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Alcohol – Excessive Consumption: Responsible Beverage Service Training

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What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 11 studies (search period 1987-2009).

The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to preventing excessive alcohol consumption. This finding replaces the 2001 CPSTF recommendation for Intervention Training Programs for Servers of Alcoholic Beverages to Reduce Alcohol-Impaired Driving pdf icon [PDF - 257 kB].

Context

The context in which RBS training takes place likely plays an important role in the effectiveness of the intervention. Training programs may

  • Vary by the type of participation (e.g., state mandated, state-based incentive, voluntary research program)
  • Target establishment owners, managers, or servers
  • Be offered to groups, or delivered one-on-one
  • Be delivered by professional trainers, managers, or other staff
  • Vary in intensity and content (i.e., program can be 45 minute videotape presentations or 18 hour skill-building sessions)
  • Occur on- or off-site

Summary of Results

Detailed results from the systematic review are available in the Task Force Finding and Rationale Statement pdf icon [PDF - 167 kB].

The systematic review included 11 studies.

  • RBS training for owners and managers led to positive changes in establishment policies, such as requiring identification checks of underage-looking customers, eliminating drink promotions, providing safe drinking information for customers, denying service to obviously intoxicated customers, conducting regular meetings with the staff, promoting food and non-alcoholic beverages, and arranging alternative transportation (4 studies).
  • RBS training for servers modestly improved observed and self-reported server practices such as offering food and water, delaying service to visibly intoxicated patrons, commenting on quantity and speed of alcohol consumption, and explaining house policies to customers (4 studies).
    • Identification checks for underage-looking patrons increased by 5 and 10 percentage points (2 studies). These results were not significant, however, and the frequency of identification checks remained low following RBS training.
    • Refusal to serve obviously intoxicated patrons (or trained actors who appeared intoxicated) increased by a median of 5 percentage points, though the frequency of service refusal remained low (4 studies).
  • RBS training generally resulted in a net decrease in the number of alcoholic drinks consumed by the patrons (2 studies with 5 study arms).
  • Researchers observed a net decrease in mean blood alcohol concentration (BAC) levels among patrons whose servers had been trained (3 studies with 6 study arms).
  • The percentage of intoxicated patrons leaving an establishment decreased by a median of 26.7% (5 studies) after being helped by trained servers.
    • The effects of RBS training on alcohol consumption and intoxication were small or in the unfavorable direction in establishments where there was a perceived lax regulatory climate, as measured in a survey of bar owners and community members.
  • Three years after a state-mandated RBS training program was introduced in Oregon, fatal single vehicle nighttime crashes decreased by an estimated 23% (1 study). Fatal single vehicle nighttime crashes are closely associated with excessive alcohol consumption.

Summary of Economic Evidence

An economic review of this intervention was not conducted because the CPSTF did not have enough information to determine if the intervention works.

Applicability

Applicability of this intervention across different settings and populations was not assessed because the CPSTF did not have enough information to determine if the intervention works.

Evidence Gaps

Additional research and evaluation are needed to answer the following questions and fill existing gaps in the evidence base.

  • How do training intensity, delivery method (e.g., videotapes, lectures, role- playing), type of participation (i.e., state mandated, voluntary incentive, or research program), or type of establishment (onsite or off-site) affect outcomes of RBS training?
  • How do mandatory versus voluntary server training programs differ with respect to the following?
    • Participation level in server training programs
    • Management support to achieve program goals
    • Potential harms that can result from state offers to limit liability or sanctions in exchange for participation in training programs
    • Overall effectiveness of training programs in decreasing alcohol consumption
  • What training elements should be included in all server training programs?
  • What are the long-term effects of server training? Is one training session sufficient or 'booster sessions' are desired to maintain long-term intervention effectiveness?
  • How does server training affect establishment revenues, alcohol sales, and server tips?

Study Characteristics

Although included studies generally found positive results, two major limitations made it difficult to assess the potential public health impact of RBS training programs.

  • Most of the evaluated studies were academic research trials conducted in selected establishments, with high-quality, intensive training programs. This raises questions about whether programs implemented under more natural conditions would produce similar results.
  • The studies reported results for individual establishments, making it difficult to estimate the community-wide impact of RBS training programs.

Publications