PRC - Research - Harold D. Holder, Ph.D. - "Preventing Alcohol Trauma: A Community Trial"

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The objectives of this prevention trial were to implement and to evaluate a comprehensive five-year community intervention to reduce alcohol-involved trauma (i.e., alcohol-involved traffic crashes including injuries and fatalities) and alcohol-involved non-traffic fatalities and unintentional injuries including burns, falls, and drowning.

To achieve these two goals, the research consisted of the implementation and evaluation of a community-based intervention using five interacting and supportive components:

A Community Knowledge, Values, and Mobilization component consisted of working with existing community coalitions in the experimental communities to implement specific interventions and develop an integrated public awareness and education program that supported the overall goals and those of individual components, including concern about alcohol-involved trauma, the relationship of blood alcohol concentration (BAC) and impairment as related to increased risk of death or injury, and skills in estimating BAC.
A Responsible Beverage Service component included training servers and owner/managers of on-premises alcohol outlets to identify intoxicated and/or underage customers in bars and restaurants and to develop and implement beverage service policies that reduced the probability of customers becoming intoxicated or of their driving when intoxicated.
An Underage Drinking component included the development of school (including a normative curriculum complement) and community programs for parents and adolescents concerned with issues of sales and access to alcohol by minors, and the training of off-premise retailers to reduce sales to minors. A Risk of Drinking and Driving component increased the actual and perceived risk of apprehension rate of drivers who are under the influence of alcohol. This component consisted of increasing DWI arrest efficiency through training enforcement officers in new techniques for identifying DWI drivers and the use of passive alcohol sensors to increase the probability of detection. An Access to Alcohol component included the use of local zoning powers and other municipal controls of outlet density to reduce the availability of alcohol.

The research design was quasi-experimental with three pairs of experimental and comparison communities. The first year was a baseline data collection and planning phase involving a combination of community and emergency room surveys as well as the use of archival records. Years Two through Four were intervention phases, which made use of an iterative process evaluation and media-based feedback to the community.

The shift from targeting specific individuals or subpopulations to the overall structure and environment of a community is most demanding. Evaluation tools and analysis techniques have lagged behind program development because community-level interventions are not linked to a specific target group who can be separately studied. Thus, assumptions about using random assignment and/or comparison communities as a means to control for confounding variables are weakened when the unit of analysis is the community itself and dependent measures are subject to trending and the effects of history.