Alcohol availability and consumption: Iowa sales data revisited

Washington's liquor license system and alcohol-related adverse health outcomes

BACKGROUND AND AIMS

In June 2012, Washington state (USA) implemented Initiative 1183, privatizing liquor sales. As a result, off-premises outlets increased from 330 to over 1400 and trading hours lengthened. Increased availability of liquor may lead to increased consumption. This study examines the impact of Initiative 1183 on alcohol-related adverse health outcomes, measured by inpatient hospitalizations for alcohol-related disorders and accidental injuries. It further assesses heterogeneity by urbanicity, because outlets increased most in metropolitan-urban areas.

DESIGN

County-by-quarter difference-in-difference linear regression models, estimated statewide and within metropolitan/rural strata.

SETTING AND PARTICIPANTS

Data are from AHRQ Healthcare Cost and Utilization State Inpatient Database 2010-2014 and HHS Area Health Resource File 2010-2014. Changes in the rates of hospitalizations in the 2.5 years following Initiative 1183 in Washington (n = 39 counties) are compared with changes in Oregon (n = 36 counties).

MEASUREMENTS

County rates of hospitalizations per 1000 residents, including all records with any-listed ICD-9 Clinical Classification Software code denoting an alcohol-related disorder, and all records with any-listed external cause of injury code denoting an accidental injury.

FINDINGS

The increase in the rate of accidental injury hospitalizations in Washington's metropolitan-urban counties was on average 0.289 hospitalizations per 1000 county residents per quarter greater than the simultaneous increase observed in Oregon (P = 0.017). This result was robust to alternative specifications using a propensity score matched sample and synthetic control methods with data from other comparison states. The evidence did not suggest that Initiative 1183 was associated with differential changes in the rate of hospitalizations for alcohol-related disorders in metropolitan-urban (P = 0.941), non-metropolitan-urban (P = 0.162), or rural counties (P = 0.876).

CONCLUSIONS

Implementing Washington's Initiative 1183 (privatizing liquor sales) appears to have been associated with a significant increase in the rate of accidental injury hospitalizations in urban counties in that state but does not appear to be significantly associated with changes in the rate of hospitalizations specifically for alcohol-related disorders within 2.5 years.

Fitting Bayesian Models for Single-Case Experimental Designs

Abstract. Single-case experimental designs (SCEDs) are interrupted time-series designs that have recently gained recognition as being able to provide a strong basis for establishing intervention effect. Typically, SCED data are short time series and autocorrelated, which renders maximum likelihood and parametric analyses inadequate for data analysis, respectively. Although Bayesian methods overcome these challenges, most practitioners do not use Bayesian estimation because of: (a) its steep learning curve, (b) lack of Bayesian training, and (c) lack of knowledge of Bayesian software solutions. This study demonstrates two Bayesian interrupted time-series models using freeware programs R and JAGS. Practitioners could modify these codes and run them for their own data by changing the values in the codes where indicated. Providing practitioners with such tools to facilitate their analysis is one way to improve methodological rigor in applied research.

The effect of concealed carry weapons laws on firearm sales

Despite numerous studies exploring the link between concealed carry weapons (CCW) laws and the effect of "more guns, more/less crime" it is unknown if liberalizing CCW laws indeed influences legal firearm sales. Building on previous research, I hypothesize that liberal CWW laws are associated with increases in handgun sales while having no association with long gun sales. Using National Instant Background Check System (NICS) data as a proxy for firearm sales and state fixed-effects regression models to examine the effect of CCW laws on gun sales in all 50 states the results can be simply put: liberal CCW laws are associated with increases in handgun sales, are not associated with long gun sales, and are associated with an increase in the overall share of firearms sold that are handguns. This work supports the idea that the expansion of gun rights via liberal CCW laws has increased the rate of handgun sales in the United States, but not the rate of long gun sales. Implications for future research on firearms and policy are discussed.

Opinions on the Privatization of Distilled-Spirits Sales in Washington State: Did Voters Change Their Minds?

OBJECTIVE

In November 2011, voters in Washington State approved Initiative 1183 (I-1183), which ended the government monopoly on distilled-spirits sales. The current study examined the relationship between demographics, spirits use, and voting outcomes, as well as how these variables related to wanting to change one's vote.

METHOD

The sample consisted of 1,202 adults recruited through random-digit-dial methods and reached via telephone between January and April 2014. Bivariate tests and multivariable regressions were used for statistical analyses.

RESULTS

Most notably, those who voted Yes on I-1183 had almost eight times the odds of wanting to change their votes compared with those who voted No. Older age, higher education, and being a spirits buyer/drinker were significantly associated with voting (vs. not voting). Among nonvoters, a larger proportion of those who reported that I-1183 was a success (vs. not) were spirits drinkers/nonbuyers. Those who reported that I-1183 was not a success were more likely to report that the number of liquor stores should be decreased. Opinions on taxes were not related to wanting to change one's vote or thinking that I-1183 had been a success.

CONCLUSIONS

The result of the I-1183 election likely would have been different if voters could know their future opinions of the actual situation resulting from privatization. This finding is particularly important for states considering privatization. Results also indicate that spirits drinkers/buyers may be more invested in privatization than nonbuyers and that the increased availability of spirits may affect opinions regarding privatization.

The Validity of the Comparative Interrupted Time Series Design for Evaluating the Effect of School-Level Interventions

OBJECTIVE

In this article, we examine whether a well-executed comparative interrupted time series (CITS) design can produce valid inferences about the effectiveness of a school-level intervention. This article also explores the trade-off between bias reduction and precision loss across different methods of selecting comparison groups for the CITS design and assesses whether choosing matched comparison schools based only on preintervention test scores is sufficient to produce internally valid impact estimates.

RESEARCH DESIGN

We conduct a validation study of the CITS design based on the federal Reading First program as implemented in one state using results from a regression discontinuity design as a causal benchmark.

RESULTS

Our results contribute to the growing base of evidence regarding the validity of nonexperimental designs. We demonstrate that the CITS design can, in our example, produce internally valid estimates of program impacts when multiple years of preintervention outcome data (test scores in the present case) are available and when a set of reasonable criteria are used to select comparison organizations (schools in the present case).

Availability and Sales of Alcohol in Four Canadian Provinces: A Time-Series Analysis

The research question addressed in the present study, with ARIMA time-series analyses, was the extent to which changes in economic and physical availability had an effect on sales of alcohol in four Canadian provinces during the second half of the 20th century. The annual sales, by type of beverage (spirits, wine and beer) as well as total sales, measured in pure alcohol per inhabitant age 15 and above in each province, were used as dependent variables in the analyses. The inhabitants' real disposable income, the real price of alcohol, and the number of on- and off-premise outlets per 100,000 inhabitants were used as independent variables. All the time-series were differenced to remove long-term trends. The main study period was 1951–2000. In some of the analyses the study periods were shorter, primarily due to lack of data. Changes in economic availability in general, and in price in particular, had larger effects on sales than physical availability. Among the beverages analyzed in the study, the demand for spirits was most sensitive to changes in availability. Economic availability had a greater effect on sales than the number of outlets. However, one might question to what extent the number of outlets really is a feasible measure of transaction costs associated with purchases of alcohol.

Alcohol Policy: Gaps between Legislative Action and Current Research

This paper compares alcohol policies under debate in U.S. state legislatures with policies that have been the focus of research attention. We reviewed the research literature to identify empirical studies of each policy and types of outcome variables analyzed. The two most evaluated alcohol control policies are the minimum legal drinking age and excise tax. Eight other policies had 20 or more studies evaluating them. The remaining alcohol policies received little attention in the research literature. Alcohol consumption and traffic crashes were the most frequent outcomes used in alcohol policy studies. Most studies evaluated policy changes at the state or national level, with few studies of local or institutional policies. During 1997 some 463 alcohol control bills were introduced at state legislatures. Many specific alcohol policies under debate in state legislatures have little research evidence to guide policy decision-making, pointing to areas where future research is needed.

Analysis of Price Changes in Washington Following the 2012 Liquor Privatization

AIMS

In June, 2012 the state of Washington ended a wholesale and retail monopoly on liquor sales resulting in about five times as many stores selling liquor. Three-tier restrictions were also removed on liquor, while beer and wine availability did not increase. Substantial taxes at both the wholesale and retail levels were implemented and it was expected that prices would rise.

METHODS

To evaluate price changes after privatization we developed an index of about 68 brands that were popular in Washington during early 2012. Data on final liquor prices (including all taxes) in Washington were obtained through store visits and on-line sources between November 2013 and March of 2014. Primary analyses were conducted on five or six brand indexes to allow the inclusion of most stores.

RESULTS

Washington liquor prices rose by an average of 15.5% for the 750 ml size and by 4.7% for the 1.75 l size, while only small changes were seen in the bordering states of Oregon and Idaho. Prices were found to vary greatly by store type. Liquor Superstores had generally the lowest prices while drugstore, grocery and especially smaller Liquor Store prices were found to be substantially higher.

CONCLUSION

Our findings indicate that liquor prices in Washington increased substantially after privatization and as compared to price changes in bordering states, with a much larger increase seen for the 750 ml size and with wide variation across store types. However, persistent drinkers looking for low prices will be able to find them in certain stores.

Perceived physical availability of alcohol at work and workplace alcohol use and impairment: testing a structural model

This study develops and tests a new conceptual model of perceived physical availability of alcohol at work that provides unique insight into 3 dimensions of workplace physical availability of alcohol and their direct and indirect relations to workplace alcohol use and impairment. Data were obtained from a national probability sample of 2,727 U.S. workers. The results support the proposed conceptual model and provide empirical support for a positive relation of perceived physical availability of alcohol at work to workplace alcohol use and 2 dimensions of workplace impairment (workplace intoxication and workplace hangover). Ultimately, the findings suggest that perceived physical availability of alcohol at work is a risk factor for alcohol use and impairment during the workday, and that this relation is more complex than previously hypothesized.

Effects of alcohol retail privatization on excessive alcohol consumption and related harms: a community guide systematic review

CONTEXT

Excessive alcohol consumption is the third-leading cause of preventable death in the U.S. This systematic review is one in a series exploring effectiveness of interventions to reduce alcohol-related harms.

EVIDENCE ACQUISITION

The focus of this review was on studies evaluating the effects of the privatization of alcohol retail sales on excessive alcohol consumption and related harms. Using Community Guide methods for conducting systematic reviews, a systematic search was conducted in multiple databases up to December 2010. Reference lists of acquired articles and review papers were also scanned for additional studies.

EVIDENCE SYNTHESIS

A total of 17 studies assessed the impact of privatizing retail alcohol sales on the per capita alcohol consumption, a well-established proxy for excessive alcohol consumption; 9 of these studies also examined the effects of privatization on the per capita consumption of alcoholic beverages that were not privatized. One cohort study in Finland assessed the impact of privatizing the sales of medium-strength beer (MSB) on self-reported alcohol consumption. One study in Sweden assessed the impact of re-monopolizing the sale of MSB on alcohol-related harms. Across the 17 studies, there was a 44.4% median increase in the per capita sales of privatized beverages in locations that privatized retail alcohol sales (interquartile interval: 4.5% to 122.5%). During the same time period, sales of nonprivatized alcoholic beverages decreased by a median of 2.2% (interquartile interval: -6.6% to -0.1%). Privatizing the sale of MSB in Finland was associated with a mean increase in alcohol consumption of 1.7 liters of pure alcohol per person per year. Re-monopolization of the sale of MSB in Sweden was associated with a general reduction in alcohol-related harms.

CONCLUSIONS

According to Community Guide rules of evidence, there is strong evidence that privatization of retail alcohol sales leads to increases in excessive alcohol consumption.

The effectiveness of limiting alcohol outlet density as a means of reducing excessive alcohol consumption and alcohol-related harms

The density of alcohol outlets in communities may be regulated to reduce excessive alcohol consumption and related harms. Studies directly assessing the control of outlet density as a means of controlling excessive alcohol consumption and related harms do not exist, but assessments of related phenomena are indicative. To assess the effects of outlet density on alcohol-related harms, primary evidence was used from interrupted time-series studies of outlet density; studies of the privatization of alcohol sales, alcohol bans, and changes in license arrangements-all of which affected outlet density. Most of the studies included in this review found that greater outlet density is associated with increased alcohol consumption and related harms, including medical harms, injury, crime, and violence. Primary evidence was supported by secondary evidence from correlational studies. The regulation of alcohol outlet density may be a useful public health tool for the reduction of excessive alcohol consumption and related harms.

An investigation of the effect of privatization of retail sales of alcohol on consumption and traffic accidents in Alberta, Canada

AIMS

Privatization of the retail sale of alcohol in Alberta took place primarily between the end of the 1980s and the beginning of the 1990s. The aim of this study was to evaluate the effects of this privatization on alcohol sales and on the incidence of fatal motor vehicle traffic accidents in the province.

DATA AND METHOD

Interrupted time-series analysis (ARIMA) with a quasi-experimental control area design was used, and all series were differenced to remove long-term trends. Canada, with the exception of Alberta, was the control area. The effects of privatization were measured by means of created privatization variables. In the analyses of the effects of privatization on alcohol sales, the inhabitants' disposable income and alcohol prices were used as control variables. The study period was 1950-2000. When effects on the number of fatal motor vehicle traffic accidents were analysed the number of road motor vehicle registrations was used as a control variable, and the study period was 1950-98.

FINDINGS

Privatization had a significant permanent effect on the sale of spirits, but the effect was not large enough to affect total sales. The effect on wine and beer sales was not significant. There was no significant effect on the number of fatal motor vehicle traffic accidents.

CONCLUSION

The fact that sales on the wholesale level continued to be monopolized, along with the fact that alcohol sales were never allowed in ordinary grocery stores, may explain the lack of any larger effects of privatization on alcohol sales in Alberta.

The Privatization of Wine Sales in Quebec in 1978 and 1983 to 1984

BACKGROUND

In 1978, grocery stores in Quebec were allowed to sell domestically produced wine along with wine that was imported and bottled by the Liquor Board in Quebec. This right was extended in 1983 to include imported wine that was bottled by privately owned manufacturers in Quebec. Larger grocery store chains were also allowed to sell wine in 1984. The aim of this study was to evaluate the effects of these policy changes on alcohol sales, primarily on sales of wine and total sales but also on sales of spirits and beer.

METHODS

Interrupted time-series analysis (ARIMA) with a quasi-experimental control area design was used. Canada, with the exception of the province of Quebec, was the control area. All time series were differenced to remove long-term trends. Possible permanent effects of the policy changes on alcohol sales were measured by means of intervention variables. Alcohol sales, in liters of pure alcohol per inhabitant aged 15 and above, were used as the dependent variable. Alcohol prices and the inhabitants' disposable income were used as control variables.

RESULTS

Contrary to earlier studies regarding these policy changes in Quebec, the results presented in this study showed a significant and permanent effect of the policy change in 1978. The sale of wine increased by 10%, but the effect was not so large as to affect total sales. Sales of spirits and beer were not significantly affected. In 1983 to 1984, no immediate significant increase in sales of wine was found.

CONCLUSIONS

The estimated effect of the policy change in 1978 was modest compared with results presented in most earlier studies regarding the privatization of wine sales in other jurisdictions. One explanation could be that the policy change in Quebec was valid only for a limited number of wines, which accounted for only a fraction of the total alcohol sales market.

Does drinking really decrease in bad times?

This paper investigates the relationship between macroeconomic conditions and drinking using individual-level data from 1987 to 1999 interview years of the "behavioral risk factor surveillance system" (BRFSS). We confirm the procyclical variation in overall drinking identified in previous research using aggregate sales data and show that this largely results from changes in consumption by existing drinkers, rather than movements into or out of drinking. Moreover, the decrease occurring during bad economic times is concentrated among heavy consumers, with light drinking actually rising. We also find no evidence that the decline in overall alcohol use masks a rise for persons becoming unemployed during contractions. These results suggest that any stress-induced increases in drinking during bad economic times are more than offset by declines resulting from changes in economic factors such as lower incomes.

What if alcoholism had not been invented? The dynamics of American alcohol mythology

This essay speculates on what might have been had alcoholism not been invented. The invention is viewed as a product of the ongoing myth-making process whereby society continuously defines and redefines alcohol, seeking to integrate it into the culture in ways that allow enjoyment of its pleasures with minimum pain. Had alcoholism not been invented, (a) the myth-making process might have yielded another simplistic explanation of drunkenness, but more likely alcohol would have remained the supposed cause; (b) the per capita alcohol consumption uptrend of some 50 years standing might not have reversed as it did in 1982; (c) chronic drunkards might still be denied life-saving hospitalization which gains them more time for the natural reform process to work for them; and (d) local communities nationwide might have taken common-sense actions to facilitate the natural rehabilitation process and provided more benefit to more alcoholics for less cost than treating alcoholism. It is expected that Americans will continue to drink and will continue to seek a more harmonious relationship with alcohol. The informal social controls will continue to largely constrain individual appetites for alcohol's pleasures, and most alcoholics will continue to gain control of their excessive drinking in the natural course of events with or without exposure to alcoholism treatment.