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CORK Bibliography: Bars and Alcohol Sale Outlets

53 citations. January 2009 to present

Prepared: March 2010

Ayres JG; Semple S; MacCalman L; Dempsey S; Hilton S; Hurley JF et al. Bar workers' Health and Environmental Tobacco Smoke Exposure (BHETSE): Symptomatic improvement in bar staff following smoke-free legislation in Scotland. Occupational and Environmental Medicine 66(5): 339-346, 2009. (21 refs.)

Objective: To examine changes in the health of bar workers after smoke-free legislation was introduced. Design: Longitudinal study following bar workers from before legislation introduction, at 2 months after introduction and at 1 year to control for seasonal differences. Setting: Bars across a range of socio-economic settings in Scotland. Participants: 371 bar workers recruited from 72 bars. Intervention: Introduction of smoke-free legislation prohibiting smoking in enclosed public places, including bars. Main outcomes measures: Change in prevalence of self-reported respiratory and sensory symptoms. Results: Of the 191 (51%) workers seen at 1-year follow-up, the percentage reporting any respiratory symptom fell from 69% to 57% (p= 0.02) and for sensory symptoms from 75% to 64% (p= 0.02) following reductions in exposure, effects being greater at 2 months, probably partly due to seasonal effects. Excluding respondents who reported having a cold at either baseline or 1 year, the reduction in respiratory symptoms was similar although greater for "any'' sensory symptom (69% falling to 54%, p= 0.011). For non-smokers (n= 57) the reductions in reported symptoms were significant for phlegm production (32% to 14%, p= 0.011) and red/irritated eyes (44% to 18%, p= 0.001). Wheeze (48% to 31%, p= 0.006) and breathlessness (42% to 29%, p= 0.038) improved significantly in smokers. There was no relationship between change in salivary cotinine levels and change in symptoms. Conclusions: Bar workers in Scotland reported significantly fewer respiratory and sensory symptoms 1 year after their working environment became smoke free. As these improvements, controlled for seasonal variations, were seen in both non-smokers and smokers, smoke-free working environments may have potentially important benefits even for smokers.

Bondy SL; Zhang B; Kreiger N; Selby P; Benowitz N; Travis H et al. Impact of an indoor smoking ban on bar workers' exposure to secondhand smoke. Journal of Occupational and Environmental Medicine 51(5): 612-619, 2009

Objective: To evaluate the impact of an indoor smoke free bylaw in Toronto, Ontario, implemented June 2004. Methods: We used a pre-post comparison design to assess secondhand smoke (SHS) exposure among 79 eligible bar workers in Toronto, Ontario (bylaw enacted), anal 49 eligible bar workers in a control community, Windsor; Ontario and bylaw change), at four times: preban, and 1, 2 and 9 months postban. Results: SHS exposure time and urinary cotinine level, were substantially reduced in Toronto bar workers immediately after the ban h 94% (from 7.8 to 0.5 hours) and 68% (from, 24.2 to 7.8 ng/mL), respectively. The reduction was sustained throughout, follow-up. There, was no change among Windsor bar workers before and after the ban. Conclusions: Compliance with the ban was high, and the ban led to a, substantial reduction in SHS exposure.

Branas CC; Elliott MR; Richmond TS; Culhane DP; Wiebe DJ. Alcohol consumption, alcohol outlets, and the risk of being assaulted with a gun. (review). Alcoholism: Clinical and Experimental Research 33(5): 906-915, 2009. (102 refs.)

We conducted a population-based case-control study to better delineate the relationship between individual alcohol consumption, alcohol outlets in the surrounding environment, and being assaulted with a gun. An incidence density sampled case-control study was conducted in the entire city of Philadelphia from 2003 to 2006. We enrolled 677 cases that had been shot in an assault and 684 population-based controls. The relationships between 2 independent variables of interest, alcohol consumption and alcohol outlet availability, and the outcome of being assaulted with a gun were analyzed. Conditional logistic regression was used to adjust for numerous confounding variables. After adjustment, heavy drinkers were 2.67 times as likely to be shot in an assault when compared with nondrinkers (p < 0.10) while light drinkers were not at significantly greater risk of being shot in an assault when compared with nondrinkers. Regression-adjusted analyses also demonstrated that being in an area of high off-premise alcohol outlet availability significantly increased the risk of being shot in an assault by 2.00 times (p < 0.05). Being in an area of high on-premise alcohol outlet availability did not significantly change this risk. Heavy drinkers in areas of high off-premise alcohol outlet availability were 9.34 times (p < 0.05) as likely to be shot in an assault. This study finds that the gun assault risk to individuals who are near off-premise alcohol outlets is about the same as or statistically greater than the risk they incur from heavy drinking. The combination of heavy drinking and being near off-premise outlets resulted in greater risk than either factor alone. By comparison, light drinking and being near on-premise alcohol outlets were not associated with increased risks for gun assault. Cities should consider addressing alcohol-related factors, especially off-premise outlets, as highly modifiable and politically feasible approaches to reducing gun violence.

Burgess A; Donovan P; Moore SEH. Embodying uncertainty? Understanding heightened risk perception of drink 'spiking'. British Journal of Criminology 49(6): 848-862, 2009. (51 refs.)

There is a stark contrast between heightened perceptions of risk associated with drug facilitated sexual assault (MA) and a lack of evidence that this is a widespread threat. Through surveys and interviews with university students in the United Kingdom and United States, we explore knowledge and beliefs about drink-spiking and the linked threat of sexual assault. University students in both locations are not only widely sensitized to the issue, but substantial segments claim first- or second-hand experience of particular incidents. We explore students' understanding of the MA threat in relationship to their attitudes concerning alcohol, binge-drinking, and responsibility for personal safety. We suggest that the drink-spiking narrative has a functional appeal in relation to the contemporary experience of young women's public drinking.

Cameron M; Brennan E; Durkin S; Borland R; Travers MJ; Hyland A et al. Secondhand smoke exposure (PM2.5) in outdoor dining areas and its correlates. Tobacco Control 19(1): 19-23, 2010. (33 refs.)

Background: This study assessed the magnitude of secondhand smoke (SHS) exposure when people smoke in outdoor dining areas and explored conditions influencing exposure levels. Methods: Data were gathered from 69 outdoor dining areas in Melbourne, Australia, during April/May 2007. Sitting at tables within 1 metre of an active smoker, the authors measured the concentration of particulate pollution (PM2.5) using TSI SidePak Personal Aerosol Monitors. PM2.5 data were recorded by the monitor at 30-second intervals, and data were collected over an average of 25.8 minutes per venue. Information was collected about the presence of overhead coverings and the number of patrons and lit cigarettes. Results: The average background level of PM2.5 was 8.4 mg/m(3) (geometric mean (GM) 6.1 mg/m(3)), increasing to an average of 17.6 mg/m(3) (GM 12.7 mg/m(3)) over the observational period and 27.3 mg/m(3) (GM 17.6 mg/m(3)) during the time that cigarettes were actively smoked near the monitor. There was substantial variation in exposure levels, with a maximum peak concentration of 483.9 mg/m(3) when there were lit cigarettes close to the monitor. Average exposure levels increased by around 30% for every additional active smoker within 1 metre of the monitor. Being situated under an overhead cover increased average exposure by around 50%. Conclusions: When individuals sit in outdoor dining venues where smokers are present it is possible that they will be exposed to substantial SHS levels. Significant increases in exposure were observed when monitors were located under overhead covers, and as the number of nearby smokers increased. The role of outdoor smoking restrictions in minimising exposure to SHS must be considered.

Chen MJ; Gruenewald PJ; Remer LG. Does alcohol outlet density affect youth access to alcohol? Journal of Adolescent Health 44(6): 582-589, 2009. (37 refs.)

Purpose: To investigate how community alcohol outlet density may be associated with alcohol access among adolescents. Methods: Data were collected through a three-wave panel study with youth aged 14-16 at baseline using computer-assisted telephone interviews. Study participants were recruited from 50 zip codes with varying alcohol outlet density and median household income in California. Data analyses were conducted using multilevel, linear growth models and data from 1028 youth (52% male, 51% white). Results: After taking into account individual-level factors and zip code median household income, zip code alcohol outlet density was significantly and positively related to the initial levels of the likelihood and frequency of getting alcohol through various sources including commercial outlets, shoulder tapping, home or family members, and underage acquaintances. Conclusions: High levels of alcohol outlets in the community enable youth access to alcohol through commercial outlets, family, and social networks.

Clapp JD; Min JW; Trim RS; Reed MB; Lange JE; Shillington AM et al. Predictors of error in estimates of blood alcohol concentration: A replication. Journal of Studies on Alcohol and Drugs 70(5): 683-688, 2009. (30 refs.)

Objective: To identify predictors of error in estimated blood alcohol concentration (eBAC) in a sample of bar patrons. Method: Six hundred sixty-six patrons (43.6% female) were randomly sampled from 32 bars. Patrons were asked to provide a breath sample into a handheld breath alcohol concentration test unit upon entrance and exit from the bar. Patrons also completed a brief survey at entrance and exit. For analyses, this sample was stratified by whether patrons consumed alcohol before attending the bar. Estimates of BAC were calculated using Matthews and Miller's formula (1979). A three-category dependent variable was created based on the estimation accuracy of eBAC relative to breath alcohol concentration: accurate (within .02), underestimate of BAC, and overestimate of BAC. Results: of those that drank before arriving at the bar, 29% of eBACs were accurate, 32.3% were underestimates, and 38.8% were overestimates. For those who drank only at the bar, 42.0% were accurate, 20.8% were underestimates, and 37.7% were overestimates. Among those who drank before attending the bar, the number of drinks consumed before attending the bar was significantly related to eBAC underestimate. Among those who drank only at the bar, predictors of overestimate included being female, drinking more, and drinking longer. Conclusions: The accuracy of eBAC is poor at best. In an earlier study of parties, eBACs were often underestimated; in the bar setting, eBACs were often overestimated. More research is needed to understand the role of setting on eBAC calculations.

Clapp JD; Reed MB; Min JW; Shillington AM; Croff JM; Holmes MR et al. Blood alcohol concentrations among bar patrons: A multi-level study of drinking behavior. Drug and Alcohol Dependence 102(1/3): 41-48, 2009. (47 refs.)

This paper presents data from a study that collected observational data, survey data, and breath samples to estimate blood alcohol concentrations (BrAC) from patrons attending 30 bars. The study examines: (1) drinking behavior and settings prior to going to a bar; (2) characteristics of the bar where respondents are drinking; (3) Person and environmental predictors of BrAC change (entrance to exit). Purposive sampling of bars that cater to young adults gave a sample of 30 bars. Patrons were randomly selected from bars (n = 839). Approximately half of the sample was female (48.7%). Nearly three-quarters of participants reported drinking before attending the bar. Serving practices of the bars were observed: majority of bars served excessive amounts of alcohol in short periods of time. On average, those who drank before attending the bar had BrACs at approximately half the legal limit. Implications for responsible beverage service Coupled with law enforcement strategies are discussed.

Cobiac L; Vos T; Doran C; Wallace A. Cost-effectiveness of interventions to prevent alcohol-related disease and injury in Australia. Addiction 104(10): 1646-1655, 2009. (23 refs.)

Aims: To evaluate cost-effectiveness of eight interventions for reducing alcohol-attributable harm and determine the optimal intervention mix. Methods: Interventions include volumetric taxation, advertising bans, an increase in minimum legal drinking age, licensing controls on operating hours, brief intervention (with and without general practitioner telemarketing and support), drink driving campaigns, random breath testing and residential treatment for alcohol dependence (with and without naltrexone). Cost-effectiveness is modelled over the life-time of the Australian population in 2003, with all costs and health outcomes evaluated from an Australian health sector perspective. Each intervention is compared with current practice, and the most cost-effective options are then combined to determine the optimal intervention mix. Measurements: Cost-effectiveness is measured in 2003 Australian dollars per disability adjusted life year averted. Findings: Although current alcohol intervention in Australia (random breath testing) is cost-effective, if the current spending of $71 million could be invested in a more cost-effective combination of interventions, more than 10 times the amount of health gain could be achieved. Taken as a package of interventions, all seven preventive interventions would be a cost-effective investment that could lead to substantial improvement in population health; only residential treatment is not cost-effective. Conclusions: Based on current evidence, interventions to reduce harm from alcohol are highly recommended. The potential reduction in costs of treating alcohol-related diseases and injuries mean that substantial improvements in population health can be achieved at a relatively low cost to the health sector.

Cohen JE; Anglin L. Outlet density: A new frontier for tobacco control. (editorial). Addiction 104(1): 2-3, 2009. (19 refs.)

Connolly GN; Carpenter CM; Travers MJ; Cummings KM; Hyland A; Mulcahy M et al. How smoke-free laws improve air quality: A global study of Irish pubs. Nicotine & Tobacco Research 11(6): 600-605, 2009. (24 refs.)

The present study examined indoor air quality in a global sample of smoke-free and smoking-permitted Irish pubs. We hypothesized that levels of respirable suspended particles, an important marker of secondhand smoke, would be significantly lower in smoke-free Irish pubs than in pubs that allowed smoking. Indoor air quality was assessed in 128 Irish pubs in 15 countries between 21 January 2004 and 10 March 2006. Air quality was evaluated using an aerosol monitor, which measures the level of fine particle (PM2.5) pollution in the air. A standard measurement protocol was used by data collectors across study sites. Overall, the level of air pollution inside smoke-free Irish pubs was 93% lower than the level found in pubs where smoking was permitted. Levels of indoor air pollution can be massively reduced by enacting and enforcing smoke-free policies.

Etter JF. Secondhand smoke in Geneva, 1996-2006 changes in exposure, opinions, and workplace smoking bans in the absence of national legislation. International Journal of Occupational and Environmental Health 15(2): 159-165, 2009. (53 refs.)

Postal surveys were conducted in 1996 and 2006 to assess change in duration of exposure to secondhand tobacco smoke (SHS), frequency of smoking bans at the workplace, and opinions on smokefree measures in Geneva, Switzerland in the absence of national smoke-free legislation. A random sample of 742 participants in 1996 and 1487 in 2006 showed length of exposure to SHS decreased from 7 hours/week to 4 hours/week, with the largest decrease among 26-45 year olds. Work-place smoking bans increased from 33.4% to 66.3% (p<0.001). Agreement that SHS is dangerous to health increased from 77.5% to 86.0% (p=0.006). Agreement that all restaurant tables should be reserved to non-smokers also increased, from 14.8% to 41.4% (p<0.001). Opinions were more favorable to all smoke-free measures in 2006 than in 1996, except, "More information should be given on the health dangers of SHS," suggesting a level of saturation was reached for information on SHS.

Fernandez E; Fu M; Pascual JA; Lopez MJ; Perez-Rios M; Schiaffino A et al. Impact of the Spanish smoking law on exposure to second-hand smoke and respiratory health in hospitality workers: A cohort study. PLoS one 4(1): e-4244, 2009. (68 refs.)

Background: A smoke-free law came into effect in Spain on 1st January 2006, affecting all enclosed workplaces except hospitality venues, whose proprietors can choose among totally a smoke-free policy, a partial restriction with designated smoking areas, or no restriction on smoking on the premises. We aimed to evaluate the impact of the law among hospitality workers by assessing second-hand smoke (SHS) exposure and the frequency of respiratory symptoms before and one year after the ban. Methods and Finding: We formed a baseline cohort of 431 hospitality workers in Spain and 45 workers in Portugal and Andorra. Of them, 318 (66.8%) were successfully followed up 12 months after the ban, and 137 nonsmokers were included in this analysis. We obtained self-reported exposure to SHS and the presence of respiratory symptoms, and collected saliva samples for cotinine measurement. Salivary cotinine decreased by 55.6% after the ban among nonsmoker workers in venues where smoking was totally prohibited (from median of 1.6 ng/ml before to 0.5 ng/ml, p < 0.01). Cotinine concentration decreased by 27.6% (p = 0.068) among workers in venues with designated smoking areas, and by 10.7% (p = 0.475) among workers in venues where smoking was allowed. In Portugal and Andorra, no differences between cotinine concentration were found before (1.2 ng/ml) and after the ban (1.2 ng/ml). In Spain, reported respiratory symptom declined significantly (by 71.9%; p < 0.05) among workers in venues that became smoke-free. After adjustment for potential confounders, salivary cotinine and respiratory symptoms decreased significantly among workers in Spanish hospitality venues where smoking was totally banned. Conclusions: Among nonsmoker hospitality workers in bars and restaurants where smoking was allowed, exposure to SHS after the ban remained similar to pre-law levels. The partial restrictions on smoking in Spanish hospitality venues do not sufficiently protect hospitality workers against SHS or its consequences for respiratory health.

Forsyth AJM. Front, side, and back-loading: Patrons' rationales for consuming alcohol purchased off-premises before, during, or after attending nightclubs. Journal of Substance Use 15(1): 31-41, 2010. (16 refs.)

Aims: To examine motivations for consumption of alcohol purchased off-trade when visiting ontrade licensed premises. Methods: In-depth interviews were conducted with nightclub patrons who also completed a drinking diary, detailing the time and place their previous week's alcohol consumption. Results: Drinking before entering nightclubs was the norm, although the location and extent of this 'front-loading' varied. Consuming alcohol purchased elsewhere while attending nightclubs('side-loading') or continued drinking after leaving these premises ('back-loading') were reported much less frequently. Interviewees reported a range of psychosocial motives for consuming alcohol before or after night-club attendance, rather than a single reason (e.g. cost) Conclusions: The findings of this research imply that off-premises alcohol consumption by night-clubbers is widespread and motivated as much by the structure of the night-time economy as by price differentials between competing sectors of the licensed trade.

Foster JH; Herring R; Waller S; Thom B. The Licensing Act 2003: A step in the right direction? Journal of Substance Use 14(2): 113-123, 2009. (28 refs.)

The Licensing Act 2003 (covering England and Wales) introduced greater flexibility to the UK licensing laws, including the possibility of 24-h licenses. This paper reports a nation wide survey of 225 (63%) local authority chairs of licensing committees/senior members of licensing teams in England evaluating the short-term impact of the Act. A cumulative impact (saturation) area was only declared in 38 (17%) local authorities. Extended hours applications were more common than new applications in both on- and off-licensed premises. The perception of those surveyed was of 'no change' in the following alcohol-related variables; public noise levels (n=133, 59%) violence and fights (n=130, 60%), under-aged drinking (n=143, 67%), crime (n=141, 68%), and drink-driving (n=157, 86%). Contrary to the picture often presented in certain parts of the mass-media, the impact of the Licensing Act appears to be neutral. However, these are likely to be the result of a number of intervening factors, rather than the change to a more liberalized licensing regime. The role of the police would seem to be fundamental. Future research will need to disentangle the impact of these intervening factors and it will be a number of years before the impact of these changes can be assessed.

Graham K. They fight because we let them! Applying a situational crime prevention model to barroom violence. Drug and Alcohol Review 28(2): 103-109, 2009. (81 refs.)

This paper draws on situational crime prevention and social interactionist theories to develop a theoretical model for preventing aggression and injury in licensed drinking establishments. The model includes six components: (i) the presence of willing participants; (ii) the role of guardians, handlers and place managers; (iii) environmental deterrents of aggression; (iv) environmental precipitators of aggression; (v) theories regarding the effects of alcohol that contribute to increased risk of aggression; and (vi) social interaction theory relevant to the process of aggressive incidents in drinking establishments. The model provides a basis for developing a range of strategies to reduce barroom aggression that includes but is not restricted to addressing the role of alcohol. The paper discusses how these strategies can be developed and implemented through interventions, programs, policies or regulations at the level of the drinking establishment, the community level or the state/national level.

Grov C; Kelly BC; Parsons JT. Polydrug use among club-going young adults recruited through time-space sampling. Substance Use & Misuse 44(6): 848-864, 2009

Though some researchers have indicated club drug users are more likely to be polydrug users, there remains little known about the prevalence and specific combinations of the substances they use. Between 2004 and 2006, and using time-space sampling, a stratified sample of 400, 18-29-year-old New York City club-going, drug-using young adults were recruited into the Club Drugs and Health Project. Most participants (91.7%) had engaged in polydrug usage and 1,670 combinations of drugs were reported. Ecstasy (86.6% of users) and cocaine (85.7% of users) were the two most-frequently reported club drugs used in combination with other substances. In terms of poly-club drug combinations, ecstasy appeared to be the universal compliment as this drug was most often cited in combinations with other club drugs (specifically ecstasy + ketamine, ecstasy + cocaine, ecstasy + gamma hydroxybutyrate or GHB). Other frequently cited drug combinations included cocaine and marijuana, ecstasy and marijuana, LSD and marijuana, and cocaine and alcohol. These data highlight the need to develop drug health-education and prevention messages targeted at polydrug usage.

Hawkins N; Sanson-Fisher R; Shakeshaft A; Webb G. Differences in licensee, police and public opinions regarding interventions to reduce alcohol-related harm associated with licensed premises. Australian and New Zealand Journal of Public Health 33(2): 160-166, 2009. (28 refs.)

Objectives: To determine the level of support by licensees, police and the general public for interventions to reduce alcohol-related harm associated with licensed premises and to identify differences between the three groups. Methods: Participants were 108 licensees of premises licensed to sell alcohol; 132 police officers; 200 members of the public. Questionnaires were administered either through work settings or by mail. Respondents' levels of agreement with interventions to reduce alcohol-related harm associated with licensed premises: responsible service of alcohol; security and crowd control; policing; patron transport; and linking of alcohol-related harm to licensed premises and communication. Results: Police and members of the public were significantly more likely than licensees to agree with strategies under licensee control, such as subsidising patron transport and training staff to deal with intoxicated patrons. Police were more likely than licensees and members of the public to agree with strategies requiring community action and changes to liquor licensing laws. Licensees had significantly lower levels of agreement than the other groups about licensees' responsibility to reduce alcohol-related harm as a consequence of drinking at their premises. Conclusions: While there was good agreement between police officers and members of the public about strategies for reducing alcohol-related harm at licensed premises, licensees held divergent views about strategies within their control. Licensees were less likely than police and members of the public to agree they were responsible for reducing alcohol-related harm resulting from drinking at their premises.

Holmila M; Mustonen H; Osterberg E; Raitasalo K. Public opinion and community-based prevention of alcohol-related harms. Addiction Research & Theory 17(4): 360-371, 2009. (27 refs.)

Aim: This article looks at alcohol policy opinions from the point of view of the possibilities and frames for creating local alcohol control policy. Local action against harms related to drinking is a compromise between different points of view, and the question of public support is important for community-based prevention. Data and analyses: The respondents of a postal questionnaire were asked if they supported different alcohol policy measures, and logistic regression analyses were carried out to examine the impact of the demographic characteristics, drinking measures and observations of alcohol-related harms in the community. Results: The wide majority of the population supported such measures suitable for community-based prevention as enforcement of the minimum legal age to purchase alcohol, surveillance of restaurants and shops, and the ban to sell alcohol to a drunken person. Decreasing numbers of outlets of restaurants or their opening hours were least popular. There was a relationship between drinking habits and alcohol policy opinions. Abstainers and moderate drinkers were most likely to support all alcohol policy measures examined, whilst heavier drinkers were least likely to support them. There was a connection between awareness of alcohol problems in one's locality, and favourable opinions on alcohol control measures. The result is similar with the ones found earlier in other countries. Conclusion: Potential members of local alcohol policy coalitions seem to have some similarities in different countries.

Hyland A; Hassan LM; Higbee C; Boudreau C; Fong GT; Borland R. The impact of smokefree legislation in Scotland: results from the Scottish ITC Scotland/UK longitudinal surveys. European Journal of Public Health 19(2): 198-205, 2009. (38 refs.)

Background: To evaluate how Scotlands smokefree law impacted self-reported secondhand smoke (SHS) exposure in hospitality venues, workplaces and in peoples homes. In addition, we examine changes in support for the law, pub and restaurant patronage, smoking cessation indicators and whether any observed changes varied by socioeconomic status. Methods: A quasi-experimental longitudinal telephone survey of nationally representative samples of smokers and non-smokers interviewed before the Scottish law (February to March 2006) and 1 year later after the law (March 2007) in Scotland (n 705 smokers and n 417 non-smokers) and the rest of the UK (n 1027 smokers and n 447 non-smokers) where smoking in public places was not regulated at the time. Results: Dramatic declines in the observance of smoking in pubs, restaurants and workplaces were found in Scotland relative to the rest of the UK. The change in the percent of smokers reporting a smokefree home and number of cigarettes smoked inside the home in the evening was comparable in Scotland and the rest of the UK. Support for smokefree policies increased to a greater extent in Scotland than in the rest of the UK. Self-reported frequency of going to pubs and restaurants was generally comparable between Scotland and the rest of the UK; however, non-smokers in Scotland were more likely to frequent pubs more often. No differences in smoking cessation indicators were observed between countries. Conclusion: The Scottish smokefree law has been successful in decreasing secondhand smoke exposure while causing none of the hypothesized negative outcomes.

Johnson MB; Voas RA; Miller BA; Holder HD. Predicting drug use at electronic music dance events: Self-reports and biological measurement. Evaluation Review 33(3): 211-225, 2009. (16 refs.)

Most information on the prevalence of drug use comes from self-report surveys. The sensitivity of such information is cause for concern about the accuracy of self-report measures. In this study, self-reported drug use in the last 48 hr is compared to results from biological assays of saliva samples from 371 young adults entering clubs. The relationship between self-reports and drug presence in oral fluid was determined for three substances as follows: cocaine, marijuana, and amphetamine. Forty-one percent of the participants with drugs detected in their oral fluids reported no use in the last 48 hr. The significance of these results is discussed.

Kelly BC. Smoke-free air policy: Subcultural shifts and secondary health effects among club-going young adults. Sociology of Health & Illness 31(4): 569-582, 2009. (49 refs.)

In March 2003, New York City implemented legislation that called for a ban of smoking in bars, restaurants, nightclubs, and other establishments. The express purpose of this legislation was to protect the health of employees and patrons from second-hand smoke. In addition to the stated goal of protection from second-hand smoke for employees, key secondary health effects of this law have emerged in the lives of club-going youth. This paper is based upon data derived from an ethnographic research project on club-related health issues in NYC. Drawing upon ethnographic fieldwork during the implementation of the ban and in-depth interviews with club-going youth, the paper provides a grounded analysis of youth reactions to the smoking ban and a descriptive profile of the secondary health effects of the smoking ban in nightclubs. It explores the attitudes of club-going youth towards the ban and the ways in which the legislation shapes the behaviours of habitual smokers, 'social smoking', and the use of drugs within bars and clubs. In particular, the data suggest a tension between the desire to remain subculturally involved and the desire to smoke. It also highlights the adaptive character of subcultures and the importance of social relations in behavioural patterns.

Larsen H; Engels RCME; Granic I; Overbeek G. An experimental study on imitation of alcohol consumption in same-sex dyads. Alcohol and Alcoholism 44(3): 250-255, 2009. (34 refs.)

Aim: In order to study the role of imitation in relation to drinking, alcohol consumption among two peers was examined with experiments in a naturalistic drinking setting. Method: In a bar lab, 135 young adults (52% women) were exposed to either a non-drinking, a light-drinking or a heavy-drinking same-sex model (i.e. a confederate) in a 30-min time-out session. Instead of using a taste task (Quigley and Collins, 1999. The modeling of alcohol consumption: a meta-analytic review. J Stud Alcohol 60:90-8) in which participants were obliged to consume alcohol, in the current udy, a design was used in which participants were allowed to drink alcohol but could also choose non-alcoholic beverages. Results: Craving for alcohol was included as a covariate in ANCOVAs. Results showed that the participants consumed substantially more alcohol when exposed to heavy-drinking models compared to light- and non-drinking models. Craving levels were positively related to alcohol consumption during the experiment. Conclusion: Both men and women imitated same-sex peers' drinking behavior in an ad lib naturalistic bar setting.

Martin BA; McCoy TP; Champion H; Parries MT; DuRant RH; Mitra A et al. The role of monthly spending money in college student drinking behaviors and their consequences. Journal of American College Health 57(6): 587-596, 2009

Objective: Alcohol use among college students is pervasive and affected by economic factors such as personal income and alcohol price. The authors examined the relationship among students spending money, drinking rate, and alcohol-related consequences. Participants: In 2005, the authors conducted a Web-based survey among a random sample of 3,634 undergraduate students front 2 large universities. Methods: The authors used multiple logistic regression to model drinking behaviors and multiple linear regression to model alcohol-related consequences. Results: The lowest reported levels of average monthly spending money were associated with reduced levels of drinking and getting drunk. Spending money was independently, associated with experiencing alcohol-related consequences caused by a student's own drinking, even after the authors controlled for personal drinking behaviors. The effects for consequences caused by others' drinking were significant for students who had gotten drunk. Conclusions: These findings have implications for alcohol price and marketing, particularly around colleges, and suggest actions for parents to consider.

Mckee SA; Higbee C; O'Malley S; Hassan L; Borland R; Cummings KM et al. Longitudinal evaluation of smoke-free Scotland on pub and home drinking behavior: Findings from the International Tobacco Control Policy Evaluation Project. Nicotine & Tobacco Research 11(6): 619-626, 2009. (47 refs.)

On 26 March 2006, Scotland implemented a smoke-free policy prohibiting smoking in indoor public venues, including bars and pubs. Drinking and smoking are highly associated behaviors, so we evaluated whether the regulations would decrease drinking behavior among smokers in public venues. We further assessed whether this effect would be more pronounced in heavier drinkers and whether decreases in drinking behavior in pubs would be offset by increased drinking in the home. Participants (N = 1,059) were adult smokers and nonsmokers from Scotland and from the rest of the United Kingdom, which did not have comprehensive smoke-free policies during the study period. Data were collected using a random-digit-dialed telephone survey from February to March 2006, just prior to the policy implementation in Scotland. Follow-up surveys were conducted in March 2007. Using baseline data, we categorized participants as abstainers, moderate drinkers, or heavy drinkers. Overall, results demonstrated that drinking behavior did not change significantly in Scotland compared with the rest of the United Kingdom following implementation of the smoke-free policy in Scotland. However, planned comparisons examining mean changes in drinks consumed in pubs or bars following the legislation demonstrated that the smoke-free legislation was associated with reduced drinking behavior in pubs and bars among moderate- and heavy-drinking smokers in Scotland. These moderate- and heavy-drinking Scottish smokers also reduced their pub attendance following policy implementation. The smoke-free Scottish law did not increase drinking in the home. These findings suggest that smoke-free policies may have additional public health benefits for those at greater risk for alcohol-related health problems.

Menke JM. Bar patronage after a smoking ban. Journal of Drug Issues 39(2): 401-415, 2009. (34 refs.)

On May 1, 2005, the city of Flagstaff, Arizona enacted a smoking ban in standalone bars. All other establishments already had smoking bans in place for at least three years. Trained observers carried air monitoring equipment and counted lit cigarettes and patrons on two weekends before and four weekends after the ban. Monthly hospitality revenues from 2003 to 2006 were also collected from the Coconino County Tax Assessor's office and analyzed for changes after the ban. Air quality improved immediately by 87% in bars, with no appreciable decrease in the total bar revenues over the next three years. All hospitality businesses experienced a general leveling off of growth after the ban, suggesting a change in more general economic factors. As an industry, hospitality was unaffected by the smoking ban, though individual establishments could have been adversely affected. The standalone bar industry revenue continued to increase after the ban. Alcohol and cigarette co-consumption was not supported.

Miller BA; Furr-Holden D; Johnson MB; Holder H; Voas R; Keagy C. Biological markers of drug use in the club setting. Journal of Studies on Alcohol and Drugs 70(2): 261-268, 2009. (20 refs.)

Objective: The prevalence of drug and alcohol use among patrons of clubs featuring electronic music dance events was determined by using biological assays at entrance and exit. Method: Using a portal methodology that randomly selects groups of patrons on arrival at clubs, oral assays for determining level and type of drug use and level of alcohol use were obtained anonymously. Patrons provided self-reported data on their personal characteristics. A total of 362 patrons were interviewed at entrance kind provided oral assay data, and 277 provided data at both entrance and exit. Results: Overall, one quarter of all patrons surveyed at entrance were positive for some type of drug use, Based on our exit sample, one quarter of the sample was positive at exit. Individual drugs most prevalent at entrance or exit included cocaine, marijuana, and amphetamines/stimulants. Only the amphetamine/stimulant category increased significantly from entrance to exit. Drug-using patrons arrive at the club already using drugs; few patrons arrive with no drug use and leave with detectable levels of drug use. Clubs vary widely in drug-user prevalence at entrance and exit, suggesting that both events and club policies and practices may attract different types of patrons. Approximately one half of the total entrance sample arrived with detectable alcohol use, and nearly one fifth arrived with an estimated blood alcohol concentration of .08 or greater. Based on our exit sample data, one third of patrons were intoxicated, and slightly less than one fifth were using both drugs and alcohol at exit. Clubs attract a wide array of emerging adults, with both genders and all ethnicities well represented. Clubs also attract emerging adults who are not in college and who are working full time. Conclusions: At clubs featuring electronic music dance events, drug use and/or high levels of alcohol use were detected using biological assays from patrons at entrance and exit from the clubs. Thus, these clubs present a potentially important location for prevention strategies designed to reduce the risks associated with drug and alcohol use for young people. Combined substance use may prove particularly important for prevention efforts designed to increase safety at clubs. Personal characteristics do not identify drug users, suggesting that environmental strategies for club safety may offer more promise for promoting health and safety.

Miller BA; Holder HD; Voas RB. Environmental strategies for prevention of drug use and risks in clubs. Journal of Substance Use 14(1): 19-38, 2009. (73 refs.)

Environmental prevention strategies in club settings where music and dance events are featured could provide an important new arena for the prevention of drug use and other risky behaviours (e.g. sexual risk taking, intoxication and drug use, aggression, and driving under the influence). Electronic music dance events (EMDEs) occur in clubs that attract young, emerging adults (18-25 years of age) and attract individuals who engage in various types of drug use. Borrowing from the environmental prevention studies that focus on reducing alcohol use and related problems, a model for drug prevention in the club setting is proposed. Initially, an overview of the relationships between EMDEs and drug use, and other risky behaviours are presented. Next, rationales for environmental strategies are provided. Finally, an environmental approach to prevention of drug use and risky behaviours in clubs is described. This comprehensive set of environmental strategies, is designed to be mutually supportive and interactive. Environmental strategies are believed to provide potential for developing an efficacious prevention strategy. The environmental prevention approach presented here is composed of three intervention domains: (1) mobilization, (2) strategies for the exterior environment, and (3) strategies for the interior environment.

Moore RS; Lee JP; Martin SE; Todd M; Chu BC. Correlates of persistent smoking in bars subject to smokefree workplace policy. International Journal of Environmental Research and Public Health 6(4): 1341-1357, 2009. (48 refs.)

This study's goal was to characterize physical and social environments of stand-alone bars associated with indoor smoking despite California's smokefree workplace law. In a random sample of 121 stand-alone bars in San Francisco, trained observers collected data on patrons, staff, neighborhood, indoor settings and smoking behaviors. Using bivariate (chi-square) and hierarchical linear modeling analyses, we identified four correlates of patrons' indoor smoking: 1) bars serving predominantly Asian or Irish patrons, 2) ashtrays, 3) bartender smoking, and 4) female bartenders. Public health officials charged with enforcement of smokefree bar policies may need to attend to social practices within bars, and heighten perceptions of consistent enforcement of smokefree workplace laws.

Mullally BJ; Greiner BA; Allwright S; Paul G; Perry IJ. The effect of the Irish smoke-free workplace legislation on smoking among bar workers. European Journal of Public Health 19(2): 206-211, 2009. (25 refs.)

Background: On 29 March 2004, the Republic of Ireland (ROI) became the first EU country to introduce a nationwide ban on workplace smoking. While the focus of this measure was to protect worker health by reducing exposure to second-hand smoke, other effects such as a greater reduction in smoking prevalence and consumption were likely among bar workers. Methods: A random sample of bar workers from Cork city were surveyed before (n 129) and after (n 107; 82.9 follow-up rate) implementation of the smoke-free legislation. Self report and combined self report and cotinine concentration were used to determine smoking status. For comparison a cross-sectional random telephone survey of the general population (ROI) was conducted before and 1 year after the smoke-free legislation. There were 1240 pre- and 1221 participants post-ban in the equivalent age and occupational subset of the general population. Results: There was a non-significant decline in smoking prevalence among bar workers 1 year post-ban (self report: 2.8 from 51.4 to 48.6, P 0.51; combined self report and cotinine: 4.7 from 56.1 to 51.4, P 0.13), but a significant decline in consumption of four cigarettes (95 CI 2.216.36) per day. Within the occupationally equivalent general population sub-sample there was a significant drop (3.5, P 0.06) in smoking prevalence but no significant change in consumption. Conclusions: Irelands smoke-free workplace legislation was accompanied by a drop in smoking prevalence in both bar workers and the general population sub-sample.

Naimi TS; Nelson DE; Brewer RD. Driving after binge drinking. American Journal of Preventive Medicine 37(4): 314-320, 2009. (31 refs.)

Background: Although binge drinking is strongly associated with alcohol-impaired driving, little is known about the prevalence of or risk factors for driving after binge drinking. Purpose: The purpose of this study was to assess the prevalence of, and risk factors for, driving during or shortly after a specific binge drinking episode. Methods: The data were analyzed in 2007 and 2008 from 14,085 adults from 13 states in 2003 and 14 states in 2004 who reported binge drinking and answered an additional series of questions about binge drinking behaviors as part of the Behavioral Risk Factor Surveillance System survey. Binge drinking was defined as the consumption of five or more drinks during a drinking occasion. Results: Overall, 11.9% of binge drinkers drove during or within 2 hours of their most recent binge drinking episode. Those drinking in licensed establishments (bars, clubs, and restaurants) accounted for 54.3% of these driving episodes. Significant independent risk factors for driving after binge drinking included male gender (AOR=1.75); being aged 35-54 or >= 55 years compared to 18-34 years (AOR=1.58 and 2.37, respectively); and drinking in bars or clubs compared to drinking in the respondent's home (AOR=7.81). Drivers who drank most of their alcohol in licensed establishments consumed an average of 8.1 drinks, and 25.7% of them consumed >= 10 drinks. Conclusions: Because binge drinking and subsequent driving were common in establishments licensed to sell alcohol, and because licensing is conditional on responsible beverage service practices (i.e., not selling to intoxicated people), efforts to prevent impaired driving should focus on enforcing responsible beverage service in licensed establishments.

Nebot M; Lopez MJ; Ariza C; Perez-Rios M; Fu M; Schiaffino A et al. Impact of the Spanish smoking law on exposure to secondhand smoke in offices and hospitality venues: Before-and-after study. Environmental Health Perspectives 117(3): 344-347, 2009. (38 refs.)

BACKGROUND/OBJECTIVES: A smoking law was passed by the Spanish Parliament in December 2005 and was enforced by 1 January 2006. The law bans smoking in all indoor workplaces but only in some hospitality venues, because owners are allowed to establish a smoking zone (venues > 100 1132) or to allow smoking without restrictions (venues < 100 m(2)). The objective of the study is to assess the impact of the Spanish smoking law on exposure to secondhand smoke (SHS) in enclosed workplaces, including hospitality venues. MATERIALS AND METHODS: The study design is a before-and-after evaluation. We studied workplaces and hospitality venues from eight different regions of Spain. We took repeated samples of vapor-phase nicotine concentration in 398 premises, including private offices (162), public administration offices (90), university premises (43), bars and restaurants (79), and discotheques and pubs (24). RESULTS: In the follow-up period, SHS levels were markedly reduced in indoor offices. The median decrease in nicotine concentration ranged from 60.0% in public premises to 97.4% in private areas. Nicotine concentrations were also markedly reduced in bars and restaurants that became smoke-free (96.7%) and in the no-smoking zones of venues with separate spaces for smokers (88.9%). We found no significant changes in smoking zones or in premises allowing smoking, including discotheques and pubs. CONCLUSIONS: Overall, this study shows the positive impact of the law on reducing SHS in indoor workplaces. However, SHS was substantially reduced only in bars and restaurants that became smoke-free. Most hospitality workers continue to be exposed to very high levels of SHS. Therefore, a 100% smoke-free policy for all hospitality venues is required.

Public Domain

O'Mara RJ; Thombs DL; Wagenaar AC; Rossheim ME; Merves ML; Hou W et al. Alcohol price and intoxication in college bars. Alcoholism: Clinical and Experimental Research 33(11): 1973-1980, 2009. (24 refs.)

Background: Many population studies find that alcohol prices are inversely related to alcohol consumption and alcohol-related problems, including among college students and young adults. Yet, little is known about the "micro-level" effects of alcohol price on the behavior of individual consumers in natural drinking settings such as college bars. Therefore, we assessed patron's cost per gram of ethanol consumed at on-premise drinking establishments and its association with intoxication upon leaving an establishment. Methods: On 4 consecutive nights during April 2008, data were collected from 804 patrons exiting 7 on-premise establishments in a bar district located adjacent to a large university campus in the southeastern United States. Anonymous interview and survey data were collected as well as breath alcohol concentration (BrAC) readings. We calculated each patron's expenditures per unit of ethanol consumed based on self-reported information regarding the type, size, number, and cost of consumed drinks. Results: A multivariable model revealed that a 10-cent increase in cost per gram of ethanol at on-premise establishments was associated with a 30% reduction in the risk of exiting an establishment intoxicated (i.e., BrAC >= 0.08 g/210 l). Conclusions: The results are consistent with economic theory and population-level research regarding the price elasticity of alcoholic beverages, which show that increases in alcohol prices are accompanied by less alcohol consumption. These findings suggest that stricter regulation of the drink discounting practices of on-premise drinking establishments would be an effective strategy for reducing the intoxication levels of exiting patrons.

Parks KA; Hsieh YP; Collins RL; Levonyan-Radloff K; King LP. Predictors of risky sexual behavior with new and regular partners in a sample of women bar drinkers. Journal of Studies on Alcohol and Drugs 70(2): 197-205, 2009. (28 refs.)

Objective: We designed the current study to assess the rates of risky sexual behavior among women bar drinkers, as well as differences in predictors of risky Sexual behavior, based on partner type-new or regular. Method: We conducted comprehensive, in-person interviews with 241 young women who reported weekly drinking in bars. Several constructs (e.g., individual characteristics, social and sexual behavior, substance use) that we hypothesized would predict risky sexual behavior were assessed in two separate hierarchical regression models for new and regular sexual partners. Results: Rates of risky sexual behavior were significantly higher with regular partners compared with new partners. Increased risky sexual behavior with new partner.,; was significantly associated with having had a riskier regular partner in the past 6 months, lower sexually transmitted disease (STD)/pregnancy prevention assertiveness, increased expectations of sexual disinhibition when drinking, a greater history of prior sexual risk taking, and more frequent drinking in bars. Increased risky sexual behavior with a regular partner was significantly associated with being older, the use of oral contraceptives, lower assertiveness for STD/pregnancy prevention, a greater history of prior sexual risk taking, and increased drug use. Conclusions: Among young women who regularly drink in bars, sexual risk taking was significantly higher with regular partners than with new partners. The predictors of risky sexual behavior differed based on partner type. These findings have implications for including information about the role of alcohol, drinking context, and drug use, as well as individual difference characteristics and partner type in targeted prevention strategies to reduce sexual risk taking.

Pascolo PB; Carniel R; Pinese B. Human stability in the erect stance: Alcohol effects and audio-visual perturbations. Journal of Biomechanics 42(4): 504-509, 2009. (14 refs.)

Audio-visual perturbations were coupled with the consumption of an alcoholic beverage to simulate the possible perturbation affecting people at disco clubs, and the effects measured with a stabilometric platform. Methods: We studied the statokinesigrams (SKG) of 14 volunteers; 11 of them were healthy, 3 were injured. We made a series of numerical tests using a stabilometric platform to record the statokinesigrams. The tests were carried out using statistical methods, time-series analysis, and applying the "p" parameter, recently proposed by Pascolo and Marini [2006. On the introduction of a new parameter for the analysis of posture. Europa Medicophysica, 42, 145-149] as a new tool to evaluate the reactions of the central control system with respect to posture-affecting diseases (for instance Parkinson) and perturbations. Conclusion: This work shows that it is theoretically possible to define non-invasive parameters able to distinguish sober subjects from drunk subjects, with an evaluation that only uses a stabilometric platform.

Pearson J; Windsor R; El-Mohandes A; Perry DC. Evaluation of the immediate impact of the Washington, DC, smoke-free indoor air policy on bar employee environmental tobacco smoke exposure. Public Health Reports 124(Supplement 1): 135-142, 2009. (32 refs.)

Objective. On January 2, 2007, the Washington, D.C., City Council banned smoking in restaurants and bars. We sought to determine the immediate impact of the ban on cotinine-confirmed environmental tobacco smoke (ETS) levels and respiratory symptom reports of a random sample of bar employees. Methods. We conducted an assessment of 66 employees from 41 randomly selected bars in December 2006, a month before the ban went into effect. After analyses of baseline data, 52 employees were eligible and 49 of them (94%) had a post-ban assessment in February 2007. Three participants were excluded due to high cotinine levels at the post-ban assessment, yielding a final sample size of 46 bar employees. ETS exposure levels were documented using saliva cotinine analyses by tandem liquid chromatography and mass spectrometry. Employee respiratory and sensory symptoms reports were assessed by a standardized, validated form: the International Union Against Tuberculosis and Lung Disease Bronchial Symptoms Questionnaire. Employee ETS exposure reports at work were eliminated after the ban. Results. Sensory symptoms reports (at <= 4 weeks) declined significantly by 70% to 100% (p=0.0016); respiratory symptoms results were inconclusive due to a lack of data. Saliva cotinine medians declined significantly by 70% (p<0.0001), from a pre-ban mean of 2.11 nanograms per millileter (ng/mL) to a post-ban mean of 0.29 ng/mL, confirming reports of no ETS exposure at work. Conclusion. We concluded that the indoor air law was effective, eliminating employee ETS exposure reports, dramatically reducing their cotinine levels, and almost eliminating reports of sensory symptoms.

Pihl RO; Sutton R. Drugs and aggression readily mix; so what now? Substance Use & Misuse 44(9/10, Special Issue): 1188-1203, 2009. (95 refs.)

Intoxicated aggression is both a dangerous and a costly problem for society, with alcohol being involved in over 50% of violent crimes, and the cost alcohol-consumption-related crime being estimated at $205 billion in the United States alone. First, the authors reviewed the substantial evidence for the connection between alcohol consumption and aggression, and then they examined the risk factors for this problem. These included societal/cultural factors, such as availability and alcohol expectancies, and individual factors, such as demographic characteristics, personality, comorbid disorders, individual differences in response to alcohol, and cognitive functioning. Finally, interventions were suggested focusing on policy, alcohol sellers, treatments for alcohol abuse and dependency, anger management, pharmacology, and low executive functioning. Further efforts are still needed to target interventions to specific risk factors.

Pino NW; Johnson-Johns AM. College women and the occurrence of unwanted sexual advances in public drinking settings. Social Science Journal 46(2): 252-267, 2009. (28 refs.)

Using existing data from the 1999 Harvard School of Public Health College Alcohol Study, this study analyzes the social predictors of unwanted sexual advances experienced by college women and where this type of victimization occurs. Routine activities theory informed the analysis. While attendance and increased alcohol consumption at bars have a significant effect on experiences of unwanted sexual advances, attendance at parties, attendance at drink promotions, and participation in drinking games does not. Furthermore, while less satisfaction with education, having more sexual partners and friends that binge drink, and having more alcohol-related problems increase the likelihood of experiencing unwanted sexual advances, so does drinking less in general, having higher educated parents, and having a higher grade point average. These findings show that the predictors of unwanted sexual advances may differ somewhat from those that predict more serious forms of sexual victimization. Implications for future research and policy are discussed.

Popova S; Giesbrecht N; Bekmuradov D; Patra J. Hours and days of sale and density of alcohol outlets: Impacts on alcohol consumption and damage. A systematic review. (review). Alcohol and Alcoholism 44(5): 500-516, 2009. (99 refs.)

Aims: The aim of this study was to examine recent research studies published from 2000 to 2008 focusing on availability of alcohol: hours and days of sale and density of alcohol outlets. Methods: Systematic review. Results: Forty-four studies on density of alcohol outlets and 15 studies on hours and days of sale were identified through a systematic literature search. The majority of studies reviewed found that alcohol outlet density and hours and days of sale had an impact on one or more of the three main outcome variables, such as overall alcohol consumption, drinking patterns and damage from alcohol. Conclusions: Restricting availability of alcohol is an effective measure to prevent alcohol-attributable harm.

Reingle J; Thombs DL; Weiler RM; Dodd VJ; O'Mara R; Pokorny SB. An exploratory study of bar and nightclub expectancies. Journal of American College Health 57(6): 629-637, 2009

Objective: The authors identified the principal components of bar and nightclub expectancy in college students and the associations between these factors and the risk behavior of night-clubbing. Participants: A total of 4,384 undergraduates enrolled at a large, public university participated. Methods: In the first phase (July-September 2007), the authors collected preliminary data from a convenience sample. In the second phase (March 2008), the authors collected data from a separate probability sample. Results: A principal components analysis revealed 4 reliable and distinct expectancy factors. Regression analyses revealed that after adjusting for the effects of alcohol and demographic variables, expectancies explained a significant proportion of variance in bar/nightclub attendance. Different expectancy profiles distinguished high-frequency night clubbers from the most common bar attendance practice and nonmonogamous nightclubbers from monogamous nightclubbers. Conclusions: From a developmental perspective, nightclubbing appears to assist young adults with establishing and maintaining social networks, romantic and sexual relationships, and collegiate acculturation.

Room R; Livingston M. Does it matter where the drinking is, when the object is getting drunk? (commentary). Addiction 104(1): 10-11, 2009. (5 refs.)

Satterlund TD; Lee JP; Moore RS; Antin TMJ. Challenges to implementing and enforcing California's Smoke-Free Workplace Act in bars. Drugs: Education, Prevention and Policy 16(5): 422-435, 2009. (44 refs.)

California's 1995 Smoke-Free Workplace Act, Assembly Bill 13 (AB 13) as extended to bars in 1998. This paper examines the challenges faced by officials responsible for implementing and enforcing the law. As part of a series of studies evaluating AB 13 in bars, researchers conducted confidential in-depth interviews with 35 state, county and municipal authorities and representatives of non-governmental agencies. The interviews were recorded, transcribed, coded and analyzed by themes and respondent categories. Data from structured observations in sampled bars and interviews with bar staff and patrons offer contextual information. Analyses indicated the following challenges: (1) an ineffective administrative structure; (2) problems associated with the complaint-driven system used to enforce the law; (3) lack of funding for enforcement; (4) low prioritization of enforcement; and (5) the minimal deterrence effect of the sanctioning penalties. The findings indicate why indoor smoking may continue in some bars despite the state law prohibiting smoking in workplaces. Many municipalities, states and countries may be considering restricting smoking in workplaces including bars, and our findings show that clear delineation of procedures and enforcement criteria, as well as funding and substantive penalties, should be considered in drafting these laws.

Schoenmakers TM; Wiers RW. Craving and attentional bias respond differently to alcohol priming: A field study in the pub. European Addiction Research 16(1): 9-16, 2010. (41 refs.)

Background: Several experimental laboratory studies have shown that subjective craving for alcohol increases as a result of low-to-moderate levels of alcohol consumption. Less is known about alcohol prime effects on relatively automatic appetitive motivational processes such as attentional bias (AB). Also, it is not known whether the effects from laboratory studies can be generalized to real-life drinking environments, and whether effects change after higher alcohol doses than those that have been administered in lab studies. Method: In two pubs, we investigated alcohol prime dose effects in self-reported craving and AB, measured by a modified Flicker Paradigm. We included an opportunistic sample of 72 social drinkers who had been drinking various amounts of alcohol. Results: Self-reported craving was positively predicted by dose of alcohol consumed, from one up to 16 drinks. In contrast, AB was negatively predicted by dose consumed in participants who had been binge drinking. Conclusion: This field study validates earlier experimental research on alcohol prime effects in a real drinking situation. Further, it demonstrates prime effects up to much higher alcohol doses than in previous lab studies.

Theall KP; Scribner R; Cohen D; Bluthenthal RN; Schonlau M; Lynch S et al. The neighborhood alcohol environment and alcohol-related morbidity. Alcohol and Alcoholism 44(5): 491-499, 2009. (34 refs.)

Aims: The aims of this study were (1) to examine the association between neighborhood alcohol outlet density and individual self-reported alcohol-related health outcomes in the last year-sexually transmitted infections (STI), motor vehicle accidents, injury, liver problems, hypertension and experienced violence; (2) to determine whether the relationship between morbidity and alcohol outlet density is mediated by individual alcohol consumption; and (3) to explore the role of alcohol outlet density in explaining any observed racial and ethnic differences in morbidity. Method: Hierarchical models from a random sample of Los Angeles, CA, and Louisiana residents (N = 2881) from 217 census tracts were utilized. The clustering of health and social outcomes according to neighborhood varied by health problem examined. Results: There was substantial clustering of STI (intraclass correlation coefficient, ICC = 12.8%) and experienced violence (ICC = 13.0%); moderate clustering of liver problems (ICC = 3.5%) and hypertension (ICC = 3.9%); and low clustering of motor vehicle accident (ICC = 1.2%) and injury (ICC = 1.4%). Alcohol outlet density was significantly and positively associated with STI (crude OR = 1.80, 95% CI = 1.10-3.00), liver problems (crude OR = 1.33, 95% CI = 1.02-1.75) and experienced violence (crude OR = 1.31, 95% CI = 1.13-1.51) although not with other morbidity outcomes. Mediation analyses of morbidity outcomes revealed partial mediation of individual alcohol consumption in the relationship between alcohol density and STI and violence, and full mediation for liver problems. Conclusions: Findings support the concept that off-premise alcohol outlets in the neighborhood environment may impact health and social outcomes, either directly or indirectly, through individual alcohol consumption and these associations may be heterogeneous with respect to race and ethnicity.

Thombs DL; O'Mara R; Dodd VJ; Merves ML; Weiler RM; Goldberger BA et al. Event-specific analyses of poly-drug abuse and concomitant risk behavior in a college bar district in Florida. Journal of American College Health 57(6): 575-585, 2009

Objective: The authors describe the epidemiology of risk behavior associated with poly-drug use in a college bar district of a large campus community. Participants: A total of 469 bar patrons participated in the study. Methods: The authors used self-report data and biological measures collected from patrons outside bars in July and August of 2007. Results: The mean breath alcohol concentration of the exiting patrons was 0.09. Illicit and prescription drug use on the nights of data collection and in the recent past were significant features of the profile of patron risk behavior. About one-quarter of the patrons using only alcohol reported an intention to drive a vehicle within 60 minutes of leaving an establishment, compared with almost one-half of those using both alcohol and marijuana. Conclusions: A substantial amount of high-risk behavior was generated from the bar district on 4 typical nights. College bar districts should be a priority focus for prevention efforts.

Thombs DL; O'Mara R; Dodd VJ; Hou W; Merves ML; Weiler RM et al. A field study of bar-sponsored drink specials and their associations with patron intoxication. Journal of Studies on Alcohol and Drugs 70(2): 206-214, 2009. (25 refs.)

Objective: The study examined associations between bar-sponsored drink specials and alcohol intoxication at the patron level. Method: Data were collected in a college bar district located in a large campus community in the southeastern United States. Random and self-selected samples of patrons were interviewed after exiting college bars at night on four different nights (N = 383). Anonymous interview and questionnaire data were collected as well as breath alcohol concentration (BrAC) readings. Results: Significant gender differences existed in patron drinking practices. Women were more likely to take advantage of drink specials, whereas men reported greater alcohol expenditures, consumed more drinks, and drank for longer periods of time. Gender differences in BrAC were very small and not meaningful. Patrons who did not take advantage of drink specials reported consuming more drinks before bar entry than patrons who did participate in these promotions. Participation in "all-you-can-drink" promotions was significantly associated with higher BrAC readings after adjusting for covariates and random effects attributable to drinking establishment. Other drink specials did not have significant associations with alcohol intoxication. Conclusions: The all-you-can-drink special may be the specific discounting practice with the greatest potential for boosting patron intoxication and thus may need to be a stronger focus of alcohol-control policies aimed at improving the beverage service of drinking establishments.

Trocki KF; Drabble LA; Midanik LT. Tobacco, marijuana, and sensation seeking: Comparisons across gay, lesbian, bisexual, and heterosexual groups. Psychology of Addictive Behaviors 23(4): 620-631, 2009. (116 refs.)

This study examined patterns of smoked substances (cigarettes and marijuana) among heterosexuals, gays, lesbians, and bisexuals based on data from the 2000 National Alcohol Survey, a population-based telephone survey of adults in the United States. We also examined the effect of bar patronage and sensation seeking/impulsivity (SSImp) on tobacco and marijuana use. Sexual orientation was defined as lesbian or gay self-identified, bisexual self-identified, heterosexual self-identified with same-sex partners in the past 5 years, and exclusively heterosexual (heterosexual self-identified, reporting no same-sex partners). Findings indicate that bisexual women and heterosexual women reporting same-sex partners had higher rates of cigarette smoking than exclusively heterosexual women. Bisexual women, lesbians, and heterosexual women with same-sex partners also used marijuana at significantly higher rates than exclusively heterosexual women. Marijuana use was significantly greater and tobacco use was elevated among gay men compared with heterosexual men. SSImp was associated with greater use of both of these substances across nearly all groups. Bar patronage and SSImp did not buffer the relationship between sexual identity and smoking either cigarettes or marijuana. These findings suggest that marijuana and tobacco use differ by sexual identity, particularly among women, and underscore the importance of developing prevention and treatment services that are appropriate for sexual minorities.

Tutenges S. Safety problems among heavy-drinking youth at a Bulgarian nightlife resort. International Journal of Drug Policy 20(5): 444-446, 2009. (10 refs.)

Background: Vacations at international nightlife resorts represent an important but also risky element in the lives of youth in many countries. There is an urgent need for evaluating the role played by bars and nightclubs in producing and reducing risks; this task is important, especially at upcoming nightlife resorts with limited experience in managing young partygoers from other countries. Methods: Seven weeks of ethnographic fieldwork was conducted during the summer 2007 at the emerging Bulgarian nightlife resort, Sunny Beach. The research instrument "KAReN" was used as a guideline to evaluate the safety conditions in nine bars and three nightclubs. Results: The evaluation highlights five key factors at the venues that put young tourists in danger: violent security staff, overcrowding, shattered glass on the floor, dancing on furniture, and irresponsible alcohol serving. Action is needed to improve the safety conditions at the venues of Sunny Beach and other nightlife resorts. The improvements call for integrated strategies involving travel agencies, local authorities, health services, tourists and venues.

Wells S; Graham K; Tremblay PF. "Every male in there is your competition": Young men's perceptions regarding the role of the drinking setting in male-to-male barroom aggression. Substance Use & Misuse 44(9/10, Special Issue): 1434-1462, 2009. (32 refs.)

The present paper explores young men's perceptions regarding the influence of the bar setting on male-to-male barroom aggression. Focus group interviews were conducted with 27 young men aged 18-25 in London, Ontario, Canada. Participants were given a description of a typical incident of aggression between men in bars and asked to discuss why the incident happened. The following themes pertaining to the role of the selling were identified (1) sexual competition and male rivalry; (2) heightened concerns with image and social pressure to fight; (3) anonymity and taking on a different identity; (4) provocation and negative stimuli; (5) bar staff behavior; (6) acceptance and expectation of aggression; (7) high level of drunkenness; and (8) thrill, excitement, high energy level, and uncertainty of what might happen. These findings are discussed within a situational/crime prevention framework and prevention implications are highlighted.

Wells S; Graham K; Purcell J. Policy implications of the widespread practice of 'pre-drinking' or 'pre-gaming' before going to public drinking establishments-are current prevention strategies backfiring? Addiction 104(1): 4-9, 2009. (47 refs.)

Aim: To describe the research, policy and prevention implications of pre-drinking or pre-gaming; that is, planned heavy drinking prior to going to a public drinking establishment. Methods: The authors describe the phenomenon of pre-drinking, motivations for pre-drinking and its associated risks using available research literature, media and popular internet vehicles. Results: Heavy drinking prior to going out has emerged as a common and celebrated practice among young adults around the world. Apparent motivations are: (i) to avoid paying for high priced drinks at commercial drinking establishments; (ii) to achieve drunkenness and enhance and extend the night out; and (iii) to socialize with friends, reduce social anxiety or enhance male group bonding before going out. Limited existing research on pre-drinking suggests that it is associated with heavy drinking and harmful consequences. We argue that policies focused upon reducing drinking in licensed premises may have the unintended consequence of displacing drinking to pre-drinking environments, possibly resulting in greater harms. Conclusions: Effective policy and prevention for drinking in licensed premises requires a comprehensive approach that takes into account the entire drinking occasion (not just drinking that occurs in the licensed environment), as well as the 'determined drunkenness' goal of some young people.

Wells S; Graham K; Purcell J. When the object is to get drunk, pre-drinking matters. (commentary). Addiction 104(1): 11-12, 2009. (4 refs.)

Zhang B; Bondy S; Ferrence R. Do indoor smoke-free laws provide bar workers with adequate protection from secondhand smoke? Preventive Medicine 49(2-3): 245-247, 2009. (9 refs.)

Objective. To determine if bar workers are adequately protected from secondhand smoke by an Act that prohibits indoor smoking in public workplaces, including bars and restaurants, but allows smoking on unenclosed contiguous patios. Methods. A purposive sample of 25 bars with outdoor patios in Toronto, Canada was drawn. Air carcinogenic particulate polycyclic aromatic hydrocarbons (PPAH) were measured on patios and inside bars in August-September, 2006, 2-3 months after implementation of the Smoke-Free Ontario Act. Taking into account repeated measures, mixed model analysis was applied to examine the level of fine particle PPAH (ng/m(3)) by number of lit cigarettes per patio area. Results . Smoking on patios was common. With increasing numbers (0, 1.0-4.3, 4.4-8.7, 8.8-16.7 and 16.8-41.7) of lit cigarettes per 1000 ft(2) of patio area, there were increases in geometric mean (geometric standard deviation) PPAH levels, 4.7 (2.4), 9.1 (3.7), 16.9 (2.9). 19.1 (3.0) and 27.0 (2.9) ng/m(3) on patios. Mixed model analysis showed that PPAH levels increased significantly with number of lit cigarettes per patio area (p = 0.0004). High levels of PPAH on patios may be associated with sustained vascular injury. Conclusions. Complete smoking bans including outdoor workspaces are needed to adequately protect hospitality workers from secondhand smoke.

Zheng PP; Fu H; Li GY. Smoke-free restaurants in Shanghai: Should it be mandatory and is it acceptable? Health Policy 89(2): 216-224, 2009. (22 refs.)

Objectives: This study aims to describe secondhand smoke (SHS) exposure in restaurants in Shanghai and to explore the impact on the health of restaurant workers. Attitude to smoke-free restaurants among restaurant workers and customers was also determined in this study. Methods: A random sample of 242 workers, 284 customers, and 46 restaurant owners participated in face-to-face questionnaire interviews. Results: A total of 219 (90.7%) restaurant workers surveyed were found to be exposed to SHS during working hours with 24.2 +/- 18.6 h of exposure on average per week. Exposure time each week was significantly associated with the symptoms of dyspnea and irritated eyes. Among the customers surveyed 73.9% supported the concept of a 100% smoke-free law in restaurants and 49.6% expressed that they would be more likely to eat in restaurants if smoking was banned in restaurants. And 58.6% of the restaurant owners surveyed regarded smoke-free laws banning smoking in restaurant as feasible and 56.5% estimated such bans would decrease the profit. Conclusion: Both restaurant workers and customers are substantially exposed to SHS. Although some restaurant owners are concerned about a decrease in profits, the fear of losing business is not supported by the response among customers. Therefore, introducing a law-banning smoking in restaurants appears to be feasible and acceptable in Shanghai.