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James F. Mosher, JD Alcohol Policy Consultations June 9, 2013

Alcohol Policy Prevention Strategies. James F. Mosher, JD Alcohol Policy Consultations June 9, 2013 Presentation at the Preconference Workshop entitled: Drug Use and Excessive Alcohol Epidemiology: Surveillance, Prevention, and Emerging Methods

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James F. Mosher, JD Alcohol Policy Consultations June 9, 2013

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  1. Alcohol Policy Prevention Strategies James F. Mosher, JD Alcohol Policy Consultations June 9, 2013 Presentation at the Preconference Workshop entitled: Drug Use and Excessive Alcohol Epidemiology: Surveillance, Prevention, and Emerging Methods 2013 Council of State and Territorial Epidemiologists Conference, Pasadena, CA

  2. Alcohol Policy: Shifting the Focus of Intervention INDIVIDUALS ENVIRONMENTS

  3. Factors that Affect Health Smallest Impact Largest Impact Examples Eat healthy, be physically active Counseling & Education Rx for high blood pressure, high cholesterol, diabetes Clinical Interventions Immunizations, brief intervention, cessation treatment, colonoscopy Long-lasting Protective Interventions Fluoridation, 0g trans fat, iodization, smoke-free laws, tobacco tax Changing the Context to make individuals’ default decisions healthy Poverty, education, housing, inequality Socioeconomic Factors

  4. Community Guide: Recommended Strategies for Preventing Excessive Drinking • Regulation of Alcohol Outlet Density • Dram Shop (Commercial Host) Liability • Increasing Alcohol Taxes • Privatization of Retail Alcohol Sales • Maintaining Limits on Days and Hours of Sale • Maintaining Minimum Legal Drinking Age (MLDA) Laws • Enhanced Enforcement of Laws Prohibiting Alcohol Sales to Minors • Electronic Screening and Brief Intervention Source: www.thecommunityguide.org/alcohol

  5. Prevention Strategies:Research Support for Effectiveness Source: Babor et al., 2010

  6. Prevention Strategies:Research Support for Effectiveness Source: Babor et al., 2010

  7. Alcohol Outlet Density:Community Guide Recommnedation “The Task Force found sufficient evidence of a positive association between outlet density and excessive alcohol consumption and related harms to recommend limiting alcohol outlet density through the use of regulatory authority (e.g., licensing and zoning) as a means of reducing or controlling excessive alcohol consumption and related harms.”

  8. What the Science Tells Us:Alcohol Availability Increased/ decreased alcohol availability Increased/ decreased alcohol consumption Increased/ decreased public health/safety problems

  9. Retail Alcohol Outlet Density:Key Dimensions

  10. Outlet Density:Number of Alcohol Outlets

  11. Outlet DensityLocation of Alcohol Outlets Clustering Sensitive locations • Schools • Playgrounds • Churches • Hospitals • Alcoholism treatment facilities

  12. Outlet DensityTypes of Alcohol Outlets • Off-sale • Liquor stores • Convenience stores • Supermarkets • Gas stations • On-sale • Bars/lounges • Restaurants • Airplanes, trains, etc. • Festivals

  13. Outlet DensitySelling and Serving Practices • Problem practices • Furnishing minors • Service to intoxicated persons • Public nuisance activities

  14. Tools for Shaping Community Retail Alcohol Environments • Conditional Use Permits (new outlets) • Nuisance Abatement/Deemed Approved Ordinances • Responsible Beverage Service Programs • Dram shop liability laws • Monitoring and Enforcement • Fees

  15. Data Collection and Analysis • Alcohol outlet density • Place of last drink reports • Compliance checks • Law enforcement incident reports • Enforcement costs • GIS mapping

  16. Mean Number of Alcohol Outlets Near Residences by Race/Ethnicity & Income (California, 2003) Mean # of Alcohol Outlets Truong & Sturm 2009 Income Quartile

  17. The State Preemption Doctrine:A Potential Barrier to Local Action • Some States “preempt” or limit the ability of local governments to regulate community alcohol availability through CUPs, DAOs, and fees. • Local powers may vary both across and within States.

  18. Concurrent salesof alcohol and gasoline A case study in the power, and peril, of State preemption

  19. Levels of State Preemption Exclusive or near exclusive State authority High State Preemption STATE AUTHORITY LOCAL AUTHORITY State licensing; local zoning & police powers Joint State and local licensing Local licensing, minimum State standards Low State Preemption

  20. What is Dram Shop(Commercial Host) Liability? A Form of Tort Liability: A party whose intentional, reckless or negligent actions causes harm to another may be required to compensate the injured party.

  21. What is Commercial Host Liability? A form of tort liability that holds retailers responsible for alcohol-attributable harms caused by a patron who was illegally served alcohol because the patron was either intoxicated (“adult liability”) or underage (“underage liability”) at the time of service.

  22. Commercial Host LiabilityCommunity Guide Findings • Dram shop liability was associated with a substantial reductions in alcohol problems (a median reduction of 6.4 percent in alcohol-related motor vehicle crashes) • Legislation that limited the scope of dram shop liability may undercut these positive effects

  23. Commercial Host LiabilityCommunity Guide Recommendation “The Task Force on Community Preventive Services recommends the use of dram shop liability laws, on the basis of strong evidence of effectiveness in preventing and reducing alcohol-related harms.”

  24. Location of Reported Binge Drinking(Self Reports) 54.3%Bars/clubs/restaurants 35.7%Private residents 10.0%Elsewhere “Drinking in bars and restaurants is strongly associated with binge drinking and with alcohol-impaired driving among U.S. adults who report binge drinking.” Source: Driving after Binge Drinking, Am J Prev Med. 2009 37(4):314-20 25

  25. 40% or more of alcohol-related vehicle crashes originate in retail establishments.

  26. Why Commercial Host Liability? Commercial host liability common law rules substantially raise the stakes for violating these laws and encourage adoption of Responsible Beverage Service practices.

  27. How is Commercial Host Liability Established? In the absence of legislative guidance, courts are able to establish these rules through their “common law” powers. State legislatures may establish the parameters of tort liability using numerous, often complex, rules for when, how, and how much compensation is permitted.

  28. Alcohol Taxes:Community Guide Findings • Higher alcohol prices or taxes were consistently related to: • Fewer motor vehicle crashes and fatalities (10 of 11 studies) • Less alcohol-impaired driving (3 of 3 studies) • Less mortality from liver cirrhosis (5 of 5 studies) • Less all-cause mortality (1 study) • Effects also were demonstrated for measures of violence, sexually transmitted diseases, and alcohol dependence. • Reductions in excessive alcohol consumption are proportional to the size of the tax increase Elder et al. Am J Prev Med 2010;38(2):17–29 29

  29. Alcohol Taxes:Community Guide Recommendation “The Task force on Community Preventive Services recommends increasing the unit price of alcohol by raising taxes based on strong evidence of effectiveness for reducing excessive alcohol consumption and related harms. Public health effects are expected to be proportional to the size of the tax increase.”

  30. Alcohol Taxes: Meta-Analysis Wagenaar et al. Addiction 2009 • Meta-analysis of 110 studies containing 1,003 estimates of relationship between tax and price of alcohol and alcohol consumption • “A large literature establishes that beverage alcohol prices and taxes are related inversely to drinking. Effects are large compared to other prevention policies and programs. Public policies that raise prices of alcohol are an effective means to reduce drinking.”

  31. Alcohol Taxes • Local, State and federal governments impose alcohol taxes. • State preemption limits the extent of local taxation. • Taxes can be volume- or price-based (excise or ad valorem/sales). • Unlike alcohol outlet density and dram shop liability, taxes are easy to implement and enforce. • Tax increases increase governmental revenue. 32

  32. Alcohol Taxes • Other policy mechanisms are available to increase alcohol prices, thereby gaining public health benefits • Minimum pricing • Restrictions on happy hours • Restrictions on wholesaler discounting 33

  33. Societal Costs vs. Alcohol Tax Revenues State and Federal Tax Revenues $.12/drink Societal Costs All Costs: $1.90/drink Governmental Costs $.80/drink Bouchery et al. 2011; http://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm

  34. Challenges to Developing a Public Health Approach to Alcohol Regulation Conflict exists between commercial interests and public health policy reform, particularly at the state/federal levels

  35. Challenge:Push for Deregulation • Increasing pressure in states to deregulate alcohol sales to increase revenues • Expand number, permissible locations, and types of alcohol outlets • Privatize retail monopoly systems • Increase hours and days of sale • Once instituted, deregulatory measures are hard to reverse because new economic stakeholders are established 36

  36. Deregulating (Privatizing) State Alcohol Retail Stores States that privatized state stores States with proposals to privatize state stores Other control states

  37. Adult Dram Shop Host Liability 50 States and District of Columbia 1989, 2011 Number of States (including DC)

  38. Federal Excise Tax RatesPer Gallon Absolute Alcohol, 1970–2010 Excise tax Year Adjusted for inflation: 1970 baseline U.S. Bureau of Labor Statistics

  39. Average State Beer Excise Tax RatesPer Gallon of Beer, 1975–2008 Excise tax Adjusted for inflation: 1970 baseline Beer Almanac, 2009;U.S. Bureau of Labor Statistics, 2010

  40. Federal tax rates and inflation

  41. Opportunities for Change Chicago and Cook County Alcohol Taxes • Cook County doubled its alcohol taxes effective January 1, 2012 • Four alcohol tax increases in Chicago/Cook County since 2005 • Current Chicago and Cook County • alcohol taxes/gallon • Beer: $.38/gallon • Other beverages (based on alcohol content) • <14%: $.60/gallon (e.g., table wine, wine coolers) • 14%-20%: $1.34/gallon (e.g., fortified wine) • >20%: $5.18/gallon (e.g., distilled spirits)

  42. Opportunities for ChangeMaryland Alcohol Tax • Enacted a special 3% alcohol sales tax in 2011 • Promoted by a coalition of 1,200 health care and social services organizations

  43. Voter support for dime-a-drink, Maryland 2010

  44. Opportunities for Change Alcohol Outlet Density Campaigns

  45. Way Forward • Implementation of alcohol policy reforms are feasible and have potential for significant public health gains • Public health constituencies can play an instrumental role in the process • Assessing and disseminating scientific findings • Educating decision makers and key constituencies • Providing expertise to state and local coalitions • Conducting evaluations to determine effectiveness of interventions 46

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