Program Profile: Community Trials Intervention to Reduce High-Risk Drinking (RHRD)

This is a community-based program to reduce underage drinking and alcohol-related offenses. The program is rated Promising. Intervention sites reported statistically significant reductions in DUI and nighttime crashes, average drinking quantity and variance, police-reported assaults, and EMS calls involving assault and motor vehicle crashes, compared with control sites. There was no difference in ED assaults, police reports of public drunkenness, or EMS calls involving alcohol or other drugs.

A Promising rating implies that implementing the program may result in the intended outcome(s).

This program's rating is based on evidence that includes either 1) one study conducted in multiple sites; or 2) two or three studies, each conducted at a different site. Learn about how we make the multisite determination .

Program Goals

The Community Trials Intervention to Reduce High-Risk Drinking (RHRD) is a universal, multicomponent, community-based program that aims to reduce underage drinking, binge drinking, and driving under the influence (DUI). The program uses environmental interventions and community mobilization to decrease formal, social, and informal access to alcohol. The goal is to help communities prevent various types of alcohol-related accidents, violence, and injuries. Program components are tailored to individual communities and incorporate local input, dynamics, and regulations in order to produce positive outcomes.

Program Theory

RHRD is environment-based, not population-based. It focuses on changes in the social and structural contexts of alcohol use that can alter individual behavior and does not target specific groups. Environmental approaches seek to implement policy changes, affect systems and norms changes within communities, and target community leaders and policy-makers for structural changes.

Target Population

RHRD was developed for a universal audience, so that it can be implemented in any setting regardless of the race, ethnicity, and gender of the affected population. The program also takes into account the specific demographic and cultural dynamics of local communities and their distinct alcohol sales and distribution patterns and policies (e.g. norms, attitudes, ordinances and outlet density).

Program Components

RHRD is designed to reduce alcohol-related injury and trauma through five main prevention components: community mobilization and awareness, responsible beverage service, reduced underage drinking, reduced drinking and driving, and stricter alcohol access.

• Community mobilization and awareness. RHRD mobilizes communities to support prevention interventions through coalition building and media advocacy. This component also intends to increase awareness of the problems associated with youth and young adult drinking by increasing knowledge, motivate concerned adults, and alter youth perceptions of community/social norms about drinking and high-risk situations.
• Responsible beverage service. This intervention includes assistance to alcohol beverage servers and retailers (e.g. bars and restaurants) to reduce alcohol consumption onsite. Training is also provided to develop and implement beverage service policies to reduce intoxication and drinking after driving.
• Reduced underage drinking. RHRD works to reduce underage access to alcohol by training retailers who sell alcohol for off-site consumption and by increasing enforcement of underage sales laws. Police enforcement of underage sales is also enhanced.
• Reduced drinking and driving. Enhanced law enforcement efforts, such as roadside checkpoints and passive alcohol sensors, are intended to increase the actual and perceived risk of apprehension while driving under the influence. Police also equip and train officers for special DUI patrols.
• Stricter alcohol access. Communities receive assistance developing local restrictions on access to alcohol through zoning powers and other municipal controls on sales outlet density. This includes on-site server training programs by RHRD program staff as well as stings by law enforcement officials.

Key Personnel

In order for RHRD to be implemented as a community intervention, data on each individual community should be gathered from local community organizations, key opinion leaders, law enforcement, alcohol distributors, zoning and planning commissions, policymakers, and the general public. Project staff may include the following:

• Director. A director or coordinator is responsible for developing the initiative and its strategy, seeking funding, building coalitions with key community groups and leaders, and hiring project staff.
• Volunteers. Volunteers provide general support for program interventions; elicit support from the broader community and participation by key community leaders and police; assist in the comprehensive application of program components, such as media coverage of program efforts; attend community meetings and hearings; and assist with public education projects and other interventions as needed.
• Community leaders. A program task force, composed of key community leaders (e.g., police captains, zoning officials, public safety and youth commissioners), can provide and further build coalitions to support program interventions.

Data managers and administration staff may also be necessary to track program trends, manage volunteers, and process information. Other staff may be needed for day-to-day management of office operations and staff, recruiting and organizing volunteers, and implementing interventions/tactics. Staff may be employees of the lead agency implementing the program or may be hired separately.

Study

Holder and colleagues (2000) conducted a five-year quasi-experimental evaluation of the Community Trials Intervention to Reduce High Risk Drinking (RHRD) from 1992 through 1996. A longitudinal multiple time-series analysis was used to assess the impact of RHRD across three intervention communities with populations of approximately 100,000 in northern California, southern California, and South Carolina. The three sites were selected because they were interested in testing RHRD strategies. Matched communities were used as the comparison groups and did not receive the intervention components.

The five RHRD program components (community mobilization and awareness; responsible beverage service; reduced underage drinking; reduced drinking and driving; and stricter alcohol access) were implemented in phases within each intervention community. Data were collected throughout the 12-month post-intervention period. Data sources included: traffic crash records; emergency room surveys; local news coverage of alcohol-related topics; intoxicated patron and underage decoy surveys; roadside surveys conducted on weekend evenings; and a community telephone survey (including self-reported measures of drinking and of drinking while driving).

Approximately 120 random digit dialing telephone surveys of individuals over the age of 18 from intervention and comparison sites per month were conducted over 66 months. Six self-reported measures were obtained from the surveys. Every three months the proportion of survey respondents that reported alcohol consumption was assessed, with the number of observations varying by outcome measure. Multivariate analysis was used to control for differences, with authors reporting that the differences in outcomes were minimal.

Traffic record data on motor vehicle crashes were obtained from the California Statewide Integrated Traffic Reporting System and the South Carolina Department of Public Safety. Monthly aggregated crash rates were estimated for each community for nighttime crashes (8PM to 4PM), driving under the influence (DUI) citations, and daytime crashes (4AM to 8PM). Emergency department (ED) surveys were conducted in one northern California intervention-comparison matched pair and one South Carolina intervention site. Permission could not be obtained to conduct surveys at the other sites. Over the course of the study, 7,817 injury cases were admitted to EDs and 5,941 interviews were attempted, with an overall 58 percent response rate. Archived hospital data were also collected to measure the observed number of hospitalized assault cases from matched intervention-comparison sites in northern and southern California (data were not available from South Carolina). No subgroup analyses were conducted.

Study

Treno and colleagues (2007) conducted a quasi-experimental time-series comparison study to assess the efficacy of implementing RHRD at the neighborhood level in two roughly comparable communities in Sacramento, California (referred to as the South and North neighborhoods). The study, the Sacramento Neighborhood Alcohol Prevention Project (SNAPP), used environmental approaches developed in the earlier Community Trials Intervention study conducted by Holder et al. (2000) that focused on whether RHRD could be applied at the neighborhood level.

Using geo-statistical techniques, SNAPP assessed whether South and North census block groups ( n = 37) changed with respect to all other block groups in Sacramento ( n = 243). Data from the California Department of Alcoholic Beverage Control indicated that the two study areas had higher concentrations of bars and off-site alcohol outlets per roadway mile. Data from the 2000 Census revealed that the study areas also had similar rates of assaults (per 1,000 population). Thus, although not comparable to the city of Sacramento at large, results from the North and South sites were roughly comparable to each other.

Based on these findings, SNAPP was implemented from July 2000 to July 2001 (year 1) in the South neighborhood, while the North neighborhood served as the no-treatment comparison site. A second SNAPP targeting the North was conducted from January 2002 to January 2003 (year 2) to provide for comparison and to test the interventions’ long-term impact. Data were also collected from Sacramento at large to serve as a control for historical conditions at both sites.

Researchers conducted a process evaluation to track mobilization, community awareness, and law enforcement activities through the SNAPP management information system. Changes in alcohol access were monitored using Apparent Minor and Pseudo Intoxicated Patron Surveys, which were conducted in two stages: (1) an off-site establishment scouting survey was conducted to provide information on the distributor and surrounding environments; and (2) a buyer and a driver team was sent to purchase alcohol from selected sites and to obtain descriptive information about the clerk, the attempt, and the environment. The establishments’ alcohol license data were obtained from the Department of Alcoholic Beverage Control. The service frequency of alcohol to actors pretending to be intoxicated during purchases was documented.

An outcome evaluation of SNAPP was conducted using data on alcohol-related injuries and police incidents, which were indexed by police calls for assaults and public drunkenness and by Emergency Medical Services (EMS) reports of assaults, motor vehicle accidents, and other alcohol-related incidents. Data were aggregated on a monthly basis. Sacramento City Police crime data were collected between January 1996 and December 2003. Sacramento Fire Department and EMS data were collected between January 1995 and December 2003. Police data included seven years of monthly data (84 observations), while EMS data included eight years of monthly data (96 observations).

Statistical analyses of data were conducted using seemingly unrelated regression equation (SURE) models that treat each time series separately. These analyses also controlled for possible autocorrelation due to the nesting of communities. No subgroup analyses were conducted.

These sources were used in the development of the program profile:

These sources were used in the development of the program profile: