Literature Review: Assessing Wisconsin s Alcohol Abuse and How to Influence Change

Transcription

1 Literature Review: Assessing Wisconsin s Alcohol Abuse and How to Influence Change An independent study with Dr. Susan Zahner in partial fulfillment of the requirements of the Master of Public Health Program at the University of Wisconsin-Madison School of Medicine and Public Health Cassandra Greenwood December 20,

2 Introduction & Background Alcohol misuse is highly prevalent and problematic in Wisconsin. Binge drinking, underage-drinking, alcohol-related hospitalizations, and driving under the influence are some of the most challenging and widespread alcohol-related concerns. The cost of excessive alcohol consumption for Wisconsin in 2012 alone was $6.8 billion from lost productivity, health care costs, criminal justice costs, and property damage (DHS, n.d.; Economic costs, 2011). Alcohol abuse and misuse leads to many negative health and legal outcomes. Alcoholrelated hospitalizations average out to 2.0/1000 people in Wisconsin (Bellin, 2015). In 2010, alcohol caused 1,732 deaths (3% of all deaths), 3,511 injuries, and 67,345 arrests (DHS, n.d.). Drinking and driving was the cause of many of these; alcohol-related car crashes killed 190 people and injured 2,900 more in 2015 and there were roughly 24,000 drunk driving convictions that year (Wisconsin DOT, 2016). Binge drinking, is defined as having 5+ drinks on one occasion for males and 4+ drinks on one occasion for females (Bellin Health, 2015). Wisconsin s binge drinking rate is the highest in the United States, roughly 30% higher than the national average (Bellin Health, 2015). The percent of Wisconsin adults who have binged on alcohol in the past month is an astounding 24.3%--nearly one in four adults while the national percentage is 18.3%. Heavy drinking, too, is a problem. Defined as more than two drinks per day for men and more than one drink per day for women, Wisconsin adults have higher rates of heavy drinking compared to the rest of the country 9.8% in Wisconsin versus 6.6% in the U.S (DHS, n.d.) Wisconsin youths are also consuming alcohol. The percentage of Wisconsin high school students that have ever drunk alcohol is 65.0% for females and 66.6% for males (Bellin Health, 2015). The percentage of Wisconsin high school students that drank alcohol before age 13 is a sobering 14.1% for females and 15.1% for males (Bellin Health, 2015). In addition, the number 2

3 of Wisconsin high school students that drank alcohol within the past month is more than one in three (DHS, n.d.). There are 92 Local Health Departments (LHDs) in Wisconsin 71 at the county level and 21 at the city or village level (DHS, 2015). Only 13 of these LHDs have more than 36 fulltime employees, while the majority of them 48 Wisconsin LHDs have 15 or less full-time employees (DHS, 2015). In addition, LHDs account for only.4% of Wisconsin s health costs (DHS, 2015), so limited finances are an issue to preventing alcohol abuse. Local Health Departments (LHDs) face an enormous challenge trying to deter alcohol and other drug abuse. For one, alcohol is easily accessible in this state. The built environment is incredibly conducive to alcohol misuse. For example, beer, wine, and liquor are allowed to be sold from 6am until 9pm statewide, and in some parts of the state beer can be purchased until 10pm (Wikipedia, 2015). Also, whereas some states limit the purchase of hard alcohol to just liquor stores, in Wisconsin alcohol can be purchased at many different locations including but not limited to liquor stores, grocery stores, restaurants, and gas stations. Additionally, the number of alcohol outlets per capita in Wisconsin is double the national average (What Works for Health, 2013). One strategy to reduce alcohol consumption is to increase excise taxes on alcohol. Excise tax is a tax on the consumer, rather than the seller (Legis WI, 2015). Alcohol taxes are implemented at the state and federal level, and differ for beer, wine, and liquor (What Works for Health, 2013). Wisconsin has some of the lowest alcohol taxation in the nation. The spirits tax in Wisconsin is $3.25 per gallon. In contrast, the neighboring states of Minnesota, Illinois, and Michigan have much higher taxes of $8.71, $11.91, and $8.55 per gallon, respectively (Tax Foundation, 2014). Similarly, Wisconsin s wine tax rate per gallon is just $.25, compared to 3

4 $1.18 in Minnesota, $1.29 in Illinois, and $.51 in Michigan (Tax Foundation, 2014). The beer tax rate is also the 48 th lowest in the country just Missouri and Wyoming have lower beer tax rates (Tax Foundation, 2014). Wisconsin ranks 38 th out of the 50 states in alcohol taxation (U.S. Census Bureau, 2011). Just.36% of Wisconsin s annual tax revenue comes from alcohol tax, which equals roughly $55 million per year (U.S. Census Bureau, 2011). Meanwhile, the tobacco taxes in Wisconsin rank fourth in the nation, with 4.21% of tax revenue coming from tobacco taxes, which equates to $645 million per year from tobacco taxation (U.S. Census Bureau, 2011). Wisconsin currently has high tobacco taxes, but it was not always this way. In 2001 the tobacco tax increased from.77 cents to $1.77 per pack and by 2009 the tobacco taxes were $2.52 per pack (Legis WI, 2015). So, there is a precedent to increasing taxes in this state on harmful substances. Given the negative health, financial, and legal outcomes related to excessive alcohol use, the aim of this paper is to explore and discuss the role of LHD in alcohol abuse prevention and the potential impact of raising alcohol taxes as a prevention strategy. A review of the literature was conducted on alcohol abuse using two priority research questions (PRQs) from the Wisconsin Public Health Research Network. Their list of PRQs are areas of potential areas of research to be conducted by its members. The two PRQs used for this literature review are: 1) Do Local Health Departments effectively address Alcohol and Other Drug Abuse issues in both rural and urban communities, and 2) What impact could alcohol/beer tax have on consumption? Methods Between the months of August and December in 2016 a review of literature related to the two alcohol-related PRQs took place. The databases and websites that were searched include PubMed, Google Scholar, Google, What Works for Health, and the CDC s The Community 4

5 Guide. The attached Appendix contains Table 1 with search terms, the number of articles reviewed, and the number of articles included. Some of the inclusion criteria differed for each question. Inclusion criteria used for both questions were: 1) Publication between 2006 and ) published in English, and 3) free access through University of Wisconsin Madison library service. However, for the question, Do Local Health Departments effectively address Alcohol and Other Drug Abuse issues in both rural and urban communities? the only articles included were from within the United States. Although other countries likely have effective ways to address alcohol issues, the dynamics of their LHDs might differ too much to have as much relevance as those within the U.S. In contrast, for What impact could alcohol/beer tax have on consumption? articles from outside the U.S. were not excluded based on geography, but were limited to developed countries for a better comparison. Also excluded for the LHDs question were studies focusing only on reducing drug abuse. Results Do Local Health Departments effectively address Alcohol and Other Drug Abuse issues in both rural and urban communities? No literature was found that answered this question in its entirety. However, there were studies that addressed decreasing drinking and driving, underage drinking reduction, and the cost-benefit analysis from effective school-based substance abuse prevention. One article published in the Journal of Public Health Management and Practice examined impaired driving prevention in five rural counties in three states that received a grant to conduct a demonstration site project (Cox & Fisher, 2009). The grant was for LHDs to examine impaired driving so five LHDs were involved in this one study. Rural counties were chosen because of their higher risk of alcohol-related crashes and deaths due to less public 5

6 transportation and taxis and longer commutes from establishments to homes (Cox & Fisher, 2009). The different prevention strategies included mass media campaigns, responsible beverage service training, and educational outreach to high-risk populations in coordination with highvisibility enforcement all strong deterrents to impaired driving according to this study (Cox & Fisher, 2009). The lessons learned from these five counties include: Few healthcare providers participated in the training because they didn t understand relevance to their work, strong working relationships with schools are useful, and partnerships are needed (Carroll County) There is a need to build a community coalition, educational campaigns, and community surveys but they were concerned with shortage of law enforcement in rural areas to enforce drinking and driving (Fargo Cass County) There was a need to incorporate faith-based and medical communities for counseling, etc., and that schools should offer impaired driving and underage drinking programming (Fillmore and Houston Counties) The need for frequent license compliance checks and the need to work with alcohol distributors and local retailers for any educational campaigns that involve adding prevention messages to alcohol products (Garrett County). The overall lessons from these five counties about reducing impaired driving highlight the importance of partnerships with community-based organizations, working with law enforcement, and using the media to communicate messages. Additionally, the importance of peer education and engaging youth, of health education and training, and of conducting alcohol and tobacco compliance checks regularly at retailers were also noted (Cox & Fisher, 2009). One literature review looked for studies that engaged communities to prevent underage drinking (Fagan, Hawkins, & Catalano, 2011). They examined successful prevention of underage drinking and found nine community mobilization strategies with evidence of effectiveness in reducing the use and/or availability of alcohol for minors. From these nine different community prevention strategies and actions, there were three main findings: a common feature of successful community-based prevention approaches is reliance on local coalitions to select effective preventive interventions and implement them with fidelity 6

7 the inclusion of a universal, school-based drug prevention curriculum as part of the larger community initiative is associated with reductions in alcohol use among middleand high-school students environmental strategies focused on changing local laws, norms, and policies related to alcohol access and use do not appear to reduce alcohol use among adolescents younger than age 18 when implemented independently of other community-based strategies Another study looked at impaired driving reduction strategies conducting surveys with all state patrol agencies and a representative sample of local law enforcement and comparing that with data from BRFSS to determine which strategies were associated with reduced impaired driving (Sanem et al., 2015). They found that sobriety checkpoints, saturation patrols, and enforcement of open container laws were all associated with a lower prevalence of alcoholimpaired driving but that a combination of strategies was associated with a greater reduction in alcohol-impaired driving than any one strategy alone (Sanem et al., 2015). In particular, they found the highest rates of reduction with sobriety checkpoints and open containers laws estimated at 29% to 48% reductions in alcohol-impaired driving in states where all agencies reported enforcement versus states where none of the agencies reported engaging in the enforcement (Sanem et al., 2015). Sobriety checkpoints and saturation patrols were also associated with a reduction in alcohol-related crashes and associated fatal and nonfatal injuries (Sanem et al., 2015). Although many LHDs may lack the resources to conduct sobriety checks, this study found that as few as two to five officers are effective in reducing impaired driving, and that grant funding may be available (Sanem et al., 2015). Substance Abuse and Mental Health Services Administration, or SAMHSA, directed a substance abuse prevention cost-benefit analysis in SAMHSA found that if effective school-based substance abuse prevention programs were implemented in the U.S., substance abuse initiation would decline for 1.5 million youth and be delayed for 2 years on average (SAMHSA, 2008). They listed 35 effective prevention programs for schools and showed that 7

8 effective prevention programs although costly at an average of $220 per pupil could save $18 for every $1 spent in the long run. These cost savings come from reduced social costs of substance-abuse-related medical care, other resources, and lost productivity over a lifetime by an estimated $33.5 billion and persevered the quality of life over a lifetime valued at $65 billion (SAMHSA, 2008). They recommend implementing nationwide evidence-based and comprehensive prevention programs in schools (SAMHSA, 2008). What impact could alcohol/beer tax have on consumption? Increasing alcohol excise tax has been proven to reduce excessive drinking, reduce alcohol-related harms, reduce underage drinking, improve health outcomes, reduce violence, and reduce incidence of sexually transmitted infections (STI) (What Works for Health, 2013). According to The Community Guide, higher alcohol prices or taxes were associated with 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), less measures of violence (3 studies), sexually transmitted diseases (1 study), and alcohol dependence (1 study) (The Community Guide, n.d). Many other studies demonstrate a decrease in consumption of alcohol as taxes on it increase. A CDC-funded systemic review was conducted by authors known collectively as the Task Force on Community Preventive Services (2010). Their results were that nearly all studies, including those with different study designs, found that there was an inverse relationship between the tax or price of alcohol and indices of excessive drinking or alcohol-related health outcomes (Task Force on Community Preventive Services, 2010). In addition, studies examining underage drinking found that increased taxes were significantly associated with reduced consumption and alcohol-related harms (Task Force on Community Preventive 8

9 Services, 2010). A different study looking at data from the BRFSS survey found that a 25-cent increase per drink alcohol tax would result in an overall 9.2% reduction in alcohol consumption and an 11.4% reduction in heavy drinking (Daley et al., 2012). Other developed countries have similar findings a increase in alcohol taxation or price decreases consumption. One Australian study found that from alcohol consumption in Australia was negatively associated with alcohol price and positively associated with the affordability of alcohol (Jiang & Livingston, 2015). Their research suggest that a 10% increase in the price of alcohol was associated with a 2% decrease in the population-level alcohol consumption the following year (Jiang & Livingston, 2015). The reverse seems to be true, as well. A study in Finland found that when alcohol taxes were reduced by one third in 2004, alcohol consumption increased 10% that year (Mäkelä & Osterberg, 2009). Following the increased alcohol consumption alcohol-induced liver disease deaths increased by 46% from (Mäkelä & Osterberg, 2009). Decreased alcohol consumption is not the only benefit of tax increases on alcohol; many studies found decreases in negative health outcomes with an increase in alcohol tax or price. Wagenaar, Tobler, and Komro (2010) conducted a systemic review on the effects of alcohol taxes looking at its effect on alcohol-related morbitity and mortality. They found that public policies affecting the price of alcoholic beverages have significant effects on alcohol-related disease and injury rates (Wagenaar, Tobler, and Komro, 2010). In particular, their results suggest that doubling the alcohol tax would reduce alcohol-related mortality by an average of 35%, traffic crash deaths by 11%, sexually transmitted disease by 6%, violence by 2%, and crime by 1.4% (Wagenaar et al., 2010). 9

10 In 2009 Illinois increased their alcohol tax. Its effects on fatal motor vehicle crashes was studied by Wagenaar, Livingston, and Staras in They found that fatal alcohol-related motor vehicle crashes declined by 9.9 per month after the tax increase, a 26% reduction (Wagenaar, Livingston, & Staras, 2015). Also following the Illinois tax increase, the statewide gonorrhea rates decreased 21%, which was estimated at 3,506 fewer cases annually, and the statewide chlamydia rates decreased by 11%, which was estimated at 5,844 fewer infections per year (Staras et al., 2014). Similarly, a study in Maryland found significant STI reductions after the 2011 state alcohol tax increase a 24% decrease in gonorrhea, or 1,600 fewer cases statewide per year (Staras, Livingston, & Wagenaar, 2015). Three studies examining the effects of alcohol taxes on alcohol-related disease mortality for New York State, Alaska, and Florida all found that increased taxes were significantly associated with reductions in alcohol-related mortality (Delcher, Maldonado-Molina, & Wagenaar, 2012; Wagenaar, Maldonado-Molina, & Wagenaar, 2009; Maldonado-Molina & Wagenaar, 2010). A 2015 published literature review on alcohol control policies and interpersonal violence found that even a 1% increase in alcohol price could reduce violent crime including injury, assault, the probability of being assaulted, domestic abuse, and child abuse (Fittterer, Nelson, & Stockwell, 2015). Outside of the U.S., one study in Russia found that a decrease in alcohol tax was associated with rising mortality, while increases in excise tax were associated with mortality reduction (Khaltourina & Korotayev, 2015). A modelling study in England found that a minimum unit price of alcohol could prevent 624 deaths and 23,700 hospital admissions per year (Brennan et al., 2014). Conclusions & Recommendations Additional research is needed before conclusive statements and recommendations about how local health departments can effectively address alcohol and other drug abuse in its entirety. 10

11 However, increasing taxes alcohol is likely to have an effect on alcohol consumption, and, as many studies have shown, alcohol-related negative health outcomes like vehical fatalities, alcohol-related mortality, violence, injury, and STIs. From this literature review there are some recommendations that can be made: Engage and cooperate with local law enforcement to conduct and enforce sobriety checkpoints and saturation patrols to reduce impaired driving. Use or establish community coalitions to focus on reducing alcohol abuse and misuse. Enact evidence-based comprehensive school programs. Use the media to communicate effectively. Increase alcohol excise tax. Or, if that is not possible, LHDs should collaboratively campaign for the state of Wisconsin to increase its nationwide-low taxation on alcohol. 11

12 References Bellin Health. (2015). Beyond Health, Healthiest Brown County. Connecting Beyond Health Care. Brennan, A., Meng. Y., Holmes, J., Hill-McManus, D., Meier, P.S. (2014). Potential benefits of minimum unit pricing for alcohol versus a ban on below cost selling in England 2014: modelling study. BMJ. 349:g5452. The Community Guide (n.d.) Increasing Alcohol Taxes to Prevent Excessive Alcohol Use and Other Harms. Retrieved from Cox, E. & Fisher S. (2009). Drinking on the Dirt Roads of America: NACCHO's Impaired Driving Prevention in Rural Communities Demonstration Site Project. Journal of Public Health Practice and Management: 15(3): Daley, J.I., Stahre, M.A., Chaloupka, F.J., & Naimi, T.S. (2012). The impact of a 25-cent-perdrink alcohol tax increase. Am J Prev Med. 42(4): Delcher, C., Maldonado-Molina, M.M., & Wagenaar, A.C. (2012). Effects of alcohol taxes on alcohol-related disease mortality in New York State from 1969 to Addict Behav. 37(7):783-9 Fagan, A., Hawkins, J.D., & Catalano, R.F. (2011). Engaging Communities to Prevent Underage Drinking. Alcohol Research Current Reviews. 34(2): Fitterer, J.L., Nelson, T.A., & Stockwell, T. (2015). A Review of Existing Studies Reporting the Negative Effects of Alcohol Access and Positive Effects of Alcohol Control Policies on Interpersonal Violence. Front Public Health. 16;3:253. Jiang, H. & Livingston, M. (2015). The Dynamic Effects of Changes in Prices and Affordability on Alcohol Consumption: An Impulse Response Analysis. Alcohol and Alcoholism. 50(6):631-8 Khaltourina, D., & Korotayev, A. (2015). Effects of Specific Alcohol Control Policy Measures on Alcohol-Related Mortality in Russia from 1998 to Alcohol and Alcoholism. 50(5): Mäkelä, P. & Osterberg, E. (2009). Weakening of one more alcohol control pillar: a review of the effects of the alcohol tax cuts in Finland in Addiction. 104(4): Maldonado-Molina, M.M. & Wagenaar, A.C. (2010). Effects of alcohol taxes on alcohol-related mortality in Florida: time-series analyses from 1969 to Alcohol Clin Exp Res. 34(11):

13 Sanem, J.R., Erickson, D.J., Rutledge, P.C., Toomey, T.L. (2015). Association between alcohol-impaired driving enforcement-related strategies and alcohol-impaired driving. Accident Analysis & Prevention. 78: Staras, S.A., Livingston, M.D., Christou, A.M., Jernigan, D.H., & Wagenaar, A.C. (2014). Heterogeneous population effects of an alcohol excise tax increase on sexually transmitted infections morbidity. Addiction. 109(6): Staras, S.A., Livingston, M.D., & Wagenaar, A.C. (2016). Maryland Alcohol Sales Tax and Sexually Transmitted Infections: A Natural Experiment. Am J Prev Med. 50(3):e Substance Abuse and Mental Health Services Association. (2008). Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis. Retrieved from on December 10, The Task Froce on Community Preventive Services. (2010). The effectiveness of tax policy interventions for reducing excessive alcohol consumption and related harms. Am J Prev Med. 38(2): Tax Foundation. (2014). State Sales, Gasoline, Cigarette, and Alcohol Tax Rates by State, Retrieved from Wagenaar, A.C., Maldonado-Molina, M.M., & Wagenaar, B.H. (2009). Effects of alcohol tax increases on alcohol-related disease mortality in Alaska: time-series analyses from 1976 to Am J Public Health. 99(8): Wagenaar, A.C., Tobler, A.L., & Komro, K.A. (2010). Effects of alcohol tax and price policies on morbidity and mortality: a systematic review. Am J Public Health. 100(11): Wagenaar, A.C., Livingston, M.D., & Staras, S.S. (2015). Effects of a 2009 Illinois Alcohol Tax Increase on Fatal Motor Vehicle Crashes. Am J Public Health. 105(9): Wikipedia. (2015). Alcohol Laws of The United States. Retrieved from Wisconsin DOT. (2016). Drunk Driving. Retrieved from Wisconsin DHS. (2015). An Overview of Wisconsin Local Health Departments. PowerPoint slides. Retrieved from Wisconsin DHS. (n.d.). WSHA Alcohol and Drug Use. Retrieved from 13

14 Appendix: Table 1 Priority research questions Search engines/websites used Search terms used Do LHD effectively address Alcohol and Other Drug Abuse (AODA) issues in both rural and urban communities? PubMed, Google Scholar, Google, What Works for Health, The Community Guide Local health departments effectively affect alcohol and other drug abuse, local health departments substance abuse prevention, Wisconsin local health departments alcohol and other drug abuse prevention, Wisconsin health departments substance abuse prevention, reducing alcohol and other drug abuse, reducing drunk driving, reducing impaired driving, urban and rural alcohol abuse prevention What impact could alcohol/beer tax have on consumption? PubMed, Google Scholar, Google, What Works for Health, The Community Guide Effects of alcohol tax on consumption, alcohol excise tax, tax rates for alcohol, increased alcohol tax, Wisconsin alcohol tax, costbenefit analysis alcohol tax Articles reviewed Articles included