Efficacy and the Strength of Evidence of U.S. Alcohol Control Policies

doi:10.1016/j.amepre.2013.03.008

American Journal of Preventive Medicine

Volume 45, Issue 1, July 2013, Pages 19-28

https://doi.org/10.1016/j.amepre.2013.03.008 Get rights and content

Background

Public policy can limit alcohol consumption and its associated harm, but no direct comparison of the relative efficacy of alcohol control policies exists for the U.S.

Purpose

To identify alcohol control policies and develop quantitative ratings of their efficacy and strength of evidence.

Methods

In 2010, a Delphi panel of ten U.S. alcohol policy experts identified and rated the efficacy of alcohol control policies for reducing binge drinking and alcohol-impaired driving among both the general population and youth, and the strength of evidence informing the efficacy of each policy. The policies were nominated on the basis of scientific evidence and potential for public health impact. Analysis was conducted in 2010–2012.

Results

Panelists identified and rated 47 policies. Policies limiting price received the highest ratings, with alcohol taxes receiving the highest ratings for all four outcomes. Highly rated policies for reducing binge drinking and alcohol-impaired driving in the general population also were rated highly among youth, although several policies were rated more highly for youth compared with the general population. Policy efficacy ratings for the general population and youth were positively correlated for reducing both binge drinking (r=0.50) and alcohol-impaired driving (r=0.45). The correlation between efficacy ratings for reducing binge drinking and alcohol-impaired driving was strong for the general population (r=0.88) and for youth (r=0.85). Efficacy ratings were positively correlated with strength-of-evidence ratings.

Conclusions

Comparative policy ratings can help characterize the alcohol policy environment, inform policy discussions, and identify future research needs.

Section snippets

Background

Alcohol is a leading cause of morbidity, mortality, social problems, and economic costs in the U.S. and worldwide.1, 2, 3, 4, 5, 6, 7 Systematic reviews have identified a number of policies that can reduce excessive alcohol consumption and related harm,8, 9, 10 but little is known about the relative effects of multiple policies enacted in the same jurisdiction or how multiple policies function synergistically in practice. Tools are needed to compare the relative efficacy of policies and assess

Methods

The Delphi method provides guidance for areas of research where scientific information is controversial, incomplete or lacks precision, in order to synthesize expert opinion.15, 16 Ten alcohol policy experts from academia, government and the private sector, and representing different areas of expertise, including law, epidemiology, psychology, sociology, economics, and community organizing, were invited to participate on the basis of their expertise and contributions to either alcohol policy

Policy Efficacy Ratings

Table 1 displays the efficacy and strength-of-evidence ratings for each outcome (e.g., binge drinking and alcohol-impaired driving) among general and youth populations in quartiles across all 47 policies. The average efficacy ratings of the 47 alcohol policies in four outcome domains ranged from 2.5 to 2.8, a rating between somewhat effective (a score of 2) and effective (a score of 3; Table 2). Alcohol excise taxes were rated as the most effective policy in all four groups.

The mean efficacy

Discussion

The comparative rating of state alcohol control policies described in this paper builds on prior work1, 4, 6, 8, 9, 10, 11, 12, 13, 14 by (1) assessing policies specific to the U.S.; (2) examining a larger number of policies than have been examined in previous research; (3) using an expert panel with a modified Delphi approach to overcome gaps in existing research for certain policies and the relative lack of research directly comparing policies to one another; (4) rating policies using uniform

Acknowledgements

This work was funded by a grant from the National Institute of Alcohol Abuse and Alcoholism (R01 AA018377; T. Naimi, PI). The content of this manuscript does not necessarily represent the views of the National Institute of Alcohol Abuse and Alcoholism or the NIH.

No financial disclosures were reported by the authors of this paper.

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Research ArticleEfficacy and the Strength of Evidence of U.S. Alcohol Control Policies

Background

Purpose

Methods

Results

Conclusions

Section snippets

Background

Methods

Policy Efficacy Ratings

Discussion

Acknowledgements

Lancet

Am J Prev Med

Accid Anal Prev

Am J Prev Med

Am J Prev Med

Technol Forecasting Soc Change

Lancet

Alcohol: no ordinary commodity: research and public policy

Actual causes of death in the U.S., 2000

JAMA

WHO global status report on alcohol and health, 2011

Research on and prevention of alcohol-related trauma: phases, patterns, and issues

Addiction

Self-reported alcohol-impaired driving in the U.S., 2006 and 2008

Am J Prev Med

Linking science to policy. The role of international collaborative research

Alcohol Res Health

Motor vehicle-related injury prevention: reducing alcohol impaired-driving

Preventing excessive alcohol consumption

Comparative analysis of alcohol control policies in 30 countries

PLoS Med

Alcohol control policies and alcohol consumption by youth: a multi-national study

Addiction

The impact of underage drinking laws on alcohol-related fatal crashes of young drivers

Alcohol Clin Exp Res

Research Article
Efficacy and the Strength of Evidence of U.S. Alcohol Control Policies