Associations between Responsible Beverage Service Laws and Binge Drinking and Alcohol-Impaired Driving.

ABSTRACT We explored potential associations between the strength of state Responsible Beverage Service (RBS) laws and self-reported binge drinking and alcohol-impaired driving in the U.S. A multilevel logistic mixed-effects model was used, adjusting for potential confounders. Analyses were conducted on the overall BRFSS sample and drinkers only. Seven percent of BRFSS respondents lived in states with the strongest RBS laws, 15% reported binge drinking and 2% reported driving after having too much to drink at least once in the past 30 days. There was no evidence of a significant association between RBS law strength and self-reported binge drinking or alcohol-impaired driving. Future studies should include additional information about RBS laws and use a prospective research design. INTRODUCTION Excessive consumption of alcohol and alcohol-impaired driving are costly public health problems and significant contributors to injury and death in the U.S. (Brewer & Swahn, 2005; Sacks et al., 2015). Heavier drinking is associated with higher mortality rates (Mokdad, Marks, Stroup & Gerberding, 2004). Binge drinking (five or more drinks on an occasion for men, four or more for women) contributed to more than 40,000 U.S. deaths in 2010 (CDC, 2012). Excessive drinking costs the U.S. approximately $746 per capita annually; three-quarters of those expenses are attributable to binge drinking (Bouchery, Harwood, Sacks, Simon & Brewer, 2011). In 2014, according to the National Highway Traffic Safety Administration, nearly 10,000 people died in motor vehicle crashes involving alcohol-impaired driving (NHTSA, 2015). Analyzing Behavioral Risk Factor Surveillance System (BRFSS) data from 1993 through 2002, Quinlan and colleagues (2005) found that the percentage of respondents who reported driving after having too much to drink increased from the mid-1990s to 2002, as did the number of impaired driving episodes (2005). Since 2002, the percentage of respondents reporting impaired driving in past 30 days has decreased (Bergen et al., 2012), but 4.2 million adults in 2012 reported an estimated 121 million alcohol-impaired driving episodes (Jewett et al., 2015). Each year, people who reported binge drinking accounted for over 85% of self-reported alcohol-impaired driving incidents. Crashes in which alcohol-impaired driving is a factor are estimated to cost more than $44 billion annually (NHTSA, 2015). Changing the alcohol policy environment may be an effective approach to mitigating the harms and costs associated with excessive alcohol use. Using Mothers Against Drunk Driving (MADD) ratings of states' activities (e.g., policies and enforcement) to prevent driving under the influence of alcohol, Shults and associates (2002) found that BRFSS respondents living in states with a MADD grade of "D" were 60% more likely to report driving after drinking than respondents from states with an "A" grade. In a survey of U.S. college students (Weschler et al., 2003), students attending colleges in states with comprehensive alcohol control laws and strong enforcement were less likely to binge drink or drive after consuming at least five drinks. Whetten-Goldstein and colleagues (2000) concluded that dram shop liability laws, which hold alcohol establishments liable for their patrons' behavior, were associated with lower rates of alcohol-related motor vehicle fatalities; the authors surmised that liability laws encouraged more responsible server behavior, which in turn limited excessive consumption and impaired driving. One type of alcohol policy, responsible beverage service (RBS) laws, targets server behavior. RBS laws set forth requirements or incentives for retail alcohol establishments, such as bars, restaurants and liquor stores to participate in RBS training programs (Alcohol Policy Information System [APIS]; http://alcoholpolicy.niaaa.nih.gov). RBS programs are intended to help participating establishments develop policies and procedures for preventing illegal alcohol sales, then train managers and servers/sellers to implement the policies and procedures effectively (Mosher et al. …