToServe was created by scientists and developers from the University of New Mexico, the Pacific Institute for Research and Evaluation, and Klein Buendel. The engaging, media-rich program was initially evaluated in a controlled randomized trial that resulted in high trainee satisfaction and increased refusal of sales to intoxicated patrons. WayToServe was licensed to Wedge Communications, LLC and launched into the online marketplace in 2012. To date, WayToServe has been tailored and approved for sale and certification of trainers in California, Texas, Washington, and New Mexico.

To meet the needs of Spanish-speakers, Klein Buendel is currently testing a companion program, WayToServe Español. “WayToServe Español es muy importante! It could help saves lives,” said Dr. W. Gill Woodall, the project’s director. The unique Spanish-language training program will be on the market in 2021.

The original WayToServe program was funded by two grants from National Institute on Alcohol Abuse and Alcoholism to the University of New Mexico (AA014982 and AA016606; Dr. W. Gill Woodall, Principal Investigator). The WayToServe Español program is funded by a grant from the National Institute of Minority Health and Health Disparities (MD010405; Dr. W. Gill Woodall, KB Senior Scientist, Principal Investigator).

Alcohol Sale Refusals to Pseudo-Intoxicated Patrons In Primarily Spanish-Speaking Premises

Alcohol Sale Refusals to Pseudo-Intoxicated Patrons In Primarily Spanish-Speaking Premises

Klein Buendel Senior Scientist Dr. W. Gill Woodall presented data on alcohol over-service from the WayToServe-Español project on a panel discussion at the 42nd Annual Scientific Meeting of the Research Society on Alcoholism held in Minneapolis, Minnesota on June 22-26, 2019.

The over-service of alcohol to individuals who show signs of intoxication is problematic for public health because it contributes to drunk driving and alcohol-related injury and death. In addition, little is known about alcohol over-service in premises where business is conducted primarily in Spanish because these alcohol service situations have been understudied.

Dr. Woodall presented data from a baseline assessment of a randomized trial that investigated Responsible Beverage Service (RBS) training in predominately Spanish-speaking premises in Texas and New Mexico. The research provides a unique opportunity to contrast two states and communities with similar populations, but different alcohol policies and practices.

Hispanic confederates were trained to enact evidence-based signs of intoxication while attempting to purchase an alcoholic beverage in Spanish. Over-service was measured using a pseudo-intoxicated patron protocol. Baseline refusal rates were 12% in Texas and 34% in New Mexico. On the panel, Dr. Woodall discussed the implications of these baseline data for RBS training in minority communities and alcohol policy.

This research is funded by the National Institute on Minority Health and Health Disparities at the National Institutes of Health (MD010405; Dr. W. Gill Woodall, Klein Buendel, Principal Investigator). Collaborating co-authors on the presentation included Dr. Robert Saltz from the Pacific Institute for Research and Evaluation, Dr. David Buller from Klein Buendel, Dr. Victoria Sanchez and Dr. Randall Starling from the University of New Mexico, and Dr. Areli Chacon Silva and Dr. Frank Perez from the University of Texas at El Paso.

Klein Buendel Opens a Second Location

Klein Buendel Opens a Second Location

Klein Buendel is pleased to announce the opening of its first satellite location in New Mexico. The new Albuquerque office will house Klein Buendel Senior Scientist Dr. Gill Woodall and a small staff, to conduct multiple health communication and behavior research projects with people in New Mexico and Texas.

The Vacteens project aims to raise the public health profile of human papillomavirus (HPV), increase the need for responsible health services, and examine the cost-effectiveness of risk-based screening to pave the way for the development of new strategies for the prevention of HPV-induced cancers. The objectives of the project are to develop and evaluate a mobile web app to encourage HPV vaccination in New Mexico, an ethnically-diverse state. Current ongoing randomized controlled efficacy trials with parents and their adolescent children in New Mexico clinics provide data to determine the impact of these mobile web apps on informed decision making and uptake for the HPV vaccine. This research was funded by a grant from the National Cancer Institute (CA210125; Dr. W. Gill Woodall, Principal Investigator). Collaborators include Dr. Alberta Kong, Dr. Lance Chilton, and Dr. Tamar Ginossar from the University of New Mexico; Dr. Greg Zimet from Indiana University; and Dr. David Buller from Klein Buendel.

B-SMART is a project aimed at reducing intoxicated driving by people with court-ordered ignition interlock devices (IIDs) through improved communication and support from family members. Using smartphone web app technology, B-SMART teaches coping skills, communication skills, and strategies to help deter Driving While Impaired (DWI). Unique to this intervention are the involvement of family members in supporting the DWI offender to not drink and drive, English and Spanish language options, and the use of smartphone technology to make that support immediate, accessible, and diffusible. The research is funded by the National Institute on Alcohol Abuse and Alcoholism (AA022850; Dr. W. Gill Woodall, Principal Investigator) through the Small Business Innovation Research Program (SBIR). Collaborators include Dr. Barbara McCrady and Dr. Vern Westerberg from the University of New Mexico; Dr. Gary Cutter from Pythagorus, Inc. in Alabama; and Julia Berteletti from Klein Buendel.

WayToServe Espanol: A Culturally-Appropriate Online Responsible Beverage Service Training for Spanish-Speaking Servers is a redesign of WayToServe®, an evidence-based training to promote responsible alcohol beverage service (RBS). WayToServe Espanol was created after discovering current RBS training had not been tailored to address Spanish-speaking populations that represent disproportionately high rates of alcohol-related injury and death in the United States. This project promotes a culturally and linguistically adapted RBS training for Spanish-speaking servers, and changes to organizational and community norms because preventing alcohol-related injury and death is a national priority. This research is funded by the National Institute of Minority Health and Health Disparities at the National Institutes of Health (MD010405; Dr. Gill Woodall, Principal Investigator) through the SBIR. Collaborators include Dr. Victoria Sanchez from the University of New Mexico Health Sciences Center; and Dr. Areli Chacon Silva and Dr. Frank Perez from the University of Texas at El Paso.

Results of a Randomized Trial of the Way To Serve Responsible Alcohol Server Training

Results of a Randomized Trial of the Way To Serve Responsible Alcohol Server Training

Alcohol use and misuse is a leading cause of preventable death in the United States. Alcohol servers may help prevent alcohol-impaired car accidents and other harms by discouraging overconsumption by patrons. Responsible beverage service (RBS) training is designed to improve serving behavior, especially by avoiding selling too many drinks to a patron, refusing sales to intoxicated patrons, and properly checking identification to prevent sales to minors. Positive evaluations of RBS programs have been reported, yet online technologies hold promise for improving training quality, fidelity, cost, and uptake.

In a recent publication in the Journal of Studies on Alcohol and Drugs, researchers led by Klein Buendel (KB) Senior Scientist, Dr. W. Gill Woodall, reported the results of a randomized trial of the media-rich, interactive web-based WayToServe® (WTS) RBS training. The study hypothesized that servers who completed the WTS training would refuse alcohol service to apparently-intoxicated patrons at significantly higher rates compared with servers who completed the usual and customary (UC) live training.

In the study, alcohol-serving establishments (such as bars) in New Mexico were randomly assigned to receive WTS training (n=154) or the UC live training (n=155). Establishments were assessed before training, immediately after training, at six months after training, and at one year after training with a pseudo-intoxicated patron protocol (in which buyers were trained to enacting documented behavioral signs of intoxication) to assess premise alcohol service during early to mid-evening hours. The primary outcome variable for the assessment was the proportion of apparently-intoxicated buyers who were refused alcohol service.

Results indicated significantly higher refusal rates for WTS than for UC premises at the immediate (WTS=68% vs. UC=49%) and the one-year post-training assessment points (WTS=68% vs. UC=58%), but not at the six-month post-training assessment (WTS=69% vs. UC=64%). Results also indicated that younger pseudo-patrons were consistently refused more often than older pseudo-patrons. The study concluded that RBS training can be delivered online, broadening the scale of distribution and making it a potentially more cost-effective way to reach alcohol servers with effective and beneficial RBS training.

A full description of the methods, results, and limitations of this study, as well as commentaries by Buvik & Rossow (2018) and Miller (2018), and an author response, can be found in the Journal of Studies on Alcohol and Drugs.

The research was funded by the National Institute on Alcohol Abuse and Alcoholism (AA014982; W. Gill Woodall, Principal Investigator) at the National Institutes of Health. Collaborators/coauthors include Dr. Randall Starling from the University of New Mexico, Dr. Robert Saltz from the Pacific Institute for Research and Evaluation in California, Dr. David Buller from KB, and Dr. Paula Stranghetta from Paula Stanghetta & Associates, Inc. in Ontario, Canada. KB’s Creative Team produced the WayToServe® web-based training. WayToServe® has been licensed to Wedge Communications LLC for commercial sale and distribution.

Collaborator Spotlight:
Dr. Robert Saltz

Collaborator Spotlight:
Dr. Robert Saltz

Robert Saltz, Ph.D. is a Senior Research Scientist at the Pacific Institute for Research and Evaluation (PIRE) in Berkeley, California.

He received his Ph.D. in Sociology from the University of Massachusetts. His research explores ways in which drinking context may influence the risk of subsequent injury or death. He has extensive experience researching “responsible beverage service” programs aimed at having bar and restaurant personnel intervene with patrons to reduce the risk of intoxication or driving while impaired.

Dr. Saltz collaborated with Dr. David Buller and Dr. Gill Woodall at Klein Buendel (KB) on the development, trial, and commercialization of the WayToServe® responsible beverage service training program funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA; W. Gill Woodall, Principal Investigator).

Currently, Dr. Saltz is working with KB on two projects. He serves as a collaborating scientist with Dr.  Woodall on WayToServe Español: A Culturally-Appropriate Online Responsible Beverage Service Training for Spanish-Speaking Servers (MD010405; W. Gill Woodall, Principal Investigator). For this project, he will assist with the creation of culturally-appropriate content and advise on the recruitment of alcohol sales premises.  This study will systematically translate and test an alcohol server training intervention (WayToServe Español). The research will explore overcoming dissemination barriers with ethnically diverse and Spanish speaking restaurant and bar workers.  The team will tailor it to be culturally specific and compatible with the values and needs of the employees, simple to adopt, accessible for trial, and observable in direct benefits and effects on responsible alcohol services. The randomized control trial will take place at Spanish-dominant businesses in the Southwestern region of the United States. …

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