James F. Mosher, JD Alcohol Policy Consultations June 9, 2013
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Transcript of James F. Mosher, JD Alcohol Policy Consultations June 9, 2013
James F. Mosher, JDAlcohol Policy Consultations
June 9, 2013
Presentation at the Preconference Workshop entitled: Drug Use and Excessive Alcohol Epidemiology: Surveillance, Prevention, and
Emerging Methods
2013 Council of State and Territorial Epidemiologists Conference, Pasadena, CA
Alcohol Policy Prevention Strategies
INDIVIDUALS ENVIRONMENTS
Alcohol Policy: Shifting the Focus of Intervention
LargestImpact
SmallestImpact
Factors that Affect HealthExamples
Eat healthy, be physically active
Rx for high blood pressure, high cholesterol, diabetes
Poverty, education, housing, inequality
Immunizations, brief intervention, cessation treatment, colonoscopyFluoridation, 0g trans fat, iodization, smoke-free laws, tobacco tax
Socioeconomic Factors
Changing the Contextto make individuals’ default
decisions healthy
Long-lasting Protective
Interventions
ClinicalInterventions
Counseling &
Education
Community Guide: Recommended Strategies for
Preventing Excessive Drinking Regulation of Alcohol Outlet DensityDram Shop (Commercial Host) Liability Increasing Alcohol Taxes Privatization of Retail Alcohol Sales Maintaining Limits on Days and Hours of Sale Maintaining Minimum Legal Drinking Age (MLDA)
Laws Enhanced Enforcement of Laws Prohibiting Alcohol
Sales to Minors Electronic Screening and Brief Intervention
Source: www.thecommunityguide.org/alcohol
Prevention Strategies:Research Support for Effectiveness
Prevention Strategy Effectiveness rating
Research
breadth
Cross-national testing
Alcohol taxes *** *** ***Minimum legal age purchase *** *** **
Government monopoly, retail ** *** **
Restrict outlet density ** *** **Dram shop liability ** ** **Hours, days of sale ** ** ***Alcohol ad exposure restrictions */** *** **Source: Babor et al., 2010
Prevention Strategies:Research Support for Effectiveness
Prevention Strategy
Effectiveness rating
Research breadth
Cross-national testing
Industry self-regulation
0 ** **
Classroom education 0 *** **Mass media campaigns
0 *** **
Social marketing 0 ** 0
Source: Babor et al., 2010
Alcohol Outlet Density:Community Guide Recommnedation
“The Task Force found sufficient evidence of a positive association between outlet density and excessive alcohol consumption and related harms to recommend limiting alcohol outlet density through the use of regulatory authority (e.g., licensing and zoning) as a means of reducing or controlling excessive alcohol consumption and related harms.”
Increased/decreased
alcohol availability
Increased/decreased
alcohol consumption
Increased/decreased
public health/safety
problems
What the Science Tells Us:Alcohol Availability
Retail Alcohol Outlet Density:Key Dimensions
Outlet Density:Number of Alcohol Outlets
Outlet DensityLocation of Alcohol Outlets
ClusteringSensitive locationsSchoolsPlaygroundsChurchesHospitalsAlcoholism
treatment facilities
Outlet DensityTypes of Alcohol Outlets
Off-sale Liquor stores Convenience stores Supermarkets Gas stations On-sale Bars/lounges Restaurants Airplanes, trains,
etc. Festivals
Outlet DensitySelling and Serving Practices
Problem practices
Furnishing minors
Service to intoxicated persons
Public nuisance activities
Tools for Shaping Community Retail Alcohol Environments
Conditional Use Permits (new outlets)Nuisance Abatement/Deemed Approved
OrdinancesResponsible Beverage Service ProgramsDram shop liability lawsMonitoring and EnforcementFees
Data Collection and Analysis
Alcohol outlet density Place of last drink reports Compliance checks Law enforcement incident reports Enforcement costs GIS mapping
Mean Number of Alcohol Outlets Near Residences by Race/Ethnicity & Income
(California, 2003)
Mea
n #
of A
lcoh
ol O
utle
ts
Income QuartileTruong & Sturm 2009
The State Preemption Doctrine:A Potential Barrier to Local Action
Some States “preempt” or limit the ability of local governments to regulate community alcohol availability through CUPs, DAOs, and fees.
Local powers may vary both across and within States.
Concurrent salesof alcohol and gasoline
A case study in the power, and peril, of State preemption
STATE AUTHORITY
Exclusive or near exclusive State authority
State licensing; local zoning & police powers
Joint State and local licensing
Local licensing, minimum State standards
LOCAL AUTHORITY
High State Preemption
Low State Preemption
Levels of State Preemption
What is Dram Shop(Commercial Host) Liability?
A Form of Tort Liability:A party whose intentional, reckless or
negligent actions causes harm to another may be required to compensate the injured party.
What is Commercial Host Liability?
A form of tort liability that holds retailers responsible for alcohol-attributable harms caused by a patron who was illegally served alcohol because the patron was either intoxicated (“adult liability”) or underage (“underage liability”) at the time of service.
Dram shop liability was associated with a substantial reductions in alcohol problems (a median reduction of 6.4 percent in alcohol-related motor vehicle crashes)
Legislation that limited the scope of dram shop liability may undercut these positive effects
Commercial Host LiabilityCommunity Guide Findings
“The Task Force on Community Preventive Services recommends the use of dram shop liability laws, on the basis of strong evidence of effectiveness in preventing and reducing alcohol-related harms.”
Commercial Host LiabilityCommunity Guide Recommendation
Location of Reported Binge Drinking
(Self Reports)
54.3% Bars/clubs/restaurants35.7% Private residents10.0% Elsewhere
“Drinking in bars and restaurants is strongly associated with binge drinking and with alcohol-impaired driving among U.S. adults who report binge drinking.”
Source: Driving after Binge Drinking, Am J Prev Med. 2009 37(4):314-20
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40% or more of alcohol-related vehicle crashes originate in retail
establishments.
Why Commercial Host Liability?
Commercial host liability common
law rules substantially raise
the stakesfor violating these
laws and encourage adoption of Responsible
Beverage Service practices.
How is Commercial Host Liability Established?
In the absence of legislative guidance, courts are able to establish these rules through their “common law” powers.
State legislatures may establish the parameters of tort liability using numerous, often complex, rules for when, how, and how much compensation is permitted.
Alcohol Taxes:Community Guide Findings
Higher alcohol prices or taxes were consistently related to: Fewer motor vehicle crashes and fatalities (10 of
11 studies)Less alcohol-impaired driving (3 of 3 studies)Less mortality from liver cirrhosis (5 of 5 studies)Less all-cause mortality (1 study)
Effects also were demonstrated for measures of violence, sexually transmitted diseases, and alcohol dependence.
Reductions in excessive alcohol consumption are proportional to the size of the tax increaseElder et al. Am J Prev Med 2010;38(2):17–29
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Alcohol Taxes:Community Guide Recommendation
“The Task force on Community Preventive Services recommends increasing the unit price of alcohol by raising taxes based on strong evidence of effectiveness for reducing excessive alcohol consumption and related harms. Public health effects are expected to be proportional to the size of the tax increase.”
Alcohol Taxes: Meta-Analysis
Wagenaar et al. Addiction 2009Meta-analysis of 110 studies containing 1,003 estimates of relationship between tax and price of alcohol and alcohol consumption
“A large literature establishes that beverage alcohol prices and taxes are related inversely to drinking. Effects are large compared to other prevention policies and programs. Public policies that raise prices of alcohol are an effective means to reduce drinking.”
Alcohol Taxes
Local, State and federal governments impose alcohol taxes.
State preemption limits the extent of local taxation.
Taxes can be volume- or price-based (excise or ad valorem/sales).
Unlike alcohol outlet density and dram shop liability, taxes are easy to implement and enforce.
Tax increases increase governmental revenue.
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Alcohol Taxes
Other policy mechanisms are available to increase alcohol prices, thereby gaining public health benefits
Minimum pricing Restrictions on happy hours Restrictions on wholesaler discounting
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Societal Costs vs. Alcohol Tax Revenues
State and Federal Tax Revenues
$.12/drink
Societal CostsAll Costs: $1.90/drin
k
Governmental Costs $.80/drink
Bouchery et al. 2011; http://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm
Challenges to Developing a Public Health Approach to Alcohol Regulation
Conflict exists between commercial interests and public health policy reform, particularly at the
state/federal levels
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Challenge:Push for Deregulation
Increasing pressure in states to deregulate alcohol sales to increase revenues Expand number, permissible locations, and types of
alcohol outlets Privatize retail monopoly systems Increase hours and days of sale
Once instituted, deregulatory measures are hard to reverse because new economic stakeholders are established
States that privatized state storesStates with proposals to privatize state storesOther control states
Deregulating (Privatizing) State Alcohol Retail Stores
0
5
10
15
20
25
30
1989
2011
Adult Dram Shop Host Liability
50 States and District of Columbia1989, 2011
Num
ber
of S
tate
s (in
clud
ing
DC
)
Federal Excise Tax RatesPer Gallon Absolute Alcohol, 1970–
201019
70
1975
1980
1985
1990
1995
2000
2005
2010
$0.00
$5.00
$10.00
$15.00
$20.00
$25.00
Distilled Spir-its
Beer
Wine
Adjusted for inflation: 1970 baselineU.S. Bureau of Labor Statistics
Exci
se t
ax
Year
Average State Beer Excise Tax RatesPer Gallon of Beer, 1975–2008
1975
1980
1985
1990
1995
2000
2005
2008
$0.00
$0.05
$0.10
$0.15
$0.20
$0.25
$0.30
Beer
Year
Adjusted for inflation: 1970 baselineBeer Almanac, 2009;U.S. Bureau of Labor Statistics, 2010
Exci
se t
ax
Federal tax rates and inflation
1951 rate Current rate
(1991)
Adjusted for inflation
(since 1951)Beer $9 / barrel $18 /
barrel$76.23
Spirits $10.50 / proof gallon
$12.50 / proof gallon
$88.94
Wine $.17 / gallon $1.07 / gallon
$1.44
Opportunities for Change Chicago and Cook County Alcohol
Taxes Cook County doubled its alcohol taxes effective January 1, 2012
Four alcohol tax increases in Chicago/Cook County since 2005
Current Chicago and Cook Countyalcohol taxes/gallon
Beer: $.38/gallon Other beverages (based on alcohol content)
<14%: $.60/gallon (e.g., table wine, wine coolers) 14%-20%: $1.34/gallon (e.g., fortified wine) >20%: $5.18/gallon (e.g., distilled spirits)
Opportunities for ChangeMaryland Alcohol Tax
Enacted a special 3% alcohol sales tax in 2011
Promoted by a coalition of 1,200 health care and social services organizations
Voter support for dime-a-drink, Maryland 2010
Opportunities for ChangeAlcohol Outlet Density Campaigns
Way Forward
Implementation of alcohol policy reforms are feasible and have potential for significant public health gains
Public health constituencies can play an instrumental role in the process Assessing and disseminating scientific findings Educating decision makers and key
constituencies Providing expertise to state and local coalitions Conducting evaluations to determine
effectiveness of interventions
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