Differential Effects of Alcohol-related Policy across US Population Subgroups

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Abstract: Differential Effects of Alcohol-related Policy across U.S. Population Subgroups It has recently been recognized that not all groups may benefit from broad-based public health interventions. In some cases, disadvantaged groups have benefited less and this has had the unintended consequence of creating or increasing health inequities. Alcohol policy interventions are a vital tool for addressing excessive drinking and alcohol problems in the population but have not often been employed for the purpose of mitigating alcohol-related disparities. To begin to consider how alcohol policy might be used in this way, policymakers first need to know whether and to what extent alcohol policies improve both population health and health equity. This Component aims to address this question by determining which alcohol policies are likely to yield the largest reduction in alcohol-related disparities. Our study will focus on alcohol taxation, availability restrictions and treatment access, three of the most effective and prominent policy approaches for reducing alcohol consumption and problems. We will assess the effects of individual policies on the general population and on subgroups defined by race/ethnicity, socioeconomic status, gender and age, and will identify the most and least impactful policies for each group. We will also estimate the effects of hypothetical policy changes on racial/ethnic and socioeconomic disparities, and ascertain the optimal mix of tax and availability policies for mitigating disparities in alcohol consumption, problems and mortality. Our study will draw on policy data from multiple sources, particularly the NIAAA's Alcohol Policy Information System, and will use several national data sets to analyze policy-relevant outcomes. These include individual-level, survey-based alcohol consumption and problems from the Behavioral Risk Factor Surveillance System (BRFSS) and National Alcohol Survey (NAS), and state-level alcohol-related mortality and treatment utilization rates from the National Center for Health Statistics and Treatment Episode Data Set (TEDS). Analyses will focus on the period from 2000-2015 and involve pooled cross-sectional time-series models with fixed and random effects, difference-in-differences models, and interrupted time-series analyses. Our Specific Aims are to: 1) Investigate the impact of beverage- specific taxes on drinking patterns, alcohol-related problems and alcohol-attributable mortality; 2) Examine the effects of alcohol availability policies (government retail control, hours and days of sale, types of sales outlets, and alcohol outlet density) on alcohol use patterns, problems and mortality; 3) Assess the impact of treatment access policies (the Mental Health Parity and Addiction Equity Act and Affordable Care Act) on the use of specialty and primary care-based alcohol services; and 4) Identify the policies (and policy mix) from Aims 1 and 2 whose hypothetical, nationwide implementation will have the largest impact on reducing alcohol consumption, problems and related mortality in the population, and disparities in these. Study results will help public health decision makers to weigh and prioritize individual policy strategies for improving population health and health equity.