Enhanced Enforcement of Laws to Reduce Alcohol Overservice Among Licensed Establishments in New Mexico, 2004–2008

Limited information exists about the effectiveness of interventions to enforce laws prohibiting alcohol sales to intoxicated patrons in licensed establishments. New Mexico Behavioral Risk Factor Surveillance System data were used to evaluate an intervention on binge drinking intensity in licensed (eg, bars) versus unlicensed (eg, homes) locations. The proportion of binge drinkers in licensed locations who consumed 8 or more drinks on a binge drinking occasion decreased from 42.1% in 2004–2005 to 22.6% in 2007–2008 (adjusted odds ratio, 0.4; 95% confidence interval, 0.2–0.9), while the proportion in unlicensed locations was essentially unchanged. Enhanced enforcement of overservice laws may reduce excessive drinking in licensed establishments.


Objective
Binge drinking accounts for a large proportion of alcohol consumption and increases the risk of chronic diseases (1)(2)(3). Most states prohibit the sale of alcohol to intoxicated patrons (overservice) (4), but these laws are poorly enforced. Beginning in 2006, New Mexico increased overservice enforcement in licensed locations (eg, bars) throughout the state, with citations increasing from 55 during January through June 2006 to 203 during January through June 2007. The objective of this study was to evaluate the effect of this enhanced enforcement on binge drinking intensity among adults drinking in licensed on-premise locations (eg, bars) compared with adults drinking in unlicensed locations (eg, homes).

Methods
We conducted a multiple time period, cross-sectional study using alcohol consumption data from the New Mexico Behavioral Risk Factor Surveillance System (NMBRFSS), a random-digit-dialed telephone survey of adults on health-related risk behaviors (5). Because the intervention occurred in 2006, data from 2004-2005 and 2007-2008 were used to compare the pre-intervention period to the during/post-intervention period, respectively. In 2004-2005, binge drinking was defined as 5 or more drinks on at least 1 occasion in the past 30 days. In 2007-2008, binge drinking was defined as 5 or more drinks for men or 4 or more drinks for women on at least 1 occasion in the past 30 days (6).
We calculated binge intensity from the number of drinks binge drinkers consumed by type of alcoholic beverage (eg, beer, wine, liquor) during their most recent binge episode. Adults with missing information or who reported drinking fewer than 5 drinks during their most recent binge episode were excluded.
Respondents were asked about the location of their last binge episode (ie, at home, at another person's home, at a restaurant or banquet hall, at a bar or club, or at a public place). For this analysis, these drinking locations were then dichotomized into licensed locations (restaurants, bars, or clubs) and unlicensed locations (other locations).
The proportion of binge drinkers who consumed 8 or more drinks (the average binge drinking intensity in the United States www.cdc.gov/pcd/issues/2018/18_0067.htm • Centers for Disease Control and Prevention age (18-34, ≥35), annual household income (<$25,000, ≥$25,000), educational status (high school diploma or less, more than high school diploma), and marital status (married, not married). The analyses were stratified by sex and age. The analysis adjusted for complex survey design by using Stata/MP 14.0 (Stata-Corp LLC). This study is public health practice and did not require institutional review board review (www.cste2.org/webpdfs/ CSTEPHResRptHodgeFinal.5.24.04.pdf).

Discussion
This study found that enhanced enforcement of a law prohibiting overservice was associated with a nearly 50% reduction in the proportion of binge drinkers who had 8 or more drinks in licensed locations during their most recent binge drinking episode. This resulted in an average reduction of 1 drink at last binge episode. Significant reductions in binge drinking intensity were specifically found among men and among people aged 18 to 34 years, groups that are known to be at greater risk of binge drinking at high intensity (8). These declines occurred in the absence of similar declines in binge drinking intensity among those drinking in private homes or other unlicensed locations, suggesting that the observed decline in binge drinking intensity in licensed drinking locations was associated with the enhanced enforcement.
This study has several limitations. First, it is based on a repeat cross-sectional survey, which precluded the assessment of changes in binge drinking intensity among individual binge drinkers. Second, surveys are subject to nonresponse bias and inaccurate reporting of alcohol consumption; however, response rates for the NMBRFSS were similar during the preintervention and postintervention periods. Third and finally, these results may not be generalizable outside New Mexico. Despite these limitations, the findings of this study indicate that enhanced enforcement of overservice laws may reduce binge drinking intensity among adults drinking in licensed locations.