Health Promotion International Advance Access originally published online on February 18, 2005
Health Promotion International 2005 20(2):147-155; doi:10.1093/heapro/dah610
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Evaluation of a regional community action intervention in New Zealand to improve age checks for young people purchasing alcohol
Centre for Social and Health Outcomes Research and Evaluation (SHORE), Massey University, Wellesley Street, Auckland, New Zealand
Address for correspondence: Taisia Huckle, Centre for Social and Health Outcomes Research and Evaluation (SHORE), Massey University, PO Box 6137, Wellesley Street, Auckland, New Zealand E-mail: t.huckle{at}massey.ac.nz
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SUMMARY |
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 TOP SUMMARY INTRODUCTIONREGIONAL DESCRIPTIONINTERVENTION DESIGNEVALUATION METHODSEVALUATION ANALYSISRESULTSDISCUSSIONCONCLUSIONREFERENCES |
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This paper describes the evaluation of a regional community action intervention to reduce access to alcohol from off-license premises by minors. The intervention focussed on: (1) monitoring alcohol sales made without age identification from off-licenses; (2) utilizing data on alcohol sales for media advocacy and direct contact with alcohol retailers and (3) working with key enforcement staff to encourage increased monitoring and enforcement of minimum purchase age legislation for off-licenses. Evaluation of this intervention used a case study design. Purchase survey data was obtained before and after intervention. Media items were monitored and included pre- and post-intervention phases. Interviews, with key enforcement staff, and document review were undertaken post-intervention. Purchase survey data showed a significant decrease (p < 0.05) in sales of alcohol made to young people without age identification pre- and post-intervention. Pre-intervention: 60% of visits resulted in a sale made without age identification; post-intervention this proportion was 46%. Principal component analysis of newsprint media indicated increased coverage of items advocating improved age checking for off-licenses following intervention. Interview data and document review indicate that some enforcement staff in the region implemented increased enforcement strategies including, controlled purchase operations and increased visits to off-licenses due to the intervention. Evaluation findings indicate that collaborative and intersectoral community action interventions implemented regionally can be effective in redirecting resources to achieve preventive outcomes at a population level.
Key words: community action; health promotion; alcohol; youth
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INTRODUCTION |
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TOPSUMMARYINTRODUCTIONREGIONAL DESCRIPTIONINTERVENTION DESIGNEVALUATION METHODSEVALUATION ANALYSISRESULTSDISCUSSIONCONCLUSIONREFERENCES |
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The Auckland Regional Community Action Project (ARCAP) is an evaluated community action project in Auckland, New Zealand's largest region. The initiative is aimed to reduce alcohol-related harm among young people by changing the social and physical environment that affects youth drinking (Wagenaar and Perry, 1994
; Holder and Reynolds, 1998; Ministry of Health, 2001). The evaluation of the project will: (1) assess the impact of an evidence-based regional community action project on reducing alcohol-related harm among young people and (2) assess the influence of such a project on the collaborative use of existing health and related sector resource.
ARCAP is implemented regionally and relies on existing resources, working with a specific ‘community of interest’ in the health promotion and alcohol regulatory areas to achieve change at a regional level (Conway et al., 2003). The initiative was established to encourage collaborative and intersectoral cooperation in reducing alcohol-related harm. This followed an environment of devolution within the New Zealand health sector characterized, in part, by a provider/purchaser split (Boston et al., 1991). Competitive targeted contracting arrangements had initially created an environment that discouraged collaborative ventures between organizations (Conway et al., 2003).
The use of a community action approach utilizing and actively promoting collaborative sustained partnerships can lead to improved health outcomes (Mosher, 1996; Bush, 1997; Stewart et al., 1997; Treno and Holder, 1997; Labonte, 1998). Such an approach may also work to stimulate greater regional consistency and co-ordination in planning strategic health promotion activities (Conway and Casswell, 2003).
The Ministry of Health (which acts on behalf of central government) convened a series of meetings amongst the alcohol health promotion workers it funded. These meetings were to identify common objectives and collaborative activities. The specific objectives identified were: reduce social supply of alcohol to minors, reduce supply by off-license premises to minors, reduce intoxication among under 25 year olds in licensed premises and public places and to challenge existing social norms about alcohol use amongst young people.
The first ARCAP objective worked on was to reduce access to alcohol from off-license premises by minors. This was due to concern over a change in legislation in 1999 that lowered the minimum purchase age for alcohol from 20 to 18 years in New Zealand. This change did not include mandatory age identification checking.
National survey data, collected after the purchase age was lowered, indicated that minors could easily buy alcohol from some off-license premises (Habgood et al., 2001). Furthermore in Auckland, where ARCAP is implemented some licensing enforcement staff reported poor age verification practices in off-license outlets (Conway et al., 2003).
This paper reports the evaluation findings of the first regional ARCAP community action intervention: to reduce access to alcohol by minors from off-license premises in the Auckland region.
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REGIONAL DESCRIPTION |
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TOPSUMMARYINTRODUCTIONREGIONAL DESCRIPTIONINTERVENTION DESIGNEVALUATION METHODSEVALUATION ANALYSISRESULTSDISCUSSIONCONCLUSIONREFERENCES |
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The Auckland region of New Zealand is geographically large, inclusive of four metropolitan cities and three rural districts. Auckland has a usually resident population of 1.2 million people with a youth population of approximately 336 000 people aged 18 years and under.
In Auckland there has been a large increase in the number of alcohol licenses issued since restrictions were lifted on numbers of premises in 1990. For off-licenses these numbers increased from 300 to 1000 (data supplied by the Secretary-Liquor Licensing Authority, New Zealand). Some premises had also extended their trading hours, resulting in some off-licenses with 24 h licenses (Casswell and Bhatta, 2001). No corresponding increase in the numbers of licensing inspectors who check compliance with license conditions occurred.
Survey data from New Zealand (including Auckland) had indicated that in 2000, 23% of heavier drinkers aged 16–17 years had obtained alcohol from off-licensed premises in the last 12 months. This proportion was exceeded only by on-licensed premises (40%) and obtaining alcohol from friends (36%) (Habgood et al., 2001). Of those aged 16–17 years who had purchased alcohol from an off-license in 2000, 44% had purchased from a tavern, bottle shop or wine shop, 15% from a supermarket and 2% from grocery outlets (Habgood et al., 2001).
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INTERVENTION DESIGN |
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TOPSUMMARYINTRODUCTIONREGIONAL DESCRIPTIONINTERVENTION DESIGNEVALUATION METHODSEVALUATION ANALYSISRESULTSDISCUSSIONCONCLUSIONREFERENCES |
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The intervention focused on: (1) monitoring alcohol sales made without age identification from off-licenses, (2) utilizing data on alcohol sales for media advocacy and direct contact with alcohol retailers and (3) working with key enforcement staff to encourage increased monitoring and enforcement of minimum purchase age legislation for off-licenses in Auckland.
A meeting with key regulatory enforcement staff was held in mid 2002. The purpose was to (a) propose a purchase survey of off-license premises in Auckland and (b) design the survey in consultation with stakeholder groups including police, local council licensing inspectors and health promotion workers. This process served to actively involve key stakeholders in the purchase survey process, and to encourage support from the enforcement sector to proactively initiate their own actions to improve age checking practices. Key stakeholders and enforcement staff from each city and district in Auckland were present.
Subsequently a purchase survey of off-license premises was undertaken. Purchase surveys involve young people, usually of the minimum purchase age, attempting to buy alcohol without age identification. While such surveys do not measure the total sales to minors in an area they are an indication of age checking practices and the ease with which minors are able to purchase alcohol and can been used to monitor trends over time (Grabosky, 1995; Lang et al., 1996; Rydon et al., 1996; Mosher, 1999). The purchase surveys used in the ARCAP intervention served a dual purpose: (1) to function as a component of the intervention by providing evidence-based information to advocate for improved age checking practices and (2) to in part, evaluate the intervention. Purchase surveys were conducted pre- and post-intervention, in mid 2002 and 2003, respectively (Huckle et al., 2003). (The 2003 purchase survey also formed part of a second phase of intervention. This second phase is not reported in this paper as evaluation has not yet been completed.)
A media advocacy campaign was utilized by health promotion workers involved in ARCAP to increase awareness of, and advocacy for, improved age verification practices. Media advocacy is the strategic use of mass media for advancing a social or public policy initiative (Wallack, 1990; Stewart and Casswell, 1993). The health promoters worked collaboratively to optimize the use of the pre-intervention purchase survey results through several activities. These were: media training for interested key stakeholders to prepare them for media activities, media targeting improved age checking practices for off-licenses, a meeting with key stakeholders to discuss follow-up media and enforcement activities and a high profile media launch (health promotion workers involved in ARCAP received a very small sum of money to assist with undertaking media activities; approximately $NZ 4000: US $2500).
Media releases were developed by the health promoters and these were sent to all the newspapers in the Auckland region on the day of the media launch. Local and Maori media were targeted to ensure that locally relevant survey results were disseminated to communities and key local stakeholders. Some enforcement stakeholders also circulated media releases and responded to local media enquires in their respective areas.
Prior to release of the survey results key enforcement stakeholders were briefed on the results. Letters were also sent to licensees of premises surveyed. These were sent by the evaluators to maintain confidentiality of premise identity. (The ethical requirements for the purchase surveys state that reporting of aggregate data is permitted. No individual premise will be identified publicly or to Police and/or other relevant stakeholders.) These included the premise results and acted as a prompt to licensees of the importance of age checking practices. The letters also provided contact details for obtaining information on improving age checking practices.
A media launch was collaboratively organized by the health promotion workers involved in ARCAP. The launch day was designed as high impact with a feature display of the alcohol that had been purchased during the survey and the Hon. Phil Goff, Minister of Justice of New Zealand agreed to speak at the launch held in July 2002. A media kit, available at the launch, was developed with summary data and media releases targeted to different audiences. All health promoters involved in ARCAP and key enforcement staff attended the media launch.
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EVALUATION METHODS |
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TOPSUMMARYINTRODUCTIONREGIONAL DESCRIPTIONINTERVENTION DESIGNEVALUATION METHODSEVALUATION ANALYSISRESULTSDISCUSSIONCONCLUSIONREFERENCES |
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Evaluation design
A naturalistic case study design was used with a collection of evaluation measures at different points in time. Case studies have not only descriptive and exploratory purposes but explanatory ones, making causal inferences possible (Yin, 1981
). Such case study approaches have been found to enhance assessment of the complexities of community action projects (Casswell, 1999). A case-control design was considered, however there was no comparable control region and it could not be ensured that media from the Auckland region would not reach other areas of the country. Purchase survey data was obtained before and after intervention. Media items were monitored over a 12-month period and included pre- and post-intervention phases. Interviews were undertaken with key enforcement staff post-intervention. Relevant documents such as minutes of ARCAP and related sector meetings were collected from the outset of the evaluation.
Purchase surveys
Sample
For both pre- and post-intervention surveys the total population of bottle shops, supermarkets and grocery outlets holding off-licences to sell alcohol in Auckland were identified (Liquor Licensing Authority, Department of Justice, New Zealand). A random sample was selected. Representative numbers for each metropolitan city and rural district were obtained as well as for each type of premise regionally. The total number of premises randomly selected was approximately 250 for both surveys.
Field workers
For ethical reasons all the field workers were 18 years old (the minimum purchase age), and were required to provide verification of their age from a driver's license, birth certificate or passport before being hired. It has been argued that the age differential is not easy to judge around 16–18 years and that retailers should ask for age verification as the young person could be underage (Schofield et al., 1994). It is also a public health recommendation in New Zealand that those who look under 25 years be checked for age verification when purchasing alcohol (New Zealand Drug Foundation, 2002).
Data collection
Each field worker was paired up with a research supervisor/driver whose role was to drive between premises and to ensure that the research protocols were followed. Data collection for both surveys took place over three successive weekends. Weekends are when young people are most likely to be trying to buy alcohol. Data collection typically started in the afternoons on Friday and Saturday and continued till around 19:00–20:00 each night.
Field workers were required to enter a premise, choose one item of alcohol worth up to $10 and attempt to purchase the item. If asked for age identification they said to the server they had none on them. The sale then either took place or was discontinued by the server and the field worker left the premise. Field workers wrote up the results of each visit on a standard data collection sheet and this included information about the presence and visibility of age signage.
Data collection involved each randomly selected off-license being visited twice, once by a male and once by a female. This method was chosen since previous research has indicated that there are differences in the age checking of males and females by premises that sell alcohol (Lang et al., 1996).
ARCAP media activities
Newsprint items relating to alcohol issues for those under 25 years were tracked for all local papers in the Auckland region. Items were collected from national newspapers where news related specifically to young people and alcohol in Auckland. Collection of media items began in January 2002 and will continue for the duration of ARCAP.
Key informant interviews and document review
Key informants included Police and Licensing Inspectors from each metropolitan city and rural district area in the Auckland region. Interviews were conducted either face-to-face or by phone in mid 2003; post-intervention and previous to the release of the post-intervention survey results. Documents collected for review included relevant ARCAP and stakeholder meeting minutes, strategic and work plans, and actions and tasks recorded by the evaluation team.
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EVALUATION ANALYSIS |
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TOPSUMMARYINTRODUCTIONREGIONAL DESCRIPTIONINTERVENTION DESIGNEVALUATION METHODSEVALUATION ANALYSISRESULTSDISCUSSIONCONCLUSIONREFERENCES |
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Purchase surveys
The surveys were complex designs that allowed for obtaining sufficient numbers in each metropolitan city and rural district, especially the smaller rural districts, as well as in each of the different categories of off-license premise, e.g. bottle shop, supermarket and grocery outlet. This meant that there were different probabilities of selection in each category by district strata and that some strata had a high proportion of coverage. An added complexity was the repeated measures taken at each off-licence, one by a male and one by a female. The program WesVar (http://www.westat.com/wesvar/) was used to calculate the estimates and their variances for each year. Tests of significance differences in estimates between years were completed by hand assuming normality of the estimates and using the values calculated from WesVar. (Westat, 2002
) WesVar uses replication variance estimation, which consists of repeatedly calculating estimates for subgroups of the full sample and then computing the variance among these ‘replicate’ estimates. This technique implicitly accounts for the complexity of both a sample design and the estimators that are used. The replicate variance estimation method that was used in this report was the jacknife. Significant differences are reported at the 0.05 level. Weighted proportions are reported.
ARCAP media activities
A composite measure for alcohol-related news print media was derived based on Treno and Holder (Treno and Holder, 1997) using principal component analysis. It included four factors: number of articles per month, total area (cm2) per month, articles with photo/picture and front page articles per month. This measure has previously been used to examine advocacy in the newsprint media (Holder et al., 1997b; Treno and Holder, 1997) and is capable of capturing different dimensions of coverage. Therefore, it is likely to have greater validity than any one exclusive measure (Holder et al., 1997b; Treno and Holder, 1997). Scores for each factor were obtained from the first principal component in a principal component analysis. Alcohol-related news items, from which factor scores were derived, included all items from January 2002 to August 2003 specifically relevant to those 25 years and under in the Auckland region. The values of the principal component for each month were rescaled to have a minimum of zero.
Key informant interviews and document review
Key informant interviews were analysed using an interpretive approach in which data was repeatedly examined for patterns, differences and phenomena (Patton, 1990). Interview transcripts and accessible relevant documents were examined for evidence of the impact of the ARCAP intervention on improving age checking practices.
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RESULTS |
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TOPSUMMARYINTRODUCTIONREGIONAL DESCRIPTIONINTERVENTION DESIGNEVALUATION METHODSEVALUATION ANALYSISRESULTSDISCUSSIONCONCLUSIONREFERENCES |
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Purchase surveys
Of the original random sample of off-licensed premises selected pre-intervention, 84% of planned visits were made. Post-intervention this proportion was 86%. The main reason for off-license premises not being visited was because they no longer existed (Table 1).
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Overall the proportion of sales made without age identification in the Auckland region significantly decreased from 60 to 46% between pre- and post-intervention phases. The proportion of age identification signage that was present and visible significantly increased from 53 to 64%.
Evaluation of ARCAP media activities
The first principal component accounted for 76% of the total variance and had an eigenvalue of 3.0. The second principal component accounted for 18% and had an eigenvalue of 0.7. The first principal component is close to being an average of the four standardized factors (Table 2).
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Figure 1 indicates that the level of media coverage regarding the purchase survey/advocacy for improved age checking practices for off-licenses during the ARCAP planned media activity period of July 2002 was higher than pre-intervention months.
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Impact of the ARCAP intervention
Impact on regulatory stakeholders
All of the key enforcement stakeholders agreed that they would contact the off-licensed premises in their area following the public release of the purchase survey results to warn them of increased monitoring and prosecution if found to be selling to minors. Some also indicated that they would use it as an opportunity for closer intersectoral team-work promoting training, specific education and increased use of appropriate signage in licensed premises in their districts. Inadequate visible age signage in off-licenses was also identified as an issue by some key regulatory staff. Signage was delivered to off-licenses in at least two areas of Auckland by licensing staff.
Information from the pre-intervention purchase survey was used by Police in two hearings before the Liquor Licensing Authority from two different metropolitan cities as evidence of sales to minors (Liquor Licensing Authority, 2003a; Liquor Licensing Authority, 2003b; Liquor Licensing Authority, 2003c). Furthermore, the purchase survey information provided part of the justification for the police decision to conduct the Controlled Purchase Operations (CPOs) in these two respective areas. (Controlled purchase operations are conducted by Police and involve minors attempting to purchase alcohol. These operations are undertaken to determine if licensees, managers and staff are complying with the requirements of the New Zealand Sale of Liquor Act, that no one under the age of 18 years can legally purchase alcohol.) Police ensured the results of the CPOs were well publicized in the local media and also charged those premises who served to minors.
One key informant from the Police thought that the results from the purchase survey might lead to an increase in resources for the police to carry out their licensing responsibilities more effectively. For instance one informant, commenting on the lack of resources allocated to licensing within the police, said: ‘I think that may be about to change. Depends how many sales [the purchase survey] got.’
One licensing sector key informant from a rural district reported visiting all of the off-licences in that area after the pre-intervention purchase survey. Alcohol retailers were asked if they had sold alcohol (licenses were aware that they had been part of the survey as they were subsequently notified by letter) and she received a number of enquiries from licensees asking what they could do to ensure they did not sell to under 18's. ‘They said "well this has been a real wake up call for us" and they're implementing more training for their staff’.
In another metropolitan city area of the Auckland region it was announced by the major liquor retailer in the area that all staff would be required to check anyone who looked under 25 years. (This area was under the jurisdiction of a licensing trust with a virtual monopoly on off-license premises.) They have subsequently introduced a computer-generated identification prompt system, conducted their own monitoring surveys and improved signage in all of their premises.
Impact within the government sector
Results from the purchase survey were used as justification for focussing on strengthening an age identification culture in one city in the Auckland region (Manukau City Council, 2002).
The Hon. Phil Goff (Minister of Justice of New Zealand) became a significant stakeholder and actively promoted the responsibility of alcohol retailers to adopt standard age verification practices. Following the release of the pre-intervention purchase survey he called together a meeting of all the major retail bodies selling alcohol and issued them with a stern warning to improve their practices or face a change in legislation to make age identification mandatory.
Impact within the industry
There was irate feedback from some licensees who saw checking for age identification as not mandatory and therefore purely discretionary and not as standard practice. However, there was a positive response from many other licensees who saw the intervention as assisting their responsibility to ask for age identification.
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DISCUSSION |
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TOPSUMMARYINTRODUCTIONREGIONAL DESCRIPTIONINTERVENTION DESIGNEVALUATION METHODSEVALUATION ANALYSISRESULTSDISCUSSIONCONCLUSIONREFERENCES |
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This community action intervention to reduce sales of alcohol to minors from off-licenses was distinct in two main ways: (1) it was implemented on a large scale to achieve a preventive outcome at the population level and (2) and was a collaborative effort that almost entirely relied on redirection of existing resources to achieve change (Conway et al., 2003
).
In a broader context this regional community action initiative was established as a catalyst to encourage regional collaborative and intersectoral cooperation to achieve a reduction in alcohol-related harm. Collaborative solutions to achieve health outcomes at the population level have been proposed in the current New Zealand Health Strategy (Ministry of Health, 2003) and other government programmes, such as the New Zealand Alcohol Strategy (Ministry of Health, 2001).
The ARCAP intervention initiated a significant decrease (14%) in sales of alcohol made without age identification in the Auckland region. The purchase survey evidence of inadequate age checking from New Zealand's largest population centre, and the high level of media activity achieved by ARCAP, reinforced the importance of the roles of local police and licensing staff in monitoring and enforcement. Increased enforcement and monitoring of off-license practices by regulatory staff subsequently occurred and signalled redirection of available regulatory resources and intersectoral collaboration between key health promotion and regulatory agencies. Measures of this intervention's ongoing impact on regularized monitoring and enforcement will be the level of compliance achieved (through further purchase surveys) and the level of resource committed to monitoring and enforcement.
The increase in enforcement activities following intervention is likely to have played an important role in reducing sales of alcohol without identification in Auckland. Moderate increases of enforcement of the minimum purchase age have been found in the United States to reduce sales to those underage by 8% for off-license premises, especially when joined with media and other community activities (Wagenaar et al., 2000). In one study, increases in enforcement resulted in a decrease of approximately 30% in sales made to young women appearing to be underage in the US (Grube, 1997). Effective and regular compliance checks decrease alcohol sales to minors; helps reduce underage drinking; helps reduce traffic crashes, violence and other health problems associated with alcohol (Alcohol Epidemiology Program, 2000).
The media advocacy generated during the intervention phase was reflective of the collaborative activities of the health promotion workers involved in ARCAP, and indicated some redirection of resource between these agencies. The media advocacy sustained momentum in both national and local arenas. It placed the issue of easy access to alcohol by minors and the lack of effective age verification practices on both the political and community-level agendas. Media advocacy utilizing the purchase surveys was also an important factor in helping mobilize a key Government minister to become proactive in advocating for effective age checking at off-licenses. This included driving wider political initiatives to address alcohol and youth issues in not only the Auckland region, but also on a national level. Media advocacy has previously been found to be an effective tool for community prevention (Stewart and Casswell, 1993; Holder et al., 1997a; Casswell, 1999).
The lack of adequate age signage present and visible in off-licenses was identified as an issue by key health promotion and regulatory staff following the pre-intervention survey. Post-intervention survey results show significant improvement in the region. At present there is no standard age signage regionally or nationally. It represents a large resource cost however and there is potentially a need for coordination of standardized signage.
At the time of the ARCAP intervention and the time until the post-intervention survey (inclusive), no other projects or programmes in the Auckland region were specifically working on reducing alcohol sales from off-licenses to minors. There were also no changes in local, regional or national policy or legislation regarding off-license premises and sale of alcohol to minors likely to externally influence the results of the evaluation.
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CONCLUSION |
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TOPSUMMARYINTRODUCTIONREGIONAL DESCRIPTIONINTERVENTION DESIGNEVALUATION METHODSEVALUATION ANALYSISRESULTSDISCUSSIONCONCLUSIONREFERENCES |
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A community action approach may achieve regional preventive outcomes at a population level. A community action approach may also facilitate the redirection of resource such as inter-agency and intersectoral collaboration.
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ACKNOWLEDGEMENTS |
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Part of this research was carried out by researchers now at the Centre for Social and Health Outcomes Research and Evaluation, Massey University while they were members of the Alcohol and Public Health Research Unit, University of Auckland. Funding was provided by the Ministry of Health and permission to use and publish the data has been obtained.
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