Injuries are a significant public health burden and alcohol intoxication (i.e. drunkenness) is recognised as a risk factor for injuries; indeed the effects of alcohol lead to a considerable proportion of all injuries. Alcohol-associated injuries are a problem in both high- and low-income countries.
Many interventions to reduce alcohol-related injuries have a demand-side focus and aim to reduce individuals' demand and consequently consumption of alcohol. However, there is increasing attention on supply-side interventions, which attempt to alter the environment and context within which alcohol is supplied and consumed; the aim being to modify the drinking and/or the drinking environment so that potential harm is minimised.
This systematic review was conducted to examine the evidence for the effectiveness of interventions implemented in the alcohol server setting for reducing injuries. The authors of this systematic review examined all studies that compared server settings which received an intervention aimed at facilitating sensible alcohol consumption and/or preventing injuries, to server settings which did not receive such an intervention.
The authors found 23 studies; only five of these measured the effect on injury, the remaining 18 measured the effect on behaviour (by the patrons and/or the servers of the alcohol within the premises). The studies investigated a range of interventions involving server training, health promotion initiatives, a drink driving service, a policy intervention and interventions that targeted the server setting environment.
The authors concluded that there is insufficient high quality evidence that interventions in the alcohol server setting are effective in preventing injuries. The evidence for the effectiveness of the interventions on patron alcohol consumption was found to be inconclusive. There is conflicting evidence as to whether server behaviour is improved and it is difficult to predict what effect this might have on actual injury risk.
Lack of compliance with interventions seems to be a particular problem; hence mandated interventions or those with associated incentives for compliance, may be more likely to show an effect. The methodology of future evaluations needs to be improved. The focus of research should be broadened to investigate the effectiveness of interventions other than server training, where previous research dominates. When the collection of injury outcome data is not feasible, research is needed to identify the most useful proxy indicators.