Abstract
Excessive alcohol consumption contributes significantly to premature mortality, injuries and morbidity, and a range of U.S. state policies have been shown to reduce these behaviors. Monitoring state alcohol policy environments is essential, but methodologically challenging given that new laws may be passed (or repealed) each year, resulting in considerable variation across states. Existing measures have not been made public or have only a single year available. We develop a new replicable measure, the state alcohol policy score, for each state and year 2004–2009, that captures the essential features of a state’s evidence-based alcohol policies. We evaluate its similarity to two existing alcohol policy measures and validate it by replicating findings from a previous study that used one of those measures to assess its relationship with several binge drinking outcomes. Estimates of the association between one-year lagged state alcohol policy scores and state binge drinking outcomes, obtained from the 2005–2010 Behavioral Risk Factor Surveillance System surveys (n = 440,951, 2010), were produced using Generalized Linear Models that controlled for state and individual-level co-variates, with fixed effects for year and region. We find a 10-percentage point increase in the state alcohol policy score was associated with a 9% lower odds of binge drinking (aOR = 0.91, 95% CI 0.89, 0.92; N = 1,992,086), a result consistent for men, women and for most age and race subgroups. We find that gender gaps in binge drinking behaviors narrowed in states with higher state alcohol policy scores. These results were nearly identical to those found in other studies using different scores obtained with the aid of expert opinions. We conclude that the score developed here is a valid measure that can be readily updated for monitoring and evaluating the variation and impact of state alcohol policies and make available our state scores for the years of the study.
Highlights
Excessive alcohol consumption—which can include heavy drinking, binge drinking, repeated binge drinking, and the quantity of drinks consumed in a single binge episode—contributes significantly to premature mortality, injuries and morbidity in the United States [1]
Consistent with the call to replicate findings and make data available in an open science framework, we develop a state alcohol policy score 2004–2009 that relies on public use data supplemented with original legal research and employs a transparent coding approach that captures the complexity of each law, similar to Erickson [7]
Persuading states with few or only weak alcohol policies to adopt the full range of evidence-based approaches can significantly contribute to reducing alcohol-related harms
Summary
Excessive alcohol consumption—which can include heavy drinking, binge drinking, repeated binge drinking, and the quantity of drinks consumed in a single binge episode—contributes significantly to premature mortality, injuries and morbidity in the United States [1]. While some federal efforts have been made to regulate alcohol consumption, U.S states are largely responsible for establishing policies to reduce alcohol harms. Policies such as restricting prices and sales, taxation and provision of alcohol, and penalties for driving while intoxicated vary widely across states [2]. Monitoring the effectiveness of state policy environments is essential to meeting the Healthy People 2020 goals of a 10% reduction in average alcohol consumption and a 24% reduction in binge drinking by adults [5]. Ongoing policy surveillance is especially important given that evidence for some alcohol control policies is more than a generation old and changes in the demographic, economic and social context in some states—as well as social changes in alcohol consumption—may have altered their effectiveness
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