Relationships Between Alcohol Policy Strength and Adult Alcohol Consumption

A range of state-level policies have been identified to target population-level rates of alcohol use; however, a given type of alcohol policy may vary in strength across states. We assessed associations between the strength of 17 types of U.S. state-level alcohol control policies and adult alcohol consumption levels. We coded each policy (using the Alcohol Policy Information System) based on its strength, and conceptually combined the policies into four domains: underage consumption/possession, provision to underage, general availability, and server policies. We then used latent class analysis to group states based on domain-level strength scores, identifying four classes: (1) Weak policies except for strong server policies (6 states); (2) Average for all policies (29 states); (3) Strong underage consumption/possession policies but otherwise average policies (11 states); (4) Strong policies overall (4 states). We measured adult alcohol consumption (monthly, binge, and heavy) from the Behavioral Risk Factor Surveillance System. Crude comparisons showed that for all three consumption measures, mean state-level consumption was highest for Class 1, followed by Class 2, Class, 3, and lowest for Class 4. We regressed alcohol consumption on the four classes using a multi-level model, controlling for individual demographics and state-level total population and religiosity.  Using Class 2 as the referent, we found that Classes 1, 3 and 4 had lower binge drinking (p < .05).  Similar patterns were seen for monthly and heavy alcohol use. We conclude that, in general, states with stronger alcohol policy environments have lower adult alcohol consumption, although causal inferences cannot be made.