Qualitative Assessment of Training Programs for Alcohol Servers and Establishment Managers

Authors

Traci L. Toomey, PhD
Gudrun R. Kilian
John P. Gehan, MPA MA
Cheryl L. Perry, PhD
Rhonda Jones-Webb, DrPH
Alexander C. Wagenaar, PhD

About the Authors

All the authors are with the Division of Epidemiology, School of Public Health, University of Minnesota. Dr. Toomey is a Research Associate, Ms. Kilian is a Community Program Specialist, Mr. Gehan is the Project Manager of Project ARM, Dr. Jones-Webb is a Professor of Epidemiology, and Dr. Wagenaar is a Professor of Epidemiology.

Address Correspondence To:

Dr. Toomey
Div. of Epidemiology, School of Public Health
University of Minnesota
1300 South Second St., Suite 300
Minneapolis MN 55454-1015
Phone: (612) 626-9070
Fax: (612) 624-0315
Email: toomey@epivax.epi.umn.edu

Synopsis

Objective

In an attempt to reduce the societal burden associated with alcohol-related problems such as underage drinking and drunk driving, some local communities and state governments mandate training programs for employees of establishments that serve or sell alcoholic beverages. This study was designed to assess the available training programs for employees and managers and to identify states that either mandate training programs or encourage them by reducing establishments’ legal liability.

Methods

Training programs were identified through the Internet, key informants, and the research literature. Three researchers independently rated each of 22 local and national programs across I0 categories. In addition, the authors surveyed alcoholic beverage control agencies and legislative research bureaus in the 50 U.S. states.

Results

The results show that training programs are not standardized and vary widely in content, use of behavior change methods, and production quality. Most programs targeted waitstaff and bartenders. Only one program exclusively targeted owners and managers.

Conclusions

National standards must be developed for training programs for servers, managers, and owners.

Introduction

Violence and injuries are among the leading causes of death in the United States.[1] Alcohol is implicated in one-third to one-half of these deaths, which means that some 48,000 deaths per year are due to alcohol-related injury.[2] Because alcohol consumption is influenced by a myriad of behavioral, intra- and interpersonal, and environmental factors that are interactive and dynamic,[3,4] changes in people and in the environment are needed to decrease drinking rates and problems related to alcohol use.

Server and manager training programs are designed to teach alcohol establishment staff how to sell alcohol in ways that avoid sales to underage people and reduce the intoxication levels of patrons. Alcohol servers and sellers can help support a culture in which high risk drinking is not acceptable. Responsible alcohol service may involve preventive strategies-limiting the number of alcoholic beverages served per customer per hour, promoting the sale of food and non-alcoholic beverages-as well as proactive strategies-preventing alcohol-impaired patrons from driving and refusing to sell alcohol to obviously intoxicated and underage patrons (both types of sales are illegal in all states).

Evaluating Training Programs

Server training programs may vary greatly by establishment, by community and by state. Some establishments voluntarily participate in training programs, while others are mandated to do so by local or state governmental authorities. Some programs are offered in groups, either in the establishment or in a local classroom, and are led by a professional trainer. In other cases, managers may conduct training with a staff person one-on-one, show a video, or provide reading material for employees to look at on their own.

Studies of the effects of server training have shown that training: (a) increases servers’ knowledge and improves attitudes toward responsible beverage service;[5-9] (b) may increase servers promotion of food and non-alcoholic beverages;[10] (c) may reduce the risk of patron intoxication;[5-8,11,12] and (d) may decrease alcohol-related traffic crashes.[13]

These studies have produced inconsistent findings in part due to weak research designs but perhaps also due to the poor quality of the programs being evaluated. Some studies did not use control groups,[9,10] and some looked at only a small number of establishments.[5-7,11,12]

Simply having bartenders and waitstaff watch a 45- minute training videotape at the start of employment is not adequate. The programs that have been studied have demonstrated success in increasing the frequency with which servers and sellers undertake relatively simple and
straightforward interventions-offering food, soft drinks, and water, checking age identification, and making comments  about quantity consumed or driving-but not more difficult ones such as cutting off service of alcohol to an intoxicated patron.[6,8]

Altering server behaviors that result in refusal of alcohol sales is clearly a challenge and may require a more intensive, theory-based curriculum than that needed to reinforce the server behaviors that require less judgment, such as offering food.

Components of a Successful Program

To increase the likelihood of servers refusing to sell alcohol to underage and intoxicated patrons, programs must first be designed for the proper audience. Then, regardless of the target audience, quality programs should cover relevant content areas, use behavioral change techniques to increase the likelihood of behavior change, and use appropriate communication methods.

Target audience

According to behavior change theory as well as previous studies of server training programs,[3,4,12] it is essential that managers and owners of alcohol establishments support and model responsible alcohol service. Even the best server training programs will not be effective without management support. Bartenders and waitstaff will be unlikely to serve alcohol responsibly if owners and managers do not support and reinforce their training or, even worse, if management threatens to discipline staff members if they do not serve underage or intoxicated customers.

Studies have shown that training of managers can lead to changes in policies in alcohol establishments.[6,7,10] So in addition to training for alcohol servers and sellers, training is needed to help owners and managers identify, implement, and enforce effective alcohol policies for their establishments. The alcohol establishment’s policies and the behaviors of the owner and manager(s) must be consistent with the messages provided in server training [15,16]

Content

Effective training programs provide information about why changing a given behavior is important yet do not overwhelm an audience with so many details that the audience becomes bored. Key factors that need to be addressed in server training programs include perceptions of norms, the policies and practices of the establishment, and understanding of the social support for specific types of preventive and proactive interventions.[4,14,15] Emphasis must be put on refusing service to underage and intoxicated patrons as a norm. In addition, managers, owners, and servers need to understand the legal and social context in which they serve alcohol. What are the state and local laws regulating alcohol sales? What are the social consequences of underage and heavy alcohol use in our society?

Behavioral change methods

In addition to knowledge of the laws and policies regarding alcohol sales, both managers and servers need specific techniques that they can use to refuse illegal sales. Managers and servers need to increase their skills and confidence in refusing service to underage and intoxicated patrons even in emotional situations such as when a patron is belligerent or when the underage customer is close to the server’s own age. Breaking down the desired behavior into smaller components and having the servers repeat and practice those components- for example, through role playing-leads to greater skill development and self-efficacy.[3,17]

Communication methods

Quality server training programs can take lessons from interpersonal communication theory. A training program needs to capture and maintain participants’ attention.[18] A training program is not likely to have any substantive effect if participants believe that the program has little relevance to them, is unrealistic, or is boring. An evaluation of one server training program[9] showed that some servers found previous programs to be uninteresting. Also, consistent with communication theories, the major points of the server training should be repeated many times through multiple channels such as videos, lectures, discussions, and in booster sessions at a later time.[19]

It is useful to examine the quality of existing programs to determine whether further development is warranted in program design, standards, or implementation. In addition, it is important to identify government jurisdictions that mandate server training programs to determine the extent to which server training programs are being mandated across the country.

Methods

For the present study, we (a) qualitatively evaluated existing server and manager training programs and (b) identified states that legislatively mandate or encourage statewide server training.

Review of training packages

We conducted a qualitative review of server training packages commonly used throughout the United States. The authors identified 24 server training programs, including state and national programs, by searching the Internet, contacting key informants in the field, and reviewing the relevant research literature. Because a centralized list of manager and server training programs does not exist, there may be other local and state programs that the authors did not identify. Some programs consisted of either a videotape or written material, some others of a videotape and a trainers’ manual. Still others included a videotape, a trainers’ manual, and written material for trainees. Trainers’ manuals were intended for owners and managers training their own staffs or for professional trainers.

Eight of the programs were developed by alcohol industry groups, six by nonprofit or research groups, seven by for-profit training companies, and one by a state alcohol beverage control agency.

We limited our review to programs that specifically targeted establishments that sell alcohol. We excluded two programs that addressed responsible beverage service but focused on the role of the community and law enforcement rather than on alcohol establishments. We categorized the remaining 22 programs according to the intended audience: (a) bartenders and waitstaff at establishments where alcoholic beverages are sold for on-site consumption; (b) owners and managers of establishments (such as restaurants and bars) where alcoholic beverages are sold for on-site consumption; (c) both owners/managers and bartenders/waitstaff at establishments where alcoholic beverages are sold for on-site consumption; (d) clerks at establishments (such as liquor, grocery, and convenience stores) where alcoholic beverages are sold for off-site consumption; and (e) servers and other workers who interact with customers at stadiums and arenas where alcoholic beverages are sold (including security staff, parking lot attendants, and ticket takers, among others).

Based on the research literature on server training programs[8,12] and behavior change theory,[3,14,17] we identified 10 categories in which to rate server training programs.

Content

• Legal issues. The legal framework for selling to minors or intoxicated people (including criminal penalties and “dram shop” or civil liability), which identifies consequences for servers, managers, and owners.
• Physiological effects. Brief overview of how alcohol affects the body; skills to recognize cues of intoxication.
• Policy development. Skills to develop and enforce establishment policies to increase responsible service of alcohol.
• Social problems. Health problems associated with alcohol, including traffic crashes, pedestrian injuries, drownings, teen pregnancies, sexually transmitted diseases, suicide, and violence.

Behavior change elements

• Preventing intoxication. Skills to identify obviously intoxicated patrons; skills to prevent intoxication.
• Preventing underage drinking. Skills to identify minors; strategies for refusing sales to underage youth.
• Behavior change methods. Methods to build skill level and self-efficacy, such as peer leadership, role playing, and group discussion, instead of a simple lecture format.

Communication methods

• Realism. Use of real life settings, relevant scenarios, and credible role models.
• Respectful of audience. Use of a tone that respects the audience; use of attention-getting techniques such as humor, montage, and musical soundtracks.
• Production quality. Overall packaging and production values; ease of use; layout and editing.

We scored each program component (videotape, trainers’ manual, managers’ manual, and employee materials) on a 4-point scale (0=none, 1 =weak, 2=moderate, 3=strong) for each of the 10 categories, based on how well they addressed each of the 10 categories. Scores for each component represent the means of ratings by three of the co-authors, who rated each program independently. Scores were highly consistent across the three raters. Each program component also received an overall score, representing the mean of the scores for each of the 10 categories, with each category receiving equal weighting.

State policies

To identify those states that have statewide server training policies, we surveyed the 50 states’ alcohol beverage control agencies and legislative research bureaus. We mailed a 69-item questionnaire to each beverage control agency, and a longer, 117-item questionnaire to each legislative research bureau. The survey response rate was 80% for the alcohol beverage control agencies and 58% for the legislative research bureaus. Overall, we received completed questionnaires from either one or both agencies in 46 (92%) states. High response rates were ensured through multiple mailings and follow-up phone calls.

Respondents from both types of agencies were asked about changes in their states’ alcohol control laws since 1967. For the present analysis, we looked at answers to the following question: “Since 1967, has your state enacted legislation that encourages alcohol establishments to train alcohol servers?” If staff members responded yes, they were then asked whether server training was: (a) mandated by state law or (b) encouraged as a means by which establishments could reduce their legal liability for sales to intoxicated customers that result in injuries to third parties. In addition to the surveys, we conducted legal research in each of the 50 states to verify the accuracy of the completed surveys and to identify the training policies of states from which we did not receive completed surveys.

Results

Training programs

The ratings of the 22 programs are shown in the Table.

Target audience

Existing training packages varied in terms of intended audiences. Some programs had only one intended audience, while others had multiple components, each directed at a different audience. Eight of the 22 programs targeted only bartenders and waitstaff. Nine included at least one component that addressed owners or managers of alcohol establishments. Only one of these programs (consisting of a videotape) exclusively targeted owners and managers. Four of the programs had components that dealt with either off-site alcohol sales or alcohol sales at stadiums and arenas.

Tables – Qualitative Ratings of 22 Alcohol Server and Manager Training Packages

Videotapes Only

WordPress Data Table

Interactive Computer Program

WordPress Data Table

Videotape and Trainer Manual

WordPress Data Table

Written Material/Trainer Manual

WordPress Data Table

Content

Some content areas were more comprehensively covered than others. Only six of the programs had at least one component that were rated as “moderately” to “strongly” covering legal issues related to alcohol sales. Most programs discussed alcohol-related social problems only in the context of traffic crashes, if they covered social problems at all. Six programs covered several relevant social issues, such as traffic crashes and alcohol-related violence. Twelve programs addressed underage youth issues, such as ID checking and underage sales, at least moderately well, according to the raters. Two programs exclusively focused on preventing alcohol sales to underage youth and not on preventing sales to intoxicated patrons. Fifteen programs were found to cover issues related to intoxicated patrons moderately well or better. Eight of the programs had at least one component that appropriately covered physiological issues, providing neither too much nor too little information. Twelve programs were at least moderately successful in covering the importance of establishment policies. Three of these programs, however, did not target owners and managers and are therefore unlikely to result in policy changes that would support responsible alcohol service.

Behavior change methods

Few of the programs used behavior change techniques. Programs consisting of audiovisual tapes alone obviously could not use discussion groups or role playing. Some videotapes incorporated behavior change techniques by using peer leaders-alcohol servers or owners and managers-as on-screen spokespeople instead of legal or scientific experts.

Communication methods

The programs varied in terms of mode of presentation. Eleven consisted of only a videotape, with no supplemental written material to guide trainers or trainees. One program was delivered by an interactive computer program. Six of the programs used videotapes and a trainer. The remaining programs used a combination of trainers and written material.

Fewer than half the programs had one or more components that, in the raters’ opinion, adequately used realistic scenarios and recommendations. On the whole, the majority of the programs were respectful of the audience; however, eight had at least one component that we felt could be improved by incorporating realistic scenarios, such as a busy and loud bar scene, or by being more respectful of the audience, not talking down to them. Thirteen of the 22 programs had at least one component that had poor production quality.

Overall scores

Overall scores ranged widely across components and programs, from 0.83 to 2.87. Only two programs (numbers 16 and 17) received an overall rating of 2.5 or better. However, both of these programs targeted only bartenders and waitstaff.

State laws on server training

As of 1994, 13 states had enacted some form of legislation on alcohol server training. Eight states (Alaska, Delaware, Maryland, New Mexico, Oregon, Utah, Vermont, and Wisconsin) require servers to receive training. Florida, Maine, New Hampshire, and Texas have legislation that encourages but does not mandate server training. Instead, in these states alcohol establishments’ potential liability for negligent alcohol sales is either diminished or abolished if the establishments provide server training for their employees. Michigan requires insurance companies to give discounts to establishments that mandate employee server training. Eight states have a legislatively mandated system for reviewing and certifying server training programs; however, in our review of state laws, we found that the level of monitoring and the certification process vary across these states.

Discussion

Although several states mandate server training and others reduce establishments’ liability if employees are trained, a standardized server training curriculum has not yet been developed. Of the many programs that do exist, some have been designed by private, for-profit companies, some are part of publicly funded research projects, and some have been developed by organizations that have close ties to the alcohol industry.

Our review of 22 existing programs shows great variability across programs in terms of coverage of essential content areas, use of behavior change techniques, and communication methods.

Many of the programs were rated strongly in one category or had one highly rated component, but only a few programs received high scores across all categories and components. No single program was outstanding in all respects. The two programs that scored highest in our review (numbers 16 and 17) covered all content areas, had good production values, and employed behavior change techniques. These programs, however, like most of the others, focused solely on alcohol bartenders and waitstaff, with no attention given to managers or owners.

The purpose of server training programs is to alter alcohol serving practices to reduce intoxication levels of customers and prevent illegal sales to underage people, all with the ultimate goal of reducing alcohol-related problems. Training programs that do not cover essential content areas, have few behavior change components, or are poorly produced are unlikely to achieve these goals. Our results indicate that existing server training programs need further refinement.

Recommendations

Based on this qualitative review, we recommend that national standards should be developed for server and manager training programs. A national consensus conference should be held, with participants from a wide range of organizations and backgrounds, including: representatives from the National Institute on Alcohol Abuse and Alcoholism, the Centers for Disease Control and Prevention, the National Highway Transportation Safety Association, the Center for Substance Abuse Prevention, and interested foundations such as the Robert Wood Johnson Foundation; public health and behavioral change researchers; specialists in curriculum development; representatives of organizations that offer server training packages; representatives of alcohol retailers and the hospitality industry; representatives of insurance agencies that issue dram shop insurance; and experts in state alcohol laws.

The standards developed at the consensus conference should include criteria for (a) content areas that must be covered, (b) use of scientifically based behavior change techniques, and (c) use of theoretically based communication methods. State policy makers could then require that training programs in their states meet these standards. A national consensus conference could also aid in the development of guidelines for establishing state systems for evaluating and certifying quality training programs.

One recommendation may be that states set up standard training programs in neutral institutions such as technical colleges. Once programs using the identified standards and systems are developed, researchers should evaluate the programs to assess their effectiveness in reducing sales to intoxicated and underage customers and decreasing alcohol-related problems such as traffic crashes, homicides, and other forms of violence.

These approaches should significantly improve the quality of server training nationally so that good intent can be followed by effective action.

Acknowledgement

Preparation of this paper was assisted by grants from the Robert Wood Johnson Foundation and the National Institute on Alcohol Abuse and Alcoholism.

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