Reviewer Doubts Server Training Helps Curb Alcohol-Related Injuries

April 21, 2006

Programs for modifying environments where alcohol is served — including bars and liquor stores — do not help reduce alcohol-related injuries, according to a new review of controlled studies.

“There is no reliable evidence that interventions in the alcohol server setting are effective in reducing injury,” fatal or otherwise, said Katherine Ker, lead review author.

Most of the studies included in the review used decade-old data and obtained relatively low levels of compliance. Server training programs were all short-term, ranging from one or two hours to two days.

“There were some interventions that sounded promising, but if you’re only able to train 50 percent or 60 percent of the people, you can’t tell if the intervention doesn’t work or if it’s because of lack of compliance,” Ker said. “If you could address the issue of compliance, you might be able to get more favorable results.”

It is not time to abandon research into the topic, says Linda DeGutis, Dr.PH, a public- health expert not affiliated with the review.

“Alcohol-related motor vehicle crashes are one of the major things that we see as the result of alcohol intoxication and so we are concerned about it,” said DeGutis, an associate professor of surgery and public health at the Yale University Section of Emergency Medicine.

Examining the effect of interventions on the supply side — instead of focusing on trying to change drinkers’ own demand for alcohol — is a quick way for investigators to target a wide range of drinkers, according to Ker.

“Every alcohol consumer has contact with the alcohol industry in that they have to go to a pub or go to the shops to buy it, so implementing such interventions in server settings is a good way of reaching a large number of people who need it,” Ker said.

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Ker is coordinator of the Cochrane Injuries Group based at the London School of Hygiene and Tropical Medicine.

The Cochrane reviewers examined 20 studies of alcohol interventions that took place in bars, pubs, and alcohol retailers in five countries: Australia, Canada, Sweden, the United Kingdom and the United States, where 10 of the studies occurred.

Fourteen studies examined training programs that focused on serving alcohol responsibly by discussing alcohol service laws, recognizing the early signs of intoxication and using strategies for dealing with intoxicated customers.

One program found that server training reduced the number of incidents of severe patron aggression in bars.

The review also evaluated a U.S. study that used a driving service to provide free rides home to people too drunk to drive; however, data were not strong enough to confidently attribute the reduction in subsequent motor-vehicle crashes to the intervention.

The only study that assessed injury outcome compared the risk of injury to servers from two types of drinking glassware. Using specially “toughened” glassware was not found to reduce risk.

“There weren’t enough baseline studies to reach any conclusions based on the effectiveness of these interventions,” DeGutis said. “What we do know is there’s a need to continue to create interventions that would decrease those types of injuries.”

For consumers who want reliable, proven ways to prevent alcohol-related injuries, DeGutis suggests avoiding excessive drinking, choosing a designated driver ahead of time and always wearing a seatbelt. Research has also shown that sobriety checkpoints, random breath testing for drivers and better enforcement of existing liquor licensing laws reduce the risk of alcohol-related injuries.

In the United States, alcohol-related problems and injuries account for over $175 billion in health care and other costs annually, according to the Marin Institute, which describes itself as an alcohol-industry watchdog on its Web site.

Source: Ker K, Chinnock, P. Interventions in the alcohol server setting for preventing injuries. The Cochrane Database of Systematic Reviews 2006, Issue 2.
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