1. Community Trials Intervention to Reduce High-Risk Drinking (RHRD)

Community Trials Intervention to Reduce High-Risk Drinking (RHRD)

Program Goals
The Community Trials Intervention to Reduce High-Risk Drinking (RHRD) is a universal, multicomponent, community-based program that aims to reduce underage drinking, binge drinking, and driving under the influence (DUI). The program uses environmental interventions and community mobilization to decrease formal, social, and informal access to alcohol. The goal is to help communities prevent various types of alcohol-related accidents, violence, and injuries. Program components are tailored to individual communities and incorporate local input, dynamics, and regulations in order to produce positive outcomes.

Program Theory
RHRD is environment-based, not population-based. It focuses on changes in the social and structural contexts of alcohol use that can alter individual behavior and does not target specific groups. Environmental approaches seek to implement policy changes, affect systems and norms changes within communities, and target community leaders and policy-makers for structural changes.

Target Population
RHRD was developed for a universal audience, so that it can be implemented in any setting regardless of the race, ethnicity, and gender of the affected population. The program also takes into account the specific demographic and cultural dynamics of local communities and their distinct alcohol sales and distribution patterns and policies (e.g. norms, attitudes, ordinances and outlet density).

Program Components
RHRD is designed to reduce alcohol-related injury and trauma through five main prevention components: community mobilization and awareness, responsible beverage service, reduced underage drinking, reduced drinking and driving, and stricter alcohol access.

  1. Community mobilization and awareness. RHRD mobilizes communities to support prevention interventions through coalition building and media advocacy. This component also intends to increase awareness of the problems associated with youth and young adult drinking by increasing knowledge, motivate concerned adults, and alter youth perceptions of community/social norms about drinking and high-risk situations.
  2. Responsible beverage service. This intervention includes assistance to alcohol beverage servers and retailers (e.g. bars and restaurants) to reduce alcohol consumption onsite. Training is also provided to develop and implement beverage service policies to reduce intoxication and drinking after driving.
  3. Reduced underage drinking. RHRD works to reduce underage access to alcohol by training retailers who sell alcohol for off-site consumption and by increasing enforcement of underage sales laws. Police enforcement of underage sales is also enhanced.
  4. Reduced drinking and driving. Enhanced law enforcement efforts, such as roadside checkpoints and passive alcohol sensors, are intended to increase the actual and perceived risk of apprehension while driving under the influence. Police also equip and train officers for special DUI patrols.
  5. Stricter alcohol access. Communities receive assistance developing local restrictions on access to alcohol through zoning powers and other municipal controls on sales outlet density. This includes on-site server training programs by RHRD program staff as well as stings by law enforcement officials.

Key Personnel
In order for RHRD to be implemented as a community intervention, data on each individual community should be gathered from local community organizations, key opinion leaders, law enforcement, alcohol distributors, zoning and planning commissions, policymakers, and the general public. Project staff may include the following:

  • Director. A director or coordinator is responsible for developing the initiative and its strategy, seeking funding, building coalitions with key community groups and leaders, and hiring project staff.
  • Volunteers. Volunteers provide general support for program interventions; elicit support from the broader community and participation by key community leaders and police; assist in the comprehensive application of program components, such as media coverage of program efforts; attend community meetings and hearings; and assist with public education projects and other interventions as needed.
  • Community leaders. A program task force, composed of key community leaders (e.g., police captains, zoning officials, public safety and youth commissioners), can provide and further build coalitions to support program interventions.

Data managers and administration staff may also be necessary to track program trends, manage volunteers, and process information. Other staff may be needed for day-to-day management of office operations and staff, recruiting and organizing volunteers, and implementing interventions/tactics. Staff may be employees of the lead agency implementing the program or may be hired separately.

Intervention ID

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The overall evidence of the effectiveness of the Community Trials Intervention to Reduce High Risk Drinking (RHRD) program is mixed. The 2000 study by Holder and colleagues found statistically significant differences between the intervention and comparison communities on some measures. However, the 2007 study by Treno and colleagues found few statistically significant differences in their targeted outcome evaluation of alcohol-related injuries and police incidents.

Study 1
Alcohol-related Injury and Violence
Intervention sites had a significant decrease in the number of nighttime crashes per month and the monthly rates of driving under the influence (DUI) crashes relative to comparison sites. Intervention sites also had a significant decline in alcohol-related assault cases and serious alcohol-related assault cases observed in emergency departments (ED) relative to comparison sites.

  • Nighttime injury crashes. There was a 10 percent reduction in nighttime crashes per month in the intervention communities.
  • Driving under the influence (DUI) crashes. There was a 6 percent decrease in DUI crashes per month in the intervention communities.
  • Assaults observed in emergency departments (ED). Survey findings revealed that assault cases in ED declined 43 percent in the northern California sites only. (Please note that the ED survey data was not available from the other sites).
  • Hospitalized assaults. Hospitalization rates indicated that serious alcohol-related assault cases declined by 2 percent after full program implementation at the intervention sites in northern and southern California. (Please note that the ED archival data was not available from the other sites).

However, there was no decline in daytime motor vehicle crashes observed.

Alcohol Consumption
Individuals living in intervention sites reported significant reductions in drinking quantities, variances in drinking quantities, rates of driving when having had too much to drink, and rates of driving over the legal limit relative to individuals living in comparison sites.

  • Average drinking quantity. Although more people reported drinking, the mean quantity decreased from 1.37 to 1.29 drinks per occasion.
  • Average drinking variance. The variance in average drinks per occasion decreased from 2.20 to 1.74.
  • Self-reported drunk driving. Adjusted mean frequencies of self-reported driving when over the legal limit decreased from 0.77 to 0.38.

Differences between intervention and comparison sites in average frequency of drinking were not statistically significant.

Study 2
Treno and colleagues (2007) found significant reductions in assaults as reported by the police, aggregate Emergency Medical Services (EMS) outcomes, EMS reports on assaults, and EMS reports on motor vehicle accidents. However, there were no significant changes in other outcome measures, including levels of public drunkenness, EMS assault calls in the south, EMS motor vehicle outcomes in the north, and EMS reports of alcohol-related injury. Users should interpret the results with caution because the authors were not able to determine the effectiveness of each program component, but only whether the interventions were generally effective.

Police Incident Reports

  • Police incident reports on assault. The two intervention sites in Sacramento, California reported a significant reduction in alcohol-related assaults based on police data relative to the comparison site (Sacramento at large). Police calls for assault were reduced 3.9 percent in the South neighborhood and 36.5 percent in the North neighborhood.
  • Police incident reports on public drunkenness. However, there were no significant changes in reports of public drunkenness in either neighborhood.

Emergency Medical Services (EMS) Reports on Assault, Accidents, and Injury

  • EMS reports on motor vehicle accidents. EMS calls involving motor vehicle accidents were reduced 33.4 percent in the South neighborhood.  However, EMS calls involving motor vehicle accidents did not significantly change in the North neighborhood.
  • EMS reports on assault. EMS calls related to assaults were reduced 37.4 percent in the North neighborhood. However, EMS calls for assaults did not significantly change in the South neighborhood.
  • EMS reports on alcohol-related injury. There was no significant overall difference in the EMS calls for injury related to alcohol and other drugs.
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