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Tag: Pseudo Patrons

Noncompliance with laws to prevent polysubstance misuse

Noncompliance with laws to prevent polysubstance misuse

The effectiveness of statutes to combat hazardous polysubstance use (for example, alcohol and cannabis together) has rarely been evaluated. A multi-institutional team led by Klein Buendel researchers assessed compliance with a state law prohibiting recreational cannabis sales to apparently intoxicated customers in one of the first states to legalize cannabis sales. The assessment has been published in Alcohol: Clinical and Experimental Research.

In January to June 2024, pseudo-patrons visited 189 recreational cannabis stores twice in two large metropolitan areas and attempted to purchase cannabis while displaying alcohol intoxication behaviors. Observers recorded whether sellers were willing to sell the product along with characteristics of the stores (busyness, cleanliness, and signage) and cannabis sellers (sex, race and ethnicity, and age). Neighborhood characteristics by U.S. census tract were obtained (income, race, and ethnicity; population density). Sex and race and ethnicity of the pseudo-patrons, and extent and type of intoxication cues, were recorded. Descriptive statistics and logistic regression were used to describe the sales rate and predictors of the sales rate.

Assessments were completed at 173 stores. Sellers were willing to sell cannabis to pseudo-intoxicated buyers at 255 of 346 visits (73.7%). Sellers refused buyers at both visits in 6.9% of stores but in 54.3% were willing to sell at both visits. Sellers refused cannabis sales at higher rates in stores with signs saying, “no sales to intoxicated customers” (34.3%), particularly when buyers displayed more obvious signs of intoxication (39.8%).

Low compliance with the state regulation possibly occurred because sellers were unaware of the law, perceived little deterrence by the law, or lacked the skills to recognize and refuse intoxicated customers. Noncompliance with the law on selling cannabis to apparently alcohol-intoxicated customers increases the risks of polysubstance impairment and harm.

This research is supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (AA031591; Dr. W. Gill Woodall and Dr. David Buller, Multiple Principal Investigators). Additional collaborating authors include Dr. Robert Saltz from the Pacific Institute for Research and Evaluation; Dr. James Fell from Fell Consulting; Dr. Gary Cutter from the University of Alabama; and Lila Martinez, Amanda Brice, and Noah Chirico from Klein Buendel.

Mandatory Training Increases Drink Refusals to Intoxicated Patrons in California

Mandatory Training Increases Drink Refusals to Intoxicated Patrons in California

Klein Buendel scientists and staff are collaborators on a study that evaluated mandatory responsible beverage service training in California and its association with higher refusals of service to apparently intoxicated patrons in drinking establishments. The study, led by Dr. Robert Saltz at the Pacific Institute for Research and Evaluation, has been published in the Journal of Studies on Alcohol and Drugs.

The California Responsible Beverage Service (RBS) Training Act mandated training for all alcohol servers by 2023, giving this multi-institutional research team a rare opportunity to see how a statewide initiative might influence server behavior.

In 2022, 300 licensed on-premises establishments were sampled in nine counties in and around the San Francisco Bay Area. From July 2022 to January 2023, pseudo-patron and observer teams visited each establishment, and pseudo-patrons attempted to buy alcohol while displaying obvious signs of intoxication. The outcome of each purchase attempt and characteristics of establishments, servers, and pseudo-patrons, and month, day, and time, were recorded. In 2024, the same premises were visited as a follow up.

At baseline, 19.6% of the outlets refused service to the pseudo-patron. At follow up, the refusal rate increased significantly to 39.2% in a regression model controlling for establishment, server, and pseudo-patron characteristics. A typology of establishments (such as sports bar, casual restaurant, fine dining restaurant) did not show any association with refusal rate except that fine dining places refused more often than other types of establishments. Observers’ ratings of how obvious the pseudo-patron’s apparent intoxication was strongly associated with refusals.

The researchers conclude that there was substantial improvement in alcohol over-service refusals two years after the California mandatory RBS training law went into effect.

This research was funded by a grant to PIRE from the National Institute on Alcohol Abuse and Alcoholism (AA028772; Dr. Robert Saltz, Principal Investigator).  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.  

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.