Alexander C. Wagenaar

Effects of beverage alcohol price and tax levels on drinking: a meta-analysis of 1003 estimates from 112 studies

AIMS We conducted a systematic review of studies examining relationships between measures of beverage alcohol tax or price levels and alcohol sales or self-reported drinking. A total of 112 studies of alcohol tax or price effects were found, containing 1003 estimates of the tax/price-consumption relationship. DESIGN Studies included analyses of alternative outcome measures, varying subgroups of the population, several statistical models, and using different units of analysis. Multiple estimates were coded from each study, along with numerous study characteristics. Using reported estimates, standard errors, t-ratios, sample sizes and other statistics, we calculated the partial correlation for the relationship between alcohol price or tax and sales or drinking measures for each major model or subgroup reported within each study. Random-effects models were used to combine studies for inverse variance weighted overall estimates of the magnitude and significance of the relationship between alcohol tax/price and drinking. FINDINGS Simple means of reported elasticities are -0.46 for beer, -0.69 for wine and -0.80 for spirits. Meta-analytical results document the highly significant relationships (P < 0.001) between alcohol tax or price measures and indices of sales or consumption of alcohol (aggregate-level r = -0.17 for beer, -0.30 for wine, -0.29 for spirits and -0.44 for total alcohol). Price/tax also affects heavy drinking significantly (mean reported elasticity = -0.28, individual-level r = -0.01, P < 0.01), but the magnitude of effect is smaller than effects on overall drinking. CONCLUSIONS A large literature establishes that beverage alcohol prices and taxes are related inversely to drinking. Effects are large compared to other prevention policies and programs. Public policies that raise prices of alcohol are an effective means to reduce drinking.

Project Northland: outcomes of a communitywide alcohol use prevention program during early adolescence.

OBJECTIVES Project Northland is an efficacy trial with the goal of preventing or reducing alcohol use among young adolescents by using a multilevel, communitywide approach. METHODS Conducted in 24 school districts and adjacent communities in northeastern Minnesota since 1991, the intervention targets the class of 1998 (sixth-grade students in 1991) and has been implemented for 3 school years (1991 to 1994). The intervention consists of social-behavioral curricula in schools, peer leadership, parental involvement/education, and communitywide task force activities. Annual surveys of the class of 1998 measure alcohol use, tobacco use, and psychosocial factors. RESULTS At the end of 3 years, students in the intervention school districts report less onset and prevalence of alcohol use than students in the reference districts. The differences were particularly notable among those who were nonusers at baseline. CONCLUSIONS The results of Project Northland suggest that multilevel, targeted prevention programs for young adolescents are effective in reducing alcohol use.

The effects of community policies to reduce youth access to tobacco.

OBJECTIVES This study tested the hypothesis that adoption and implementation of local policies regarding youth access to tobacco can affect adolescent smoking. METHODS A randomized community trial was conducted in 14 Minnesota communities. Seven intervention communities participated in a 32-month community-organizing effort to mobilize citizens and activate the community. The goal was to change ordinances, merchant policies and practices, and enforcement practices to reduce youth access to tobacco. Outcome measures were derived from surveys of students before and after the intervention and from tobacco purchase attempts in all retail outlets in the communities. Data analyses used mixed-model regression to account for the clustering within communities and to adjust for covariates. RESULTS Each intervention community passed a comprehensive youth access ordinance. Intervention communities showed less pronounced increases in adolescent daily smoking relative to control communities. Tobacco purchase success declined somewhat more in intervention than control communities during the study period, but this difference was not statistically significant. CONCLUSIONS This study provides compelling evidence that policies designed to reduce youth access to tobacco can have a significant effect on adolescent smoking rates.

The Value of Interrupted Time-Series Experiments for Community Intervention Research

Greater use of interrupted time-series experiments is advocated for community intervention research. Time-series designs enable the development of knowledge about the effects of community interventions and policies in circumstances in which randomized controlled trials are too expensive, premature, or simply impractical. The multiple baseline time-series design typically involves two or more communities that are repeatedly assessed, with the intervention introduced into one community at a time. It is particularly well suited to initial evaluations of community interventions and the refinement of those interventions. This paper describes the main features of multiple baseline designs and related repeated-measures time-series experiments, discusses the threats to internal validity in multiple baseline designs, and outlines techniques for statistical analyses of time-series data. Examples are given of the use of multiple baseline designs in evaluating community interventions and policy changes.

MANDATED SERVER TRAINING AND REDUCED ALCOHOL-INVOLVED TRAFFIC CRASHES: A TIME SERIES ANALYSIS OF THE OREGON EXPERIENCE

This paper reports the results from an evaluation of the first statewide mandated training for alcohol servers. The state of Oregon introduced training for all alcohol servers (and for one year all owners/managers) beginning in December 1986. Servers must complete training once over a five-year cycle; by December 1989, over 50% of servers and managers had been trained. We found statistically significant reductions in single-vehicle nighttime traffic crashes (those with high percentage of alcohol involvement) by the end of 1989 following the implementation of the compulsory server-training policy.

Effects of State Medical Marijuana Laws on Adolescent Marijuana Use

OBJECTIVES Medical marijuana laws (MMLs) have been suggested as a possible cause of increases in marijuana use among adolescents in the United States. We evaluated the effects of MMLs on adolescent marijuana use from 2003 through 2011. METHODS We used data from the Youth Risk Behavior Survey and a difference-in-differences design to evaluate the effects of passage of state MMLs on adolescent marijuana use. The states examined (Montana, Rhode Island, Michigan, and Delaware) had passed MMLs at different times over a period of 8 years, ensuring that contemporaneous history was not a design confound. RESULTS In 40 planned comparisons of adolescents exposed and not exposed to MMLs across states and over time, only 2 significant effects were found, an outcome expected according to chance alone. Further examination of the (nonsignificant) estimates revealed no discernible pattern suggesting an effect on either self-reported prevalence or frequency of marijuana use. CONCLUSIONS Our results suggest that, in the states assessed here, MMLs have not measurably affected adolescent marijuana use in the first few years after their enactment. Longer-term results, after MMLs are more fully implemented, might be different.

Developing public health regulations for marijuana: lessons from alcohol and tobacco.

Until November 2012, no modern jurisdiction had removed the prohibition on the commercial production, distribution, and sale of marijuana for nonmedical purposes-not even the Netherlands. Government agencies in Colorado and Washington are now charged with granting production and processing licenses and developing regulations for legal marijuana, and other states and countries may follow. Our goal is not to address whether marijuana legalization is a good or bad idea but, rather, to help policymakers understand the decisions they face and some lessons learned from research on public health approaches to regulating alcohol and tobacco over the past century.

Communities mobilizing for change on alcohol: Lessons and results from a 15-community randomized trial

Communities Mobilizing for Change on Alcohol (CMCA) is a 15-community randomized trial designed to develop, implement, and evaluate a 2½ year community organizing intervention to change policies and practices of major community institutions. Pre- and post-data were collected via: surveys of high school students, surveys of youth age 18–20, surveys of alcohol retailers, alcohol purchase attempts, content analyses of media coverage, arrest and car crash indicators, surveys of strategy team members, and process records. Organizers and local strategy teams changed policies and practices of community institutions such as law enforcement agencies, alcohol merchants, and sponsors of community events, leading to significant changes in alcohol-related behaviors among 18- to 20-year-olds, and significant reductions in the propensity of alcohol establishments to serve alcohol to youth.

Policy Options for Prevention: The Case of Alcohol

Reducing the availability of alcohol through alcohol control policies such as excise taxes and the minimum legal drinking age has been effective in reducing a wide range of alcohol-related problems, including traffic crashes, liver cirrhosis, and violence. Alcohol control policies may be classified into two overlapping categories-public and institutional policies. Some policies such as alcohol server training may be either mandated by governmental jurisdictions or voluntarily adopted by individual institutions, which include alcohol retail establishments, other businesses, worksites, schools, colleges/universities, law enforcement agencies, religious institutions, insurance agencies, and alcohol producers. Public policies may be mandated by national, state/provincial, or local governments to regulate where, when, and how alcohol is sold and consumed. This paper describes the wide array of public and institutional policies available to reduce alcohol-related problems. Summaries of research evaluating specific alcohol control policies are provided when available.

Enforcement of the Legal Minimum Drinking Age in the United States

We studied patterns and levels of enforcement of the legal drinking age in the United States. Major findings include: (1) rates of enforcement of the legal drinking age are very low; (2) actions against outlets or adults providing alcohol to youth are particularly rare; (3) two of every thousand occasions of illegal drinking by youth under 21 are estimated to result in an arrest; (4) five of every 100,000 youth drinking occasions are estimated to result in an Alcohol Beverage Control agency action against an alcohol outlet; (5) penalties appear too lenient to deter providers of alcohol; and (6) levels of enforcement of the drinking age vary significantly across states.Recommendations for public policy and enforcement actions include: (1) increased enforcement effort be directed at those who provide alcohol to underage youth; (2) significant increases in the numbers of Alcohol Beverage Control enforcement personnel are needed; (3) one or more officers in each local enforcement agency should be designated as the alcohol control officer; (4) regular sting operations in retail alcohol outlets are needed; (5) all police-attended alcohol-involved incidents should include a record of the source of the alcohol; and (6) effective long-term efforts will require attention to the broader environment that encourages youth drinking.