Aims To identify barriers and facilitators associated with initial implementation of a US alcohol and other substance use Screening, Brief Intervention, and Referral to Treatment (SBIRT) grant program, and to identify modifications in program design that addressed implementation challenges. Design A mixed-method approach used quantitative and qualitative data, including SBIRT provider ratings of implementation barriers and facilitators, staff interview responses and program documentation. Setting Multiple sites within the first seven programs funded in a national demonstration program in the United States. Participants One hundred and two SBIRT providers were surveyed; 221 SBIRT stakeholders and staff were interviewed. Measurements Mean ratings of barriers and facilitators were calculated using provider survey responses. An inductive content analysis of interview responses identified factors perceived to support and challenge implementation; program modifications that occurred over time were recorded. Findings Providers rated pre-selected implementation facilitators higher than barriers. Content analysis of interview responses revealed six themes: committed leaders; intra-and inter-organizational communication/collaboration; provider buy-in and model acceptance; contextual factors; quality assurance; and grant requirements. Over time, programs tended to: adopt more efficient 'pre-screen' item sets; screen for risk factors in addition to alcohol/substance use; use contracted specialists to deliver SBIRT services; conduct services in high-volume emergency department and trauma center settings; and implement on-site and telephonic treatment delivery. Conclusions Screening, Brief Intervention and Referral to Treatment program implementation in the United States is facilitated by committed leadership and the use of substance use specialists, rather than medical generalists, to deliver services. Many implementation challenges can be addressed by an adequate start-up phase focused on comprehensive education and training, and on the development of intra-and inter-organizational communication and collaboration; opinion leader support; and practitioner and host site buy-in.

Aims To assess the sustainability of Screening, Brief Intervention and Referral to Treatment (SBIRT) services after cessation of initial start-up funding. Design Descriptive study with quantitative and qualitative data collected from 34 staff participants from six grantees (comprising 103 sites) funded previously through a large, federally supported SBIRT program. Setting Primary care out-patient clinics and hospitals in the United States. Participants Thirty-four granteerelated staff members, including administrators, evaluators, key stakeholders and SBIRT service providers from six grantees. Measurements Changes to levels and types of service delivery activities after federal funding stopped, alternative sources of funding and obstacles to delivery of services. Findings Of the 103 original sites in the six SBIRT grantee programs, 69 sites continued providing services in some capacity (same as before, reduced, modified or expanded). Most of the 69 sites (67%) adapted and redesigned the delivery of SBIRT services post-initial grant funding. In addition, new sites were added after grant funding ended, bringing the total number of sites to 88. Analysis of participant responses identified four primary factors that influenced SBIRT sustainability: presence of champions, funding availability, systemic change and SBIRT practitioner characteristics. Conclusions Almost 70% of the Screening, Brief Intervention and Referral to Treatment (SBIRT) services in the United States funded initially through a federal program were able to sustain operations after federal funding ceased and some expanded SBIRT services beyond the original sites. The key factors related to sustainability were securing new funding, having champions, adapting and making system changes and managing program staffing challenges.

The alcohol industry's current self-regulatory framework is ineffective at preventing content violations but could be improved by the use of new rating procedures designed to better detect content code violations.

From a public health perspective, alcohol advertising should not be directed at vulnerable groups, nor should it portray excessive drinking or other objectionable content such as illegal activity. To promote the responsible advertising of alcoholic beverages, alcohol industry groups have developed self‐regulation guidelines that describe which types of content (and exposure markets) are unacceptable. In 2006 the US Beer Institute revised the content guidelines of the 1997 Beer Code. This study was designed to determine whether these changes made the revised Code more or less likely for expert judges to report guideline violations, and for alcohol advertisements to include otherwise inappropriate content from a public health perspective. Six alcohol advertisements known or suspected to have multiple content violations were rated by 139 experts selected on the basis of their expertise in public health, mental health, alcohol research and marketing. The ads were rated on two occasions with feedback about other viewers' ratings provided at the second rating. The data were collected by means of a computer‐based rating program that used multiple items to evaluate the eight major content guidelines of the US Beer Code. The ratings were scored according to both the 1997 and the 2006 versions of the Beer Code. According to the 1997 criteria, raters identified an average of 26 guideline violations across the six ads; the number of violations was reduced to 18 when the 2006 criteria were applied. The difference was statistically significant and was primarily attributable to changes in guidelines dealing with the portrayal of illegal activity, humorous situations and the act of drinking. By removing or revising commonly violated guidelines, the 2006 Beer Code revision permits portrayal of previously objectionable ad content and increases the likelihood that risky drinking behaviours will be portrayed in US beer advertisements. Copyright © 2009 John Wiley & Sons, Ltd.