Overview of State Laws Restricting Alcohol Outlet Density in the United States.

OBJECTIVES: Complementing the extensive research literature demonstrating that increased alcohol outlet density is associated with excessive alcohol consumption and related harms, this article synthesizes information on the types of alcohol outlet density restrictions in US state-level laws. DESIGN: Statutes and regulations related to alcohol outlet density in all 50 states and the District of Columbia in effect as of January 1, 2022, were collected using Westlaw. State-level density restrictions were coded according to 4 variables and overlaid with existing research on state-specific local authority to regulate outlet density. Alcohol outlet density laws in Michigan and Massachusetts were analyzed in detail as case studies. SETTING: United States. MAIN OUTCOME MEASURE: US state-level licensing laws restricting alcohol outlet density. RESULTS: Thirty-three states and the District of Columbia have state-level licensing laws that limit alcohol outlet density. Of those, 25 have population-based restrictions, 8 have distance-based restrictions, 7 have quotas, and 6 require the licensing agency to consider density-related factors. Within the same group of 34 jurisdictions, 22 apply restrictions to both on- and off-premises outlets, 5 apply them only to on-premises outlets, and 7 apply them only to off-premises outlets. Among the 32 states where localities lack authority to license alcohol outlets, two-thirds have state-level laws restricting outlet density. State-level density restrictions also exist in approximately two-thirds of the states where localities have licensing authority. Case studies of Michigan and Massachusetts highlight how state-level density restrictions operate in practice. CONCLUSIONS: Two-thirds of jurisdictions have state-level alcohol outlet density restrictions, with population-based restrictions being the most common. In addition, outlet density restrictions may exist regardless of limits on local control and whether localities with authority to enact density restrictions have done so. Policymakers and others can reference this assessment to identify examples and opportunities to strengthen the alcohol policy environment in any given state.

Using the International Alcohol Control (IAC) policy index to assess effects of legislative change in Aotearoa New Zealand.

BACKGROUND: The IAC Policy Index was developed to allow comparison in alcohol policy between countries and within countries over time including in low resource settings. It measures four effective alcohol policies and takes into account stringency of regulation and the actual impact on the alcohol environment, such as trading hours and prices paid. This framework was used to assess policy in Aotearoa New Zealand in a time period covering two relevant legislative changes. This is the first study to use an alcohol policy index to assess and describe legislative change within country. METHODS: Data to calculate the IAC Policy Index was collected for 2013 and 2022. Stringency of policy was assessed from legislative statutes and impacts of policy on the alcohol environment from administrative data and specifically designed data collection. RESULTS: The overall IAC Policy Index score improved over the time period. The scores for the separate policy areas reflected the legislative changes as hypothesised, but also independent changes in impact, given ecological changes including reduced enforcement of drink driving countermeasures and increased exposure to marketing in digital channels. The IAC Policy index reflects the changes in policy status observed in Aotearoa, NZ. DISCUSSION: The IAC Policy Index provided a useful framework to assess and describe change in alcohol legislation contextualised by other influences on policy impact over time within a country. The results indicated the value of assessing stringency and impact separately as these moved independently. CONCLUSIONS: The IAC Alcohol Policy Index, measuring both stringency and actual impact on the alcohol environment with a focus on only the most effective alcohol policies provides meaningful insights into within-country policy strength over time. The IAC Policy Index used over time can communicate to policy makers successes and gaps in alcohol policy.

Interrupted Time Series Analysis of Bar/Tavern Closing Hours and Violent Crime.

Importance: It is well established that alcohol outlets (ie, places that sell alcohol) attract crime, particularly during late-night hours. Objective: To evaluate the association of Maryland Senate Bill 571 (SB571), which reduced the hours of sale for bars/taverns in 1 Baltimore neighborhood from 6 am to 2 am to 9 am to 10 pm, with violent crime within that neighborhood. Design, Setting, and Participants: This controlled interrupted time series analysis compared the change in violent crime density within an 800-ft buffer around bars/taverns in the treatment neighborhood (ie, subject to SB571) and 2 control areas with a similar mean baseline crime rate, alcohol outlet density, and neighborhood disadvantage score in the City of Baltimore between May 1, 2018, and December 31, 2022. The interrupted time series using Poisson regression with overdispersion adjustment tested whether the violent crime density differed before vs after the policy change in the treatment neighborhood and whether this difference was localized to the treatment neighborhood. Exposure: Statutory reduction of bar/tavern selling hours from 20 to 13 hours per day in the treatment neighborhood. Main Outcomes and Measures: The primary outcome was all violent crime, including homicide, robbery, aggravated and common assault, and forcible rape. Secondary outcomes were homicides and assaults. All violent crime measures summed the monthly incidents within 800 ft of bars/taverns from 8 pm to 4 am. For each outcome, a level change estimated the immediate change (first month after implementation), and a slope change estimated the sustained change after implementation (percent reduction after the first month). These level and slope changes were then compared between the treatment and control neighborhoods. Results: The treatment neighborhood included 26 bars/taverns (mean [SD] population, 524.6 [234.6] residents), and the control neighborhoods included 41 bars/taverns (mean [SD] population per census block, 570.4 [217.4] residents). There was no immediate level change in density of all violent crimes the month after implementation of SB571; however, compared with the control neighborhoods, the slope of all violent crime density decreased by 23% per year in the treatment neighborhood after SB571 implementation (annualized incidence rate ratio, 0.77; 95% CI, 0.60-0.98; P = .04). Similar results were seen for homicides and assaults. Several sensitivity analyses supported the robustness of these results. Conclusions and Relevance: This study's findings suggest that alcohol policies that reduce hours of sale could be associated with a reduction in violent crimes. Given these findings, SB571 may serve as a model for other cities looking to create safer neighborhoods.

Do tougher drinking policies affect men's smoking behavior - Evidence from China.

In 2011, China implemented tougher driving-under-the-influence laws, which criminalized driving under the influence of alcohol for the first time and increased penalties. This paper provides the first comprehensive analysis of the effects of stricter drinking policies on men's smoking behavior by using data from the 2010 and 2012 waves of the China Family Panel Studies. The results show that stricter drinking policies reduced smoking initiation and the number of cigarettes smoked per day among men by reducing the frequency and quantity of alcohol consumption. Heterogeneity analyses show that the impact of the policy is more pronounced not only for men aged 41-55, but also for men who have higher educational qualifications, who are employed, or who are not members of the Communist Party.

Relationships Between Alcohol Policies and Infant Morbidities and Injuries.

INTRODUCTION: Previous research has found that policies specifically focused on pregnant people's alcohol use are largely ineffective. Therefore, the purpose of this study is to analyze the relationships between general population policies regulating alcohol physical availability and outcomes related to pregnant people's alcohol use, specifically infant morbidities and injuries. METHODS: Outcome data were obtained from Merative MarketScan, a longitudinal commercial insurance claims data set. Policy data were obtained from the National Institute on Alcohol Abuse and Alcoholism's Alcohol Policy Information System, the National Alcohol Beverage Control Association, and Liquor Handbooks and merged using policies in effect during the estimated year of conception. Relationships between state-level policies regulating sites, days/hours, and government monopoly of liquor sales and infant morbidities and injuries were examined. Analyses used logistic regression with individual controls, fixed effects for state and year, state-specific time trends, and SEs clustered by state. The study analysis was conducted from 2021 to 2023. RESULTS: The analytic sample included 1,432,979 infant-birthing person pairs, specifically people aged 25-50 years who gave birth to a singleton between 2006 and 2019. A total of 3.1% of infants had a morbidity and 2.1% of infants had an injury. State government monopoly on liquor sales was associated with reduced odds of infant morbidities and injuries, whereas gas station liquor sales were associated with increased odds of infant morbidities and injuries. Allowing liquor sales after 10PM was associated with increased odds for infant injuries. No effect was found for allowing liquor sales in grocery stores or on Sundays. CONCLUSIONS: Findings suggest that limiting alcohol availability for the general population may help reduce adverse infant outcomes related to pregnant people's alcohol use.

Beyond the Laws: Parental Monitoring, Perceived Acceptability of Underage Drinking and Alcohol Use Among Belgian Youth.

Parental monitoring behaviors are negatively associated with adolescent substance use. Yet, the processes explaining these associations are still unclear. The current study examined adolescents' knowledge of minimum legal drinking age laws and their perceived acceptability of underage drinking as potential mediators of the links between parental monitoring behaviors and youth alcohol use. The sample included 1154 Belgian adolescents (Mage = 16.34, SD = 1.33; 71% girls), who were recruited in Wallonia (54.9%) and in Flanders (45.1%). Path analyses revealed that higher parental rule setting, but not solicitation, was related to lower alcohol use. Acceptability of underage drinking mediated this link, but not knowledge of the laws. Results suggest that beyond laws regulating the minimum legal drinking age, alcohol use prevention programs should consider the importance of parental rule setting and youth's perceived acceptability of underage drinking.

Industry influence over global alcohol policies via the World Trade Organization: a qualitative analysis of discussions on alcohol health warning labelling, 2010-19.

BACKGROUND: Accelerating progress to implement effective alcohol policies is necessary to achieve multiple targets within the WHO global strategy to reduce the harmful use of alcohol and the Sustainable Development Goals. However, the alcohol industry's role in shaping alcohol policy through international avenues, such as trade fora, is poorly understood. We investigate whether the World Trade Organization (WTO) is a forum for alcohol industry influence over alcohol policy. METHODS: In this qualitative analysis, we studied discussions on alcohol health warning labelling policies that occurred at the WTO's Technical Barriers to Trade (TBT) Committee meetings. Using the WTO Documents Online archive, we searched the written minutes of all TBT Committee meetings available from Jan 1, 1995, to Dec 31, 2019, to identify minutes and referenced documents pertaining to discussions on health warning labelling policies. We specifically sought WTO member statements on health warning labelling policies. We identified instances in which WTO member representatives indicated that their statements represented industry. We further developed and applied a taxonomy of industry rhetoric to identify whether WTO member statements advanced arguments made by industry in domestic forums. FINDINGS: Among 83 documents, comprising TBT Committee minutes, notifications to the WTO of the policy proposal, and written comments by WTO members, WTO members made 212 statements (between March 24, 2010, and Nov 15, 2019) on ten alcohol labelling policies proposed by Thailand, Kenya, the Dominican Republic, Israel, Turkey, Mexico, India, South Africa, Ireland, and South Korea. WTO members stated that their claims represented industry in seven (3·3%) of 212 statements, and 117 (55·2%) statements featured industry arguments. Member statements featured many arguments used by industry in domestic policy forums to stall alcohol policy. Arguments focused on descaling and reframing the nature and causes of alcohol-related problems, promoting alternative policies such as information campaigns, promoting industry partnerships, questioning the evidence, and emphasising manufacturing and wider economic costs and harms. INTERPRETATION: WTO discussions at TBT Committee meetings on alcohol health warnings advanced arguments used by the alcohol industry in domestic settings to prevent potentially effective alcohol policies. WTO members appeared to be influenced by alcohol industry interests, although only a minority of challenges explicitly referenced industry demands. Increased transparency about vested interests might be needed to overcome industry influence. FUNDING: None.

COVID-19 infection among bartenders and waiters before and after pub lockdown.

OBJECTIVE: To assess how different bans on serving alcohol in Norwegian bars and restaurants were related to the detection of SARS-CoV-2 in bartenders and waiters and in persons in any occupation. METHODS: In 25 392 bartenders and waiters and 1 496 328 persons with other occupations (mean (SD) age 42.0 (12.9) years and 51.8% men), we examined the weekly rates of workers tested and detected with SARS-CoV-2, 1-10 weeks before and 1-5 weeks after implementation of different degrees of bans on serving alcohol in pubs and restaurants, across 102 Norwegian municipalities with: (1) full blanket ban, (2) partial ban with hourly restrictions (eg, from 22:00 hours) or (3) no ban, adjusted for age, sex, testing behaviour and population size. RESULTS: By 4 weeks after the implementation of ban, COVID-19 infection among bartenders and waiters had been reduced by 60% (from 2.8 (95% CI 2.0 to 3.6) to 1.1 (95% CI 0.5 to 1.6) per 1000) in municipalities introducing full ban, and by almost 50% (from 2.5 (95% CI 1.5 to 3.5) to 1.3 (95% CI 0.4 to 2.2) per 1000) in municipalities introducing partial ban. A similar reduction within 4 weeks was also observed for workers in all occupations, both in municipalities with full (from 1.3 (95% CI 1.3 to 1.4) to 0.9 (95% CI 0.9 to 1.0)) and partial bans (from 1.2 (95% CI 1.1 to 1.3) to 0.5 (95% CI 0.5 to 0.6)). CONCLUSION: Partial bans on serving alcohol in bars and restaurants may be similarly associated with declines in confirmed COVID-19 infection as full bans.

Impacto de ley de cero alcohol en Uruguay: resultados sobre el consumo y la siniestralidad vial / Impact of the implementation of a zero blood alcohol concentration law in Uruguay: effect on consumption and fatal crashes / Impacto da lei de tolerância zero ao álcool no Uruguai: resultados no consumo e acidentes rodoviários / Impact of the implementation of a zero blood alcohol concentration law in Uruguay: effect on consumption and fatal crashes

Resumen: Introducción: apuntando a la prevención y disminución de la siniestralidad vial, se promulgó la Ley 19360 "de alcohol cero" que modifica la tolerancia de alcohol en sangre para conductores, bajándola de 0,3 g/l a 0,0 g/l, con probados resultados de disminución de siniestros fatales en el corto plazo. Objetivo: analizar el impacto de dicha norma en la venta declarada de alcohol y sobre los usuarios de vías siniestrados por tipo de vehículo y región. Metodología: estudio inferencial, de impacto de intervención. Se analizaron series de tiempo de distintas fuentes, para medir si hubo cambios significativos en éstas mediante la modelización ARIMA, comparando antes y después de la sanción de la Ley 19360. Resultados: el consumo de alcohol declarado no sufrió modificaciones importantes a pesar de la ley cero, mientras que la cantidad de motociclistas fallecidos y heridos de gravedad caen de manera significativa a partir de la sanción de la Ley 19360. Conclusiones: los motociclistas son los más beneficiados con esta legislación, con numerosas vidas salvadas. Los datos sugieren un posible cambio de comportamiento de los conductores de vehículos respecto al consumo de alcohol antes y durante el manejo. La mejora continua de la información disponible para la ciudadanía es clave para comprender mejor estos fenómenos.

Summary: Introduction: law 19360 of "Zero blood alcohol concentration" was passed to prevent and reduce road accidents by modifying the tolerance to blood alcohol concentration for drivers. It lowered it from 0.3 g/l to 0.0 g/l and results proved the reduction of fatal crashes in the short term. Objective: to analyze the impact of the new law on the official alcohol sales and on drivers by type of vehicle and region. Method: inferential study, impact of intervention. Time-series analyses for different sources were performed to find out whether there were meaningful changes using the ARIMA model, comparing figures corresponding to the periods before and after Law 19360 was passed. Resultados: declared consumption of alcohol did not evidence important modifications despite the zero law, whereas the number of dead motorcyclists and severely wounded significantly dropped after Law 19360 was passed. Conclusions: motorcyclists are those who benefit the most with the law, since a great number of deaths were saved. Data suggest there might be a change in the behaviour of vehicle drivers in regards to alcohol consumption before and after driving. The steady improvement of information available for citizens is essential to better understand these phenomena.

Resumo: Introdução: visando a prevenção e redução dos acidentes de trânsito, foi promulgada a Lei 19360 "de tolerância zero ao álcool", que modifica a tolerância ao álcool no sangue para motoristas, baixando-a de 0,3 g/l para 0,0 g/l, com resultados comprovados de redução de sinistros fatais no curto prazo. Objetivo: analisar o impacto do referido regulamento na venda declarada de álcool e nos usuários das estradas afetados por tipo de veículo e região. Metodologia: estudo inferencial, de impacto da intervenção. Séries temporais de diferentes fontes foram analisadas para medir se houve mudanças significativas nestes por meio de modelagem ARIMA, comparando antes e depois da promulgação da Lei 19360. Resultados: o consumo declarado de álcool não sofreu modificações importantes apesar da lei de tolerância zero ao álcool, enquanto o número de motociclistas falecidos e gravemente feridos caiu significativamente após a promulgação da Lei 19.360. Conclusões: os motociclistas são os que mais se beneficiam com essa legislação, com muitas vidas salvas. Os dados sugerem uma possível mudança no comportamento dos condutores de veículos em relação ao consumo de álcool antes e durante a condução. O aprimoramento contínuo das informações disponibilizadas ao público é fundamental para um melhor entendimento desses fenômenos.

Unnatural deaths, alcohol bans and curfews: Evidence from a quasi-natural experiment during COVID-19.

BACKGROUND: Coronavirus disease-19 (COVID-19) restrictions, particularly relating to the sale of alcohol and hours of curfew, have had a marked effect on the temporal pattern of unnatural deaths in South Africa. Methods. Death data were collected over 68 weeks from January 2020 to April 2021, together with information on the nature of restrictions (if any) on the sale of alcohol, and hours of curfew. Data were analysed using a simple ordinary least square (OLS) regression model to estimate the relative contribution of restrictions on the sale of alcohol and hours of curfew to the pattern of excess unnatural deaths. Results. The complete restriction on the sale of alcohol resulted in a statistically significant reduction in unnatural deaths regardless of the length of curfew. To the contrary, periods where no or limited restrictions on alcohol were in force had no significant effect, or resulted in significantly increased unnatural deaths. Conclusions. The present study highlights an association between alcohol availability and the number of unnatural deaths and demonstrates the extent to which those deaths might be averted by disrupting the alcohol supply. While this is not a long-term solution to addressing alcohol-related harm, it further raises the importance of implementing evidence-based alcohol control measures.

Government Options to Reduce the Impact of Alcohol on Human Health: Obstacles to Effective Policy Implementation.

Evidence for effective government policies to reduce exposure to alcohol's carcinogenic and hepatoxic effects has strengthened in recent decades. Policies with the strongest evidence involve reducing the affordability, availability and cultural acceptability of alcohol. However, policies that reduce population consumption compete with powerful commercial vested interests. This paper draws on the Canadian Alcohol Policy Evaluation (CAPE), a formal assessment of effective government action on alcohol across Canadian jurisdictions. It also draws on alcohol policy case studies elsewhere involving attempts to introduce minimum unit pricing and cancer warning labels on alcohol containers. Canadian governments collectively received a failing grade (F) for alcohol policy implementation during the most recent CAPE assessment in 2017. However, had the best practices observed in any one jurisdiction been implemented consistently, Canada would have received an A grade. Resistance to effective alcohol policies is due to (1) lack of public awareness of both need and effectiveness, (2) a lack of government regulatory mechanisms to implement effective policies, (3) alcohol industry lobbying, and (4) a failure from the public health community to promote specific and feasible actions as opposed to general principles, e.g., 'increased prices' or 'reduced affordability'. There is enormous untapped potential in most countries for the implementation of proven strategies to reduce alcohol-related harm. While alcohol policies have weakened in many countries during the COVID-19 pandemic, societies may now also be more accepting of public health-inspired policies with proven effectiveness and potential economic benefits.

Alcohol control policies add to secular trends in all-cause mortality rates in young adults.

Alcohol consumption is a major risk factor for premature mortality. Although alcohol control policies are known to impact all-cause mortality rates, the effect that policies have on specific age groups is an important area of research. This study investigates the effect of alcohol control policies implemented in 2009 and 2017 in Lithuania on all-cause mortality rates. All-cause mortality rates (deaths per 100,000 people) were obtained for 2001-2018 by 10-year age groups (20-29, 30-39, 40-49 years, etc.). All-cause mortality rates, independent of macro-level secular trends (e.g., economic trends) were examined. Following a joinpoint analysis to control for secular trends, an interrupted time series analysis showed that alcohol control policies had a significant effect on all-cause mortality rates (p = .018), with the most significant impact occurring among young adults (20-29 and 30-39 years of age). For these age groups, their mortality rate decreased during the 12 months following policy implementation (following the policy in 2009 for those 20-29 years of age, p = .0026, and following the policy in 2017 for those 30-39 years of age, p = .011). The results indicate that alcohol control policy can impact all-cause mortality rates, above and beyond secular trends, and that the impact is significant among young adults.

Impact of Public Health Policies on Alcohol-Associated Liver Disease in Latin America: An Ecological Multinational Study.

BACKGROUND AND AIMS: Alcohol-associated liver disease (ALD) is the leading cause of liver-related mortality in Latin America, yet the impact of public health policies (PHP) on liver disease is unknown. We aimed to assess the association between alcohol PHP and deaths due to ALD in Latin American countries. APPROACH AND RESULTS: We performed an ecological multinational study including 20 countries in Latin America (628,466,088 inhabitants). We obtained country-level sociodemographic information from the World Bank Open Data source. Alcohol-related PHP data for countries were obtained from the World Health Organization Global Information System of Alcohol and Health. We constructed generalized linear models to assess the association between the number of PHP (in 2010) and health outcomes (in 2016). In Latin America, the prevalence of obesity was 27% and 26.1% among male and female populations, respectively. The estimated alcohol per capita consumption among the population at 15 years old or older was 6.8 L of pure alcohol (5.6 recorded and 1.2 unrecorded). The overall prevalence of alcohol use disorders (AUD) was 4.9%. ALD was the main cause of cirrhosis in 64.7% of male and 40.0% of female populations. A total of 19 (95%) countries have at least one alcohol-related PHP on alcohol. The most frequent PHP were limiting drinking age (95%), tax regulations (90%), drunk-driving policies and countermeasures (90%), and government monitoring systems and community support (90%). A higher number of PHP was associated with a lower ALD mortality (PR, 0.76; 95% CI, 0.61-0.93; P = 0.009), lower AUD prevalence (PR, 0.80; 95% CI, 0.65-0.99; P = 0.045), and lower alcohol-attributable road traffic deaths (PR, 0.81; 95% CI, 0.65-1.00; P = 0.051). CONCLUSIONS: Our study indicates that in Latin America, countries with higher number of PHP have lower mortality due to ALD, lower prevalence of AUD, and lower alcohol-attributable road traffic mortality.