The effects of beer taxes on physical child abuse

Alcohol prices, the April effect, and the environment, in violence-related injury in England and Wales

Violent injury varies widely across England and Wales as does the price of alcohol. While the links between alcohol consumption and violence are well established in the medical and epidemiological literature, a causal link is questionable. This paper cuts through the causative argument by reporting a link between the general price of alcohol and violence-related injury across the economic regions of England and Wales. It examines the influence of the real price of alcohol and identifies an 'April effect' that coincides with the annual uprating of alcohol prices for excise duties, on violence-related injuries recorded at Emergency Department attendance. The data are monthly frequency of violent injury rates covering the period 2005-2014 across the economic regions. The principal finding is that a one-way relationship between the real price of alcohol and violent injury is established, and tax policy can be used to reduce the incidence of violent injury and the associated health costs.

Can alcohol policy prevent harms to women and children from men's alcohol consumption? An overview of existing literature and suggested ways forward

The World Health Organization's list of cost-effective alcohol control policies is a widely-used resource that highlights strategies to address alcohol-related harms. However, there is more evidence on how recommended policies impact harms to people who drink alcohol-such as physical health problems caused by heavy alcohol use-than on secondhand harms inflicted on someone other than the person drinking alcohol, i.e., alcohol's harms to others. In this essay, we describe evidence of impacts of alcohol policy on harms to women and children resulting from men's alcohol consumption, as well as options for making policies more relevant for reducing intimate partner violence and child abuse. We begin with an overview of harms to women and children resulting from men's alcohol consumption and review cost-effective alcohol policies with potential to reduce these harms based on likely mechanisms of action. Next, we present a rapid review of reviews to describe existing evidence of impacts of these policies on the outcomes of physical violence, sexual violence, and child abuse and neglect. We found little evidence of systematic evaluation of impacts of these important alcohol policies on harms to women and children. Thus, we advocate for increased attention in evaluation research to the impacts of alcohol policies on harms experienced by women and children who are exposed to men who drink alcohol. We also argue for more consideration of a broader range of policies and interventions to reduce these specific types of harm. Finally, we present a conceptual model illustrating how alcohol policies may be supplemented with other interventions specifically tailored to reduce alcohol-related harms commonly experienced by women and children as a result of men's alcohol use.

Gender Wage Gap and Male Perpetrated Child Sexual Abuse

Given the fact that child abuse and intimate partner violence often co-occur, intra-household bargaining models provide a useful framework to investigate the relationship between macro-economic factors and child sexual abuse (CSA). Non-cooperative bargaining models predict that labor market opportunities that benefit women improve their bargaining power and lead to lower levels of intimate partner violence against them. We posit that this protective effect extends to children as well, and exploit exogenous variation in macro-economic factors to examine the impact of gender specific wages and employment on police reported CSA in South Carolina, Tennessee, and Virginia from 2006 to 2019. The empirical analysis provides evidence that narrowing the gender wage gap leads to a decline in police reported CSA incidents perpetrated by mothers' intimate partners, whereas improvements in relative employment opportunities do not yield any such effects. Consistent with previous literature, our results show that wages, not employment, determine bargaining power. The findings also underscore important spillover benefits of policy solutions directed towards narrowing the gender wage gap.

Neighborhood market potentials for alcohol use and rates of child abuse and neglect

BACKGROUND

Alcohol use can lead to child abuse and neglect even if the person using alcohol does not use heavily. Yet relatively few measures that reflect alcohol use are available at smaller geographic units. We assess whether the estimated level of total alcohol use per capita is related to measures of child abuse and neglect that include substantiated reports of maltreatment, total entries into foster care, and alcohol-related entries into foster care.

METHODS

Our sample consists of 326 Census block groups in Sacramento, California over three time points (978 space-time units). Administrative data for substantiations of child abuse and neglect and foster care entries are our outcomes. We create market potentials for alcohol use among 18- to 29-year-olds as our primary independent variable. Data are analyzed using Bayesian conditionally autoregressive spatio-temporal models.

RESULTS

Higher alcohol use potentials (as measured by total volume per capita of 18- to 29-year olds) are related to more children entering foster care due to drinking-related concerns by a parent or caregiver (RR = 1.032, 95% CI = [1.013, 1.051]), but not total substantiations for foster care entries. Neighborhoods with higher total volume of alcohol per 18- to 29-year-olds had more foster care entries when we used number of substantiations as the denominator (RR = 1.012, 95% CI = [1.0001, 1.023]) but were not related to foster care entries with alcohol misuse as a concern as a subset of all foster care entries.

CONCLUSIONS

Higher estimated volume of alcohol use per capita among young adults (aged 18 to 29) was related to more children entering foster care due to alcohol-related concerns. Reducing alcohol supply in alcohol outlets, specifically through off-premise establishments, might reduce rates for all entries into foster care or other out-of-home placement and substantiated child abuse and neglect.

The effects of false identification laws on underage alcohol-related traffic fatalities

We examine the effects of policies aimed at restricting the use of false identification to purchase alcohol on traffic fatalities involving alcohol-impaired underage drivers. We find that the implementation of policies that incentivize alcohol retailers to adopt ID scanners reduces traffic fatalities from accidents involving 16-18 year old drivers with a BAC >0, but we do not find that similar policies like vertical ID laws lead to statistically significant changes in traffic fatalities involving underage impaired drivers. A back-of-the-envelope calculation suggests that if all remaining states passed ID scanner laws, the reduction in underage alcohol-related fatal accidents would generate over $400 million in annual economic benefits.

Do ridesharing services increase alcohol consumption?

Recent studies suggest ridesharing services, such as Uber and Lyft, may reduce instances of intoxicated driving. However, such services may reduce the costs, and thus increase the frequency and intensity, of drinking activity. To examine whether ridesharing affects alcohol consumption, we leverage spatial and temporal variation in the presence of Uber's taxi-like service, UberX, across the United States. Using self-reported measures of alcohol consumption in the past 30 days among individuals aged 21 to 64, we find that UberX is associated with a 3.6% increase in number of drinks per drinking day, a 2.7% increase in drinking days, a 5.4% increase in total drinks, a 4.3% increase in the maximum number of drinks in a single occasion, and a 1.3% increase in those who report drinking any alcohol. For certain groups, such as males, individuals aged 21-34, and students, UberX is associated with even larger increases in drinking. For example, among those aged 21-34, total drinks increase by 7.4% and binge drinking instances increase by 9.5%. We also find that the marginal impact of Uber on drinking is larger in areas that have weaker public transit. Using administrative employment data, we find that some of the additional alcohol consumption is occurring at bars. Specifically, we estimate that UberX is associated with a 3.5% increase in employment and a 3.7% increase in total earnings among workers at NAICS-designated "drinking places".

The political economy of drug and alcohol regulation during the COVID-19 pandemic

States tightly regulate access to alcohol and other substances. During the pandemic and related state of emergency, state and federal governments adopted a variety of regulations affecting this access. State shelter-in-place orders included decisions about whether liquor stores and marijuana dispensaries are essential businesses. Decisions about telehealth access to medical marijuana or treatments for substance use disorders were made at the state and federal levels. This article examines the political economy behind these decisions, focusing on deviations from the norm including Pennsylvania's decision to close state-run liquor stores. Interest groups and other political considerations help explain state and federal policy changes affecting access to alcohol and other substances.

Do expansions in adolescent access to public insurance affect the decisions of substance use disorder treatment providers?

We apply a mixed-payer economy model to study the effects of changes in the generosity of children's public health insurance programs - measured by Medicaid and Children's Health Insurance Program income thresholds - on substance use disorder (SUD) treatment provider behavior. Using government data on specialty SUD treatment providers over the period 1997-2011 combined with a two-way fixed-effects model and local event study, we show that increases in the generosity of children's public health insurance induce providers to participate in some, but not all, public markets. Our effects appear to be driven by non-profit and government providers. Non-profit providers also appear to increase treatment quantity slightly in response to coverage expansions.

Impact of Alcohol Outlet Density on Reported Cases of Child Maltreatment in Japan: Fixed Effects Analysis

Background: Parental drinking habits or binge drinking are a known risk factor of child maltreatment. Though drinking habits are affected by alcohol outlet density, the direct association between alcohol outlet density and child maltreatment is still controversial.

Purpose: This study aimed to examine the impact of off-premises alcohol outlet density on child maltreatment cases reported to Child Guidance Centers in Japan.

Methods: A fixed effects model was used to investigate the association between a change in off-premises alcohol outlet density and a change in child maltreatment cases in each unit. Time-series of cross-sectional ecological data collected from across Japan over 16 years (2000 to 2015) was used, and maltreatment cases were further sub-grouped by type of maltreatment (physical, sexual, psychological abuse and neglect) and by perpetrators (father, stepfather, mother, and stepmother).

Results: The association between alcohol outlet density and total cases of child maltreatment was not observed (coefficient = 0.98, 95% confidence interval: −6.30, 8.25). However, alcohol outlet density was shown to be positively associated with neglect (coefficient = 3.08, 95% confidence interval: 0.54, 5.62), which indicates that 1 alcohol outlet per 1,000 adults increase would lead to 3 more neglect cases per 10,000 children. Also, a negative association was observed between a change in the incidence of total child maltreatment by father and a change in alcohol outlet density (coefficient = −3.03, 95% confidence interval: −5.78, −0.28).

Conclusion: The findings suggest that off-premises alcohol outlet density may have a causal effect on the increasing cases of neglect and decrease in maltreatment by father in Japan.

Assessing the impact of alcohol taxation on rates of violent victimization in a large urban area: an agent-based modeling approach

AIMS

To use simulation to estimate the impact of alcohol taxation on drinking, non-fatal violent victimization and homicide in New York City (NYC). We simulate the heterogeneous effects of alcohol price elasticities by income, level of consumption and beverage preferences, and examine whether taxation can reduce income inequalities in alcohol-related violence.

DESIGN

Agent-based modeling simulation.

SETTING

NYC, USA.

PARTICIPANTS

Adult population aged 18-64 years in the year 2000 in the 59 community districts of NYC. The population of 256 500 agents approximates a 5% sample of the NYC population.

MEASUREMENTS

Agents were parameterized through a series of rules that governed alcohol consumption and engagement in violence. Six taxation interventions were implemented based on extensive reviews and meta-analyses, increasing universal alcohol tax by 1, 5 and 10%, and beer tax by 1, 5 and 10%.

FINDINGS

Under no tax increase, approximately 12.2% [95% credible interval (prediction interval, PI) = 12.1-12.3%] were heavy drinkers. Taxation decreased the proportion of heavy drinkers; a 10% tax decreased heavy drinking to 9.6% (95% PI = 9.4-9.8). Beer taxes had the strongest effect on population consumption. Taxation influenced those in the lowest income groups more than the highest income groups. Alcohol-related homicide decreased from 3.22 per 100 000 (95% PI = 2.50-3.73) to 2.40 per 100 000 under a 10% universal tax (95% PI = 1.92-2.94). This translates into an anticipated benefit of ~1200 lives/year.

CONCLUSION

Reductions in alcohol consumption in a large urban environment such as New York City can be sustained with modest increases in universal taxation. Alcohol tax increases also have a modest effect on alcohol-related violent victimization. Taxation policies reduce income inequalities in alcohol-related violence.

Does daughter deficit promote paternal substance use? Evidence from China

BACKGROUND

China and various other countries have experienced unbalanced sex ratios in the marriage market, which triggers intense competition and pressure to get married. Meanwhile, China has more smokers and drinkers than any other countries in the world. This paper provides evidence on smoking and alcohol use as a stress coping strategy for the competitive marriage market.

METHODS

This paper utilizes two household longitudinal datasets from rural China-a national survey and a regional survey-to examine paternal substance use in response to skewed sex ratios of their children's generation. The longitudinal feature of the two datasets enables us to explore within household variation in smoking and alcohol use. Sex ratios are matched using a 1% sample of the 2000 China Population Census.

RESULTS

Strikingly, paternal smoking and alcohol use are more intense for families with a son living in communities with higher sex ratios. In contrast, those with a daughter do not demonstrate this pattern. Coping with the marriage market pressure is a plausible pathway linking the observed skewed sex ratios and intense substance use.

CONCLUSIONS

High male-to-female sex ratios promote smoking and alcohol drinking among fathers with sons. Considering the highly competitive marriage market in the coming decade and the prevalent substance use that generates lasting health impacts and large negative externalities to society, policies that address the skewed sex ratios could lead to substantial welfare gains.

The impact of alcohol policies on alcohol-attributable diseases in Taiwan-A population-based study

BACKGROUND

Taiwan has some of the strictest alcohol-related driving laws in the world. However, its laws continue to be toughened to reduce the ever-increasing social cost of alcohol-related harm.

AIM

This study assumes that alcohol-related driving laws show a spillover effect such that behavioral changes originally meant to apply behind the wheel come to affect drinking behavior in other contexts. The effects of alcohol driving laws and taxes on alcohol-related morbidity are assessed; incidence rates of alcohol-attributable diseases (AAD) serve as our measure of morbidity.

METHODS

Monthly incidence rates of alcohol-attributable diseases were calculated with data from the National Health Insurance Research Database (NHIRD) from 1996 to 2011. These rates were then submitted to intervention analyses using Seasonal Autoregressive Integrated Moving Average models (ARIMA) with multivariate adaptive regression splines (MARS). ARIMA is well-suited to time series analysis while MARS helps fit the regression model to the cubic curvature form of the irregular AAD incidence rates of hospitalization (AIRH).

RESULTS

Alcoholic liver disease, alcohol abuse and dependence syndrome, and alcohol psychoses were the most common AADs in Taiwan. Compared to women, men had a higher incidence of AADs and their AIRH were more responsive to changes in the laws governing permissible blood alcohol. The adoption of tougher blood alcohol content (BAC) laws had significant effects on AADs, controlling for overall consumption of alcoholic beverages.

CONCLUSION

Blood alcohol level laws and alcohol taxation effectively reduced alcohol-attributable morbidities with the exception of alcohol dependence and abuse, a disease to which middle-aged, lower income people are particularly susceptible. Attention should be focused on this cohort to protect this vulnerable population.

A Review of Existing Studies Reporting the Negative Effects of Alcohol Access and Positive Effects of Alcohol Control Policies on Interpersonal Violence

Alcohol consumption often leads to elevated rates of violence yet alcohol access policies continue to relax across the globe. Our review establishes the extent alcohol policy can moderate violent crime through alcohol availability restrictions. Results were informed from comprehensive selection of peer-reviewed journals from 1950 to October 2015. Our search identified 87 relevant studies on alcohol access and violence conducted across 12 countries. Seventeen studies included quasi-control design, and 23 conducted intervention analysis. Seventy-one (82%) reported a significant relationship between alcohol access and violent offenses. Alcohol outlet studies reported the greatest percentage of significant results (93%), with trading hours (63%), and alcohol price following (58%). Results from baseline studies indicated the effectiveness of increasing the price of commonly consumed alcohol, restricting the hours of alcohol trading, and limiting the number of alcohol outlets per region to prevent violent offenses. Unclear are the effects of tax reductions, restriction of on-premises re-entry, and different outlet types on violent crime. Further, the generalization of statistics over broad areas and the low number of control/intervention studies poses some concern for confounding or correlated effects on study results, and amount of information for local-level prevention of interpersonal violence. Future studies should focus on gathering longitudinal data, validating models, limiting crime data to peak drinking days and times, and wherever possible collecting the joint distribution between violent crime, intoxication, and place. A greater uptake of local-level analysis will benefit studies comparing the influence of multiple alcohol establishment types by relating the location of a crime to establishment proximity. Despite, some uncertainties particular studies showed that even modest policy changes, such as 1% increases in alcohol price, 1 h changes to closing times, and limiting establishment densities to <25 outlets per postal code substantively reduce violent crime.

A Review of the Statistical and Quantitative Methods Used to Study Alcohol-Attributable Crime

Modelling the relationship between alcohol consumption and crime generates new knowledge for crime prevention strategies. Advances in data, particularly data with spatial and temporal attributes, have led to a growing suite of applied methods for modelling. In support of alcohol and crime researchers we synthesized and critiqued existing methods of spatially and quantitatively modelling the effects of alcohol exposure on crime to aid method selection, and identify new opportunities for analysis strategies. We searched the alcohol-crime literature from 1950 to January 2014. Analyses that statistically evaluated or mapped the association between alcohol and crime were included. For modelling purposes, crime data were most often derived from generalized police reports, aggregated to large spatial units such as census tracts or postal codes, and standardized by residential population data. Sixty-eight of the 90 selected studies included geospatial data of which 48 used cross-sectional datasets. Regression was the prominent modelling choice (n = 78) though dependent on data many variations existed. There are opportunities to improve information for alcohol-attributable crime prevention by using alternative population data to standardize crime rates, sourcing crime information from non-traditional platforms (social media), increasing the number of panel studies, and conducting analysis at the local level (neighbourhood, block, or point). Due to the spatio-temporal advances in crime data, we expect a continued uptake of flexible Bayesian hierarchical modelling, a greater inclusion of spatial-temporal point pattern analysis, and shift toward prospective (forecast) modelling over small areas (e.g., blocks).

The effects of alcohol on the consumption of hard drugs: regression discontinuity evidence from the National Longitudinal Study of Youth, 1997

This paper estimates the effect of alcohol use on consumption of hard drugs using the exogenous decrease in the cost of accessing alcohol that occurs when individuals reach the minimum legal drinking age. By using a regression discontinuity design and the National Longitudinal Study of Youth 1997, I find that all measures of alcohol consumption, even alcohol initiation increase discontinuously at age 21 years. I also find evidence that consumption of hard drugs decreased by 1.5 to 2 percentage points and the probability of initiating the use of hard drugs decreased by 1 percentage point at the age of 21 years, while the intensity of use among users remained unchanged. These estimates are robust to a variety of specifications and also remain robust across different subsamples.

Alcohol Control and Foster Care

Parental alcohol consumption is often associated with an increased likelihood of child abuse. As consumption is related to price, the purpose of this paper is to investigate the propensity for increases in the full price of alcohol to influence entry rates and the length of time spent in foster care. Using alcoholic beverage prices and a measure of availability in combination with data on foster care cases, we find that higher alcohol prices are not effective in reducing foster care entry rates; however, once in foster care, the duration of stay may be shortened by higher prices and reduced availability.

Alcohol and the law

Society has had an interest in controlling the production, distribution, and use of alcohol for millennia. The use of alcohol has always had consequences, be they positive or negative, and the role of government in the regulation of alcohol is now universal. This is accomplished at several levels, first through controls on production, importation, distribution, and use of alcoholic beverages, and second, through criminal laws, the aim of which is to address the behavior of users themselves. A number of interventions and policies reduce alcohol-related consequences to society by regulating alcohol pricing, targeting alcohol-impaired driving, and limiting alcohol availability. The legal system defines criminal responsibility in the context of alcohol use, as an enormous percentage of violent crime and motor death is associated with alcohol intoxication. In recent years, recovery-oriented policies have aimed to expand social supports for recovery and to improve access to treatment for substance use disorders within the criminal justice system. The Affordable Care Act, also know as "ObamaCare," made substantial changes to access to substance abuse treatment by mandating that health insurance include services for substance use disorders comparable to coverage for medical and surgical treatments. Rather than a simplified "war on drugs" approach, there appears to be an increasing emphasis on evidence-based policy development that approaches alcohol use disorders with hope for treatment and prevention. This chapter focuses on alcohol and the law in the United States.

Alcohol tax policy in relation to hospitalization from alcohol-attributed diseases in Taiwan: a nationwide population analysis of data from 1996 to 2010

BACKGROUND

The effects of alcohol taxes and prices on drinking and mortality are well established, but the effects of alcohol taxes on measures of alcohol-related morbidity from noninjury health outcomes have not been fully elucidated. We assess the 2 opposing effects of alcohol tax policy interventions (tax rate increase in 2002 and decrease in 2009) on alcohol-attributed diseases (AADs) in Taiwan.

METHODS

Admissions data from 1996 to 2010 were retrieved from the National Health Insurance Research Database (NHIRD) claims file and analyzed in this study. Data on 430,388 men and 34,874 women aged 15 or above who had an admission due to an AAD were collected. An interrupted time series analysis examining the effects of the implementation of alcohol tax policy on quarterly age- and sex-specific incidence rates of hospitalization for AADs was employed. The same method was also used to analyze hospitalizations for alcoholic liver disease.

RESULTS

The teen/adult groups all showed significant (p < 0.05) changes in the adjusted incidence rate of hospitalization (AIRH) for AADs and alcoholic liver disease in 2002. Men aged 15 to 64 years showed an abrupt decline in the rate of AADs (9.1%) and in the rate of alcoholic liver disease (10.3%). A 16% reduction in the AAD rate was found in teen/adult women after the alcohol tax increase. In contrast, a 17.4% increase in the same rate was seen in the first quarter of 2010 for this group. A similar pattern was presented for the AIRH for alcoholic liver disease among women. The effect of tax intervention was not significant among the elderly.

CONCLUSIONS

This study provides evidence that alcohol taxation in response to international trade liberalization has resulted in an immediate reduction of AADs in Taiwan. The policy of increasing alcohol tax rates may have favorable influences on the time trend for the rate of AADs, most notably among young and middle-aged men and women.

Understanding heterogeneity in price elasticities in the demand for alcohol for older individuals

This paper estimates the price elasticity of demand for alcohol using Health and Retirement Study data. To account for unobserved heterogeneity in price responsiveness, we use finite mixture models. We recover two latent groups, one is significantly responsive to price, but the other is unresponsive. The group with greater responsiveness is disadvantaged in multiple domains, including health, financial resources, education and perhaps even planning abilities. These results have policy implications. The unresponsive group drinks more heavily, suggesting that a higher tax would fail to curb the negative alcohol-related externalities. In contrast, the more disadvantaged group is more responsive to price, thus suffering greater deadweight loss, yet this group consumes fewer drinks per day and might be less likely to impose negative externalities.

The virtuous tax: lifesaving and crime-prevention effects of the 1991 federal alcohol-tax increase

The last time that federal excise taxes on alcoholic beverages were increased was 1991. The changes were larger than the typical state-level changes that have been used to study price effects, but the consequences have not been assessed due to the lack of a control group. Here we develop and implement a novel method for utilizing interstate heterogeneity to estimate the aggregate effects of a federal tax increase on rates of injury fatality and crime. We provide evidence that the relative importance of alcohol in violence and injury rates is directly related to per capita consumption, and build on that finding to generate estimates. A conservative estimate is that the federal tax (which increased alcohol prices by 6% initially) reduced injury deaths by 4.5% (6480 deaths), in 1991, and had a still larger effect on violent crime.

Temporal changes in geographical disparities in alcohol-attributed disease mortality before and after implementation of the alcohol tax policy in Taiwan

Background

Taxation of alcohol-containing products may effectively reduce alcohol consumption. However, whether alcohol taxation may lead to a decrease in alcohol-attributed disease mortality (ADM) remains unclear. The objective of this study was to assess the effect of alcohol tax policy in 2002 in Taiwan on temporal changes in geographical disparities in ADM before and after implementation of the policy.

Methods

Local spatial statistical methods were used to explore the geographic variations in ADM rates and identify statistically significant clusters among townships.

Results

Our results indicate that the areas with the highest rates of ADM (127-235 deaths per 100,000 people) were located in mountainous regions, and the areas with the lowest rates of ADM (less than 26 deaths per 100,000 people) were clustered in the most populated areas. The areas where the rates of ADM significantly declined after alcohol taxation was initiated were clustered in the central, southwest and northeast parts of the country.

Conclusions

This study provides evidence of a township-level relationship between the reduction of ADM and alcohol taxation in Taiwan.

Are Alcohol Prices and Taxes an Evidence-Based Approach to Reducing Alcohol-Related Harm and Promoting Public Health and Safety? A Literature Review

This literature review examines alcohol prices and taxes as potential prevention strategies—examining the links with high-risk drinking and drinking patterns and alcohol-related harm. A literature search of the studies on alcohol price and taxation was conducted using multiple electronic bibliographic databases. Examined outcomes were a) drinking patterns and high risk drinking; and b) harm from alcohol. Fifty-four relevant studies were evaluated, and the majority found that a change in price or taxes on alcohol had an impact on one or more of the two main outcome variables. Significant variations exist across studies in terms of designs, settings, effects across groups, and types of harm. In order to reduce alcohol-related trauma, chronic disease, and other consequences of high-risk drinking, an increase in pricing/taxation is a central component of an overall alcohol strategy.

A time-series analysis of alcohol tax policy in relation to mortality from alcohol attributed causes in Taiwan

It is known that taxation on alcohol products may effectively reduce the alcohol consumption. However, whether alcohol taxation may lead to a decrease in alcohol attributed disease mortality (ADM) has been inclusively. We conducted this time-series analysis to assess the effect of alcohol tax policy intervention in 2002 on rate of ADM in Taiwan. Mortality data were retrieved from Taiwan's Death Registry. We employed the autoregression integrated moving average technique to examine secular patterns of quarterly rate of ADM in residents aged 15 or above between 1991 and 2007, and to determine whether alcohol tax policy intervention, imposed in January 2002, had affected the time trend in rate of ADM in subsequent years. We observed a statistically significant reduction in the rate of ADM following the implementation of alcohol tax policy for all sex- and age-specific segments of population. Further analyses revealed that the effect was most obvious in men aged 15-64 years, who showed an abrupt decline in AMD rate (10.9%) in the first quarter of 2002. For elderly men and women, the tax intervention was followed by a gradually declining trend of ADM, with a magnitude ranging from 0.53% per season (elderly women) to 0.63% per season (elderly men). This study demonstrated that alcohol taxation policy may pose favorite influences on the time trend of ADM rate in Taiwan, and such influence was most noteworthy in young and middle aged men.

Sunday Liquor Laws and Crime

Many jurisdictions have considered relaxing Sunday alcohol sales restrictions, yet such restrictions' effects on public health remain poorly understood. This paper analyzes the effects of legalization of Sunday packaged liquor sales on crime, focusing on the phased introduction of such sales in Virginia beginning in 2004. Differences-in-differences and triple-differences estimates indicate the liberalization increased minor crime by 5% and alcohol-involved serious crime by 10%. The law change did not affect domestic crime or induce significant geographic or inter-temporal crime displacement. The costs of this additional crime are comparable to the state's revenues from increased liquor sales.

Taxing sin and saving lives: Can alcohol taxation reduce female homicides?

With costs exceeding $5.8 billion per year, violence against women has significant ramifications for victims, their families, the health care systems that treat them, and the employers who depend on their labor. Prior research has found that alcohol abuse contributes to violence against both men and women, and that stringent alcohol control policies can reduce alcohol consumption and in turn some forms of violence. In this paper, we estimate the direct relationship between an important alcohol control measure, excise taxes, and the most extreme form of violence, homicide. We use female homicide rates as our measure of severe violence, as this measure is consistently and accurately reported across multiple years. Our results provide evidence that increased alcohol taxes reduce alcohol consumption and that reductions in alcohol consumption can reduce femicide. Unfortunately, a direct test of the relationship does not have the power to determine whether alcohol taxes effectively reduce female homicide rates. We conclude that while alcohol taxes have been shown to effectively reduce other forms of violence against women, policy makers may need alternative policy levers to reduce the most severe form of violence against women.

Alcohol Consumption and Its Adverse Effects in Poland in Years 1950–2005

This study examines changes in alcohol consumption and its adverse effects in Poland from 1950 to 2005. First, we estimate the total alcohol demand function and test Becker and Murphy's (1988) rational addiction model. Next, we explore substitution effects between beer, wine, and spirits and report income and own- and cross-price elasticities of demand for beer, wine, and spirits. Finally, we examine some adverse effects of alcohol consumption: traffic accidents, suicide rates, and vandalism rates. In particular, the effect of lowering the blood alcohol level limit (BAC) on traffic accidents is estimated.

Effects of alcohol tax and price policies on morbidity and mortality: a systematic review

OBJECTIVES

We systematically reviewed the effects of alcohol taxes and prices on alcohol-related morbidity and mortality to assess their public health impact.

METHODS

We searched 12 databases, along with articles' reference lists, for studies providing estimates of the relationship between alcohol taxes and prices and measures of risky behavior or morbidity and mortality, then coded for effect sizes and numerous population and study characteristics. We combined independent estimates in random-effects models to obtain aggregate effect estimates.

RESULTS

We identified 50 articles, containing 340 estimates. Meta-estimates were r = -0.347 for alcohol-related disease and injury outcomes, -0.022 for violence, -0.048 for suicide, -0.112 for traffic crash outcomes, -0.055 for sexually transmitted diseases, -0.022 for other drug use, and -0.014 for crime and other misbehavior measures. All except suicide were statistically significant.

CONCLUSIONS

Public policies affecting the price of alcoholic beverages have significant effects on alcohol-related disease and injury rates. Our results suggest that doubling the alcohol tax would reduce alcohol-related mortality by an average of 35%, traffic crash deaths by 11%, sexually transmitted disease by 6%, violence by 2%, and crime by 1.4%.

Effects of alcohol taxes on alcohol-related mortality in Florida: time-series analyses from 1969 to 2004

BACKGROUND

Over a hundred studies have established the effects of beverage alcohol taxes and prices on sales and drinking behaviors. Yet, relatively few studies have examined effects of alcohol taxes on alcohol-related mortality. We evaluated effects of multiple changes in alcohol tax rates in the state of Florida from 1969 to 2004 on disease (not injury) mortality.

METHODS

A time-series quasi-experimental research design was used, including non-alcohol deaths within Florida and other states' rates of alcohol-related mortality for comparison. A total of 432 monthly observations of mortality in Florida were examined over the 36-year period. Analyses included ARIMA, fixed-effects, and random-effects models, including a noise model, tax independent variables, and structural covariates.

RESULTS

We found significant reductions in mortality related to chronic heavy alcohol consumption following legislatively induced increases in alcohol taxes in Florida. The frequency of deaths (t = -2.73, p = 0.007) and the rate per population (t = -2.06, p = 0.04) declined significantly. The elasticity effect estimate is -0.22 (t = -1.88, p = 0.06), indicating a 10% increase in tax is associated with a 2.2% decline in deaths.

CONCLUSIONS

Increased alcohol taxes are associated with significant and sizable reductions in alcohol-attributable mortality in Florida. Results indicate that 600 to 800 lives per year could be saved if real tax rates were returned to 1983 levels (when the last tax increase occurred). Findings highlight the role of tax policy as an effective means for reducing deaths associated with chronic heavy alcohol use.

What is learned from longitudinal studies of advertising and youth drinking and smoking? A critical assessment

This paper assesses the methodology employed in longitudinal studies of advertising and youth drinking and smoking behaviors. These studies often are given a causal interpretation in the psychology and public health literatures. Four issues are examined from the perspective of econometrics. First, specification and validation of empirical models. Second, empirical issues associated with measures of advertising receptivity and exposure. Third, potential endogeneity of receptivity and exposure variables. Fourth, sample selection bias in baseline and follow-up surveys. Longitudinal studies reviewed include 20 studies of youth drinking and 26 studies of youth smoking. Substantial shortcomings are found in the studies, which preclude a causal interpretation.

The effectiveness of tax policy interventions for reducing excessive alcohol consumption and related harms

A systematic review of the literature to assess the effectiveness of alcohol tax policy interventions for reducing excessive alcohol consumption and related harms was conducted for the Guide to Community Preventive Services (Community Guide). Seventy-two papers or technical reports, which were published prior to July 2005, met specified quality criteria, and included evaluation outcomes relevant to public health (e.g., binge drinking, alcohol-related crash fatalities), were included in the final review. Nearly all studies, including those with different study designs, found that there was an inverse relationship between the tax or price of alcohol and indices of excessive drinking or alcohol-related health outcomes. Among studies restricted to underage populations, most found that increased taxes were also significantly associated with reduced consumption and alcohol-related harms. According to Community Guide rules of evidence, these results constitute strong evidence that raising alcohol excise taxes is an effective strategy for reducing excessive alcohol consumption and related harms. The impact of a potential tax increase is expected to be proportional to its magnitude and to be modified by such factors as disposable income and the demand elasticity for alcohol among various population groups.

Changes in alcohol-related problems after alcohol policy changes in Denmark, Finland, and Sweden

OBJECTIVE

European Union travelers' allowances for alcohol import to Denmark, Sweden, and Finland were abolished in 2004. In addition, excise taxes on alcohol were lowered in 2003 and 2005 in Denmark, and in 2004 in Finland. Using northern Sweden as a control site, this study examines whether levels of reported alcohol problems have changed in Denmark, Finland, and southern Sweden as a consequence of these policy changes.

METHOD

Annual cross-sectional surveys were conducted in Denmark, Finland, and Sweden from 2003 to 2006. Five dependency items and seven extrinsic alcohol-related problems were examined. Changes were analyzed within each country/region with logistic regressions and tested for short- and long-term changes. Differential change was also tested between each country and the control site, northern Sweden.

RESULTS

Prevalence of alcohol problems decreased over the study period. Only in selected subgroups did problems increase. This mainly occurred in the samples for northern Sweden and Finland, and mostly among older age groups and men. In relation to the control site, however, no increases in problem prevalence were found.

CONCLUSIONS

Our findings on a decline in reported alcohol problems largely agree with published reports on alcohol consumption over the same period in the study countries. They do not agree, however, with findings on changes in health and social statistics in Finland and Denmark, where some significant increases in alcohol-related harm have been found.

Deadly partners: interdependence of alcohol and trauma in the clinical setting

Trauma is the leading cause of death for Americans aged 1 to 45. Over a third of all fatal motor vehicle collisions and nearly eighty percent of completed suicides involve alcohol. Alcohol can be both a cause of traumatic injury as well as a confounding factor in the diagnosis and treatment of the injured patient. Fortunately, brief interventions after alcohol-related traumatic events have been shown to decrease both trauma recidivism and long-term alcohol use. This review will address the epidemiology of alcohol-related trauma, the influence of alcohol on mortality and other outcomes, and the role of prevention in alcohol-related trauma, within the confines of the clinical setting.

Drugs and aggression readily mix; so what now?

Intoxicated aggression is both a dangerous and a costly problem for society, with alcohol being involved in over 50% of violent crimes, and the cost of alcohol-consumption-related crime being estimated at $205 billion in the United States alone. First, the authors reviewed the substantial evidence for the connection between alcohol consumption and aggression, and then they examined the risk factors for this problem. These included societal/cultural factors, such as availability and alcohol expectancies, and individual factors, such as demographic characteristics, personality, comorbid disorders, individual differences in response to alcohol, and cognitive functioning. Finally, interventions were suggested focusing on policy, alcohol sellers, treatments for alcohol abuse and dependency, anger management, pharmacology, and low executive functioning. Further efforts are still needed to target interventions to specific risk factors.

Effects of alcohol tax increases on alcohol-related disease mortality in Alaska: time-series analyses from 1976 to 2004

OBJECTIVE

We evaluated the effects of tax increases on alcoholic beverages in 1983 and 2002 on alcohol-related disease mortality in Alaska.

METHODS

We used a quasi-experimental design with quarterly measures of mortality from 1976 though 2004, and we included other states for comparison. Our statistical approach combined an autoregressive integrated moving average model with structural parameters in interrupted time-series models.

RESULTS

We observed statistically significant reductions in the numbers and rates of deaths caused by alcohol-related disease beginning immediately after the 1983 and 2002 alcohol tax increases in Alaska. In terms of effect size, the reductions were -29% (Cohen's d = -0.57) and -11% (Cohen's d = -0.52) for the 2 tax increases. Statistical tests of temporary-effect models versus long-term-effect models showed little dissipation of the effect over time.

CONCLUSIONS

Increases in alcohol excise tax rates were associated with immediate and sustained reductions in alcohol-related disease mortality in Alaska. Reductions in mortality occurred after 2 tax increases almost 20 years apart. Taxing alcoholic beverages is an effective public health strategy for reducing the burden of alcohol-related disease.

Preventing alcohol-related violence: a public health approach

BACKGROUND

Studies of the relationship between alcohol and violent injury confirm that while there is some evidence of a direct pharmacological association, many other factors are relevant to the frequency and severity of both violent perpetration and being a victim of violence. It is now widely recognized that official police statistics are a poor indicator of the nature and extent of public violence.

AIMS

Accident and emergency departments and trauma surgeons are not only in a position to provide more accurate information on the nature and extent of clinically significant injury, but they can contribute substantially to violence prevention. This can be achieved through individually targeted interventions in conjunction with other clinicians on the one hand, and on the other through public health and community initiatives, in conjunction with other community agencies, including the police and local authorities. This article describes some of those initiatives and the evidence underpinning them.

The price of alcohol: a consideration of contextual factors

BACKGROUND

The current study considers the determinants of prices charged for alcoholic beverages by on-premise and off-premise outlets in Alaska. Alcohol outlet densities, a surrogate measure for local retail competition, are expected to be negatively associated with prices while costs associated with distribution are expected to be positively related to prices. Community demographic and economic characteristics may affect observed local prices via the level of demand, retail costs borne by retailers, or the quality of brands offered for sale.

METHODS

The core data for these analyses came from a telephone survey of Alaskan retail establishments licensed to serve alcohol. This survey utilized computer-assisted telephone interviewing (CATI) techniques to collect alcohol-pricing information from on-premise (i.e., establishments where alcohol is consumed at the point of purchase such as bars and restaurants) and off-premise (i.e., establishments such as grocery stores and convenience markets where consumption occurs in other locations) alcohol retailers throughout the state of Alaska. Price estimates were developed for each beverage-type based on alcohol content. Separate regression analyses were used to model each of the 8 price indices (on-premise and off-premise measures for beer, spirits, wine, and the average price across beverage types). All regressions also controlled for a set of zip-code level indicators of community economic and demographic characteristics based on census data.

RESULTS

Outlet density per roadway mile was unrelated to price for both on- and off-premise establishments, either across or between beverage types. In contrast, overall distribution costs did appear to be related to alcohol price. The demographic and economic variables, as a group, were significantly related to observed prices.

CONCLUSIONS

More attention needs to be directed to the manner in which sellers and buyers behave relative to alcoholic beverages. Alcohol demand remains responsive to prices; yet, consumers have considerable latitude in determining the price that they pay for alcohol.

Magnitude of alcohol-related mortality and morbidity among U.S. college students ages 18-24: changes from 1998 to 2001

Integrating data from the National Highway Traffic Safety Administration, the Centers for Disease Control and Prevention, national coroner studies, census and college enrollment data for 18-24-year-olds, the National Household Survey on Drug Abuse, and the Harvard College Alcohol Survey, we calculated the alcohol-related unintentional injury deaths and other health problems among college students ages 18-24 in 1998 and 2001. Among college students ages 18-24 from 1998 to 2001, alcohol-related unintentional injury deaths increased from nearly 1600 to more than 1700, an increase of 6% per college population. The proportion of 18-24-year-old college students who reported driving under the influence of alcohol increased from 26.5% to 31.4%, an increase from 2.3 million students to 2.8 million. During both years more than 500,000 students were unintentionally injured because of drinking and more than 600,000 were hit/assaulted by another drinking student. Greater enforcement of the legal drinking age of 21 and zero tolerance laws, increases in alcohol taxes, and wider implementation of screening and counseling programs and comprehensive community interventions can reduce college drinking and associated harm to students and others.

Income, family characteristics, and physical violence toward children

OBJECTIVE

This paper discusses the ways in which existing microeconomic theories of partner abuse, intra-family bargaining, and distribution of resources within families may contribute to our current understanding of physical child abuse. The empirical implications of this discussion are then tested on data from the 1985 National Family Violence Survey (NFVS) in order to estimate the effects of income, family characteristics, and state characteristics on physical violence toward children.

METHODOLOGY

The sample consists of 2,760 families with children from the NFVS. Probit and ordered probit models are used to explore relationships between income, family characteristics, state characteristics, and physical violence toward children among single-parent and two-parent families.

RESULTS

In both single-parent and two-parent families, depression, maternal alcohol consumption, and history of family violence affect children's probabilities of being abused. Additionally, income is significantly related to violence toward children in single-parent families.

CONCLUSIONS

These results reinforce earlier findings that demographic characteristics, maternal depression, maternal alcohol use, and intra-family patterns of violence may largely contribute to child abuse. This research also suggests that income may play a substantially more important role in regard to parental violence in single-parent families than in two-parent families.

Underage drinking: frequency, consequences, and interventions

OBJECTIVES

To examine the frequency of underage drinking, driving after drinking and alcohol-related crashes, trends in these behaviors, and promising interventions.

METHODS

We examined drinking and drinking- and-driving behaviors reported in the United States in the 2001 U.S. National Household Survey of Drug Abuse, the Centers for Disease Control and Prevention 2001 Youth Risk Behavior Survey, the 1992 National Longitudinal Alcohol Epidemiologic Study, and the 1999 National Survey of Drinking and Driving conducted for the National Highway Traffic Administration. We also examined the 1999 European School Survey Project on Alcohol and Other Drugs. Alcohol-related fatal crashes were examined from the U.S. Fatality Analysis Reporting System. Evaluation of interventions to reduce teenage drinking and driving after drinking were reviewed.

RESULTS

In the United States, 19% of youth ages 12-20 consumed five or more drinks on an occasion in the past 30 days. Although European nations have lower legal drinking ages (16-18) than in the United States (21), similar proportions engage in underage drinking. In two-thirds of European countries, a greater percentage of 15-16 year-olds drank five or more drinks on an occasion in the past month than in the United States. In both the United States and Europe, the earlier people begin to drink, the greater the likelihood of developing alcohol dependence and other alcohol-related problems, including alcohol-related crash involvement, during adolescence and adult years. During the past 20 years alcohol-related traffic deaths among people younger than 21 have been cut in half in the United States, but progress has halted since 1995 and the problem is still large. Interventions shown by research to reduce alcohol-related crashes among youth include raising the legal drinking age to 21, zero tolerance laws, and some interventions that are family, school, or community based.

CONCLUSIONS

Despite research showing that a variety of interventions can reduce underage drinking and alcohol-related crash fatalities, the frequency of these behaviors remains high and the average age of drinking initiation is declining in the United States. Efforts are needed to enhance publicized enforcement of underage drinking laws. Comprehensive community interventions that include enforcement of these laws also are needed.

A general causal model to guide alcohol, tobacco, and illicit drug prevention: assessing the research evidence

The problems associated with the use of alcohol, tobacco, and other drugs (ATOD) extract a significant health, social, and economic toll on American society. While the field of substance abuse prevention has made great strides during the past decade, two major challenges remain. First, the field has been disorganized and fragmented with respect to its research and prevention practices; that is, there are often separate ATOD prevention "specialists." Second, both the prevention researchers who test the efficacy of specific prevention strategies and the practitioners who implement prevention efforts often lack an overall perspective to guide strategy selection. To address these limitations, we present an ATOD causal model that seeks to identify those variables (Domains) that are theoretically salient and empirically connected across alcohol, tobacco, and illicit drugs. For the researcher, the model demonstrates important commonalities, as well as gaps, in the literature. For the practitioner, the model is a means to recognize both the complexity of the community system that produces ATOD problems and the multiple intervention points that are possible within this system. Researchers and practitioners are thus challenged to work synergistically to find effective and cost-effective approaches to change or reduce ATOD use and associated problems.

Alcohol dependence and the price of alcoholic beverages

This study estimates the impact of the price of alcoholic beverages on latent dimensions of current alcohol dependence and abuse. A three-part econometric model is used to estimate the impact of price on three latent dimensions (factors). For heavier drinking, the estimated price elasticity is -1.325 (P = 0.027); for physical and other consequences of drinking, -1.895 (P = 0.003); for increased salience of drinking, -0.411 (P = 0.339). For a single latent factor characterized simply as dependence/abuse, estimated price elasticity is -1.487 (P = 0.012). These results suggest that higher prices for alcohol reduce important dimensions of current alcohol dependence and abuse.

Does alcohol-use increase the risk of sexual intercourse among adolescents? Evidence from the NLSY97

This study investigates the causal link between alcohol-use and adolescent sexual activity. In a recent paper, using data from the 1995 wave of the National Longitudinal Study of Adolescent Health, Rees et al. [Journal of Health Economics 20 (5) (2001)] found little evidence of such a link. The data used here are from the National Longitudinal Study of Youth, 1997 (NLSY97), and results indicate that alcohol-use increases the probability of sexual intercourse, even after accounting for the potential endogeneity. However, consistent with Rees et al., there is less evidence that heavy drinking has a significant effect on sexual intercourse.

The economics of alcohol abuse and alcohol-control policies

Economic research has contributed to the evaluation of alcohol policy through empirical analysis of the effects of alcohol-control measures on alcohol consumption and its consequences. It has also provided an accounting framework for defining and comparing costs and benefits of alcohol consumption and related policy interventions, including excise taxes. The most important finding from the economics literature is that consumers tend to drink less ethanol, and have fewer alcohol-related problems, when alcoholic beverage prices are increased or alcohol availability is restricted. That set of findings is relevant for policy purposes because alcohol abuse imposes large "external" costs on others. Important challenges remain, including developing a better understanding of the effects of drinking on labor-market productivity.