Brad S. Krevor, Ph.D. Bill DeJong, Ph.D. Joel Grube, Ph.D. Brandeis University Boston University...
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Transcript of Brad S. Krevor, Ph.D. Bill DeJong, Ph.D. Joel Grube, Ph.D. Brandeis University Boston University...
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
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
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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
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
• 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.
13
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?
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?
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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
16
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
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
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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
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
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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
23
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
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
TobaccoInspections
Baseline 1Compliance
Baseline 2Compliance
CompliantB1 & B2
Florida 81% 86% 66%
Iowa 43% 51% 33%
Overestimation of compliance
Variability 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 profilelength of time predictive of complianceunderage sales a “crime of inattention”