The Relationship of Outlet Densities to Alcohol Consumption: A Time Series Cross-Sectional Analysis

The implementation of regulations on access to alcoholic beverages, whether through beverage taxes or restrictions on the availability of this commodity through alcohol outlets, has often been proposed as a legitimate and politically feasible approach to the prevention of alcohol-related problems. Empirical studies of the effects of these approaches to regulation on alcohol consumption and problems, however, have not been unanimous in their support of these preventive measures. While support exists for the suggestion that increases in alcohol beverage prices reduce consumption and have preventive effects upon the occurrence of problems, relatively little evidence exists for the supposition that the regulation of alcohol availability will have similar preventive effects. The lack of evidence in support of the latter thesis rests primarily upon the difficulty of obtaining sufficient data to examine comprehensive models of access to alcohol.
The current paper analyzes aggregate time series cross-sectional data from states of the U.S. to evaluate the relationships between alcohol beverage prices, availability, and alcohol sales within one analytic model. The model relates beverage prices and alcohol availability directly to alcohol sales in the context of an assumed simultaneous relationship between sales and availability. The results show that, independent of the effects of beverage prices, and controlling for the endogeneity of sales and availability, physical availability of alcohol was directly related to sales of spirits and wine.     

Alcohol Availability and Injury: The Role of Local Outlet Densities

BACKGROUND: We analyzed the relationship between alcohol availability and injury that occurred during the 6 months before survey administration. METHOD: The data examined were from a general population survey administered to 13,440 California respondents as part of a community-based project to reduce alcohol-involved injury and death. Two separate analyses were performed. The first considered individual local outlet densities (which included both on-premise establishments such as bars and restaurants and off-premise establishments such as liquor and grocery stores) as they affect individual phone survey respondents' self-reported injuries. To address potential spatially autocorrelated errors and geographically lagged effects, a second analysis considered aggregate outlet densities within geographic areas as they affect the proportion of survey respondents who reported injury. No spatial autocorrelation or significant lagged effects were found, which supported our individual-level analyses. RESULTS: Our analyses indicated an association between both on-premise and off-premise individual-level outlet densities and self-reported injuries. CONCLUSION: Alcohol availability seems to be related to self-reported injury. The mechanisms behind this relationship, however, are not clear, and further study is indicated.     

Beverage Effects on Patterns of Alcohol Consumption

In this paper an analysis is made of beverage preferences and their effect on alcohol consumption patterns. For this purpose we have used the 1993 Spanish National Household Health Survey conducted on members of the population aged 16 or over. Beer and spirits are consumed more frequently by young people and wine by older people. The most consumed daily drink is wine and beer on a weekly basis. Men always drank more frequently and consumed a greater number of drinks per occasion than women for the three types of drink analyzed. The study shows that beverage preference is an important factor in the characterization of alcohol use patterns.     

Alcohol Availability and Intimate Partner Violence Among US Couples

Objectives: We examined the relation between alcohol outlet density (the number of alcohol outlets per capita by zip code) and male‐to‐female partner violence (MFPV) or female‐to‐male partner violence (FMPV). We also investigated whether binge drinking or the presence of alcohol‐related problems altered the relationship between alcohol outlet density and MFPV or FMPV. Methods: We linked individual and couple sociodemographic and behavioral data from a 1995 national population‐based sample of 1,597 couples to alcohol outlet data and 1990 US Census sociodemographic information. We used logistic regression for survey data to estimate unadjusted and adjusted odds ratios between alcohol outlet density and MFPV or FMPV along with 95% confidence intervals (CIs) and p‐values. We used a design‐based Wald test to derive a p‐value for multiplicative interaction to assess the role of binge drinking and alcohol‐related problems. Results: In adjusted analysis, an increase of one alcohol outlet per 10,000 persons was associated with a 1.03‐fold increased risk of MFPV (p‐value for linear trend = 0.01) and a 1.011‐fold increased risk of FMPV (p‐value for linear trend = 0.48). An increase of 10 alcohol outlets per 10,000 persons was associated with 34% and 12% increased risk of MFPV and FMPV respectively, though the CI for the association with FMPV was compatible with no increased risk. The relationship between alcohol outlet density and MFPV was stronger among couples reporting alcohol‐related problems than those reporting no problems (p‐value for multiplicative interaction = 0.01). Conclusions: We found that as alcohol outlet density increases so does the risk of MFPV and that this relationship may differ for couples who do and do not report alcohol‐related problems. Given that MFPV accounts for the majority of injuries related to intimate partner violence, policy makers may wish to carefully consider the potential benefit of limiting alcohol outlet density to reduce MFPV and its adverse consequences.     

Alcohol prices, beverage quality, and the demand for alcohol: quality substitutions and price elasticities

BACKGROUND: Although the published literature on alcohol beverage taxes, prices, sales, and related problems treats alcoholic beverages as a simple good, alcohol is a complex good composed of different beverage types (i.e., beer, wine, and spirits) and quality brands (e.g., high-, medium-, and low-quality beers). As a complex good, consumers may make substitutions between purchases of different beverage types and brands in response to price increases. For this reason, the availability of a broad range of beverage prices provides opportunities for consumers to mitigate the effects of average price increases through quality substitutions; a change in beverage choice in response to price increases to maintain consumption. METHODS: Using Swedish price and sales data provided by Systembolaget for the years 1984 through 1994, this study assessed the relationships between alcohol beverage prices, beverage quality, and alcohol sales. The study examined price effects on alcohol consumption using seemingly unrelated regression equations to model the impacts of price increases within 9 empirically defined quality classes across beverage types. The models enabled statistical assessments of both own-price and cross-price effects between types and classes. RESULTS: The results of these analyses showed that consumers respond to price increases by altering their total consumption and by varying their brand choices. Significant reductions in sales were observed in response to price increases, but these effects were mitigated by significant substitutions between quality classes. CONCLUSIONS: The findings suggest that the net impacts of purposeful price policy to reduce consumption will depend on how such policies affect the range of prices across beverage brands.     

Loss of Control Drinking among First Offender Drunk Drivers

A mathematical model of alcohol consumption, which characterizes individual drinking in terms of frequency of consumption and subsequent loss of control drinking once consumption has been initiated, is introduced. The model provides a conceptual link between behavioral indices of alcohol consumption patterns and theoretical models of the role of loss of control drinking in the genesis of alcohol dependence and alcoholism. Based on data from a large sample of first offender drunk drivers, it is shown that specific measures of consumption patterns can be used to provide individual estimates of parameters of the model. These estimates are shown to be strongly related to one measure of alcohol dependence and to introspective reports of loss of control drinking.     

Difficulties with Questions on Usual Drinking and the Measurement of Alcohol Consumption

Questions about usual drinking play an important role in the construction of alcohol consumption measures. However, little is known about difficulties in answering these questions for respondents with variability in their drinking patterns. We investigated this in a community sample of 945 drinkers and in a clinical sample of 400 patients treated for alcohol and/or drug problems. Demographic variables were not consistently related to self-reported difficulty in answering, but a diagnosis of current DSM-IV alcohol dependence was significantly related in both samples. In modeling the relationship between alcohol consumption and DSM-IV alcohol dependence, the fit of the model to the data was significantly improved by the addition of a variable indicating respondents'difficulty answering the usual drinking questions. Using this information in the development of alcohol consumption questions may provide more precise estimates of the risk from alcohol consumption to outcomes such as alcohol dependence.     

Alcohol Reactions in Subjects of European Descent: Effects on Alcohol Use and on Physical and Psychomotor Responses to Alcohol

Self-reports of reactions to small amounts of alcohol, obtained between 1990 and 1992, were compared with reports of alcohol use, obtained in 1990–1992 and also in 1979–1981, in twin subjects of European descent. Data on subjective, physiological, psychomotor, and metabolic responses to a test dose of alcohol, taken in 1979–1981, were also available. Alcohol reactions were more common in women than in men, and were associated with less alcohol use, both at the time that information about reactions was obtained and as recorded on average 12 years previously, in both sexes. Physiological and psychomotor responses to alcohol were similar across the reaction groups, except that deterioration in standing steadiness was greater in those who subsequently reported adverse reactions to alcohol. Contrary to expectation, skin temperature changes after alcohol were less in the subjects who reported always reacting to alcohol than in the other groups. Subjective reports of intoxication were greatest in subjects who subsequently reported alcohol reactions. The pattern of twin pair concordance for reactions suggests low heritability, so alcohol reactions in subjects of European descent are not caused by a single gene of high penetrance of the type found in the Asian alcohol flush reaction.     

The Relationship Between Genetic Influences on Alcohol Dependence and on Patterns of Alcohol Consumption

Background: Genetic factors impact substantially both on alcohol consumption (AC) and on the risk for alcohol dependence (AD). However, we know little about the degree to which measures of AC index the genetic risk for AD. Methods: We assessed a lifetime history of AD by DSM‐IV criteria and four measures of AC at the time of heaviest drinking (drink frequency, regular quantity, maximum quantity, and drunk frequency) in 5,073 adult twins from same‐sex pairs from the Virginia Twin Registry. Structural models were fitted using Mx. Results: We found evidence for different genetic structure in the sexes. In women, genetic risk for AD and for the four measures of AC was entirely shared. In men, the AC measures captured 85% of the genetic risk for AD. In women, the genetic relationship with AD was strongest for drunk frequency and in men for both drunk frequency and regular quantity. Conclusions: In a population‐based sample of twins, four relatively simple measures of AC obtained for the time of lifetime heaviest drinking were able to capture all (in women) or a very large proportion (in men) of the genetic risk for the complex multi‐dimensional construct of AD. If replicated, these results have practical implications for studies aiming to assess genetic risk for AD.     

The Association between Moderate Alcoholic Beverage Consumption and Serum Estradiol and Testosterone Levels in Normal Postmenopausal Women: Relationship to the Literature

The major source of endogenous estrogens in postmenopausal women is the aromatization of androgens to estrogens; because alcohol is known to increase aromatization, the relationship between moderate alcoholic beverage consumption and serum estradiol levels was evaluated in 128 normal postmenopausal women. Alcohol intake was based on a composite of self-report and food record information. Among the 78.8% of women reporting alcohol use, weekly intake was 4.8 +/- 0.6 drinks. Among abstainers, estradiol levels were 100.8 +/- 12.1 pmol/liter, significantly lower than in alcohol users, 162.6 +/- 11.9 pmol/liter. Significant bivariate correlations were found between the logarithm of estradiol and total weekly drinks. In multiple linear regression analyses inclusion of alcohol as a variable increased the amount of explained variation in estradiol. Similar findings were demonstrable when the crude estimator of aromatization, the estradiol:testosterone ratio logarithm was the dependent variable. Together, these findings suggest that moderate alcohol use is an important factor for postmenopausal estrogen status and may offer a partial explanation for the reported protective effect of moderate alcohol consumption with respect to postmenopausal cardiovascular disease risk.