Sustained Alcohol Service Refusal Rates to Underage Patrons in Nightlife Setting: 25-Year Follow-Up of a Swedish...

In 1996, a multicomponent alcohol prevention intervention was launched and later institutionalized in Stockholm. This study examines the long-term effects of the program on compliance with the legal minimum age limit for alcohol service at licensed premises.

The intervention comprised community mobilization and collaboration, training, and enforcement aimed at preventing alcohol service to underage (<18 years) or obviously intoxicated patrons. Six cross-sectional studies were conducted between 1996 and 2022 in Stockholm using pseudo-underage mystery shoppers attempting to enter licensed premises and order alcoholic beverages. The primary outcome was refusal of entry to the premises or refusal of alcohol service.

Throughout the study period, regular collaboration meetings were held, the number of annual inspections and trained staff increased, and the number of sanctions varied. The refusal rate of alcohol service to pseudo-underage mystery shoppers rose from 54.8% in 1996 (baseline) to 59.1% in 1998, 67.6% in 2001, 88.3% in 2007, 91.3% in 2013, and 79.6% in 2022. Compared to the reference year 1996, all rates from 2001 to 2022 showed significant increases in the odds of refusal.

The multicomponent alcohol prevention program has been successfully sustained through collaboration and community mobilization, training, and enforcement. This success is evidenced by consistently high refusal rates for alcohol sales to underage customers over an extended period.