Brad S. Krevor, Ph.D. Bill DeJong, Ph.D. Joel Grube, Ph.D.

1. Reducing youth access to alcohol: the state-of-the-art in preventing underage sales and use of age-restricted products April 18, 2006 • Brad S. Krevor, Ph.D. Bill DeJong, Ph.D. Joel Grube, Ph.D. • Brandeis University Boston University PIRE

2. 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)

3. 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

4. Paradox of Enforcement Enforcement is the sine qua non of compliance… 1) But public agencies have inadequate resources to inspection frequently

5. Paradox of Enforcement 1. Inadequate enforcement resources 2. “Educate into compliance”: … but not when turnover rates > enforcement frequency

6. Paradox of Enforcement 1.Inadequate enforcement resources 2. “Educate into compliance” 3. Wagenaar study (2005): pedagogic effects short-lived

7. 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

8. Integrated Responsible Retailing Model a continuous system supported by the efforts of retailers, agencies, and other public and private stakeholders

9. Protocols for age verification/ sales declination • Point-of-sales aids: • Signage • Specialty calendars • ID scanning Hiring, Supervision, Training

10. 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”

11. Responsible Retailing • Policies • Laws and Regulations • Enforcement protocols • Penalties • Affirmative Defense • Funding Public Policy What Policies will encourage adoption of effective RR practices?

12. 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.

13. RR Systems Project Developing an operational model 1. Businessanalogue 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?

14. RR Systems Project Developing an operational model 2. Health care analogue: Best Practices = Clinical Guidelines How to implement clinical guidelines in medical practice sites?

15. RR Systems Project Developing an operational model Why 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

16. Public Health model • State Stakeholder: • Health Depts. • Medical societies • Insurers Medical Practice Site Patient—Doctor • Community Resources: • Quit lines • Counselors • Cessation classes • Planning Guide • Pharmacology • Self-help Materials • Tech. Assistance

17. Public Health model applied to retailing • State Stakeholder: • Regulators • Health Depts. • Trade ass’ns Retail Establishment Customer—Clerk / Server • Community Resources: • Clerk / Server Training • Mystery Shoppers • Coalitions Planning Guide RR materials Tech Ass’t

18. 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

19. 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

20. 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

21. RR Systems Project Lessons from Phase 1: Variability of retailers ChainsOwner-operated high Number of employees low “ Turnover “ “ Need for Systems “ “ Level of technology “ “ Explicit policies “ no Manager is change agent? yes

22. 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

23. RR Systems Project Phase 2(beginning Sept 2005): Community roll-out of “enforcement + assistance” model Study sites: Albuquerque, NM Montgomery, AL Iowa City, AL Waukesha, WI Gettysburg, PA

24. 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

25. 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.

26. 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

27. Insights derived from RR Research Electronic Age Verification (EAV) device Field effectiveness study: Study sites: Tallahassee, FL; Iowa City, IA Primary findings: attitudes; utilization

28. Insights derived from RR Research Electronic Age Verification (EAV) device study Variability of “compliance” Overestimation of compliance

29. 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

30. Insights derived from RR Research Who makes underage sales? No profile length of time predictive of compliance underage sales a “crime of inattention”