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. Author manuscript; available in PMC: 2022 May 7.
Published in final edited form as: Subst Use Misuse. 2021 May 7;56(8):1216–1223. doi: 10.1080/10826084.2021.1914107

A Group Randomized Trial of the Stop Service to Obviously-impaired Patrons (S-STOP) Program to Prevent Overservice in Bars and Restaurants in College Communities

Joel W Grube 1, Brad S Krevor 2, William DeJong 3
PMCID: PMC8159893  NIHMSID: NIHMS1690601  PMID: 33960263

Abstract

Background:

College student drinking in on-premises establishments has been associated with heavy alcohol consumption and a range of problems including assault, fighting, risky sex, and drinking and driving. Although more strictly enforcing overservice laws might reduce heavy drinking in on-premises establishments, law enforcement agencies have few resource-efficient tools for doing so, resulting in these laws seldom being enforced.

Objectives:

In this paper, we report the results of an evaluation of the Stop Service to Obviously-impaired Patrons (S-STOP) program that was implemented in 303 bars and restaurants in 18 university communities in California using a randomized cross-over design (early vs. delayed implementation). The S-STOP program: (a) deployed pseudo-intoxicated patrons who attempted to purchase a drink when showing obvious signs of intoxication; (b) provided feedback to owners and managers on staff performance; and (c) offered free online refresher training for staff.

Results:

Overall, alcohol servers in bars and restaurants in these college communities were willing to serve a pseudo-intoxicated mystery shopper 90% of the time. The study found no evidence that S-STOP reduced the prevalence of alcohol sales to apparently impaired patrons during the two intervention stages of the study.

Conclusions:

The findings highlight the need for developing effective interventions to prevent overservice and should prompt college and university leaders to take the lead in addressing the problem of alcohol overservice at on-premises establishments by working with community leaders, law enforcement, and retailers.

Keywords: alcohol, intoxication, overservice, college communities, mystery shop, prevention

Even though serving alcohol to intoxicated individuals is prohibited in most states in the U.S., alcohol overservice in on-premises drinking establishments (i.e., bars, restaurants, pubs, clubs) remains a serious problem. Nearly half of young people leaving dance clubs have been found to be impaired or legally intoxicated (Miller, Byrnes, Branner, Voas, & Johnson, 2013). Similarly, college students leaving bars are often impaired or intoxicated, with blood alcohol concentrations (BAC) averaging 0.07% and ranging as high as 0.26% (Martin, Brechbiel, Chaney, Cremeens-Matthews, & Vail-Smith, 2016; Martin et al., 2018).

Because of this heavy drinking, people consuming alcohol at on-premises establishments are at elevated risk for a range of adverse outcomes. Over 50% of impaired driving events involve drivers originating from bars (Naimi, Nelson, & Brewer, 2009). Heavy drinking at bars is over five times more likely to result in drink driving than is heavy drinking in other venues (Cotti, Dunn, & Tefft, 2014). Overservice in on-premises serving outlets has also been associated with physical and sexual aggression (Graham, Bernards, Osgood, & Wells, 2006; Graham, Osgood, Wells, & Stockwell, 2006) and injuries (Macdonald et al., 2006) in those venues.

College communities, in particular, may need programs to reduce overservice. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has identified college student drinking as a priority area of concern (NIAAA, 2021). Studies routinely show that college students drink more frequently and more heavily than other young adults (Patrick & Terry-McElrath, 2017; Stern, Terry-McElrath, & Patrick, 2017). Estimates are that over 1,800 college students die each year in the United States from alcohol-related unintentional injuries and motor-vehicle crashes (Hingson, Zha, & Weitzman, 2009). Nearly 700,000 U.S. college students annually are the victim of an alcohol-related assault, and nearly 100,000 are victims of sexual assault related to drinking (Hingson, Heeren, Winter, & Wechsler, 2005). About 25% of college students report having problems related to their school work because of their drinking (Wechsler, Dowdall, Maenner, Gledhill-Hoyt, & Lee, 1998). College student drinking in on-premise establishments, in particular, has been associated with heavy consumption (Clapp et al., 2007; Clapp, Reed, Holmes, Lange, & Voas, 2006; Thombs, O’Mara, Tobler, Wagenaar, & Clapp, 2009) and a range of problems including assault, fighting, risky sex, and drinking and driving (Bersamin, Paschall, Saltz, & Zamboanga, 2012; Cotti et al., 2014; Harford, Wechsler, & Muthen, 2003; Huckle, Gruenewald, & Ponicki, 2016).

Unfortunately, servers and bartenders overserve with alarming frequency. In a study in 11 U.S. Midwestern communities, for example, 79% of on-premises establishments served alcohol to pseudo-intoxicated patrons who simulated signs of obvious impairment (Toomey et al., 1999; Toomey et al., 2001). A second study of Midwestern bars and restaurants reported a service rate of 65% (Lenk, Toomey, & Erickson, 2006). In Sacramento, CA, pseudo-intoxicated bar patrons were served 58% of the time (Freisthler et al., 2003). More recently, a study of 340 bars and restaurants in a Midwestern metropolitan area found that 82% served alcohol to a pseudo-intoxicated customer (Toomey et al., 2016). Research also indicates that servers and bartenders in bars catering to college students are willing to serve a pseudo-customer amounts of alcohol that would lead to serious impairment (Clapp et al., 2009). Similar findings regarding the prevalence of overservice have been reported in Europe, Australia, and elsewhere, indicating that overservice is a global problem (Buvik & Rossow, 2015; Gosselt et al., 2013; Andréasson, Lindewald, & Rehnman, 2000; Hughes et al., 2014; Rydon, Stockwell, Lang, & Beel, 1996).

Although enforcing overservice laws more strictly can reduce heavy drinking in on-premise establishments (Fell, Fisher, Yao, & McKnight, 2017; McKnight & Streff, 1994; Tomedi et al., 2018), law enforcement agencies have few resource-efficient tools for doing so, resulting in these laws seldom being enforced (Lenk, Toomey, Nelson, Jones-Webb, & Erickson, 2014). Obtaining Place of Last Drink (POLD) data from DWI arrestees or at roadside checkpoints can help identify establishments where overservice has occurred in order to focus enforcement efforts on problematic venues (Fell et al., 2017) and is sometimes advocated as a means of motivating bar owners and managers to adopt responsible retailing practices (National Liquor Law Enforcement Association, 2021). Systematic evidence about the effectiveness of using POLD feedback as a tool for reducing overservice, however, is limited. Some enforcement agencies inspect bars to observe whether customers have been served to the point of intoxication, but the absence of valid and reliable protocols for these inspections, comparable to those used to enforce underage sales laws, compromises their effectiveness (Graham et al., 2014; Saltz, 2011). Moreover, having little opportunity to interact with customers during a walk-through, law officers often are unable to ascertain whether overservice has occurred (Barry, Weiler, & Dennis, 2014). Given the lack of consistent findings, the CDC’s Community Preventive Services Task Force concluded there is only limited evidence that enhanced enforcement of overservice laws is effective (Rammohan et al., 2011).

An approach commonly advocated to prevent overservice of alcohol is responsible beverage service (RBS) training. Such training usually includes a review of laws, penalties, and server obligations relating to overservice; instruction in how to recognize when a customer has had too much to drink; and opportunities to learn and practice refusal skills. An important component of many RBS programs focuses on encouraging managers and owners to develop and consistently apply effective policies and practices to prevent overservice (Lenk et al., 2018). In the U.S., some states require RBS training from an approved vendor, some incentivize voluntary training, and others are silent on the issue (Alcohol Policy Information System, 2020). Overall, evidence for the effectiveness of RBS has been mixed (Ker & Chinnock, 2008), leading some to question whether continued investment in developing these programs is justified (Buvik & Rossow, 2017). In a recent study, for example, although significant reductions in overservice were observed, about one-third of on-premise servers and bartenders who completed a mandatory server training course still served alcohol to visibly intoxicated pseudo-patrons (Woodall, Starling, Saltz, Buller, & Stanghetta, 2018). Other studies indicate that the effects of RBS on overservice dissipate within 3–6 months (Toomey et al., 2008; Toomey et al., 2017).

As a matter of public policy, all individuals who sell or serve alcohol should be well-trained in preventing sales to intoxicated customers. By itself, however, RBS training is unlikely to be adequate for preventing overservice and its consequences. There are at least two missing elements: (a) the lack of direct feedback to licensees about whether their staff are consistently refusing service to obviously-impaired patrons and (b) the unavailability of easily accessed follow-up training. Responsible retailing mystery shop programs that provide performance feedback to staff and owners/managers and follow-up training opportunities have been found to significantly reduce sales of age-restricted products to minors (Biglan et al., 1996; Flewelling et al., 2013; Grube, DeJong, DeJong, Lipperman-Kreda, & Krevor, 2018; Krevor, Ponicki, Grube, & DeJong, 2011; Moore et al., 2012; Van Ryzin, Lee, & Biglan, 2019). To date, however, an approach that combines such feedback with follow-up training has not been applied to reducing overservice in bars and restaurants.

We report the results of an evaluation of the Stop Service to Obviously-impaired Patrons (S-STOP) program that was implemented in 303 bars and restaurants in 18 college communities in California using a group randomized cross-over design (early vs. delayed implementation). The S-STOP program deployed pseudo-intoxicated patrons who attempted to purchase a drink; provided written feedback to owners and managers about whether their staff were willing to serve the pseudo-intoxicated patron; and offered free online follow-up training for staff that focused on their legal obligation to deny alcohol service to intoxicated patrons, common signs of impairment, and tactics for refusing service. Follow-up interviews were conducted with a sample of owners and managers after the program ended to identify barriers to S-STOP’s effectiveness. Our hypothesis was that the program would significantly reduce the prevalence of alcohol sales to apparently impaired patrons during the study’s two intervention stages.

The study was reviewed and approved by the Institutional Review Board (IRB) of the Pacific Institute for Research and Evaluation (FWA00003078) and conducted in accordance with the ethical standards presented in the 1964 Declaration of Helsinki and its later amendments. The study was preregistered in the U.S. National Institutes of Health ClinicalTrials.gov Protocols Registration System (NCT03608787).

Method

Procedures

Study design.

The study was a group-randomized cross-over trial. Sampled communities were paired based on population size and other demographic characteristics and then randomly assigned to receive either an early or a delayed S-STOP intervention. Licensees were sent a letter that described the study and allowed them to opt out. In all, seven pseudo-intoxicated mystery shop visits were planned for each licensee. The first three constituted a baseline where no feedback was provided to the owners/managers. Following the third mystery shop, the owners/managers assigned to the early intervention condition were sent a letter that reported the result of the most recent inspection, provided a website link where they could view a video of how a typical pseudo-patron would have behaved when ordering a drink, and provided a link to a brief training module for their staff on how to recognize and skillfully refuse service to customers who appear to be impaired. The early intervention group received additional reports of pseudo-intoxicated inspections after the fourth and fifth mystery shops, but not the sixth and seventh. Owners/managers assigned to the delayed intervention group received a mailed report of staff conduct after the fifth, sixth and seventh mystery shops. Because of IRB concerns direct feedback was not given to servers or bartenders nor did the reports include any information (e.g., day or time of the mystery shop) that could identify an individual server or bartender.

Sample of college communities.

The study sites were 18 California communities that were home to a university (Berkeley, Carson, Chico, Davis, Fresno, Fullerton, Hayward, La Jolla, Los Angeles, Riverside, Sacramento, San Diego, San Francisco, San Luis Obispo, San Jose, and Santa Barbara). There were two study sites in Los Angeles located adjacent to college campuses in geographically separated areas.

Sample of bars and restaurants.

License data obtained from the California Department of Alcohol Beverage Control were used to identify bars and restaurants located within a 3-mile radius of each university’s campus center, or within a 4 or 5-mile radius when necessary to identify at least 20 outlets. In communities with more than 20 eligible outlets within the buffer, a sample of 20 was randomly selected for the study. In all, 360 outlets were sampled. Because this study was an effectiveness trial, no incentives other than receiving feedback about staff serving behavior and the opportunity to access online training and related materials were offered to the bars and restaurants to encourage participation in the study.

Exclusion of bars and restaurants.

Because of conditions imposed by the IRB to reduce the risk to servers and bartenders of being sanctioned by their employers, establishments that had fewer than three servers and bartenders on duty at the time of the first mystery shop were excluded (N = 20). Additional establishments were excluded because they (a) were permanently closed or consistently closed during the hours the mystery shops were conducted (N = 15), (b) were considered unsafe by the mystery shoppers (N = 1), (c) opted out of the study (N = 4), (d) refused entry to the mystery shoppers (N = 1), (e) did not meet other inclusion criteria (e.g., were private clubs, upscale “white tablecloth” restaurants; N = 7), or (f) met other exclusion criteria (e.g., routinely long waits; N = 9). The final sample comprised 303 bars and restaurants (84% of those initially sampled).

Pseudo-intoxicated patrons.

The pseudo-intoxicated mystery shoppers were young adults who were recruited through actor websites and theater programs. Actors received three hours of classroom training conducted by a study consultant with fifteen years’ experience as a pseudo-intoxicated mystery shopper and trainer of pseudo-intoxicated mystery shoppers. The training consisted of reviewing the study protocols and instruction in how to act demonstratively impaired, simulating a BAC of approximately 0.12% (imbalance, slurring, fumbling with keys, talking loudly). The actors developed their “back stories,” (e.g. celebrating a special occasion, winding down after a stressful day). To further reinforce servers’ and bartenders’ perceptions of their impaired state, the pseudo-intoxicated patrons explicitly mentioned that they had been drinking throughout the day (e.g., “Well, I’ve been drinking margaritas all day, so I think I’ll have another”). Each actor then participated in two or more mystery shop inspection that were observed and subsequently critiqued by the trainer. These practice inspections occurred in establishments not part of the study sample and the results of these practice inspections were not included in the study. An example of how the mystery shoppers were trained to behave when attempting to order an alcoholic beverage can be viewed at the Responsible Retailing Forum website (Responsible Retailing Forum, 2021).

Mystery shop protocol.

The study design called for each bar or restaurant to be visited on 7 occasions by a team of two, one of whom was a pseudo-intoxicated mystery shopper. If the bartender or server agreed to the request, the mystery shopper made an excuse to leave before the drink order was completed (e.g., “Oh, I’ve got to make a call, I’ll be back in a while”) and left. After leaving, mystery shoppers recorded on a coding sheet whether the bartender or server agreed to serve a drink (yes, no). They also recorded how busy the establishment was using a 4-point scale (1 = only a few customers; 4 = very busy), the sex (male, female, unsure) and approximate age (under 25 years old, 25–35 years, over 35 years) of the bartender or server, and whether a doorman was present at the establishment’s entrance (yes, no).

On occasion, a specific mystery shop could not be completed because of temporary circumstances (e.g., an establishment was closed to the public for a private event). In those cases, a separate attempt was made on a different day. If the second attempt could not be completed, the mystery shop round was skipped for that establishment. Because the analyses could accommodate differing numbers of observations, the establishment was retained in the sample. Overall, 1,855 mystery shop observations were completed in the 303 establishments, for an average of 6.1 mystery shops each.

Owner/Manager interviews.

Starting three months after the study concluded, an interviewer contacted a non-representative convenience sample of 50 owners/managers by telephone. They were asked whether they recalled receiving any mailed reports about an overservice mystery shop program, which included a link to a website where they could see a short video that showed how the pseudo-intoxicated mystery shoppers acted and provided an opportunity to register their employees for a brief, interactive training module on how to handle intoxicated patrons who should not be served alcohol.

Analysis plan

We used generalized linear mixed-model logistic regression as our primary analytic approach for the mystery shop data. The model included mystery shop outcomes (level 1) nested within outlets (level 2) and outlets nested within communities (level 3). Community and outlet were treated as random effects and all level 1 effects were treated as fixed. Level 1 included a dummy variable representing experimental condition (early vs. delayed implementation). To test the effects of the S-STOP program, a dummy variable was included to indicate whether a mystery shop was conducted during an intervention or non-intervention period. Specifically, mystery shops 4 and 5 were coded as 1 for the early intervention condition and 0 otherwise, and mystery shops 6 and 7 were coded as 1 for the delayed intervention condition and 0 otherwise. To control for secular trends as well as the variable timing of the mystery shops, the sequence of mystery shops was represented as an ordinal variable with the first shop as the reference group. Other level 1 covariates included (a) presence of a doorman, (b) sex of the server/bartender, (c) approximate age of server/bartender, and (d) how busy the establishment was. Sex of the server/bartender was coded as male versus non-male. Server/bartender age was treated as an ordinal variable with < 25 years as the reference category. We used descriptive statistics for the owner/manager interview data.

Results

Pseudo-intoxicated mystery shopper outcomes.

Figure 1 summarizes the outcomes from the pseudo-intoxicated patron mystery shops by intervention group. Consistent with previous studies, all seven rounds of mystery shops had a very high percentage of successful purchase attempts, with an overall rate of 90%. The logistic regression analysis (Table 1) indicated that the intervention was not significantly associated with decreases in the prevalence of selling alcohol to the pseudo-intoxicated mystery shoppers relative to the secular trend, AOR = 2.50, p < .09, 95% CI [0.87, 7.23]. Servers and bartenders in the delayed intervention group were less likely to agree to serve the mystery shoppers than those in the early intervention group, AOR = .26, p < .03, 95% CI [0.08, 0.85] (Figure 1). The only significant covariate was having a doorman present, which was associated with increased odds of a server or bartender agreeing to serve the pseudo-intoxicated mystery shopper, AOR = 1.45, p < .03, 95% CI [1.05, 1.99].

Figure 1.

Figure 1

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Percentage of Bars and Restaurants Serving Alcohol to a Pseudo-Intoxicated Patron by Early or Delayed Feedback Intervention Condition

Table 1.

Results of Multi-Level Logistic Regression of S-STOP Program Effects on Service of Alcohol to a Pseudo-intoxicated Patron

Variable b SEb t p AOR (95% CI)
 Intercept 4.514 1.256 3.60 < .001
 S-STOP Intervention 0.918 0.540 1.70 .09 2.50 (0.87, 7.23)
 Secular Trend
  MS 1a -- -- -- -- --
  MS 2 −0.006 0.418 −0.01 .99 0.99 (0.44, 2.26)
  MS 3 −0.285 0.452 −0.63 .53 0.75 (0.31, 1.83)
  MS 4 0.327 0.482 0.68 .50 1.39 (0.54, 3.57)
  MS 5 0.662 0.396 1.67 .10 1.94 (0.89, 4.21)
  MS 6 0.615 0.676 0.91 .36 1.85 (0.49, 6.96)
  MS 7 0.785 0.780 1.01 .31 2.19 (0.48, 10.12)
 Early vs. Delayed −1.366 0.610 −2.24 .03 0.26 (0.08, .85)
 Doorman Present 0.369 0.163 2.26 .03 1.45 (1.05, 1.99)
 Server Sex (Male) −0.158 0.159 −0.99 .32 0.85 (0.63, 1.17)
 Server Age
  < 25 Yearsa -- -- -- -- --
  25–35 Years −0.136 .330 −.41 .68 0.87 (.46, 1.67)
  > 35 Years 0.342 0.347 0.98 .33 1.41 (.71, 2.78)
 How Busy −0.042 .134 −.31 0.75 0.96 (0.74, 1.25)
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a

Reference category

Owner/Manager surveys.

When interviewed, 74% of the owners/managers said they did not recall receiving any mailed reports with the results of a pseudo-intoxicated mystery shop, while an additional 14% were unsure. Accordingly, 80% did not recall being invited to visit a website to see a short video of how the pseudo-intoxicated mystery shoppers acted during a mystery shop, with 14% being unsure. Finally, 84% did not recall being given the opportunity to register their staff for a brief online training module on how to handle intoxicated patrons who should not be served alcohol, with 10% being unsure.

Discussion

Two findings from the study stand out. First, across the rounds of mystery shops, just 10% of servers and bartenders, on average, declined to sell alcohol to a pseudo-intoxicated mystery shopper who reported drinking throughout the day and displayed obvious signs of alcohol impairment. This highlights the pervasiveness of overservice in on-premises drinking establishments in college communities. Although the rates of overservice we observed were very high, similar findings have been reported elsewhere in the U.S. (Freisthler, et al., 2003; Lenk,, Toomey, & Erickson, 2006; Toomey, et al., 1999, 2001, 2016; and internationally (Andréasson, Lindewald, & Rehnman, 2000; Buvik & Rossow, 2015; Gosselt et al., 2013; Hughes et al., 2014; Rydon, Stockwell, Lang, & Beel, 1996), indicating that overservice is a global problem that undoubtedly contributes to the overall burden of alcohol mortality and morbidity. Second, the S-STOP intervention – which entailed mailing the owners/managers a report of their mystery shop results, providing access to a video showing how a typical mystery shopper would have behaved when ordering a drink, and offering a brief training module for their employees – failed to improve staff performance.

Finding that three reports on staff conduct during the intervention period did nothing to reduce the rates of overservice was disappointing and raises questions about why overservice is so deeply rooted and how it might be prevented. Further research is needed to better understand what causes overservice in order to intervene effectively. Possible factors include not having effective in-house policies, owners/managers failing to enforce their policies, owners/managers and staff not understanding the legal consequences of overservice or believing it to be unlikely that overservice would be detected by law enforcement, and staff’s lack of confidence in being able to refuse service to an intoxicated patron firmly and safely. Developing more effective approaches than the current S-STOP program will require a fuller understanding of which factors contribute most to this problem.

As with all research, the current study has some limitations. Although it was implemented in 18 college communities and over 300 bars and restaurants, the study was limited to a single U.S. state, and the findings may not generalize to other states or countries. In addition, the present study’s protocol differed in one key respect from that used in most successful mystery shop programs to improve ID-checking to avoid underage sales of alcohol (Grube, et al., 2018; Van Ryzin, Lee, & Biglan, 2019) and tobacco (Krevor, Ponicki, Grube, & DeJong, 2011). In those studies, employees waiting on a mystery shopper (a person of legal age, but young enough to warrant an ID check) received immediate feedback on whether they passed or failed the shop. In the S-STOP program, immediate feedback to staff was not provided because of the IRB’s concern about possible negative repercussions for staff if they served the pseudo-intoxicated mystery shopper. Some research suggests that delivering the feedback by letter to owners/managers, as was the case in the S-STOP program, may be less consistently effective than providing immediate feedback to clerks (Van Hoof, Gosselt, Baas, & De Jong, 2012). Moreover, the follow-up interviews with a convenience sample of owners and managers found that a great majority did not recall receiving any mailed feedback reports. Some managers may have received and read the S-STOP mail, but did not remember since the interview occurred a few months after the intervention ended. In other cases, respondents may not have opened their S-STOP mail. Another possibility is that the report was delivered to an absentee owner who failed to pass on the feedback to the onsite manager, a disconnect that would undermine any responsible retailing program using mailed feedback, unless it were sent directly to the onsite manager. If mystery shop programs or similar interventions are to be effective, it is essential to determine the most effective form of feedback, how it should be delivered, and how to motivate owners and managers to attend to and act upon it.

Despite any limitations, the study has important implications. The finding that alcohol servers were willing to serve a pseudo-intoxicated mystery shopper 90% of the time should alarm the university communities where the S-STOP program was evaluated. College and university officials across the U.S. and elsewhere likely know that many bars, restaurants, and other on-premises establishments are willing to serve both underage and intoxicated customers, but perhaps without being fully aware of the true extent of the problem. Because students often drink off campus, some colleges have created safe ride programs or promoted other alternative transportation options to prevent alcohol-impaired driving (Zimmerman & DeJong, 2003), but traffic crashes are far from the only negative outcome that heavily drinking students might experience.

Unfortunately, for the past 30 years, relatively few campus leaders have sought to address the problems of underage sales and alcohol overservice by working directly with community leaders, law enforcement, or retailers themselves (Gebhardt, Kaphingst, & DeJong, 2000; Saltz, Paschall, McGaffigan, & Nygaard, 2010; Wolfson, et al., 2012; Wood, DeJong, Fairlie, Lawson, Resendes, & Cohen, 2009). This needs to change. College presidents, as respected leaders in their communities, are in a position to call for and organize campus-community efforts to develop and implement policies and programs to create safer environments for both their students and local residents (Saltz, Paschall, McGaffigan, & Nygaard, 2010). The time for this to become standard practice in higher education is long overdue (DeJong, 2016).

A number of effective policies have been identified by the U.S. National Institute on Alcohol Abuse and Alcoholism on their CollegeAim website that would help address problems of overservice in college communities, including restricting price promotions and happy hours, setting minimum prices for drinks, and restricting hours of sale (NIAAA, 2021). Dramshop liability laws that hold owners and managers responsible for damages caused by impaired patrons leaving their establishments may be especially effective in motivating them to implement overservice polices and ensure that their staff abide by them.

The high rates of overservice observed in this study, and internationally, coupled with the lack of effects for the S-STOP intervention, underscore the need for developing effective approaches for addressing this problem. Overservice and its associated costs are likely to remain serious global issues unless coordinated action is taken to implement publicly supported policies and programs at the national, state, local, and institutional level (Xuan, Blanchette, Nelson, Heeren, Oussayef, & Naimi, 2015; Zimmerman & DeJong, 2003), make increased law enforcement a priority, reinforce and meet the growing consumer demand for low-alcohol and no-alcohol products (Anderson, Llopis, O’Donnell, Manthey, & Rehm, 2020; Anderson, Llopis, & Rehm, 2020), and make both overservice and overconsumption as socially unacceptable as alcohol-impaired driving (Grasmick, Bursik, & Arneklev, 1993).

Acknowledgements

Funding.

This study and preparation of this manuscript were supported by grant number R44-AA024992 from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) of the U.S. National Institutes of Health (NIH). Additional support for Dr. Grube during the preparation of this manuscript was provided by NIAAA grant number P60-AA006282. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIAAA or the NIH.

Footnotes

Disclosure of interest. Drs. Krevor, Grube, and DeJong have been supported within the past three years by funding from the alcohol industry to evaluate industry-sponsored programs to reduce alcohol sales to minors and other alcohol-related harms.

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