Comparative Effectiveness of State-level Alcohol Control Policies in the U.S

Background: State governments promulgate alcohol policies to mitigate adverse impacts from excessive alcohol consumption and underage (youth) drinking. However, information about the relative effectiveness and strength of evidence among various U.S. alcohol policies is lacking.

Methods: A modified Delphi process involving 10 U.S. alcohol policy experts was used to rate the comparative effectiveness based on 5-point Likert scale and strength of evidence for 47 alcohol policies nominated by those experts in terms of their ability to reduce binge drinking and alcohol-impaired driving among the general population and among youth.

Results: Increasing alcohol excise taxes was rated as the most effective policy for reducing binge drinking (general population mean = 4.7, youth mean = 4.6) and impaired driving (general population mean = 4.5, youth mean = 4.5). For reducing binge drinking, the second highest-rated policy for adults was monopoly control systems (mean = 4.0), and for youth was minimum legal drinking age laws (mean = 4.2). Policy effectiveness was positively associated with strength of evidence among the general population (r = 0.70 for binge drinking; r = 0.82 for impaired driving) and among youth (r = 0.67 for binge drinking, r = 0.79 for impaired driving).

Conclusions: Comparative effectiveness ratings of a comprehensive set of alcohol policies can be used to evaluate the strength of the alcohol policy environment in states, and will help determine the extent to which such environments account for existing state-level differences in excessive drinking and related harms among adults and youth.