Keg Registration, Server Training, Beer Excise Tax and Underage Drinking: A Multi-level Analysis

Transcription

1 Keg Registration, Server Training, Beer Excise Tax and Underage Drinking: A Multi-level Analysis Young-Hee Yoon, Ph.D.; Chiung M. Chen, M.A.; Sherrie Aitken, Ph.D.; and Mary C. Dufour, M.D., M.P.H. Alcohol Epidemiologic Data System, NIAAA/NIH CSR, Incorporated, 2107 Wilson Boulevard, Suite 1000, Arlington, VA Poster presented at the 131 st Annual Meeting of the American Public Health Association, November 15-19, 2003, San Francisco, California

2 INTRODUCTION Since the passage of the National Minimum Drinking Age Act of 1984, purchase or consumption of alcohol by young people under the age of 21 has been prohibited by law. Sales or provision of alcohol to minors are also prohibited. In spite of these measures, underage youth have fairly easy access to alcohol, especially from adults (Wagenaar et al., 1996). Because of its variety of adverse health and social consequences, underage drinking has received increasing attention from policy makers as well as researchers in public health areas. State alcohol regulations, such as keg registration, server training, and beer excise tax have been suggested in the literature as affecting youths accessibility to alcohol. Beer kegs are often a main source of alcohol at teenage parties (Jones-Webb et al., 1997). In addition, kegs may encourage harmful drinking because youth may perceive beer provided in this form to be less expensive or free. Keg registration is a strategy to identify and punish third party adults who buy beer kegs for underage youth. Server training is an educational program for employees/licensees/managers at alcohol outlets designed to prevent alcohol sales to underage youths or intoxicated patrons. Some studies have suggested that server training is effective in increasing server trainees knowledge of and attitudes toward responsible beverage service (Molof, 1993), reducing intoxication (Saltz, 1987; Geller et al., 1987; Glicksman and Single, 1988), and reducing alcohol-related traffic fatalities (Holder and Wagenaar, 1994). Huang et al. (2002) found that only mandatory server training reduced the likelihood of underage drinking. Other studies show that offsale (e.g., grocery and liquor stores) server training has no significant effect on sales to minors (Grube, 1997; Wolfson et al., 1996). Despite the inconclusive findings and lack of research on the relationship between keg registration or server training policy and underage drinking, these two policies have been recommended as important strategies to prevent underage

3 drinking (Toomey and Wagenaar, 1999; Komro and Toomey, 2002; National Research Council and Institute of Medicine, 2003). Previous studies have found that many alcohol-related problems, such as alcohol-related traffic crashes and violent crime, significantly decline with increased alcohol taxes (Chaloupka et al., 2002; Laixuthai and Chaloupka, 1993; Markowitz and Grossman, 1998; Toomey and Wagenaar, 1999). Several studies have also shown that youth are particularly sensitive to changes in alcohol price (Grossman et al., 1994; Laixuthai and Chaloupka, 1993). The purpose of the current study is to explore the combined effect of keg registration and server training policy controlling for beer excise tax on underage drinking. The major questions addressed in this study are: Do these alcohol-related policies have independent impacts on underage drinking? If so, are there combined effects of these policies? Under a multilevel model framework, this study explores whether these policies, as contextual factors at the state level, have independent and/or combined effects on underage drinking, net of individual characteristics and state drinking norms? DATA AND METHODS Data on underage drinking measures and individual background characteristics were taken from the 1999 and 2001 National School-based Youth Risk Behavior Survey (YRBS) restricted-use data produced by the Centers for Disease Control and Prevention (CDC). To increase the reliability of the estimates, data from the two survey years were combined. The YRBS includes a nationally representative sample of high school students in grade 9-12 in public and private schools 1. Data on state server training policy and beer excise tax were provided by Dr. Alexander Wagenaar at the Alcohol Epidemiology Program (AEP) of the University of Minnesota. Data on keg registration were drawn from a report by the Alcohol Epidemiology Program (2000). Since policy implementation requires some time to have impact on drinking 1 The overall response rate of YRBS was 66% for 1999 and 63% for 2001.

4 behaviors, state policy data from 1998 and 2000 were applied to individual data collected in 1999 and 2001, respectively. Data on drinking measures among ages by state were taken from the 1999 and 2001 Behavior Risk Factor Surveillance System, also produced by CDC. All descriptive statistics were computed using the statistical software package STATA with standard errors and statistical significance levels adjusted for design effects associated with the complex sampling design of YRBS. Because the data have a hierarchical structure with students nested in the states and alcohol policy measures such as server training, keg registration, and beer tax as contextual factors at the state level, multilevel models were fitted to partition the variance into individual and state level components. Specifically, the procedure was used to assess whether state alcohol policies account for differences across states after controlling for individual characteristics. MEASURES Outcome Variables: Current Drinking: Had at least one drink of alcohol during the past month. Episodic Heavy Drinking: Had five or more drinks of alcohol within a couple of hours at least once during the past month. Predictor Variables: (See Figure 1 for detailed categories.) Individual Level: Sex: dummy-coded with female as the reference category. Race/Ethnicity: 7 dummy-coded variables with White as the reference category. Grade: 3 dummy-coded variables with 9th grade as the reference category. Metropolitan Status: 2 dummy-coded variables with urban residence as the reference category.

5 Age at Drinking Onset: in years; coded as current age for those who never started drinking (i.e., right-censored). Survey Year: dummy coded with survey year 1999 as the reference category. State Level: Keg registration/server Training Policy: 3 dummy-coded variables with neither keg registration nor mandatory server training policy as the reference category. Beer Excise Tax: Cents per drink (i.e. 12 oz of beer) in 2000 constant dollars. State Drinking Norms Among Adults Ages 21-29: Current Drinking: Percent adults ages who had at least one drink during the past month. Episodic Heavy Drinking: Percent adults ages who had five or more drinks at least once during the past month. RESULTS The study sample of YRBS includes 28,950 high school students residing in 34 states (23 states in 1999 and 28 states in 2001) representing high school students from 9th to 12th grade nationwide. No states in the study sample underwent changes in policies regarding either keg registration or server training between 1998 and Table 1 shows that 3 states (New Jersey, Wisconsin and Tennessee) had mandatory server training without keg registration, 3 states (California, Idaho and Maine) had keg registration without mandatory server training, 3 states (Washington, Oregon and New Mexico) had both policies, and 25 states had neither policy. Table 1 also shows that 3 states (Alabama, West Virginia and South Carolina) had highest beer excise tax, and Missouri, Wisconsin, and Illinois had the lowest beer excise tax. During the study period, the 3 states with the highest beer excise tax did not have either keg registration or mandatory server training policy.

6 Descriptive Statistics Figure 1 presents the prevalence of current drinking and episodic heavy drinking by individual characteristics and state policy measures. The distribution patterns are quite similar between the two outcome variables. The following are the highlights of the observed patterns (including only comparisons with p <.10). During the past 30 days, 48.9 percent of 9-12 th graders had at least one drink of alcohol and 30.7 percent had five or more drinks of alcohol in a row within a few hours. Male high school students were more likely to be current drinkers and episodic heavy drinkers than female students. Compared with White students, Asian and African American students had lower rates of current drinking and episodic heavy drinking. Other minority students, however, showed no significant difference from White students, except that Hispanic students had lower rates of episodic heavy drinking than White students. From 9th to 10th grade, the rates of both current drinking and episodic heavy drinking increased significantly. Small changes occurred between 10th and 11th grade. From 11th to 12 th grade, the rates increased significantly again. Students living in suburban areas had a slightly higher rate of current drinking than students living in urban areas. Students living in rural areas also had a higher rate of current and episodic heavy drinking than students living in urban areas. High school students in states with mandatory server training policy were less likely to be current drinkers or episodic heavy drinkers than those students in states without either mandatory server training or keg registration policy. Students alcohol use did not vary significantly with beer excise tax. Multilevel Regression Analyses Table 2 presents results from the two-level unit specific logistic regression using hierarchical model.

7 At the individual level, the patterns of the relationships appear to be similar to those shown in the descriptive analyses. Being in higher grades and living in rural areas were associated with increased risks for current drinking and episodic heavy drinking. Minority students, especially African American and Asians, had lower risks than White students for both current and episodic heavy drinking. Hispanic students had lower risks than White students for episodic heavy drinking. However, gender difference was no longer significant in current drinking, although male students were still significantly more likely to engage in episodic heavy drinking. Delaying the age of drinking onset also reduced risks for current drinking. At the state level, the patterns of the relationships were also similar to what were observed in the descriptive results. Controlling for individual and other factors, mandatory server training was associated with a reduction of about one-third of the risk for current drinking (odds ratio=0.68), compared with no implementation of server training or keg registration. Students residing in states that implemented mandatory server training were 38 percent (odds ratio=0.62) less likely to engage in episodic heavy drinking compared with students residing in states without either policy. Students residing in states with both policies keg registration and mandatory server training were 39 percent (odds ratio=0.61) less likely to engage in episodic heavy drinking, compared with students residing in states without either policy, indicating no increased effect of the combined policies. After controlling for individual factors and other statelevel alcohol policies, beer excise tax did not show significant effect on either current drinking or episodic heavy drinking. DISCUSSION This study is an attempt to examine the combined effects of two state alcohol policies mandatory server training and keg

8 registration on underage drinking, while controlling for beer excise tax and individual characteristics. Results from this study at the individual level showed significant effects of sex, grade, race/ethnicity, metropolitan status, and age at onset of alcohol use among high school students. These findings are consistent with findings from previous studies (O'Malley et al., 1998). Results at the state level suggest that mandatory server training may be effective in reducing both current drinking and episodic heavy drinking among youths. This is consistent with Huang et al s study in States with both keg registration and mandatory server training also showed a significantly reduced likelihood of episodic heavy drinking among youth. However, the reduction was not greater than that shown by mandatory server training policy alone. Contrary to previous studies (Coate and Grossman, 1988; Grossman et al., 1994), our data did not provide evidence for negative effect of beer excise tax on underage drinking. This lack of price sensitivity of youth drinking may be explained by the full price of alcohol argument. According to Laixuthai and Chaloupka (1993), the full price of alcohol includes both the monetary price and the indirect cost of illegal drinking for underage youth. Implementing mandatory server training and/or keg registration policy at state level may create political environments that emphasize enforcement effort (Komro and Toomey, 2002). Strengthening the enforcement effort may increase the indirect cost of illegal drinking, thus reducing the relative contribution of beer excise tax to youth drinking. Other research also suggests that beer consumption is less sensitive to price changes than consumption of wine or spirits (Leung and Phelps, 1993). In addition, since our current measure of beer excise tax lacks adjustment for local cost of living index, further investigation is required with such adjustments. REFERENCE Alcohol Epidemiology Program. Alcohol Policies in the United States: Highlights from the 50 States. Minneapolis: University of Minnesota, Chaloupka, F.J.; Grossman, M.; and Saffer, H. The effects of price on alcohol consumption and alcohol-related problems. Alcohol Research & Health 26(1): 22-34, 2002.

9 Coate, D., and Grossman, M. Effects of alcoholic beverage prices and legal drinking ages on youth alcohol use. Journal of Law and Economics 31 (1): , Geller, E.S.; Russ, N.W.; and Delphos, W.A. Does server intervention make a difference? Alcohol Health and Research World 11: 64-69, Gliksman, L. and Single, E. A field evaluation of a server intervention program: Accommodating reality. Paper presented at the Canadian Evaluation Society Meeting, Montreal, Canada, May Grossman, M.; Chaloupka, F.J.; Saffer, H.; and Laixuthai, A. Effects of alcohol price policy on youth: A summary of economic research. Journal of Research on Adolescence 4 (2): , Grube, J.W. Preventing sales of alcohol to minors: Results from a community trial. Addiction 92: S251-60, Grube, J.W., and Nygaard, P. Adolescent drinking and alcohol policy. Contemporary Drug Problems 28: , Holder, H.D. and Wagenaar, A.C. Mandated server training and reduced alcohol involved traffic crashes: A time series analysis of the Oregon experience. Accident Analysis and Prevention 26(1): 89-97, Huang, G.; Yoon, Y-H.; Yi, H-y.; Dufour, M.C.; and Chen, C.M. State Alcohol Server Training Policy and Drinking Among High School Students: A Multi-level Analysis. Poster presented at the 130 th Annual meeting of the American public Health Association, November 9-13, Philadelphia, Pennsylvania. Jones-Webb, R.; Toomey, T.L.; Miner, K.; Wagenaar, A.C.; Wolfson, M.; and Poon, R. Why and in what context adolescent obtain alcohol from adults: A pilot study. Substance Use & Misuse 32(2): , Komro, K.A. and Toomey, T.L. Strategies to prevent underage drinking. Alcohol Research and Health 26(1): 5-14, Laixuthai, A., and Chaloupka, F.J. Youth alcohol use and public policy. Contemporary Policy Issues 11(4): 70-81, Leung, S.F., and Phelps, C.E. My Kingdome for a drink? A review of estimates of the price sensitivity of demand for alcoholic beverages. In Hilton, M.E., and Gloss, E. (eds.). Economics and the Prevention of Alcohol-Related Problems. NIAAA Research Monograph No. 25., NIH Pub. No Bethesda, MD. Markowitz, S., and Grossman, M. Alcohol regulation and domestic violence towards children. Contemporary Economic Policy 16(3): , Molof, M.J. Evaluation of the Oregon alcohol server training program: Report on knowledge changes before and immediately after the class, pre-class expectations and evaluation of the class. Eugene, OR: Integrated Research Services, Inc., National Research Council and Institute of Medicine. Reducing Underage Drinking: A Collective Responsibility. Committee on Developing a Strategy to Reduce and Prevent Underage Drinking, Richard J. Bonnie and Mary Ellen O Connell, Editors. Board on Children, Youth, and Families, Division of Behavioral and Social Sciences and Education. Washington, D.C.: The National Academies Press, O'Malley, P.M.; Johnston, L.D.; and Bachman, J.G. Alcohol use among adolescents. Alcohol Health and Research World 22(2): 85-93, Saltz, R.F. The role of bars and restaurants in preventing alcohol -impaired driving: An evaluation of server intervention. Evaluation and the Health Professions 10(1): 5-27, Toomey, T.L. and Wagenaar, A.C. Policy options for prevention: The case of alcohol. Journal of Public Health Policy 20(2): , Wagenaar, A.C.; Toomey, T.L.; Murray, D.M.; Short, B.J.; Wolfson, M.; and Jones- Webb, R. Sources of alcohol for underage drinkers. Journal of Studies on Alcohol 57: , Wolfson, M.; Toomey, T.L.; Murray, D. M.; Forster, J.L.; Short, B.J.; and Wagenaar, A.C. Alcohol outlet policies and practices concerning sales to underage people. Addiction 91(4): , 1996

10 Figure 1. Prevalence (%) of current drinking and episodic heavy drinking by individual and state level variables, Total Sex Female Male Race White Am Indian/Alaska Native Asian African American Hispanic or Latino Native Hawaiian/Other PI Multiple-Hispanic Multiple-Non-Hispanic Grade level 9th grade 10th grade 11th grade 12th grade Metropolitan status Urban Suburban Rural Alcohol policy Neither Server training only Keg registration only Both Beer Tax < > Current drinking Episodic heavy drinking %

11 Alcohol policies in 23 states as of 1998 NA Server training only Neither Keg registration only WA CA OR NV ID UT MT WY CO ND SD NE KS MN IA MO WI IL MI OH IN WV KY NY PA VA ME VT NH MA RI CT NJ DE MD DC AZ NM OK AR TN NC SC AK HI TX LA MS AL GA FL Alcohol policies in 28 states as of 2000 NA Neither Server training only Keg registration only Both WA CA OR NV ID UT MT WY CO ND SD NE KS MN IA MO WI IL MI OH IN WV KY NY PA VA ME VT NH MA RI CT NJ DE MD DC AZ NM OK AR TN NC SC AK HI TX LA MS AL GA FL

12 Beer excise tax in 23 states as of 1998 WA CA OR NV ID UT MT WY CO ND SD NE KS MN IA MO WI IL MI OH IN WV KY NY PA VA ME VT NH MA RI CT NJ DE MD DC AZ NM OK AR TN NC SC AK HI TX LA MS AL GA FL NA 0 11 cents per drink Beer excise tax in 28 states as of 2000 WA CA OR NV ID UT MT WY CO ND SD NE KS MN IA MO WI IL MI OH IN WV KY NY PA VA ME VT NH MA RI CT NJ DE MD DC AZ NM OK AR TN NC SC AK HI TX LA MS AL GA FL NA 0 11 cents per drink

13 Table 1. State Alcohol Policy, United States, State Keg Registration Server Training Beer Excise Tax 1 Alabama -- Voluntary West Virginia South Carolina Hawaii North Carolina Georgia Florida -- Voluntary 4.61 Mississippi New Mexico Yes Mandatory 3.84 Oklahoma Virginia Maine Yes Voluntary 3.28 Louisiana -- Voluntary 3.17 Washington Yes Mandatory 2.44 Michigan -- Voluntary 1.96 California Yes Texas -- Voluntary 1.86 Ohio New York Arizona -- Voluntary 1.54 Idaho Yes Montana Tennessee -- Mandatory 1.24 Illinois -- Voluntary 1.21 New Jersey -- Mandatory 1.15 Indiana Pennsylvania Massachusetts Rhode Island -- Voluntary 0.95 Nevada Oregon Yes Mandatory 0.79 Colorado Wisconsin -- Mandatory 0.62 Missouri Note: 1 State excise tax on beer is a volume tax (cents per 12 oz. of beer) in 2000 constant dollars. Tax is applicable to regular strength brewed malt beverages with an alcohol content between 3.9 and 6 percent by volume.

14 Table 2. Two-level unit specific logistic regression of current drinking and episodic heavy drinking on alcohol policies, adjusting for individual level variables, and prevalence of current or episodic heavy drinking among adults ages Predictor Variables 1 Odds Ratio Current drinking Episodic heavy drinking Individual level Sex (Female) Male ** Race (White) Am Indian / Alaska Native Asian 0.38 ** 0.32 ** Black or African American 0.53 ** 0.28 ** Hispanic or Latino * Native Hawaiian/other PI Multiple Hispanic * Multiple - Non-Hispanic * Grade level (9th grade) 10th grade 1.61 ** 1.70 ** 11th grade 2.14 ** 2.18 ** 12th grade 3.47 ** 3.18 ** Metropolitan status (Urban) Suburban Rural 1.22 * 1.25 ** Age of drinking onset 0.75 ** 0.80 ** State level Alcohol policies (Neither) Server training 2 only 0.68 ** 0.62 ** Keg registration only Both * Beer tax 3 (cents per drink) Prevalence of current or episodic heavy drinking among adults ages Year (1999) Constant ** 8.51 ** Level 2 variance * p <.05; ** p <.01 Note: 1 The reference category is in parentheses. 2 Based on the previous finding suggesting that voluntary server training has no significant effect on youth drinking, voluntary server training is coded as zero, and mandatory server training is coded as one. 3 State excise tax on beer is adjusted to 2000 constant dollars.