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

Evidence Rating: Promising - One study Promising - One study

Date: This profile was posted on May 03, 2013

Program Summary

A multicomponent program for all ages that aims to reduce underage drinking, binge drinking, and drinking and driving by using environmental interventions and community mobilization. The program is rated Promising. The program evidence is mixed with one study finding differences between the intervention and comparison on some measures. However, another study found few statistically significant differences in their targeted outcome evaluation of alcohol-related injuries and police incidents.

Program Description

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.

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.

Evaluation Outcomes

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The overall evidence of the effectiveness of the Community Trials Intervention to Reduce High Risk Drinking (RHRD) program is mixed. The 2000 study by Holder and colleagues found statistically significant differences between the intervention and comparison communities on some measures. However, the 2007 study by Treno and colleagues found few statistically significant differences in their targeted outcome evaluation of alcohol-related injuries and police incidents.

Study 1
Alcohol-related Injury and Violence
Intervention sites had a significant decrease in the number of nighttime crashes per month and the monthly rates of driving under the influence (DUI) crashes relative to comparison sites. Intervention sites also had a significant decline in alcohol-related assault cases and serious alcohol-related assault cases observed in emergency departments (ED) relative to comparison sites.

  • Nighttime injury crashes. There was a 10 percent reduction in nighttime crashes per month in the intervention communities.
  • Driving under the influence (DUI) crashes. There was a 6 percent decrease in DUI crashes per month in the intervention communities.
  • Assaults observed in emergency departments (ED). Survey findings revealed that assault cases in ED declined 43 percent in the northern California sites only. (Please note that the ED survey data was not available from the other sites).
  • Hospitalized assaults. Hospitalization rates indicated that serious alcohol-related assault cases declined by 2 percent after full program implementation at the intervention sites in northern and southern California. (Please note that the ED archival data was not available from the other sites).

However, there was no decline in daytime motor vehicle crashes observed.

Alcohol Consumption
Individuals living in intervention sites reported significant reductions in drinking quantities, variances in drinking quantities, rates of driving when having had too much to drink, and rates of driving over the legal limit relative to individuals living in comparison sites.
  • Average drinking quantity. Although more people reported drinking, the mean quantity decreased from 1.37 to 1.29 drinks per occasion.
  • Average drinking variance. The variance in average drinks per occasion decreased from 2.20 to 1.74.
  • Self-reported drunk driving. Adjusted mean frequencies of self-reported driving when over the legal limit decreased from 0.77 to 0.38.

Differences between intervention and comparison sites in average frequency of drinking were not statistically significant.

Study 2
Treno and colleagues (2007) found significant reductions in assaults as reported by the police, aggregate Emergency Medical Services (EMS) outcomes, EMS reports on assaults, and EMS reports on motor vehicle accidents. However, there were no significant changes in other outcome measures, including levels of public drunkenness, EMS assault calls in the south, EMS motor vehicle outcomes in the north, and EMS reports of alcohol-related injury. Users should interpret the results with caution because the authors were not able to determine the effectiveness of each program component, but only whether the interventions were generally effective.

Police Incident Reports

  • Police incident reports on assault. The two intervention sites in Sacramento, California reported a significant reduction in alcohol-related assaults based on police data relative to the comparison site (Sacramento at large). Police calls for assault were reduced 3.9 percent in the South neighborhood and 36.5 percent in the North neighborhood.
  • Police incident reports on public drunkenness. However, there were no significant changes in reports of public drunkenness in either neighborhood.

Emergency Medical Services (EMS) Reports on Assault, Accidents, and Injury

  • EMS reports on motor vehicle accidents. EMS calls involving motor vehicle accidents were reduced 33.4 percent in the South neighborhood.  However, EMS calls involving motor vehicle accidents did not significantly change in the North neighborhood.
  • EMS reports on assault. EMS calls related to assaults were reduced 37.4 percent in the North neighborhood. However, EMS calls for assaults did not significantly change in the South neighborhood.
  • EMS reports on alcohol-related injury. There was no significant overall difference in the EMS calls for injury related to alcohol and other drugs.
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Evaluation Methodology

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Study 1
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 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).

Study 2
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.

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The Community Trials Intervention to Reduce High Risk Drinking (RHRD) program typically costs less than $10,000, including the cost of the training manual. Other costs vary by community depending on the specific intervention components and scope of evaluation required. Additional information on costs and budgeting can be found on the website for the Pacific Institute for Research and Evaluation:
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Implementation Information

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Training and details on program implementation are available from the developers at the Pacific Institute for Research and Evaluation. Implementation minimally requires a full-time project manager. More details can be obtained by contacting the developers or viewing their Web site.

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Evidence-Base (Studies Reviewed)

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

Study 1
Holder, Harold D., Paul J. Gruenewald, William R. Ponicki, Andrew J. Treno, Joel W. Grube, Robert F. Saltz, Robert B. Voas, Robert Reynolds, Johnetta Davis, Linda Sanchez, George Gaumont, and Peter Roeper. 2000. “Effect of Community-Based Interventions on High-Risk Drinking and Alcohol-Related Injuries.” Journal of the American Medical Association 284(18):2341-2347.

Study 2
Treno, Andrew J., Paul J. Gruenewald, Juliet P. Lee, and Lillian G. Remer. 2007. “The Sacramento Neighborhood Alcohol Prevention Project: Outcomes from a Community Prevention Trial.” Journal of Studies on Alcohol and Drugs 68(2):197-207.
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Additional References

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

Grube, Joel W. 1997. “Preventing Sales of Alcohol to Minors: Results from a Community Trial.” Addiction 62(Supp.2):S251-S260. (This study was reviewed but did not meet criteria for inclusion in the overall program rating.)

Holder, Harold D., Robert F. Saltz, Joel W. Grube, Robert B. Voas, Paul J. Guenewald, and Andrew J. Treno. 1997. “A Community Prevention Trial to Reduce Alcohol-Involved Accidental Injury and Death: Overview.” Addiction 92(Supp.2):S155-S171.

Holder, Harold D., Robert F. Saltz, Andrew J. Treno, Joel W. Grube, and Robert B. Voas. 1997. “Evaluation Design for a Community Prevention Trial: An Environmental Approach to Reduce Alcohol-Involved Trauma.” Evaluation Review 21(2):140-165.

Holder, Harold D., and Andrew J. Treno. 1997. “Media Advocacy in Community Prevention: News as a Means to Advance Policy Change.” Addiction 92(Supp.2):S189-S199.

Holder, Harold D., Andrew J. Treno, Robert F. Saltz, and Joel W. Grube. 1997. “Recommendations and Experiences for Evaluation of Community-Level Prevention Programs.” Evaluation Review 21(2):268-278.

Reynolds, Robert I., Harold D. Holder, and Paul J. Gruenewald. 1997. “Community Prevention and Alcohol Retail Access.” Addiction 92(Supp.2):S261-272.

Roeper, Peter, Robert B. Voas, Linda Padilla-Sanchez, and Ruth Esteban. 2000. “A Long-Term Community-Wide Intervention to Reduce Alcohol-Related Traffic Injuries: Salinas, California.” Drugs: Education, Prevention and Policy 7(1):51-60.

Saltz, Robert F. 1997. “Evaluating Specific Community Structural Changes: Examples from the Assessment of Responsible Beverage Service.” Evaluation Review 21(2):246-267.

Saltz, Robert F., and Paula Staghetta. 1997. “A Community-Wide Beverage Service Program in Three Communities: Early Findings.” Addiction 92(Supp.2):S237-S249.

Treno, Andrew J., and Harold D. Holder. 1997. “Evaluating Efforts to Reduce Community-Level Problems Through Structural Rather Than Individual Change: A Multicomponent Community Trial to Prevent Alcohol-Involved Problems.” Evaluation Review 21(2)133-139.

Treno, Andrew J., and Harold D. Holder. 1997. “Community Mobilization, Organizing, and Media Advocacy: A Discussion of Methodological Issues.” Evaluation Review 21(2)166-190.

Voas, Robert B., James Lange, and Andrew J. Treno. 1997. “Documenting Community-Level Outcomes: Lessons from Drinking and Driving.” Evaluation Review 21(2)191-208.

Voas, Robert B. “Drinking and Driving Prevention in the Community: Program Planning and Implementation.” Addiction 92(Supp.2):S201-219.
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Related Practices

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Following are practices that are related to this program:

Sobriety Checkpoints
Sobriety checkpoints are police operations that aim to reduce the number of alcohol-related car crashes by preventing people from driving under the influence of alcohol and other substances. Driving under the influence (DUI) is prevented by increasing the perceived and actual risk of detection and apprehension by the police. The practice is rated Promising for reducing the number of car crashes.

Evidence Ratings for Outcomes:
Promising - One Meta-Analysis Drugs & Substance Abuse - Car Crashes
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Program Snapshot

Age: 0+

Gender: Both

Geography: Rural, Suburban, Urban

Setting (Delivery): Workplace, Other Community Setting, High Crime Neighborhoods/Hot Spots

Program Type: Community and Problem Oriented Policing, Community Awareness/Mobilization, Community Crime Prevention , Violence Prevention, Alcohol and Drug Prevention, Specific deterrence

Targeted Population: Young Offenders, Alcohol and Other Drug (AOD) Offenders

Current Program Status: Active

Listed by Other Directories: Model Programs Guide, National Registry of Evidence-based Programs and Practices

Program Developer:
Andrew Treno
Senior Research Scientist
Prevention Research Center
1995 University Avenue
Berkeley CA 94704
Phone: 510.486.1111
Fax: 510.644.0594