The Alcohol Policy Environment and Policy Subgroups as Predictors of Binge Drinking Measures Among US Adults

Objectives. We examined the relationships of the state-level alcohol policy environment and policy subgroups with individual-level binge drinking measures.Methods. We used generalized estimating equations regression models to relate the alcohol policy environment based on data from 29 policies in US states from 2004 to 2009 to 3 binge drinking measures in adults from the 2005 to 2010 Behavioral Risk Factor Surveillance System surveys.Results. A 10 percentage point higher alcohol policy environment score, which reflected increased policy effectiveness and implementation, was associated with an 8% lower adjusted odds of binge drinking and binge drinking 5 or more times, and a 10% lower adjusted odds of consuming 10 or more drinks. Policies that targeted the general population rather than the underage population, alcohol consumption rather than impaired driving, and raising the price or reducing the availability of alcohol had the strongest independent associations with reduced binge drinking. Alcohol taxes and outlet density accounted for approximately half of the effect magnitude observed for all policies.Conclusions. A small number of policies that raised alcohol prices and reduced its availability appeared to affect binge drinking.Excessive alcohol consumption is a leading cause of mortality, morbidity, social, and economic burden in the United States.1–6 Of the adverse consequences linked to excessive alcohol consumption, binge drinking accounts for approximately half of alcohol-attributable deaths, two thirds of years of potential life lost, and three fourths of economic costs.5–7 Patterns of excessive alcohol consumption, including binge drinking, vary substantially across US states.8–10 Alcohol control policies, which consist of the laws, regulations, and practices designed to reduce excessive alcohol use and related harms, also differ considerably among US states.11,12A number of discrete alcohol policies have been shown to reduce excessive alcohol consumption and related problems at the population level.1,13–23 However, the alcohol policy “environment” in US states is complex, and any discrete alcohol policy coexists with many other policies. Because the presence of a policy may be correlated with other policies, and because the effect of a policy may depend on its interaction with other policies, the relationship between a policy and an outcome may be inadequately characterized by failing to account for other policies that are in effect. Therefore, assessing the effect of multiple policies is crucial not only for understanding the cumulative effects of alcohol policies, but also for understanding the independent effects of policy subgroups or individual policies.Policy scales have been used to examine policy environments in several public health concerns, including alcohol use,24 tobacco use25–27 and obesity.28,29 We recently developed the Alcohol Policy Scale (APS) to represent the alcohol policy environment in all 50 states and Washington, DC, from 1999 to 2011.11 Previous analyses validated the APS scores by demonstrating that states with higher APS scores (representing mixes of more effective or better implemented policies) were associated with a lower state-level prevalence of binge drinking in both repeated cross-sectional generalized estimating equation (GEE) models and longitudinal models.11 However, analyses that rely on state-level outcomes can be susceptible to ecological fallacy.30 Furthermore, the effect of the policy environment among demographic groups and the independent effects of subgroups of alcohol policies have not been assessed previously. Our aims were (1) to determine the associations between the state alcohol policy environment and 3 individual-level binge drinking measures, overall and stratified by demographic factors; and (2) to assess the independent effects of policy subgroups and selected individual policies on these 3 binge drinking measures.     

Neighborhood Alcohol Outlets and the Association with Violent Crime in One Mid-Atlantic City: The Implications for Zoning Policy

Violent crime such as homicide causes significant excess morbidity and mortality in US urban areas. A health impact assessment (HIA) identified zoning policy related to alcohol outlets as one way to decrease violent crime. The objectives were to determine the relationship between alcohol outlets including off-premise alcohol outlets and violent crime in one urban area to provide local public health evidence to inform a zoning code rewrite. An ecologic analysis of census tracts in Baltimore City was conducted from 2011 to 2012. The data included violent crimes (n = 51,942) from 2006 to 2010, licensed alcohol outlets establishments (n = 1,327) from 2005 to 2006, and data on neighborhood disadvantage, percent minority, percent occupancy, and drug arrests from 2005 to 2009. Negative binomial regression models were used to determine the relationship between the counts of alcohol outlets and violent crimes controlling for other factors. Spatial correlation was assessed and regression inference adjusted accordingly. Each one-unit increase in the number of alcohol outlets was associated with a 2.2 % increase in the count of violent crimes adjusting for neighborhood disadvantage, percent minority, percent occupancy, drug arrests, and spatial dependence (IRR = 1.022, 95 % CI = 1.015, 1.028). Off-premise alcohol outlets were significantly associated with violent crime in the adjusted model (IRR = 1.048, 95 % CI = 1.035, 1.061). Generating Baltimore-specific estimates of the relationship between alcohol outlets and violent crime has been central to supporting the incorporation of alcohol outlet policies in the zoning code rewrite being conducted in Baltimore City.     

饮酒与健康危害及其干预的研究进展

饮酒可引发60多种危害健康的疾病和威胁生命安全的事件,占全球4%的疾病负担,致死致残是吸烟和高血压危害的总和。发达国家价格政策对酒类调控和健康教育干预等综合措施对不当饮酒造成的健康和安全危害发挥积极的预防和有效控制作用。我国应加大饮酒危害研究和重视饮酒危害预防干预工作。     

Determinants of Underage College Student Drinking: Implications for Four Major Alcohol Reduction Strategies

Guided by the assumptions of the social ecological model and the social marketing approach, this study provides a simultaneous and comprehensive assessment of 4 major alcohol reduction strategies for college campuses: school education programs, social norms campaigns, alcohol counter-marketing, and alcohol control policies. Analysis of nationally representative secondary survey data among 5,472 underage students reveals that alcohol marketing seems to be the most formidable risk factor for underage drinking, followed by perceived drinking norms (injunctive norm) and lax policy enforcement. This analysis suggests that, to make social norms campaigns and alcohol control policies more effective, alcohol reduction strategies should be developed to counter the powerful influence of alcohol marketing and promotions.     

Reducing Resistance to Narrative Persuasion About Binge Drinking: The Role of Self-Activation and Habitual Drinking Behavior

This study explores the effects of habitual health risk behaviors and self-activation on resistance to narrative persuasion. In two experiments, heavier drinkers were more resistant to an anti-binge-drinking narrative public service announcement (PSA) in which a binge drinker suffers a negative outcome. Specifically, heavier drinkers were more likely to generate counterarguments, unrealism judgments, and negative evaluations about the message compared to lighter drinkers or nondrinkers. However, activating self-concept when processing the persuasive narrative reduced unrealism judgments and negative evaluations, particularly among heavier drinkers. Self-activation also decreased perceived freedom threat among both heavier and lighter drinkers, which further led to higher perceived risk of binge drinking. Theoretical and practical implications are discussed.     

Factors in Adolescent Drinking/Driving: Binge Drinking, Cigarette Smoking, and Gender

ABSTRACT: During three consecutive years, 3,137 high school seniors from three graduating classes in one Michigan county were surveyed. The primarily White sample reported their use of alcohol and cigarettes, driving experience, and drinking/driving experience. Survey data were linked with state driver history records. Fully one-third of the high school seniors reported driving after drinking in the past six months. To identify factors associated with self-reported drinking/driving, correlation and regression analyses were conducted. Frequent binge drinking and riding with a drinking driver were consistent factors in driving after drinking frequency. Being male, smoking cigarettes, having frequent use of a motor vehicle, having a driving offense on record, and number of years licensed were important correlates, varying by year of graduation. Comprehensive interventions to moderate drinking, smoking, and driving after drinking are needed.     

Child Neglect: Developmental Consequences, Intervention, and Policy Implications

This paper reviews the literature on child neglect with respect to child outcomes, prevention and intervention, and implications for policy. First, the prevalence of the problem is discussed and then potential negative outcomes for neglected children, including behavior problems, low self-esteem, poor school performance, and maladjustment/psychopathology, are discussed. Risk factors and current child neglect interventions are then reviewed. Popular family support programs, such as family preservation, have mixed success rates for preventing child neglect. The successes and shortcomings of other programs are also examined with a focus on implications for future research and policy. Overall, the research supports a multidisciplinary approach to assessment, intervention, and research on child neglect. Furthermore, the need for a combined effort among parents, community members, professionals, and policymakers to increase awareness and prevention endeavors is discussed. Targeted attempts to educate all involved parties should focus on early intervention during specific encounters with at-risk families via medical settings, school settings, and parent education programs.     

Utility of the Physical Activity Resource Assessment for Child-centric Physical Activity Intervention Planning in Two Urban Neighborhoods

Children’s physical activity (PA) may be determined, in part, by environmental influences such as access to diverse and safe places to play. As part of the development of a community-based PA program, a PA asset assessment was conducted in two low-income urban neighborhoods that support elementary schools serving minority youth. Resources were rated using an adapted version of the Physical Activity Resource Assessment (PARA), a multi-dimensional instrument that rates various venues on their features, amenities, and incivilities. Seventy-one child-centric venues (e.g., parks, playgrounds, community centers, sports facilities, fitness centers, etc.) were assessed within a three-mile radius of each school. Community member feedback via interviews with parent–child dyads revealed issues (e.g., bullying) not captured by the PARA that can influence venue use. Whereas the PARA can be a useful needs assessment and program planning tool for community-based PA programs, supplementing PARA data with community-based input may reduce contextual error in program development.     

Binge Drinking among Men Who Have Sex with Men and Transgender Women in San Salvador: Correlates and Sexual Health Implications

High rates of heavy alcohol use among men who have sex with men (MSM) and transgender women (TW) have been linked to increased vulnerability for HIV and poor mental health. While theories explaining elevated drinking levels among sexual minorities have been forwarded, few investigations have assessed the potential pathways using empirical data, particularly with an explicit focus on self-stigma and among MSM and TW in low- and middle-income countries. This study examined the relationship between stigma-related stress (specifically, self-stigma and concealment of one’s sexual orientation) and binge drinking in a sample of MSM and TW (n = 670) in San Salvador, El Salvador, recruited using respondent-driven sampling. Levels of alcohol consumption among participants were high: only 39 % of the sample did not drink alcohol or did not binge drink, while 34 % engaged in binge drinking at least weekly. Among MSM, high self-stigma was associated with binge drinking at least weekly (adjusted relative risk ratio (aRRR) = 2.1, p < 0.05). No such relationship was found with less than weekly binge drinking. Among both MSM and TW, having a female partner was associated with binge drinking less than weekly (aRRR = 3.3, p < 0.05) and binge drinking at least weekly (aRRR = 3.4, p < 0.05), while disclosure of sexual orientation to multiple types of people was associated with binge drinking less than weekly (aRRR = 2.9 for disclosure to one–two types of people, p < 0.01; aRRR = 4.0 for disclosure to three–nine types of people, p < 0.01). No such relationship was found with at least weekly binge drinking. Binge drinking at least weekly was marginally associated with a number of sexual health outcomes, including high number of lifetime partners (adjusted odds ratio (aOR) = 1.7, p < 0.10), inconsistent condom use with a non-regular partner (aOR = 0.5, p < 0.10), and decreased intention to test for HIV in the next 12 months (aOR = 0.6, p < 0.10). With the exception of inconsistent condom use with a non-regular partner (aOR = 0.4, p < 0.05), binge drinking less than weekly was not associated with increased sexual risk behavior and was actually associated with increased intention to test for HIV in the next 12 months (aOR = 2.8, p < 0.01). These findings support multiple pathways linking stigma-related stress to alcohol use. Specifically, those with high self-stigma and identity concealment may be using alcohol as a maladaptive coping and emotion regulation strategy, while those who have disclosed their sexual orientation to multiple types of people may be more engaged with the sexual minority community, likely in bars and other venues where permissive norms for alcohol use prevail. That this frequency of binge drinking does not appear to be associated with increased sexual risk behavior (and may even be associated with increased intention to test for HIV in the next 12 months) lends further support to the suggestion that these individuals with healthy concepts of the self (as indicated by high levels of disclosure and low levels of risky sexual behavior) may engage in binge drinking because of the influence of the social environment. Further research is needed to establish the pathways linking stigma-related stress to heavy alcohol use so that points of intervention can be identified.     

NekNominate: Social Norms,Social Media,and Binge Drinking

This study examines the social-media-based binge drinking game NekNominate and how this phenomenon is related to social norms. NekNominate is a game wherein players are nominated to film themselves “neking” or chugging copious amounts of alcohol or drinking alcohol in a novel or humorous manner. The player then nominates other players via social media who then have a specific timeframe in which they must complete their challenge or face ridicule. Health communication research on drinking behaviors has often looked at the role of social norms in determining these behaviors. News stories (n = 44) of NekNominate and tweets (n = 851) culled using the hashtag #NekNominate during three different time periods are analyzed to identify the normative forces at play in this recent phenomenon.     

Mapping Urban Malaria and Diarrhea Mortality in Accra, Ghana: Evidence of Vulnerabilities and Implications for Urban Health Policy

Historic increase in urban population numbers in the face of shrinking urban economies and declining social services has meant that a large proportion of the urban population lives in precarious urban conditions, which provide the grounds for high urban health risks in low income countries. This study aims to identify, investigate, and contrast the spatial patterns of vulnerability and risk of two major causes of mortality, viz malaria and diarrhea mortalities, in order to optimize resource allocation for effective urban environmental management and improvement in urban health. A spatial cluster analysis of the observed urban malaria and diarrhea mortalities for the whole city of Accra was conducted. We obtained routinely reported mortality data for the period 1998–2002 from the Ghana Vital Registration System (VRS), computed the fraction of deaths due to malaria and diarrhea at the census cluster level, and analyzed and visualized the data with Geographic Information System (GIS, ArcMap 9.3.1). Regions of identified hotspots, cold spots, and excess mortalities were observed to be associated with some socioeconomic and neighborhood urban environmental conditions, suggesting uneven distribution of risk factors for both urban malaria and diarrhea in areas of rapid urban transformation. Case–control and/or longitudinal studies seeking to understand the individual level factors which mediate socioenvironmental conditions in explaining the observed excess urban mortalities and to establish the full range of risk factors might benefit from initial vulnerability mapping and excess risk analysis using geostatistical approaches. This is key to evidence-based urban health policy reforms in rapidly urbanizing areas in low income economies.     

Subjective Reality: The Influence of Perceived and Objective Conversational Valence on Binge Drinking Determinants

Previous studies have shown that interpersonal communication, and particularly perceived conversational valence (i.e., the perceived negativity or positivity of conversations) about health topics, influences health determinants. On the basis of 43 dyads (N = 86) discussing the topic of alcohol consumption, this study is the first to show that whereas perceived and objective conversational valence are positively related, only perceived conversational valence is a significant predictor of binge drinking attitudes and intentions. Thus, subjective reality matters more than objective reality. Furthermore, only the perceived valence of the participants’ own contributions—and not of their conversation partners—influences binge drinking intentions, indicating that self-persuasion is more influential than persuasion by others. Thus, conversations in which discussants themselves express negative opinions about unhealthy behaviors can enhance public health.     

The Geography of Violence,Alcohol Outlets,and Drug Arrests in Boston

Objectives. We examined the relationship between alcohol outlets, drug markets (approximated by arrests for possession and trafficking), and violence in Boston, Massachusetts, in 2006. We analyzed geographic and environmental versus individual factors related to violence and identified areas high in violent crime.Methods. We used data from the Boston Police Department, US Census, and Massachusetts State Alcohol Beverage Control Commission. Spatial modeling was employed at the block group level, and violent crime, alcohol outlets, and drug markets were mapped.Results. Relative to other block groups, block groups in the highest decile of violent crime (n = 55) were found to be poorer (e.g., lower incomes, higher percentages of vacant homes), and they had greater numbers of alcohol outlets and higher drug arrest rates. Alcohol outlets and drug possession and trafficking arrests were predictive of violent crime. Also, spatial effects resulting from neighboring block groups were related to violent crime. Both alcohol outlet density and type were associated with violent crime in a differentiated and complex way.Conclusions. With drug possession and trafficking arrests as a proxy for drug markets, spatial relationships between alcohol outlets and violence were found in addition to typical sociodemographic predictors.Understanding the environmental and social contexts in which violence occurs has been an increasingly important area of research, one that has broad applicability to public policies on violence mitigation far beyond purely research issues. Increased theoretical understanding of the spatial and environmental contexts of violence, such as theories relating alcohol outlets to violence, have gone hand in hand with improvements in spatial techniques and computing power, transforming this area of research. Furthermore, although there have been studies on violence related to types and densities of alcohol outlets,1–5 there has been less research attempting to include measures of drug arrests and to more fully incorporate spatial features such as characteristics of adjacent geographic areas.Locations of alcohol outlets are frequently related to occurrence of violence. The incidence of interpersonal violence appears to increase in and around locations with alcohol outlets, particularly bars and liquor stores.1,3–5 There are several possible mechanisms. First, bars and liquor stores often attract individuals likely to be involved in violent interactions, such as young males (alcohol availability theory).6 Second, these retail alcohol outlets are often located in areas with less guardianship than others (social disorganization theory).1,3,7 Third, these types of outlets provide opportunities for social interactions that may lead to violence (alcohol availability and niche theory).Finally, establishments serving alcohol can foster increased expressions of aggression.6 Empirical studies have shown a correlation between higher rates of violence and increased proximity to bars and liquor stores1,8–10 as well as sales through alcohol outlets.11 Similar arguments have been suggested to support empirically observed cross-sectional relationships between rates of violence and locations of off-premise establishments.9,12Establishment effects, however, may be related to other crime-related aspects of the environments of off-premise outlets, such as illegal drug activity and prostitution.13 Questions remain as to whether effects related to alcohol outlets are due to the outlets themselves or the general characteristics of the areas in which they are located. Recent criminological research on bars and taverns suggests that managers of these establishments create environments that suppress or facilitate violence through business-related choices such as types of activities and entertainment, staff and training, and property characteristics.14Two theoretical concerns have guided much of the empirical work over the past 2 decades. First, alcohol outlets might serve as markers for other population or environmental features that are related to violence. These markers could consist of specific population characteristics related to greater levels of violence (e.g., poverty, female-headed households)10 or place-based characteristics related to lower levels of police enforcement and surveillance (e.g., vacant retail establishments).15 Second, violence and alcohol outlets are part of the continuous spatial fabric of communities, and thus standard statistical analyses of data, which assume independence of observations, are complicated by spatial autocorrelation between observations.16 Spatial models have been applied to help correct for bias or increased sampling variation of effect estimates arising from a lack of spatial independence in modeling violence outcomes.17We examined the relationship between alcohol outlets and violent crime in an analytical framework that treats alcohol outlets as potentially both “producers” of violent behavior and markers or attractors of violence. Our initial assessments of the effects of typical sociodemographic measures demonstrated that there remained effects of alcohol outlet presence not accounted for by these features. Subsequently, to capture more spatial and environmental characteristics and to illustrate the presence of spatial effects that were distinct from the 2 types of effects just mentioned, we assessed how adjacent area characteristics relate to violent crime in the target area. To deal with the different ways in which outlets are posited to be related to violence, we accounted for outlet density and type and whether a violent crime occurred on a weekend or weekday.In addition, we included information on drug arrests for trafficking and possession (as estimators of drug markets) to properly account for the relationship between violence and drug markets when assessing the effects of alcohol outlets. Although Martinez et al.18 found a significant relationship between drug markets and violence when accounting for social disorganization, our analysis is the first, to our knowledge, to also include alcohol outlet type and density.     

The Premises is the Premise: Understanding Off- and On-premises Alcohol Sales Outlets to Improve Environmental Alcohol Prevention Strategies

Environmental strategies to prevent the misuse of alcohol among youth—e.g., use of public policies to restrict minors’ access to alcohol—have been shown to reduce underage drinking. However, implementation of policy changes often requires public and private partnerships. One way to support these partnerships is to better understand the target of many of the environmental strategies, which is the alcohol sales outlet. Knowing more about how off-premises outlets (e.g., liquor and convenience stores) and on-premises outlets (e.g., bars and restaurants) are alike and different could help community-based organizations better tailor, plan, and implement their environmental strategies and strengthen partnerships between the public and commercial sectors. We conducted a survey of managerial or supervisory staff and/or owners of 336 off- and on-premises alcohol outlets in six counties in South Carolina, comparing these two outlet types on their preferences regarding certain alcohol sales practices, beliefs toward underage drinking, alcohol sales practices, and outcomes. Multilevel logistic regression showed that while off- and on-premises outlets did have many similarities, off-premises outlets appear to engage in more practices designed to prevent sales of alcohol to minors than on-premises outlets. The relationship between certain Responsible Beverage Service (RBS) practices and outcomes varied by outlet type. This study furthers the understanding of the differences between off- and on-premises alcohol sales outlets and offers options for increasing and tailoring environmental prevention efforts to specific settings.     

Sexual Minority Youth Report High-Intensity Binge Drinking: The Critical Role of School Victimization

Purpose

To examine standard binge drinking (≥4 drinks for females, ≥5 drinks for males) and high-intensity binge drinking (≥8 drinks for females, ≥10 drinks for males) among heterosexual and sexual minority youth in the US and whether reports of school-based victimization mediate this association.