Drink-driving Policy Research Articles

The relationship between alcohol availability and drink-driving policies and admissions to substance use disorder treatment during pregnancy.

Pregnancy-specific alcohol policies are widely adopted yet have limited effectiveness and established risks. It is unknown whether general population alcohol policies are effective during pregnancy. This study investigated associations between general population policies and alcohol treatment admission rates for pregnant people specifically. Data are from the Treatment Episodes Data Set: Admissions and state-level policy data for 1992-2019 (n=1,331 state-years). The primary outcome was treatment admissions where alcohol was the primary substance, and the secondary outcome included admissions where alcohol was any substance. There were five policy predictors: 1) Government spirits monopoly, 2) Ban on Sunday sales, 3) Grocery store sales, 4) Gas station sales, and 5) Blood alcohol concentration (BAC) laws. Covariates included poverty, unemployment, per capita cigarette consumption, state and year fixed effects, and state-specific time trends. In models with alcohol as the primary substance, prohibiting spirits sales in grocery stores (vs. allowing heavy beer and spirits) had lower treatment admission rates [IRR=0.88, 95% CI: 0.78-0.99, p=0.028]. States with BAC laws at 0.10% (vs. no law) had higher treatment admission rates [IRR=1.24, 95% CI: 1.08-1.43, p=0.003]. When alcohol was any substance, prohibiting spirits sales in grocery stores (vs. allowing heavy beer and spirits) was again associated with lower treatment admission rates [IRR=0.89, 95% CI: 0.80-0.98, p=0.021], but there was no association for BAC laws. Restrictions on grocery store spirits sales and BAC laws were associated with lower and higher alcohol treatment admission rates among pregnant people, respectively, suggesting general population alcohol policies are relevant for pregnant people's treatment utilization.

The role of alcohol control policies in the reversal of alcohol consumption levels and resulting attributable harms in China

Yearly adult per capita consumption of alcohol in China between 2016 and 2019 decreased by 2.4 L of pure alcohol, or 33%. According to the World Health Organization, this decrease in consumption was accompanied by reductions in alcohol-attributable mortality of 23% between 2015 and 2019. This paper examines the contribution of alcohol control policies in China to these public health gains. A systematic search of the literature was conducted on alcohol control policies and their effectiveness in China as part of a larger search of all countries in WHO Western Pacific Region. In addition to articles on empirical evidence on the impact of such alcohol control policies, we also searched for reviews. The plausibility of changes of traditional alcohol control policies (taxation increases, availability restrictions, restriction on advertisement and marketing, drink-driving laws, screening and brief interventions) in explaining reductions of consumption levels and attributable mortality rates was explored. There was some progress in the successful implementation of strict drink-driving policies, which could explain reductions in traffic injuries, including fatalities. Other traditional alcohol control policies seem to have played a minimal role in reducing alcohol consumption and attributable harms during the time period 2016–2019. However, an anti-corruption campaign was extensive enough to have substantially contributed to these reductions. The campaign prohibited the consumption of alcoholic beverages in everyday life of government officials and thus contributed to a de-normalization of alcohol. While this anti-corruption campaign was the only policy to potentially explain marked decreases in levels of alcohol consumption and attributable mortality, more detailed research is required to determine exactly how the campaign achieved these decreases.

Quantitative tools and measurements for assessing the implementation of regulatory policies in reducing alcohol consumption and alcohol-related harms: A scoping review.

Implementation of alcohol control policy is a global priority as alcohol contributes to negative individual health and societal impacts. However, there are no available reviews that comprehensively provide tools and measurements for assessing the implementation of alcohol control policy. This study reviews tools and measurements for assessing alcohol policy implementation. Policies considered include alcohol pricing and taxation, alcohol marketing control, physical availability control and drink-driving policy. We conducted a scoping review from Scopus, Web of Science and the World Health Organization's website. We included studies on policy implementation for the four most effective prevention policies published worldwide between 2000 and 2021. The search yielded 11,654 articles and these were narrowed down to 39 included studies. Of these 39 studies, almost half assessed the implementation of a drink-driving policy (n=19), followed multipolicy (n=12) and physical availability control (n=8). There was no single study assessing policy implementation of pricing and taxation or alcohol marketing control. The majority of the studies were conducted in high-income countries (n=31). Globally, there is no standardised tool or guidelines for measuring the policy implementation of these four policies. The tools for measuring policy implementation mostly focused on a single policy, and few covered multiple policies. We recommend developing standardised tools and measurements to monitor policy implementation across multiple policies at country levels. This review highlighted a lack of comprehensive and standardised tools to assess policy implementation and the limited number of studies on alcohol policy implementation in low- and middle-income countries.

Barriers and Facilitators to the Implementation of Effective Alcohol Control Policies: A Scoping Review.

Implementation of effective alcohol control policies is a global priority. However, at the global and national levels, implementing effective policies is still challenging, as it requires commitment from multiple stakeholders. This review provides a synthesis of barriers and facilitators to implementing effective alcohol control policies. We conducted a scoping review from two main databases: Scopus and Web of Science, and the grey literature from the World Health Organization’s website. We included any studies investigating barriers and facilitators to implementing four effective policies: Alcohol pricing and taxation, control of physical availability, alcohol marketing control, and drink-driving policy. Articles published between 2000 and 2021 were included. The search yielded 11,651 articles, which were reduced to 21 after the assessment of eligibility criteria. We found five main barriers: resource constraint; legal loopholes; lack of evidence to support policy implementation, particularly local evidence; low priority of policy implementation among responsible agencies; and insufficient skills of implementers. Facilitators, which were scarce, included establishing monitoring systems and local evidence to support policy implementation and early engagement of implementing agencies and communities. We recommend that national governments pay more attention to potential barriers and facilitators while designing alcohol control regulations and implementing effective policies.

Are Countries' Drink-Driving Policies Associated With Harms Involving Another Driver's Impairment?

International drink-driving policy research generally focuses on aggregate outcomes (e.g., rates of crashes, fatalities) without emphasizing secondhand alcohol-related vehicular harms. In contrast, we investigate associations between drink-driving policies and harms involving another driver's impairment. Alcohol's harms to others (AHTO) survey data from 12 countries (analytic N=29,616) were linked to national alcohol policy data from the World Health Organization. We examined separately associations of two 12-month driving-related AHTOs (passenger with an impaired driver; vehicular crash involving someone else's drink driving) with 3 national drinking-driving policies-legal blood alcohol concentration (BAC) limits, use of random breath testing, use of sobriety checkpoints, and comprehensive penalties for drink-driving (community service, detention, fines, ignition interlocks, license suspension/revocation, mandatory alcohol treatment, vehicle impoundment, and penalty point system), plus 2 alcohol tax variables (having excise taxes and value-added tax [VAT] rate). Multilevel logistic regression addressed clustering of individuals within countries and subnational regions, while adjusting for individuals' gender, age, marital status, risky drinking, and regional drinking culture (% male risky drinkers in sub-national region). Controlling for national-, regional-, and individual-level covariates, comprehensive penalties were significantly and negatively associated with both outcomes; other vehicular policy variables were not significantly associated with either outcome. A society's VAT rate was negatively associated with riding with a drunk driver. Regional male drinking culture was positively associated with riding with an impaired driver, but was not significantly associated with being in a vehicular crash due to someone else's drinking. In both models, being male, being younger, and engaging in risky drinking oneself each were positively associated with vehicular harms due to someone else's drinking. Although results are associational and not causal, comprehensive penalties may be promising policies for mitigating driving-related harms due to another drinker. Higher VAT rate might reduce riding with a drunk driver.

Comprehensive analysis of alcohol policies in the Latin America and the Caribbean.

The aim of this paper is to describe the context of alcohol use and problems in Latin America and the Caribbean (LAC), the environmental context for alcohol-related policy, drinking trends, harm and policy and to systematically review policies implemented to reduce alcohol-related burden. LAC-based studies relating to the existence and effects of public health-oriented alcohol policies are described. The review is informed by a literature search of alcohol policies in LAC in English and in Spanish in several platforms, and in publications of international organisations, including grey and scientific literature. Only 30 documents measuring policy impact were identified for the policy analysis. Most of the policies are focused on brief interventions, and most have little evidence on their effectiveness. Alcohol taxation and drink-driving policies appear to have the highest impact if enforcement is adequately performed. The studies reviewed indicate a pattern of modelling policy interventions but implementing only a few, and a paucity of sustained or systematic evaluations. Although patterns of use indicate alcohol use should be a major public health priority, only a few countries in LAC have a national policy or plan dedicated to alcohol, representing a low political commitment to considering alcohol as a public health priority.

Alcohol policy in Chile: a systematic review of policy developments and evaluations.

To comprehensively review enacted and proposed alcohol laws and existing impact evaluations of national alcohol policies in Chile. We searched enacted laws in the Chilean National Library of Congress, proposed laws in the websites of the House of Deputies and Senate and impact evaluations in PubMed, Web of Science, Scopus, Scielo, JSTOR, Epistemonikos and OpenGrey from inception to February 2019. Eligibility criteria included enacted laws and proposed laws on national alcohol policies and research studies evaluating the impact of national alcohol policies. One author screened enacted laws and proposed laws; two authors independently screened research records. We included any national alcohol policy intervention and classified policies according to 10 World Health Organization (WHO) alcohol policy domains. We used the Cochrane EPOC Review Group criteria to assess risk of bias of research records. We registered the review protocol in PROSPERO, registration record CRD42016050156. We identified and screened 229 enacted laws, 138 proposed laws and 1538 research records. Of these, 72 enacted laws, 118 proposed laws and three research articles were eligible for synthesis. We found enacted policies in all WHO alcohol policy domains. Regarding the most cost-effective policies, Chile has made limited use of taxation, has not regulated alcohol marketing and has weakened alcohol availability regulation. We found a large number of proposed laws, 79% of which would strengthen alcohol control. The few impact evaluation studies examined drink-driving policies and found a short-term reduction of alcohol-related injuries and deaths. Chile has enacted alcohol policies in all World Health Organization policy domains, but has not adopted policies with highest likely cost-effectiveness. Only the impact of drink-driving policies has been evaluated.

Adolescents' alcohol use and strength of policy relating to youth access, trading hours and driving under the influence: findings from Australia.

To determine (i) whether the strength of Australian alcohol control policy in three domains (youth access, trading hours and drink driving) changed during the 2000s; and (ii) estimate associations between these policies and adolescent drinking after adjusting for television alcohol advertising exposures, alcohol outlet density, alcohol price changes, exposure to negative articles about alcohol in daily newspapers and adult drinking prevalence. Repeated cross-sectional surveys conducted triennially from 2002 to 2011. Multi-level modelling examined the association between alcohol control policies and drinking prevalence after adjusting for covariates. Four Australian capital cities between 2002 and 2011. Students aged 12-17years participating in a triennial national representative school-based survey (sample size range/survey: 9805-13 119). Outcome measures were: past month drinking and risky drinking (5+ drinks on a day) in the past 7days. Policy strength in each of three domains (youth access, trading hours, drink-driving) were the key predictor variables. Covariates included: past 3-month television alcohol and alcohol-control advertising, alcohol outlet density, alcohol price change, negatively framed newspaper alcohol articles, adult drinking prevalence and student demographic characteristics. During the study period, the strength of youth access policies increased by 10%, trading hours policies by 14% and drink-driving policies by 58%. Past-month and risky drinking prevalence decreased (e.g. past-month: 2002: 47.4% to 2011: 26.3%). Multivariable analyses that included all policy variables and adjusted for year, student and other covariates showed past-month drinking to be associated inversely with stronger trading hours policies [odds ratio (OR)=0.80, 95% confidence interval (CI)=0.69, 0.94], but not youth access (OR=0.92 95% CI=0.81, 1.04) or drink-driving (OR=1.00, 95% CI=0.93, 1.09). Risky drinking was associated inversely with stronger youth access policies (OR=0.82, 95% CI=0.69, 0.98), but not trading hours (OR=0.85, 95% CI=0.66, 1.09) or drink-driving (OR=1.02, 95% CI=0.90, 1.14) policies. Population-directed policies designed to reduce alcohol availability and promotion may reduce adolescents' alcohol use.

S08 * ESBRA-NIAAA JOINT SYMPOSIUM ALCOHOLIC LIVER DISEASE: FROM PATHOGENESIS TO TREATMENT * S08.1 * INCREASING BURDEN OF ALCOHOLIC LIVER DISEASE 2011

S08 * ESBRA-NIAAA JOINT SYMPOSIUM ALCOHOLIC LIVER DISEASE: FROM PATHOGENESIS TO TREATMENT * S08.1 * INCREASING BURDEN OF ALCOHOLIC LIVER DISEASE 2011

Policy Implications of the WHO Strategy to Reduce the Harmful Use of Alcohol

Aims: To describe the supporting evidence and policy implications of the 10 target areas of the WHO strategy to reduce the harmful use of alcohol. Methods: Based on published systematic reviews of the literature and publications of the World Health Organization, the supporting evidence and policy implications of the 10 target areas are described. Findings: There is evidence to support action in each of the 10 target areas: leadership, awareness and commitment; health services’ response; community action; drink-driving policies; availability of alcohol; marketing of alcoholic beverages; pricing policies; reducing the negative consequences of intoxication; reducing the public health impact of illegal and informal alcohol; and monitoring and surveillance. Conclusions: The following policy measures have the strongest evidence: increasing alcohol taxes; government monopolies for the retail sale of alcohol; restricting the density of outlets and the days and hours of sale; increasing the minimum age of purchase; lowering the legal BAC levels for driving; introducing random breath-testing for driving; implementing widespread brief advice for hazardous and harmful alcohol consumption; and ensuring treatment for alcohol use disorders. There is reasonable evidence to support the introduction of a minimum price per gram of alcohol; restricting the volume of commercial communications; and enforcing the restrictions of sales to intoxicated and under-age people.

A Kind of Consensus on the Roads? Drink Driving Policy in Britain 1945-1970

The history of drink driving and legislative responses to it remain virtual terra incognita. This contribution traces developments in Britain between 1945 and the aftermath of the Road Safety Act in 1967. The first section focuses on the formation of an extra-parliamentary pressure group in the 1950s. This is complemented by an interpretation of the impact of the government-backed Drew Report (1959), and the ways in which Drew's research was rhetorically and creatively deployed by Graham Page, leading spokesman for the Pedestrians' Association and Ernest Marples, the Conservative Minister of Transport. The final section interrogates key debates leading up to the introduction of the breathalyser. The article concludes that belated introduction of road safety legislation in Britain in the 1960s revealed a high degree of cross-party consensus. Only senior officials at the Home Office, and to a lesser extent, at the Ministry of Transport, repeatedly threatened to delay reform.