Variation in Alcohol Policy Enforcement Across Urban and Non-Urban Communities

Abstract

Purpose:

The goal of this study was to assess whether different types of communities (ie, urban, suburban, small town, and rural) vary in the alcohol enforcement activities they conduct.

Methods:

We conducted a cross-sectional study using data from a national survey of local law enforcement agencies.

Data:

The survey assessed enforcement of a range of alcohol policies at 1,082 law enforcement agencies. U.S. Census data were used to categorize agencies based on community type.

Results:

Agencies in urban areas conducted more enforcement activities than agencies in other community types. Urban agencies were more likely than rural agencies to conduct underage compliance checks (PR: 0.42; CI: 0.34-0.53), saturation patrols (PR: 0.80; CI: 0.67-0.95), sobriety checkpoints (PR: 0.68; CI: 0.53-0.86), and enforcement aimed at illegal sales to intoxicated patrons (PR: 0.59; CI: 0.42-0.81). Urban agencies were also more likely than small town agencies to do compliance checks (PR: 0.66; CI: 0.56-0.79) and sobriety checkpoints (PR: 0.75; CI: 0.61-0.91), and they were more likely than suburban agencies to do compliance checks (PR: 0.67; CI: 0.57-0.78) and enforcement actions around the sale of alcohol to intoxicated patrons (PR: 0.64; CI: 0.45-0.90), provision of alcohol to minors (PR: 0.77; CI: 0.65-0.92), and consumption by minors (PR: 0.90; CI: 0.82-0.99).

Conclusions:

Enforcement of alcohol laws differs by community type. Future research is needed to identify mechanisms to increase enforcement by agencies in different types of communities.

Alcohol use remains a major cause of public health problems in the US,¹ including traffic crashes, suicide, and several types of cancer.^2-6 Alcohol-related problems vary by type of community (eg, rural, urban).^7-11 A study of alcohol-impaired driving in California found that the highest rate of alcohol-involved fatalities and severe injuries were concentrated in rural areas. Rural areas have a greater proportion of fatal traffic crashes overall compared to urban areas.¹² Drivers from rural areas are also involved in approximately 34%-37% of all fatal alcohol-involved traffic crashes, compared to being just 17% of the population.¹³

Differences in alcohol consumption between urban and rural communities may explain, at least in part, some of these differences. Overall, residents in rural areas have higher rates of alcohol abstinence while urban residents are more likely to engage in heavy drinking.¹⁴ However, rural youth (ages 12-18) have higher rates of alcohol use and binge-drinking than urban youth.¹⁵ Because youth are more likely than adults to be involved in a traffic crash, and traffic crashes are a leading cause of death for this age group, higher alcohol consumption by youth may explain part of why rural areas have a higher incidence of fatal traffic crashes.

Many different alcohol control policies have been implemented to address alcohol misuse and alcohol-related health problems, and a number of these policies have evidence of effectiveness. For example, age-21 minimum legal drinking age policies are associated with a decrease in alcohol use, traffic crashes and other alcohol-related problems among youth.^16-19 Policies specifying the legal blood alcohol content (BAC) limit of 0.08 gm/dl for driving have led to fewer traffic crash related deaths.^20,21 Enforcement of strong alcohol control policies can increase their effectiveness in improving public health outcomes.^22-24

People are more likely to comply with laws if they perceive a high likelihood of being caught and penalized for an infraction.²⁵ Several effective strategies used to enforce alcohol control and alcohol impaired driving policies have been identified. For example, sobriety checkpoints (locations where law enforcement officers are stationed to check drivers for signs of impairment) are an enforcement strategy used to strengthen effects of 0.08 BAC policies to reduce alcohol-related motor vehicle crashes.²⁶ Compliance checks are a way of enforcing the minimum drinking age through law enforcement-supervised underage purchase attempts and are associated with reductions in the illegal sale of alcohol to underage patrons.²⁷

State- and local-level enforcement agencies can enforce alcohol control policies. The use of specific enforcement strategies varies by type of strategy and across jurisdictions. Erickson and associates surveyed local law enforcement agencies nationwide²⁸ and found that approximately 63% conducted saturation patrols (defined by the National Highway Traffic Safety Administration as an increased number of squad cars conducting enforcement in a targeted area to gain voluntary compliance of traffic laws and create general deterrence to prevent traffic violations),²⁹ but only 41% conducted sobriety checkpoints or enforced open container laws (laws prohibiting the presence of unsealed containers of alcoholic beverages on sidewalks, streets, and inside vehicles). Other studies have found that 35% of local law enforcement agencies reported conducting compliance checks,³⁰ 42% reported conducting enforcement efforts targeting adults who provide alcohol to underage youth,³¹ and 20% reported conducting enforcement efforts to reduce sales of alcohol to obviously intoxicated patrons.³² Differences in enforcement may explain some of the observed disparities in alcohol-related problems across different types of communities. Currently, we are not aware of any studies that investigate whether enforcement of alcohol control policies by local law enforcement agencies is systematically different across community types. The purpose of this study was to determine whether enforcement of alcohol control and alcohol-impaired driving policies differ by the type of community in which an agency is located (urban, suburban, small town, or rural).

Methods

Data Sources and Measures

We conducted surveys of a random sample of local law enforcement agencies in the United States from 2010. This study was reviewed and approved by the Institutional Review Board at the University of Minnesota.

Local Law Enforcement Agency Data

We selected law enforcement agencies from a US Department of Justice, Bureau of Justice Statistics list of 15,838 municipal and county agencies using a multi-stage sampling strategy. Agencies were sampled proportionately based on the number of agencies in each state, the number of officers in each agency, and the proportion of agencies in each state that were county sheriff versus municipal police (n=1,484). We included all 4 of Hawaii’s local law enforcement agencies and randomly selected 16 of Texas’s unique constable agencies. Finally, to ensure we captured agencies in the largest cities, we added the municipal police agency from the 3 largest cities in each state if they were not already included in our sample (n=127). Our final sample consisted of 1,631 local law enforcement agencies. We received responses from 1,082 of the agencies (response rate=66.3%, ranging from 50% to 86% across states) after excluding 16 agencies that we could not match with a community type. For the analyses presented in this paper, we excluded responses from the 16 constable agencies that completed the survey because there were relatively few and they were limited to Texas. Thus, our total sample analyzed was 1,066 agencies.

Independent Variable: Community Type

We constructed the community type measure using 2010 U.S. Census data. The Census Bureau identifies 2 types of urban areas: 1) urbanized areas of 50,000 or more people and 2) urban clusters of at least 2,500 and less than 50,000 people. Rural areas are all other areas not included within an urban area. We created a 4-level variable: urban, suburban, small towns, and rural. We divided urbanized areas into 2 categories: urban and suburban. Any city that was considered by the U.S. Census Bureau to be a core of the urbanized area (ie, the city shares its name with the urbanized area name) was labeled as an urban community type, while all other cities within that same urbanized area were labeled as suburbs of the urbanized area city core(s). We renamed urban clusters to small towns for a clearer description of this area type.

We defined rural areas as designated by the U.S. Census Bureau. Any city that shared both an urbanized area and rural area designation (if part of the city was within an urbanized area and part was outside), we designated as urban.

Dependent Variables: Enforcement Actions

We had 7 dependent variables that measured whether or not agencies conducted enforcement activities across 3 different areas of alcohol policy within the last year. Three enforcement types of strategies focused on underage drinking: compliance checks to prevent illegal alcohol sales, enforcement against social providers of alcohol to underage drinkers, and enforcement against minors consuming alcohol. We also assessed whether agencies conducted enforcement focused on illegal service of alcohol to obviously intoxicated patrons. Finally, we assessed whether they conducted 3 different types of enforcement focused on driving while impaired: saturation patrols, sobriety checkpoints, and enforcement of open container laws. These measures were dichotomous, indicating whether or not a law enforcement agency had conducted a given enforcement activity in the past year (0=no, 1=yes).

Control Variables

Three control variables measured agency characteristics: agency size, agency type, and whether they had an alcohol-specific officer. For agency size, we created a dichotomous measure (large vs. small) based on the population size of the jurisdiction that the agency served. Within each community type strata (eg, urban, rural), we used the median of the population jurisdiction to categorize small agencies (below the median population) versus large agencies (above the median population size). For example, the median jurisdiction population for small town agencies was 8,746 people. Small town agencies with jurisdictions greater than 8,746 were considered “large” agencies, while those at or below 8,746 people were defined as “small” agencies. Agency type was another dichotomous measure that designated either a municipal or sheriff agency. For alcohol-specific officer, we used an enforcement survey question: “Do you have any officers that are assigned specifically to the enforcement of alcohol-related laws (yes, no)?” We also included 2 control variables focused on demographic characteristics of each agency’s jurisdiction: percentage living in poverty and percentage aged 18-30 (U.S. Census, 2010).

Analyses

First, we calculated descriptive statistics for all variables. Next, we conducted bivariate analyses to assess associations between community type and the dependent variables as well as the control variables (agency and jurisdiction characteristics; Chi square, P < .05). We then fit a multivariable mixed effects Poisson regression model with robust standard errors for each dependent variable that included all independent measures and a random intercept to account for similarity of agencies within the same state. Given the prevalence of our outcomes of interest (24%-82%) we used Poisson regression to model risk rates (prevalence ratios). Previous validation studies have shown that Poisson models with robust standard errors are able to approximate risk ratios for dichotomous outcome variables.^33-35 We selected Poisson models instead of models designed for binomial distributions (eg, logistic regression) because the latter models typically produce odds ratios, which tend to overestimate effects when outcomes are common (ie, >10% prevalence). In addition, we could not fit log-binomial models due to issues with non-convergence. These analyses were done using SAS version 9.3 (SAS Institute Inc., Cary, NC) and Stata version 15.1 (StataCorp., College Station, TX).

Results

Descriptive statistics and bivariate results are presented in Table 1. There were 134 (13%) urban agencies, 267 (25%) suburban, 362 (34%) small town, and 303 (28%) rural. Across all community types, 42% of agencies conducted compliance checks, 46% conducted enforcement for laws against social provision of alcohol to minors, 82% conducted enforcement against minors consuming alcohol, 24% enforced prohibition of alcohol sales to intoxicated patrons, 66% conducted saturation patrols, 44% did sobriety checkpoints, and 44% conducted enforcement actions for open container laws. Agencies in urban communities were more likely than other agencies to have an officer devoted to alcohol control enforcement (40%), and these communities tended to have a higher proportion of younger adults (21%). Suburban areas had the lowest percentage of people living in poverty (10%) while rural areas had the highest (17%).

Table 1.

Descriptive Statistics and Bivariate Analysis

Jurisdiction characteristics	All communities	Urban (n=134)	Suburban (n=267)	Small town (n=362)	Rural (n=303)	P valuea
Population: mean	68,421	325,569	79,315	19,512	5,300	< .0001
Poverty	15%	16%	10%	16%	17%	< .0001
Ages 18-30	17%	21%	16%	18%	15%	< .0001
Agency characteristics
Agency type						< .0001
Municipal	78%	83%	90%	65%	79%
Sheriff	21%	16%	9%	32%	20%
Has alcohol-specific officer	28%	40%	29%	30%	20%	< .0001
Enforcement activities
Compliance checks	42%	71%	45%	42%	26%	< .0001
Intoxicated patrons	24%	37%	23%	27%	18%	< .0001
Alcohol provision to minors	46%	57%	44%	46%	44%	.074
Consumption by minors	82%	85%	78%	86%	81%	.039
Saturation patrols	66%	74%	76%	66%	54%	< .0001
Sobriety checkpoints	44%	56%	52%	42%	34%	< .0001
Open container enforcement	44%	45%	42%	47%	43%	.556

^aTests across community type generated from chi-square tests for categorical measures, and simple generalized linear models for continuous measures.

Tests for independence between enforcement activities and community type using unadjusted models are also shown in Table 1. Enforcement differed significantly by community type for compliance checks, sales to intoxicated patrons, consumption of alcohol by minors, and saturation patrols. Urban agencies were more likely than agencies in other types of communities to conduct compliance checks and enforcement of illegal sales to intoxicated patrons. Rural agencies were least likely to report conducting compliance checks, enforcement against illegal sales to intoxicated patrons, and saturation patrols. Suburban agencies were least likely to perform enforcement activities regarding underage alcohol consumption while other community types were approximately equal.

Multivariable analyses showed several differences in enforcement across community types (Table 2). Similar to what was found in the bivariate analyses, urban agencies were more likely than rural agencies to conduct underage compliance checks, saturation patrols, and enforcement aimed at illegal sales to intoxicated patrons. Compliance checks showed the greatest disparity, with the proportion of agencies conducting compliance checks being 58% greater among urban areas compared to rural areas. Another way to interpret this is that for every 100 urban agencies conducting compliance checks, only 42 rural agencies conduct these checks after adjusting for several factors. In contrast, the difference for saturation patrols was smaller—urban agencies had only a 20% higher proportion of these activities when compared to rural areas.

Table 2.

Multivariate Results: Enforcement Activities by Community Type

	Compliance checks	Sale to intoxicated patrons	Providing alcohol to minors	Consumption of alcohol by minors	Saturation patrols	Sobriety checkpoints	Open container
Community type	Adjusted Prevalence Ratio (95% CI)
Rural	0.42 (0.34-0.53)	0.59 (0.42-0.81)	0.88 (0.72-1.07)	0.98 (0.91-1.06)	0.80 (0.67-0.95)	0.68 (0.53-0.86)	1.07 (0.84-1.35)
Small town	0.66 (0.56-0.79)	0.89 (0.65-1.22)	0.87 (0.71-1.05)	1.05 (0.97-1.15)	0.95 (0.81-1.10)	0.75 (0.61-0.91)	1.07 (0.88-1.30)
Suburban	0.67 (0.57-0.78)	0.64 (0.45-0.90)	0.77 (0.65-0.92)	0.90 (0.82-0.99)	1.06 (0.93-1.21)	0.99 (0.81-1.23)	0.98 (0.79-1.22)
Urban	ref	ref	ref	ref	ref	ref	ref
Covariates
Agency Size
Small	0.73 (0.62-0.86)	0.77 (0.63-0.95)	0.89 (0.76-1.03)	0.95 (0.90-1.00)	0.90 (0.81-1.00)	0.90 (0.77-1.05)	1.06 (0.92-1.22)
Large	ref	ref	ref	ref	ref	ref	ref
% ages 18-30a	1.11 (0.98-1.24)	1.02 (0.83-1.25)	1.08 (0.94-1.23)	1.03 (0.99-1.07)	1.07 (0.98-1.17)	1.05 (0.93-1.20)	1.02 (0.89-1.16)
% povertya	0.94 (0.84-1.04)	0.88 (0.76-1.02)	0.92 (0.82-1.02)	0.97 (0.93-0.99)	0.98 (0.91-1.06)	1.07 (0.97-1.19)	1.04 (0.97-1.12)
Agency type
Sheriff	0.79 (0.64-0.97)	0.52 (0.38-0.69)	0.99 (0.83-1.02)	0.85 (0.76-0.95)	0.97 (0.82-1.13)	1.19 (1.00-1.41)	1.06 (0.89-1.28)
Municipal	ref	ref	ref	ref	ref	Ref	ref
Alcohol officer
Yes	1.44 (1.22-1.70)	1.72 (1.38-2.14)	1.45 (1.27-1.67)	1.07 (1.01-1.14)	1.31 (1.19-1.45)	1.37 (1.17-1.62)	1.63 (1.42-1.88)
No	ref	ref	ref	ref	ref	ref	ref

BOLD = P < .05

^aEstimates are the prevalence ratio associated with a 10% increase in the covariate.

Urban agencies were also more likely than small town and suburban agencies to do compliance checks, and they were more likely than suburban agencies to do enforcement actions around the sale of alcohol to intoxicated patrons or provision of alcohol to minors. The magnitude of the estimates for compliance checks when comparing urban to suburban and urban to small town were nearly identical, with a 33%-34% greater proportion of urban agencies conducting these checks. The smallest difference between suburban and urban agencies was for enforcement activities around the consumption of alcohol by minors, where the difference in proportion was 10%.

There were also several associations between our covariates and various enforcement activities. Across all activities, agencies with at least one officer devoted to enforcement of alcohol-related laws were more likely to conduct enforcement activities when compared to agencies without an officer. Larger agencies were also more likely to conduct compliance checks or enforcement activities around the illegal sale of alcohol to intoxicated patrons. Having a younger population (% ages 18-30) or higher poverty was related to a greater likelihood of agencies doing sobriety checkpoints. Finally, municipal agencies were more likely than county agencies to conduct compliance checks, enforcement activities for the illegal sale of alcohol to intoxicated patrons, and activities around the consumption of alcohol by minors.

Discussion

We found that alcohol enforcement activities varied depending on the type of activity and by the type of community which the agency serves. Agencies in urban areas were more likely to enforce policies related to illegal sales at alcohol establishments (ie, compliance checks to prevent sales to underage youth and enforcement activities targeting sales to intoxicated patrons) compared with agencies in other community types. In addition, across all the alcohol-related enforcement activities we assessed, urban agencies on average were more likely than agencies in other types of communities to conduct those activities. Agencies operating in urban areas may be better equipped to conduct many different enforcement activities because they tend to have more resources. Enforcement activities may also mirror levels of specific types of problems. For example, urban areas may have more alcohol establishments compared to other community types and thus be more concerned with enforcing policies related to alcohol sales. Having a higher density of people may also lead to a greater need to enforce policies overall since some alcohol-involved problems (eg, driving while intoxicated) have the potential to harm bystanders. There may also be differences in social cohesion between community types affecting enforcement activities. Smaller rural communities may have officers who know more of the people living in the area, and thus, may be more hesitant to conduct enforcement targeting people they know.

We observed fewer differences across types of communities in terms of enforcement of drinking and driving policies (ie, saturation patrols, sobriety checkpoints, activities around open containers), with the only significant differences being that agencies in rural areas were less likely to conduct saturation patrols and sobriety checkpoints than agencies in urban areas (suburban agencies were also less likely to conduct sobriety checkpoints). Agencies in rural areas have lower density populations (fewer people, with people further away from one another), a larger geographic area to cover, and more alcohol-related problems (eg, underage binge drinking). Activities like saturation patrols—where a large number of officers patrol within a small geographic area—may be seen as an inefficient use of limited law enforcement resources. We must identify strategies that may be more effective and more feasible in smaller communities. For example, while sobriety checkpoints may be resource-intensive, it may be more difficult for drivers to avoid them when compared with saturation patrols—particularly when there are a limited number of roadways such as in rural areas. This may explain why we saw no differences in certain drinking and driving policies between smaller and larger communities.

Overall, we found that less than half of law enforcement agencies reported several types of enforcement activities (compliance checks, enforcement activities regarding sales to intoxicated patrons, enforcement activities regarding providing alcohol to minors, sobriety checkpoints, activities around open containers while driving). In our previous papers using these data,^27-30 we reported a need to improve on enforcement strategies. When examining each community type subgroup, we found similar results—all types of communities have room for improvement. Agencies in urban communities often conducted more alcohol enforcement than other types of communities, but many agencies located in urban areas did not conduct specific enforcement activities (illegal sales to intoxicated patrons, sobriety checkpoints, open container enforcement activities). Enforcement activities related to sale of alcohol to intoxicated patrons (24%), compliance checks (42%), and sobriety checkpoints (44%) were the least likely to be conducted. There may be several reasons for this gap. For one, some states do not allow the use of sobriety checkpoints. Activities to address consumption of alcohol by minors (eg, party patrols, open field patrols) may integrate more easily with routine policing, whereas compliance checks or activities around sales to intoxicated patrons (such as pseudo-intoxicated or pseudo-underage purchase attempts) require more specialized skills and do not integrate as easily with other enforcement activities.

Limitations

This study has several limitations. Data are self-report measures from participants who may have lacked knowledge of all the enforcement activities being conducted by their agency. However, we did ask to talk to the individual at the agency most knowledgeable about alcohol-related enforcement activities. Self-report measures are also susceptible to social desirability bias. However, many of our respondents were comfortable reporting that their agencies were not conducting several of the enforcement activities. Data collected from law enforcement agencies were cross-sectional, so we are unable to assess how enforcement activities varied over time. In addition, these data represent enforcement that was occurring in 2010. Thus, results may not be applicable to enforcement that is occurring today. It is possible that the prevalence of enforcement could have changed over time, either increasing or decreasing. However, to our knowledge, these are the most recent data available related to enforcement of alcohol policies. We also did not collect information on fines or other penalties as a result of enforcement activities, which may influence the effectiveness of enforcement activities.

Conclusion

Future studies should investigate the reasons differences in enforcement activities exist between community types. Qualitative methods may be useful for investigating how different social and cultural contexts across community types and across agencies may inform how certain enforcement activities are prioritized over others. In addition, studies should measure enforcement activities of alcohol policies over time. Enforcement may fluctuate over time due to changes in financial or political circumstances. Studying how these different circumstances coincide with more or less enforcement activities can help determine how to promote more effective strategies. Finally, studies should also include measures of agency resources, such as the number of officers or agency budget.

Our results demonstrate variability in use of enforcement activities and across community types to address alcohol-related problems, a major cause of preventable death in the United States. Suburban and rural agencies, in particular, were less likely than urban areas to conduct several enforcement activities. Although urban areas may be doing more in comparison to others, there is still room for improvement in efforts to enforce alcohol policies across all community types. More work is needed to understand how to increase enforcement activities across all types of communities.