Brad S. Krevor, Ph.D. Bill DeJong, Ph.D. Joel Grube, Ph.D. Brandeis University Boston University PIRE

Reducing youth access to alcohol:

the state-of-the-art in preventing underage sales and use of age-restricted products

April 18, 2006

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Background

RR Forum as outgrowth of Attorney General Consumer Protection Initiative: CP Authority as alternative legal theory for underage sales Agreements with national chains

National CDC-sponsored meeting (March 2000)

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CSAP Report

Report on Best Practices for RR

Innovations of CSAP Report: Identified components of RR

Emphasis upon management systems

Role of public agencies: enforce and assist licensees identify and implement Best Practices for RR

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Paradox of Enforcement

Enforcement is the sine qua non of compliance…

1) But public agencies have inadequate resources to inspection frequently

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Paradox of Enforcement

1. Inadequate enforcement resources

2. “Educate into compliance”: … but not when turnover rates > enforcement frequency

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Paradox of Enforcement

1. Inadequate enforcement resources2. “Educate into compliance”

3. Wagenaar study (2005): pedagogic effects short-lived

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Paradox of Enforcement

1. Inadequate enforcement resources

2. “Educate into compliance”

3. Pedagogic effects short-lived

4. Deterrent effect is undermined by the uncertainty of how to avoid risk:

Policies do not translate into consistent clerk (or manager) performance

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Integrated Responsible Retailing Model

a continuous system supported by the efforts of retailers, agencies, and other public and private stakeholders

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Protocols for age verification/ sales declination

Point-of-sales aids:

Signage

Specialty calendars

ID scanning

Hiring, Supervision,

Training

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A “Community Policing” model employs a “problem-solving” approach to underage access and use.

Identify and address actual sources of age-restricted products in the community

An involved, concerned community is decisive in motivating public agencies, which in turn can engage—and assist—retailers.

“Retailers as Active Partners”

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Responsible Retailing

Policies

• Laws and Regulations

• Enforcement protocols

• Penalties

• Affirmative Defense

• FundingWhat Policies will encourage adoption of effective RR practices?

Public PolicyPublic Policy

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RR Systems Project

1st RR Forum: March 2003, Orlando, FL Staffed by Brandeis and FSU support from Diageo / Diageo Foundation

1st priority recommendation:Demonstrate and evaluate the integrated RR systems model.

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RR Systems ProjectDeveloping an operational model 1. Business analogue for implementing BPs:

ExxonMobil Assurance of Voluntary Compliance• Adoption of many Best Practices in CSAP Report• Continual monitoring• Remedial response to age-verification failures• Company-wide commitment

How would one replicate the ExxonMobil model at the level of community?

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RR Systems Project

Developing an operational model 2. Health care analogue:

Best Practices = Clinical Guidelines

How to implement clinical guidelines in medical practice sites?

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RR Systems Project

Developing an operational modelWhy primary care physicians don’t adopt guidelines:

[note similarity to explanations for not checking IDs]

Unfamiliarity Time constraints: too busy Inability to overcome inertia of prior practice Doubts regarding effectiveness Doubts regarding self-efficacy (for tobacco) Aversion to confrontation

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Public Health model

Medical Practice SitePatient—Doctor

Community Resources:•Quit lines•Counselors•Cessation classes

State Stakeholder:•Health Depts.•Medical societies•Insurers

•Planning Guide •Pharmacology•Self-help Materials•Tech. Assistance

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Community Resources:•Clerk / Server Training•Mystery Shoppers•Coalitions

Public Health model applied to retailing

Retail EstablishmentCustomer—Clerk / Server

State Stakeholder:•Regulators•Health Depts. •Trade ass’ns

Planning Guide RR materials

Tech Ass’t

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RR Systems Project

Phase 1 (Sept 2003 – May 2005):

Focus upon Tier 1: Retail-level Objective: Develop tools to assist retailers and implementation strategies

Study Sites: Birmingham, AL Springfield, MO Santa Fe, NM Des Moines, IA

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RR Systems Project

Assistance to retailers:1. Develop “A Planning Tool for [Iowa] Retailers”

a quality improvement tool to assess current practices identifies absent Best Practices Promoted and supported by state Regulatory / Enforcement

agency: R / E Agency is engine that drives the model

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RR Systems Project

Assistance to retailers:2. Monitoring / Feedback

Multiple inspections by young adults Reports to retailers on individual inspections

Feedback—not penalties! Will include inspections by pseudo-intoxicated

customers

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RR Systems Project

Lessons from Phase 1: Variability of retailers

Chains Owner-operatedhigh Number of employees low “ Turnover “ “ Need for Systems “ “ Level of technology “ “ Explicit policies “ no Manager is change agent? yes

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RR Systems Project

Lessons from Phase 1: Stakeholders face challenge in engaging retailers regulatory / enforcement agencies are feared independent retailers don’t belong to trade

associations

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RR Systems Project

Phase 2 (beginning Sept 2005): Community roll-out of “enforcement + assistance” model

Study sites:

Albuquerque, NMMontgomery, AL Iowa City, AL

Waukesha, WI Gettysburg, PA

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RR Systems Project

Phase 2

Focus: Community context (2nd tier of model)

Objectives:

1) Engage retailers in quality improvement model

2) Employ community policing principles to identify actual sources of alcohol (both commercial and social) in the community

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RR Systems Project

Phase 3 (begin 2007/08):

Focus: 3rd tier: system-level RR

Objective: conduct a multi-state community trial to evaluate the effectiveness of the “enforcement + assistance” model at the level of county, with study arms that employ various implementation strategies to engage retailers.

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Insights derived from RR Research

The problems that we face are in the domain of public health . . .

. . . but the solutions are in the domain of organizational behavior

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Insights derived from RR Research

Electronic Age Verification (EAV) device Field effectiveness study:

Study sites: Tallahassee, FL; Iowa City, IA

Primary findings: attitudes; utilization

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Insights derived from RR Research

Electronic Age Verification (EAV) device study

TobaccoInspections

Baseline 1Compliance

Baseline 2Compliance

CompliantB1 & B2

Florida 81% 86% 66%

Iowa 43% 51% 33%

Overestimation of compliance

Variability of “compliance”

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Insights derived from RR Research Electronic Age Verification (EAV) device study

Variability of clerks:Clerk is an important determinant of whether the

store is found to be compliant

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Insights derived from RR Research

Who makes underage sales?No profilelength of time predictive of complianceunderage sales a “crime of inattention”