James F. Mosher

Efficacy and the strength of evidence of U.S. alcohol control policies

BACKGROUND Public policy can limit alcohol consumption and its associated harm, but no direct comparison of the relative efficacy of alcohol control policies exists for the U.S. PURPOSE To identify alcohol control policies and develop quantitative ratings of their efficacy and strength of evidence. METHODS In 2010, a Delphi panel of ten U.S. alcohol policy experts identified and rated the efficacy of alcohol control policies for reducing binge drinking and alcohol-impaired driving among both the general population and youth, and the strength of evidence informing the efficacy of each policy. The policies were nominated on the basis of scientific evidence and potential for public health impact. Analysis was conducted in 2010-2012. RESULTS Panelists identified and rated 47 policies. Policies limiting price received the highest ratings, with alcohol taxes receiving the highest ratings for all four outcomes. Highly rated policies for reducing binge drinking and alcohol-impaired driving in the general population also were rated highly among youth, although several policies were rated more highly for youth compared with the general population. Policy efficacy ratings for the general population and youth were positively correlated for reducing both binge drinking (r=0.50) and alcohol-impaired driving (r=0.45). The correlation between efficacy ratings for reducing binge drinking and alcohol-impaired driving was strong for the general population (r=0.88) and for youth (r=0.85). Efficacy ratings were positively correlated with strength-of-evidence ratings. CONCLUSIONS Comparative policy ratings can help characterize the alcohol policy environment, inform policy discussions, and identify future research needs.

A new scale of the U.S. Alcohol policy environment and its relationship to binge drinking

BACKGROUND Of outcomes related to excessive drinking, binge drinking accounts for approximately half of alcohol-attributable deaths, two thirds of years of potential life lost, and three fourths of economic costs. The extent to which the alcohol policy environment accounts for differences in binge drinking in U.S. states is unknown. PURPOSE The goal of the study was to describe the development of an Alcohol Policy Scale (APS) designed to measure the aggregate state-level alcohol policy environment in the U.S. and assess the relationship of APS scores to state-level adult binge drinking prevalence in U.S. states. METHODS Policy efficacy and implementation ratings were developed with assistance from a panel of policy experts. Data on 29 policies in 50 states and Washington DC from 2000-2010 were collected from multiple sources and analyzed between January 2012 and January 2013. Five methods of aggregating policy data to calculate APS scores were explored; all but one was weighted for relative policy efficacy and/or implementation. Adult (aged ≥18 years) binge drinking prevalence data from 2001-2010 was obtained from the Behavioral Risk Factor Surveillance System surveys. APS scores from a particular state-year were used to predict binge drinking prevalence during the following year. RESULTS All methods of calculating APS scores were significantly correlated (r >0.50), and all APS scores were significantly inversely associated with adult binge drinking prevalence. Introducing efficacy and implementation ratings optimized goodness of fit in statistical models (e.g., unadjusted beta=-3.90, p<0.0001, R(2)=0.31). CONCLUSIONS The composite measure(s) of the alcohol policy environment have internal and construct validity. Higher APS scores (representing stronger policy environments) were associated with less adult binge drinking and accounted for a substantial proportion of the state-level variation in binge drinking among U.S. states.

State Laws Mandating or Promoting Training Programs for Alcohol Servers and Establishment Managers: An Assessment of Statutory and Administrative Procedures

We conducted a qualitative analysis of 23 state Responsible Beverage Service (RBS) laws to determine how effective the laws are in mandating or encouraging high-quality RBS programs. As of January, 2001, 12 states at least partially mandate RBS training for alcohol establishments and 11 states offer incentives to encourage participation in RBS training. We collected information regarding state RBS laws from two sources: (1) RBS statutes and associated regulatory provisions, and (2) telephone surveys of Alcoholic Beverage Control agency staff. We identified and evaluated five components of RBS laws: program requirements, administrative requirements, enforcement provisions, penalties for lack of compliance with law, and benefits for participation in training programs. Comprehensiveness of RBS laws varied by state; however, RBS legislation was weak across all states overall. While some states were strong in one or two of the RBS components, almost all states were weak in at least one component.

Public health, not social warfare: a public health approach to illegal drug policy.

This article makes three major arguments: (1) the current War on Drugs undercuts public health values and premises, resulting in a war on the poor, disenfranchised, people of color, the homeless, and the unemployed; (2) drug problems should be addressed primarily within the realm of public health policy rather than criminal justice policy; and (3) to achieve a viable public health drug policy, the public health community needs to build grassroots support and become effective activists. The article reviews the history of past drug wars, analyzes recent trends in illegal drug use and problems, and critiques current policy initiatives and their consequences. It then outlines a comprehensive, public health approach to addressing illegal drug problems, and concludes with an analysis of what steps are needed to become effective in the public policy arena.

Preemption or Prevention?: Lessons from Efforts to Control Firearms, Alcohol, and Tobacco

The judicial doctrine of preemption allows federal or state governments to restrict the ability of state or local governments, respectively, to regulate in a given area. Industries whose products create substantial public health risks have begun to promote preemptive legislation which prevents the lower levels of government from adopting strong public health protections. This article discusses the implications of preemptive legislation concerning three of the most harmful products available in America: tobacco, firearms and alcohol. These examples illustrate the potential danger that preemptive legislation poses to efforts to prevent illness, injury and death caused by these products.

Justifying Alcohol Taxes to Public Officials

a G\ Y now most scholars working in the field of alcoholism S and other alcohol-related problems are familiar with the B 12 2 following thesis: mean consumption of alcohol in a population is related to the incidence of heavy consumption. : Measures undertaken by governments to control mean Q__OtSs consumption-such as alcohol taxes, restrictions on the drinking age, and the like-play an important role in limiting the adverse health consequences of heavy alcohol consumption-e.g. cirrhosis, highway crashes related to alcohol, and so forth (1). The evidence supporting this public health approach to the prevention of alcohol-related disease is not without controversy. Nevertheless, the number of studies, their diverse methodologies, and the recurrence of these findings in a number of different locales and settings make it difficult for the scholar or the public official to dismiss them out of hand. The public debate over measures to control alcohol consumption has already begun. This is especially the case with age restrictions. But a similar debate is beginning concerning excise taxes for alcohol. Governments at all levels are hungry for revenues, if for no better reason than to offset massive budget deficits, and the alcohol tax is appealing for several reasons. It has not been raised at the federal level for over thirty years. In this past year the cigarette tax was raised. Both of these commodities are traditional sources of taxation. A motive no more complex than equal treatment of like commodities mingled with revenge on the part of the tobacco lobby may result in increased federal excise taxes for alcohol. As the topic of alcohol taxation returns to the public agenda, it may help to ask some basic policy questions. We see these as three-fold: First, how have we employed the alcohol tax in the past and what is our current pattern of taxation? Second, what do these trends, plus the public health

Public action and awareness to reduce alcohol-related problems: a plan of action.

Inconsistency and confusion about the use of alcohol are the rule in the major institutions of American society. Efforts to change the drinking behavior of individuals have failed because institutional messages are at odds with public health messages. Thus changing the institutional environment around alcohol must be a priority for prevention efforts. Messages inconsistent with prevention goals emanate from federal, state and local governments; media and educational institutions; professional sports; medical institutions; corporations; charitable foundations; the retail beverage industry; the insurance industry; judicial and legal institutions; churches; and institutions in minority populations. Changing the practices of these institutions requires well-coordinated grassroots efforts. A successful plan of action must include translation and dissemination of research through action-oriented informational resources: seminars, conferences and workshops introducing people to the institutional perspective on alcohol-related problems; designation and training of leaders; creation of issue-oriented coalitions which provide the basis for broadening cooperation; creation of alcohol-specific positions in major national advocacy organizations; development of a national alcohol response network, facilitating constant contact and coordinated planning among alcohol policy activists; and creation of technical assistance centers, which can provide training and resources to potential activists and nascent coalitions.

Underage Drinking: A Review of Trends and Prevention Strategies

Underage drinking and its associated problems have profound negative consequences for underage drinkers themselves, their families, their communities, and society as a whole, and contribute to a wide range of costly health and social problems. There is increased risk of negative consequences with heavy episodic or binge drinking. Alcohol is a factor related to approximately 4,300 deaths among underage youths in the U.S. every year. Since the mid-1980s, the nation has launched aggressive underage drinking prevention efforts at the federal, state, and local levels, and national epidemiologic data suggest that these efforts are having positive effects. For example, since 1982, alcohol-related traffic deaths among youth aged 16-20 years have declined by 79%. Evidence-based or promising strategies for reducing underage drinking include those that limit the physical, social, and economic availability of alcohol to youth, make it illegal for drivers aged <21 years to drive after drinking, and provide mechanisms for early identification of problem drinkers. Strategies may be implemented through a comprehensive prevention approach including policies and their enforcement, public awareness and education, action by community coalitions, and early brief alcohol intervention and referral programs. This paper focuses on underage drinking laws and their enforcement because these constitute perhaps the most fundamental component of efforts to limit youth access to and use of alcohol.

State Pre-Emption, Local Control, and Alcohol Retail Outlet Density Regulation

The substantial health and economic costs of excessive alcohol consumption make its reduction a major public health and economic concern. The Community Preventive Services Task Force, based on a systematic review of the research literature, concluded that restricting alcohol retail outlet density through local land use and zoning regulations is an effective strategy for reducing these costs. Yet the implementation of the Task Forces recommendation is limited by state pre-emption, which determines the extent to which states allow local government to adopt policies and enact legislation. This article summarizes the state pre-emption doctrine, its status in the 50 states pertaining to alcohol retail outlet density regulation, and findings from state legal analyses conducted in six states. Data reflect state laws in effect as of January 1, 2012. Analyses were conducted during the 2012 calendar year. An examination of relevant state laws found five distinct pre-emption categories: exclusive state licensing, exclusive state licensing and concurrent local zoning, joint licensing, exclusive local licensing, and a mixed system. The analysis demonstrated wide variability across the states, ranging from exclusive state pre-emption to broad state delegation of authority to local governments. Pre-emption is applied differentially in many states based on retail outlet characteristics. In many cases, state pre-emption laws are ambiguous in terms of their application, leading to inconsistent and confusing court interpretations. Reforms targeting the adverse impact of state pre-emption on alcohol retail outlet density have the potential for reducing the harm associated with excessive alcohol consumption. State and local public health departments can support such reforms by implementing educational, analytic, monitoring, and technical assistance activities.

Alcohol Policy and the Nation's Youth

blem among young people. Alcohol-related motor vetf X hicle crashes are the leading cause of death among those e under 25 years of age, and approximately 1,000 young *vKsts( children die each year of alcohol-related causes. Thousands more young lives are shattered by crippling injuries and other alcohol-related problems. And the problems extend to childrens immediate environment-the family. According to a recent Harris poll, 56 percent of all respondents report that a member of their family or a close friend drinks too much. Family violence, family breakups, and child abuse, increasingly recognized as serious public health problems in the United States, are closely associated with heavy alcohol consumption. These statistics suggest the need for a vigorous, comprehensive alcohol policy aimed at preventing alcohol-related problems. During the last twenty years, important strides have been made, notably in a commitment to school-based education efforts, increased availability of treatment programs, more mass media campaigns, and more effective deterrence policies, particularly regarding drinking and driving. Prevention, however, requires a far broader set of goals and agendas. Individuals, particularly young people, act within a social, economic and cultural environment that shapes the choices available to them. The missing component in current alcohol policy is precisely the examination of these broader factors-how they are shaped and what public policy options are available to us as a society to change them.