Results of a Randomized Trial of Web -based Responsible Beverageggyg Service Training: WayToServe. org G. Woodall, University of New Mexico Center on , Substance Abuse , and Addictions (();,CASAA); R. Saltz, Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley; D . Buller , Klein -Buendel, Inc ., Golden , CO; R . Starling , University of New Mexico CASAA; and P. Stanghetta, Paula Stanghetta Associates, Kitchener, ON, Canada &HQWHURQ$OFRKROLVP6XEVWDQFH$EXVHDQG$GGLFWLRQV &$6$$ 8QLYHUVLW\RI1HZ0H[LFR KWWSFDVDDXQPHGX •PiPremises were assessed at blibaseline, iditimmediate post- ,1752'8&7,21 training, 6monthpost-training, and one-year post-training 5(68/76 intervals. Pseudo Patron (PP) assessments were employed Research indicates that use and misuse is the third to assess whether apparently intoxicated patrons would be A 2 (level of training) x 4 (time of assessment) repeated leading cause of preventable death in the United States served in premises at each of the four time assessment measures analilyysisof variance was conddducted on the data, (Mokd ad et al., 2004). The NtiNational High way TffiTraffic SftSafety points. At each assessment point, the PP/observer teams and found significant main effects for training (F(1, Administration ((,NHTSA, 2010) found that fatalities due to would visit each establishment twice. The purpose of 264)=5.55, p=.019), time of assessment (F(3, 792)=34.07, (BAC .08+) accounted for approximately 32% of conddiucting two viiisits was to reduce the possibility of p=.0001) and asiiifitgnificant tiitraining by time itinteracti on all traffic deaths in 2009. On average, a person is killed in an collecting anomalous data per a single visit to an (((F(3,792)=2.88, p=.035).Plaaednned t-test s (one -taaed)iled) at each alcohol related driving crash every 50 minutes in the United establishment. All assessment occurred between summer assessment period found no significant differences for refusal States. Research indicates that up to half of people arrested 2009 and fllfall 2011. rate btbetween WTSWayToServe and UC tiitraining at blibaseline for driving-while-intoxicated (DWI) were drinking in alcohol ((yWayToServe refusal rate mean=36%; UC refusal rate serving establis hments (e.g. bars, restaurants, l)lounges) prior •Although a number of dependent measures were collected, mean=35%), but a highly significant difference at immediate to their arrest (Ventura County Behavioral Health, 2007). we shall focus here on rate of refusal: how often apparently post-training (t(288)=3.265, p<.00001) between WayToServe Recent research from Naimi, et al. (2009) indicated that over intoxicated PPs were refused service in any given (refusal rate mean=68%) and UC (refusal rate mean=49%). 10 percent of binge didrin kers (five or more didrin ksonasiilngle establis hment. This istheprimary outcome of the At six months follow-up, no differences were detected occasion) drove a vehicle within 2 hours of their most recent investigation. between WayToServe (mean refusal rate=69%) and UC occasion, and that drinking in licensed The WayToServe website is based on the content of the tiitraining (mean refflusal rate=65%). However, at one year post- establi s hment s accounttded for over 54% of those didrivi ng assessment, a significant difference was detected between episodes. Current research in Responsible Beverage Service state mandated New Mexico Alcohol Server Training curriculum. WayToServe was developed through several WayToServe training (mean refusal rate=68%) and UC Training (RBS) suggests that such training can be an effective tiitraining (mean refflusal rate=58%), t(272)=1.739,p=.0025). means of preventing over-service of alcohol, and ultimately focus groups across New Mexico with members of the target population in order to determine proper terminology, Figure 1 disppylays these means. can reduce the incidence of drunk driving;e.g., alcohol Fig. 1 servers may help prevent alcohol-impaired crashes by idea groupings, and sensitive titopics. Once the iitilinitial webitbsite discouraging over-consumption of alcohol among their was developed, project members conducted additional 80. 00% multimedia focus groups with alcohol servers and RBS patrons.. RtRecent reviews of the RBS literat ure suggest tha t 70.00% 69.57% 67. 61% 68. 70% training methods and implementation are an important factor policy makers (incl udi ng the direc tor of AGD) through out the 65.07% 60.00% in determining whether RBS training can achieve desired state in order to refine the design and structure of the early 58. 33% alhllcohol-reltdlated outcomes. There are now a number of beta version of the website. Prior to conducting the efficacy 50.00% 49.67% Intervention titria l, WTSWayToServe was subject ed toabtbeta-tttest in four Premises commercially available web-based RBS training courses 35. 71% communities in New Mexico. The final version of the website 40.00% Control (e.g., learn2serve.com, tipsalcohol.com); however, to date, no PiPremises consists of six multimedia, interactive content modules that 34.84% systematic examination of the effectiveness of these online 30.00% RBS courses has been published. Reported here is the first include information on the following: randomized trial effectiveness evidence for a web-based RBS 1)Alcohol laws - What one can do legygally as a server, what 20.00% one must do as a server, and the penalties one could face on-premise ( by the drink) training – WayToServe.org, 10.00% an RBS tiitraining webitbsite systttillematically dlddeveloped and ttdtested for failure to uphold the alcohol laws. 2)PtiPreventing service tominors - IfInformati on is presentdted 0.00% via a grant from NIH/NIAAA (R01 AA014982) . BliBaseline PtPost 6M6 Mon th OYOne Year that will help in identifying underage patrons, including the Intervention Follow-up Follow-up 0(7+2' finer points of checking an ID and information on strategies used byminors inattempti ng toobta inallhlcohol. OllOverall, these results iditindicate tha t WTSWayToServe tiitraining ldled 3)Alcohol and ppgregnancy - Information about Fetal Alcohol to siggynificantly more refusals to apparentl y intoxicated • The New MiMexico Alcoh ol and GiGaming Divi si on (AGD) Spectrum Disorders (FASD) is presented, and includes customers than the Usual and Customary training available pro vided a list ofo aacolcoho l serving establi shme nts from which frequently asked questions about FASD. in New Mexico. Although refusals also increased secularly one hundred fifty-five (N=155) were then randomly 4)Facts about alcohol - Information is presented about the in the UC training ggproup,significant refusal rate differences seltdlected across four communities in New MiMexico. effects of alcohol and how to recognize a patron who has were detected in 2 of the three follow-up assessment Establishments had to have at least a beer and wine had too much to drink. Also, information is provided points, most notably at One Year follow-up. license and serve alcohol independent of any food order. regarding the dfiitidefinition of asttddandard didrin k and the 6800$5< • These 155 on-site premises were then randomly assigned definition of blood alcohol concentration levels. toeither the WTSWayToServe tiitraining (n=77) or to theusual 5)The intoxicated patron - Here, the user learns about the aadnd custo m ar y traagining (n=78) pporovided in live cl asses in active role heor sheplays inreffiusing fthfurther alhllcohol service The most promi nent fi ndi nggg i n th e present i nvestig iati on is New Mexico by local trainers. Establishments randomized to intoxicated patrons and ppgreventing patrons from driving that web -based training (provided by WayToServe) toreceive the WTSWayToServe tiitraining were then contttdacted by under the influence of alcohol. It includes a skill building provides superior refusal rate outcomes when compared to ppjroject staff for pppurposes of recruiting them into the study. activity for these purposes. usual an d cus tomary live tra ini ng. Given the lac k o f any 6)Responsible alcohol sales practices - In this section, the rando mized tria l resea rc h on oth er w eb-based RBS • Individuals of at least 21 years of age were recruited and user will have the opportunity to learn about the SERVE programs, this is an important addition to the RBS research trained to act as “pseudo-patron” (PP) buyer and observer system, and also to apply and practice each one of its literat ure. Mos t no ta bly, the impac t o f Way To Serve teams. The teams consiitdsted of an idiidlindividual whoattempt ed points. The SERVE system is a summary of what has been maintained over the year follow-uppp period , a finding to purchase alcohol while acting obviously intoxicated at presented in the previous five sections. Below are screen suggesting that the longitudinal impact of this training the alcohol serving establishments and an observer of the captures from WayToServe. persists. It is further worthwhile to note that the level of purchase attempt whoacttded as an itinnocent btdbystander. The refusal (close to 70% at Year One follow-up) re presents a use of pseudo-patrons in previous studies to evaluate the high level of refusal compared to other similar outcomes in effectiveness of various alcohol server training models is the literature. well established (Gliksman et al., 1993; McKnight, 1989, 1991, 1993; Russ & Geller, 1987; Saltz, 1989). 5()(5(1&(6

•Thebuyer/observer teams were blind to the experimental Gliksman, L., McKenzie, D., Single, E., Douglas, R., Brunet, S., & Moffatt, K. (1993). The role condition of each premise. of alcohol providers in prevention: An evaluation of a server intervention programme. Addiction, 88, 1195-1203. • DiDesign: The didesign emplldoyed in this ititiinvestigation was a 2 McKnigg,ht, A. J. (1989 ). Developppment and Field Test of a Responsible Alcohol Service (level of training:WayToServe vs. Usual and Customary – Program. Volume 3. Final results prevention program. (DOT HS 807449). Washington D.C.: National Highway Traffic Safety Administration. UC - training) x 4(time of assessment: baseline vs. McKnight, A. J. (1991). Factors influencing the effectiveness of server-intervention education. immediate post-training vs. 6 month follow-up vs. one year JlfStdiAlhl52Journal of Studies on Alcohol, 52, 589-397. McKnight, A. J. (1993) . Server intervention. Alcohol, Health, & Research World, 17, 76-83. follow-up) mixed factorial design. Mokdad, A. H., Marks , J.S ., Stroup, D. F., and Gerberding, J. L. (2004). Actual causes of death in the United States, 2000. JAMA, 291, 1238-1245. Naimi, T.X., Nelson, D.E., and Brewer, R.D. (2009). Driving after binge drinking. American Journal of Preventive Medicine, 37, 314-320. National Highway Traffic Safety Administration (2010). Alcohol-impaired driving. Retrived June 30, 2011 from http:// www.nht sa.gov/ st a tic files/ ncsa/ pdf/2010/811385 .pdf Russ, N. W., & Geller, E. S. (1987). Training bar personnel to prevent drunken driving: A field evaluation. American Journal of Public Health , 77, 952-954. Saltz, R. F. (1989). Research needs opportunities in server intervention programs. Health Education Quarterly, 16, 429-438. Ventura Country Behavioral Health, Alcohol and Drug Prevention Division (2007). Ventura County Place of last Drink Survey. Ventura, CA: author

Poster presented at the 25th CASAA Anniversary Celebration at the Hotel Andaluz, Albuquerque, NM on November 7, 2014