A New Scale of the U.S. Alcohol Policy Environment and Its Relationship to Binge Drinking


      Of outcomes related to excessive drinking, binge drinking accounts for approximately half of alcohol-attributable deaths, two thirds of years of potential life lost, and three fourths of economic costs. The extent to which the alcohol policy environment accounts for differences in binge drinking in U.S. states is unknown.


      The goal of the study was to describe the development of an Alcohol Policy Scale (APS) designed to measure the aggregate state-level alcohol policy environment in the U.S. and assess the relationship of APS scores to state-level adult binge drinking prevalence in U.S. states.


      Policy efficacy and implementation ratings were developed with assistance from a panel of policy experts. Data on 29 policies in 50 states and Washington DC from 2000–2010 were collected from multiple sources and analyzed between January 2012 and January 2013. Five methods of aggregating policy data to calculate APS scores were explored; all but one was weighted for relative policy efficacy and/or implementation. Adult (aged ≥18 years) binge drinking prevalence data from 2001–2010 was obtained from the Behavioral Risk Factor Surveillance System surveys. APS scores from a particular state-year were used to predict binge drinking prevalence during the following year.


      All methods of calculating APS scores were significantly correlated (r >0.50), and all APS scores were significantly inversely associated with adult binge drinking prevalence. Introducing efficacy and implementation ratings optimized goodness of fit in statistical models (e.g., unadjusted beta=−3.90, p<0.0001, R2=0.31).


      The composite measure(s) of the alcohol policy environment have internal and construct validity. Higher APS scores (representing stronger policy environments) were associated with less adult binge drinking and accounted for a substantial proportion of the state-level variation in binge drinking among U.S. states.
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        • Babor T.
        • Caetano R.
        • Casswell S.
        • et al.
        Alcohol: no ordinary commodity: research and public policy.
        Oxford University Press, Oxford2010
        • Mokdad A.H.
        • Marks J.S.
        • Stroup D.F.
        • Gerberding J.L.
        Actual causes of death in the U.S., 2000.
        JAMA. 2004; 291: 1238-1245
        • Rehm J.
        • Mathers C.
        • Popova S.
        • Thavorncharoensap M.
        • Teerawattananon Y.
        • Patra J.
        Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders.
        Lancet. 2009; 373: 2223-2233
        • WHO.
        Global status report on alcohol and health 2011.
        WHO, Geneva, Switzerland2011
        • Bouchery E.E.
        • Harwood H.J.
        • Sacks J.J.
        • Simon C.J.
        • Brewer R.D.
        Economic costs of excessive alcohol consumption in the U.S., 2006.
        Am J Prev Med. 2011; 41: 516-524
        • CDC.
        Online tools: Alcohol-Related Disease Impact (ARDI) software. Alcohol and public health.
        CDC, Atlanta GA2008
        • Klingemann H.K.
        • Holder H.D.
        • Gutzwiller F.
        Research on and prevention of alcohol-related trauma: phases, patterns, and issues.
        Addiction. 1993; 88: 861-866
        • Babor T.F.
        Linking science to policy. The role of international collaborative research.
        Alcohol Res Health. 2002; 26: 66-74
      1. LaVallee RA, Yi H. Apparent per capita alcohol consumption: national, state, and regional trends, 1977-2009. Bethesda MD: National Institute on Alcohol Abuse and Alcoholism, 2011. Surveillance Report No.: 92

        • Kerr W.C.
        Categorizing U.S. state drinking practices and consumption trends.
        Int J Environ Res Public Health. 2010; 7: 269-283
        • Fell J.C.
        • Fisher D.A.
        • Voas R.B.
        • Blackman K.
        • Tippetts A.S.
        The impact of underage drinking laws on alcohol-related fatal crashes of young drivers.
        Alcohol Clin Exp Res. 2009; 33: 1208-1219
        • Wagenaar A.C.
        • Maldonado-Molina M.M.
        • Wagenaar B.H.
        Effects of alcohol tax increases on alcohol-related disease mortality in Alaska: time-series analyses from 1976 to 2004.
        Am J Public Health. 2009; 99: 1464-1470
        • Hingson R.
        • Merrigan D.
        • Heeren T.
        Effects of Massachusetts raising its legal drinking age from 18 to 20 on deaths from teenage homicide, suicide, and nontraffic accidents.
        Pediatr Clin North Am. 1985; 32: 221-232
        • Chang K.
        • Wu C.C.
        • Ying Y.H.
        The effectiveness of alcohol control policies on alcohol-related traffic fatalities in the U.S..
        Accid Anal Prev. 2012; 45: 406-415
        • Wagenaar A.C.
        • Toomey T.L.
        Effects of minimum drinking age laws: review and analyses of the literature from 1960 to 2000.
        J Stud Alcohol Suppl. 2002; : 206-225
        • Gilpin E.A.
        • Stillman F.A.
        • Hartman A.M.
        • Gibson J.T.
        • Pierce J.P.
        Index for U.S. state tobacco control initial outcomes.
        Am J Epidemiol. 2000; 152: 727-738
        • Joossens L.
        • Raw M.
        The Tobacco Control Scale: a new scale to measure country activity.
        Tob Control. 2006; 15: 247-253
        • Schaap M.M.
        • Kunst A.E.
        • Leinsalu M.
        • et al.
        Effect of nationwide tobacco control policies on smoking cessation in high and low educated groups in 18 European countries.
        Tob Control. 2008; 17: 248-255
        • Taber D.R.
        • Chriqui J.F.
        • Perna F.M.
        • Powell L.M.
        • Chaloupka F.J.
        Weight status among adolescents in states that govern competitive food nutrition content.
        Pediatrics. 2012; 130: 437-444
        • Nanney M.S.
        • Nelson T.
        • Wall M.
        • et al.
        State school nutrition and physical activity policy environments and youth obesity.
        Am J Prev Med. 2010; 38: 9-16
        • Cohen D.A.
        • Mason K.
        • Scribner R.
        The population consumption model, alcohol control practices, and alcohol-related traffic fatalities.
        Prev Med. 2002; 34: 187-197
        • Davies P.
        • Walsh B.
        Alcohol problems and alcohol control in Europe.
        Croom Helm, London1983
        • Lenk K.M.
        • Erickson D.J.
        • Nelson T.F.
        • Winters K.C.
        • Toomey T.L.
        Alcohol policies and practices among four-year colleges in the U.S.: prevalence and patterns.
        J Stud Alcohol Drugs. 2012; 73: 361-367
        • Nelson T.F.
        • Naimi T.S.
        • Brewer R.D.
        • Wechsler H.
        The state sets the rate: the relationship among state-specific college binge drinking, state binge drinking rates, and selected alcohol control policies.
        Am J Public Health. 2005; 95: 441-446
      2. National Institute of Alcohol Abuse and Alcoholism. Alcohol Policy Information System (APIS), 2012.

        • Brand D.A.
        • Saisana M.
        • Rynn L.A.
        • Pennoni F.
        • Lowenfels A.B.
        Comparative analysis of alcohol control policies in 30 countries.
        PLoS Med. 2007; 4: e151
        • Paschall M.J.
        • Grube J.W.
        • Kypri K.
        Alcohol control policies and alcohol consumption by youth: a multi-national study.
        Addiction. 2009; 104: 1849-1855
        • Gilligan C.
        • Kuntsche E.
        • Gmel G.
        Adolescent drinking patterns across countries: associations with alcohol policies.
        Alcohol Alcohol. 2012; 47: 732-737
        • Nelson T.F.
        • Xuan Z.
        • Babor T.
        • et al.
        Rating the efficacy and strength of evidence of alcohol control policies for the U.S.: a comparative assessment.
        Am J Prev Med. 2013; 45: 19-28
        • Nardo M.
        • Saisana M.
        • Saltelli A.
        • Tarantola S.
        • Hoffman A.
        • Giovannini E.
        Handbook on constructing composite indicators: methodology and user guide.
        OECD Publishing, 2005
        • CDC.
        Vital signs: binge drinking among high school students and adults—U.S., 2009.
        MMWR Morb Mortal Wkly Rep. 2010; 59: 1274-1279
        • Elder R.W.
        • Lawrence B.
        • Ferguson A.
        • et al.
        The effectiveness of tax policy interventions for reducing excessive consumption and related harms.
        Am J Prev Med. 2010; 38: 217-229
        • Campbell C.A.
        • Hahn R.A.
        • Elder R.
        • et al.
        The effectiveness of limiting alcohol outlet density as a means of reducing excessive alcohol consumption and alcohol-related harms.
        Am J Prev Med. 2009; 37: 556-569
        • Middleton J.C.
        • Hahn R.A.
        • Kuzara J.L.
        • et al.
        Effectiveness of policies maintaining or restricting days of alcohol sales on excessive alcohol consumption and related harms.
        Am J Prev Med. 2010; 39: 575-589
        • Hahn R.A.
        • Kuzara J.L.
        • Elder R.
        • et al.
        Effectiveness of policies restricting hours of alcohol sales in preventing excessive alcohol consumption and related harms.
        Am J Prev Med. 2010; 39: 590-604
        • Rammohan V.
        • Hahn R.A.
        • Elder R.
        • et al.
        Effects of dram shop liability and enhanced overservice law enforcement initiatives on excessive alcohol consumption and related harms: two Community Guide systematic reviews.
        Am J Prev Med. 2011; 41: 334-343
        • Ritter A.
        Comparing alcohol policies between countries: science or silliness?.
        PLoS Med. 2007; 4: e153
        • Nelson D.E.
        • Naimi T.S.
        • Brewer R.D.
        • Roeber J.
        U.S. state alcohol sales compared to survey data, 1993-2006.
        Addiction. 2010; 105: 1589-1596
        • Paschall M.J.
        • Ringwalt C.L.
        • Gitelman A.M.
        The validity of state survey estimates of binge drinking.
        Am J Prev Med. 2010; 39: 179-183