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Harold D. Holder, PhD; Paul J. Gruenewald, PhD; William R. Ponicki, MA; Andrew J. Treno, PhD; Joel W. Grube, PhD; Robert F. Saltz, PhD; Robert B. Voas, PhD; Robert Reynolds, MA; Johnnetta Davis, MS; Linda Sanchez, BA; George Gaumont, BS; Peter Roeper, MPH

JAMA. 2000;284:2341-2347.

Context  High-risk alcohol consumption patterns, such as binge drinking and drinking before driving, and underage drinking may be linked to traffic crashes and violent assaults in community settings.

Objectives  To determine the effect of community-based environmental interventions in reducing the rate of high-risk drinking and alcohol-related motor vehicle injuries and assaults.

Design and Setting  A longitudinal multiple time series of 3 matched intervention communities (northern California, southern California, and South Carolina) conducted from April 1992 to December 1996. Outcomes were assessed by 120 general population telephone surveys per month of randomly selected individuals in the intervention and comparison sites, traffic data on motor vehicle crashes, and emergency department surveys in 1 intervention-comparison pair and 1 additional intervention site.

Interventions  Mobilize the community; encourage responsible beverage service; reduce underage drinking by limiting access to alcohol; increase local enforcement of drinking and driving laws; and limit access to alcohol by using zoning.

Main Outcome Measures  Self-reported alcohol consumption and driving after drinking; rates of alcohol-related crashes and assault injuries observed in emergency departments and admitted to hospitals.

Results  Population surveys revealed that the self-reported amount of alcohol consumed per drinking occasion declined 6% from 1.37 to 1.29 drinks. Self-reported rate of "having had too much to drink" declined 49% from 0.43 to 0.22 times per 6-month period. Self-reported driving when "over the legal limit" was 51% lower (0.77 vs 0.38 times) per 6-month period in the intervention communities relative to the comparison communities. Traffic data revealed that, in the intervention vs comparison communities, nighttime injury crashes declined by 10% and crashes in which the driver had been drinking declined by 6%. Assault injuries observed in emergency departments declined by 43% in the intervention communities vs the comparison communities, and all hospitalized assault injuries declined by 2%.

Conclusion  A coordinated, comprehensive, community-based intervention can reduce high-risk alcohol consumption and alcohol-related injuries resulting from motor vehicle crashes and assaults.

Author Affiliations: Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, Calif (Drs Holder, Gruenewald, Treno, Grube, and Saltz, and Messrs Ponicki and Roeper); Pacific Institute for Research and Evaluation, Landover, Md (Dr Voas); Pacific Institute for Research and Evaluation, Rockville, Md (Mr Reynolds and Ms Davis); PARTS, Salinas, Calif (Ms Sanchez); and Prevention Research Center, Pacific Institute for Research and Evaluation, Oceanside, Calif (Mr Gaumont).

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