States with lower rates of binge drinking have stronger policies toward alcohol, a new study suggests.
This is the first study to relate alcohol policies within each U.S. state to the levels and likelihood of binge drinking in adults.
"We found that states with stronger and more effective alcohol policies had less binge drinking than states with weaker alcohol policies," said study researcher Dr. Timothy Naimi, an associate professor of medicine at Boston University's Schools of Medicine and of Public Health.
"Most states could be doing a lot better to address a leading cause of preventable deaths," Naimi said.
Alcohol is the third-leading cause of preventable death in the United States, after smoking and the combined effects of over-eating and inactivity, Naimi said.
There's a slight uptick in binge drinking during the holiday season, Naimi said. But it's a serious problem among adults year-round, responsible for more than half of the estimated 80,000 alcohol-attributable deaths that occur each year in the United States.
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In the study, the researchers defined binge drinking as five or more drinks for men, and four or more drinks for women on one occasion during the last 30 days, which is the same definition used by a monthly health survey conducted by the Centers for Disease Control and Prevention.
The findings were published online Tuesday in the American Journal of Preventive Medicine.
To find out whether varying policy environments in states across the country accounted for differences in binge drinking, researchers asked a panel of experts to rate the alcohol policies in 50 states and the District of Columbia. These experts rated the number and effectiveness of alcohol policies in each state, and the degree to which the policies had been implemented between 2000 and 2010.
For example, the experts evaluated state policies aimed at reducing binge drinking, such as drunk driving laws and taxes on alcohol sales, and whether the state limited the number of retail outlets that sell alcohol beverages in a given area. They also looked at whether states restricted the days and hours of alcohol sales at stores, bars and restaurants, and if they held retailers responsible for problems caused by selling alcohol to underage drinkers or visibly drunk customers.
These policy ratings, along with data on the statewide prevalence of adult binge drinking, were used to calculate an alcohol policy score in each state on a yearly basis over the 10-year study period.
This analysis found that states with stronger policy scores had lower amounts of binge drinking.
For example, in 2008, Oklahoma, Tennessee, Alabama, Utah, Kansas and Washington had strong policies and low rates of binge drinking. Meanwhile, the states with the weakest alcohol policy environments, such as South Dakota, Wisconsin, Iowa, Colorado, Wyoming and Montana, who ranked in the bottom quarter of states, had higher binge drinking rates. In fact, their rates were one-third higher compared with the top quarter of states with the strongest policies.
The researchers looked at single years for their comparisons, because states' policies about alcohol change slowly, Naimi said.
These findings held true even after researchers took into account other factors that could also contribute to the amount of drinking seen within a state's population, such as its residents' age, sex, race, income and religious composition.
Almost half the states' scores were lower than 50% of the maximum score, so there's lots of room for improvement, Naimi said.
Alcohol-related policies can play an important part in helping states reduce the health and social problems, and economic costs, of people drinking too much, Naimi said.
"This study shows that for reducing alcohol-related problems, effective policies are the solution," Naimi said. But he said that alcohol policy may not sound as exciting as a newly discovered pill or vaccine.
"Much more than clinical treatment for alcoholism and educational interventions, alcohol policies are the only thing that can move the needle across the population," Naimi said.
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