Citation

Silver D, Bae JY, McNeill E, Macinko J. Drug Alcohol Depend. 2022; 239: e109591.

Copyright

(Copyright © 2022, Elsevier Publishing)

DOI

10.1016/j.drugalcdep.2022.109591

PMID

35947919

Abstract

BACKGROUND: Public policies are a powerful tool to change behaviors that may harm population health, but little is known about how state alcohol policies affect different population groups. This study assesses the effects of a comprehensive measure of the state alcohol regulatory environment (the State Alcohol Policy Score or SAPS) on heavy drinking-a risk factor for premature death-on different population groups, defined by levels of educational attainment, then by race/ethnicity, and sex.

METHODS: We pool each state's Behavioral Risk Factor Surveillance Survey (BRFSS) 2011-2019 and use robust Poisson regression analyses that control for individual-level factors, state-level factors (1 year lagged SAPS score for each state, state fixed effects), and year fixed effects to assess the relationship between SAPS and heavy drinking behaviors by education group. Interaction terms test whether education moderates the relationship by race/ethnicity and gender.

RESULTS: SAPS scores increased 2010-2018, but substantial gaps persist between states. A 10 % increase in a state's alcohol policy score is associated with a 2 % lower prevalence in current drinking (APR=0.97, 95 % CI=0.97-0.97, p < 0.0011) although not for those with a high school education or less. A 10 % increase in the SAPS was associated with a 3 % lower prevalence of heavy drinking; interaction terms in models reveal that a 10 % increase in the SAPS was associated with a lower prevalence of heavy drinking among those with less than a college education.

CONCLUSION: Narrowing gaps in alcohol policies between states may reduce heavy drinking among those with lower educational attainment.

Language: en

Keywords

Alcohol policies; Educational attainment; Heavy drinking; State policy scores