Although individual alcohol policies can reduce alcohol-related harms, the policy environment in states is highly variable. Previously, our research team characterized the U.S. state policy environment, conceptualized as the effect of multiple concurrent policies and operationalized as Alcohol Policy Scale (APS) measures. We found that stronger state alcohol policy environments were associated with fewer binges drinking, less youth drinking, less impaired driving, and increased remission from alcoholism. We now propose to assess the relationships between the alcohol policy environment and leading causes of alcohol-related mortality. ARCF: Although ARCF has declined due in part to the enactment of driving-oriented policies, the proportion of fatal crashes that are alcohol-relate remains unchanged since 1995, a period when several effective drinking-oriented policies have eroded. Our current works finds that drinking-oriented policies have a strong association with adult impaired driving, independent of driving-oriented policies.
Aim 1 is to: a) determine the relationship between the alcohol policy environment and AIDF;b) assess independent associations and interactions between drinking-oriented versus driving-oriented policy subgroups and AIDF, and determine if the relationship between drinking-oriented policies and AIDF is mediated by binge drinking;c) assess independent associations of drinking-oriented policy subgroups targeting alcohol prices versus physical availability with AIDF. Violent Deaths: Suicide and homicide mortality differs by age, sex and race. We hypothesize that differential effects of the state policy environment may partly explain these disparities, and that some groups of related policies are more protective for violent deaths than others.
Aim 2 is to: a) determine the relationship between the alcohol policy environment and suicide, overall and by age, sex and race;b) assess independent associations and interactions between population-oriented versus youth-oriented policies and suicide among youth and young adults;c) assess independent associations between policy subgroups targeting alcohol prices versus physical availability and suicide among males and racial minorities.
Aim 3 will assess homicide mortality using identical aims and analogous models as for Aim 2. Alcoholic Cirrhosis: Few studies have examined the associations between alcohol policies and cirrhosis, or whether consumption patterns mediate that relationship. We hypothesize that stronger state alcohol policy environments are associated with reduced cirrhosis mortality through reductions in both average consumption and binge drinking.
Aim 4 is to: a) determine the relationship between the alcohol policy environment and alcoholic cirrhosis mortality by sex;b) assess whether this relationship is mediated by binge drinking, after accounting for average consumption. Using our previously developed methods, we will collect three additional years of policy data and utilize population-based data sets in state- and individual-level analyses of data from 1999-2014 to improve the understanding of how state alcohol policy environments may influence alcohol-related mortality and to assist with prevention strategies.

Public Health Relevance

This three-year application builds off our current grant (RO1AA018377) in which we developed Alcohol Policy Scales (APS) to represent the policy environment in U.S. states and Washington, D.C., and then associated the APS scores with alcohol consumption patterns among adults and youth. For this application, we will examine how the policy environment associates with downstream mortality outcomes for the leading causes of alcohol-attributable death, including alcohol-related motor vehicle crash fatalities, suicide, homicide, and alcoholic cirrhosis. We will also examine independent effects and causal mechanisms associated with subgroups of related policies for outcomes among the general population and among high-risk groups.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Research Project (R01)
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Community-Level Health Promotion Study Section (CLHP)
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Bloss, Gregory
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Boston Medical Center
United States
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Naimi, Timothy S; Xuan, Ziming; Cooper, Susanna E et al. (2016) Alcohol Involvement in Homicide Victimization in the United States. Alcohol Clin Exp Res 40:2614-2621
Xuan, Ziming (2016) Light to moderate alcohol intake may be associated with non-minimal cancer risk. Evid Based Med 21:77
Xuan, Ziming; Naimi, Timothy S; Kaplan, Mark S et al. (2016) Alcohol Policies and Suicide: A Review of the Literature. Alcohol Clin Exp Res 40:2043-2055
Xuan, Ziming; Babor, Thomas F; Naimi, Timothy S et al. (2016) Comment on ""binge drinking and alcohol prices"". Health Econ Rev 6:4
Hadland, Scott E; Xuan, Ziming; Blanchette, Jason G et al. (2015) Alcohol Policies and Alcoholic Cirrhosis Mortality in the United States. Prev Chronic Dis 12:E177
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