Association for Public Policy Analysis & Management

Background: Excessive alcohol consumption is one of the leading modifiable risk behaviors in the United States contributing to nearly 1 in 10 deaths in 2006-2010. With the exception of federal laws regulating the labeling and packaging of alcohol, the establishment of the legal minimum drinking age, and some laws regarding underage drinking and driving, regulation of alcohol is largely left to the states. Over the past few decades US states have adopted (and in some cases repealed) many evidence-based state alcohol control policies, creating substantively different policy environments.

Although alcohol consumption patterns differ by gender and educational levels, little is known about how alcohol control policies might affect high risk alcohol consumption among different subgroups of men and women at different levels of schooling.

Methods: For each U.S. state (2011-2013) we construct 1-year lagged alcohol policy scores for the presence of laws restricting alcohol price, availability and consumption, using public use data and original legal research. Poisson regression models test the relationship between alcohol policy scores and binge and heavy drinking among male and female subgroups (by age group, education, and race/ethnicity) of adult current drinkers, using the US Behavioral Risk Factor Surveillance System data.

Results: A significant inverse relationship between higher state policy scores and binge and heavy drinking behaviors was found for men, but not women. In stratified models, a 10% increase in the policy score was associated with a 12% lower prevalence of heavy drinking among men who did not finish high school (aPR=0.88, 95% CI 0.81-0.96) and a 4% lower rate among men with a high school diploma or GED (aPR=0.95, 95% CI 0.92-0.99), and a 7-8% lower prevalence of heavy drinking for men in the 25-54 year age groups.  In contrast, a positive, significant relationship between state alcohol policy scores and heavy drinking among white women (aPR=1.03, 95% CI 1.00-1.06), women aged 35-44 (aPR=1.08, 95% CI 1.01-1.16), and women who are college-educated (aPR=1.04, 95% CI 1.00-1.08). The observed relationships between policy scores and heavy drinking for both sexes persist in states with alcohol consumption below the median. However, a negative relationship between the state alcohol policy score and binge drinking was found in states with alcohol consumption above the median for both sexes.

Conclusion: US states have adopted different policies to reduce high risk alcohol use, creating different policy environments for their residents, even as consumption patterns across states vary. This study provides evidence that the strength of these policy environments is associated with reductions in both heavy and binge drinking, but these effects may be largely experienced by men, and their impact is uneven across age, education and racial subgroups. Changing patterns of high risk drinking among women add urgency to the need for stronger, more effective and targeted policies (including taxation) and programs to reduce these behaviors, better communication about the risks of high risk drinking, and enhanced enforcement of existing strategies to limit excessive consumption.