18th Alcohol Policy Conference April 11-13, 2018 Washington, DC - USA

8:45am - 10:15am

8:00am - 8:30am Continental breakfast – Advocate Institute
8:30am - 5:00pm Advocate Institute - Day 1
Studio B
Description:

The first-ever Advocate Institute convened in conjunction with the Alcohol Policy Conference series will explore ways in which advocates have translated alcohol policy research into public health practice. Attendees will focus on the recognized science and strategies to preventing excessive drinking and the alcohol-related harms in their communities. 

Facilitators:

Diane Riibe
U.S. Alcohol Policy Alliance (USAPA)
Michael Sparks, MA
SparksInitiatives and USAPA Advisory Board

4:00pm - 7:00pm AP18 Registration open
8:30am - 6:00pm AP18 Registration open
8:00am - 8:30am Continental breakfast - Advocate Institute
8:30am - 11:30am Advocate Institute Day 2
Studio B
Description:

The first-ever Advocate Institute convened in conjunction with the Alcohol Policy Conference series will explore ways in which advocates have translated alcohol policy research into public health practice. Attendees will focus on the recognized science and strategies to preventing excessive drinking and the alcohol-related harms in their communities.

Facilitators:

Diane Riibe
U.S. Alcohol Policy Alliance
Michael Sparks, MA
Sparks Initiatives and USAPA Advisory Board

1:00pm - 2:30pm OPENING SESSION - ALCOHOL AND CANCER: PREVIEW OF COMING ATTRACTIONS
Salon 4
Presenters:

Diane Riibe
U.S. Alcohol Policy Alliance
Susan Gapstur, Phd, MPH
American Cancer Society

Christine Molmenti, PhD, MPH
American Institute for Cancer Research

Kevin Shield, PhD
Centre on Addiction and Mental Health, Canada

William Klein, PhD
National Cancer Institute
Timothy S. Naimi, MD, MPH
Boston Medical Center

2:45pm - 4:15pm Concurrent Sessions

C-1 ALCOHOL CONTROL AS CANCER CONTROL: MOVING FORWARD FROM EVIDENCE TO ACTION

Studio D
Presenters:

Norman Giesbrecht, PhD - moderator
Emeritus, Centre for Addiction and Mental Health, Canada
Christine Molmenti, PhD, MPH
American Institute for Cancer Research
Janette Merrill, MS CHES
American Society of Clinical Oncology
Kevin Shield, PhD
Centre on Addiction and Mental Health, Canada

William Klein, PhD
National Cancer Institute
Robert Pezzolesi, MPH
U.S. Alcohol Policy Alliance
Maik Düennbier
IOGT International
Susan Gapstur, PhD, MPH
American Cancer Society

 

Description:

With the current gap between research (finding alcohol use to be a causal risk factor for several cancers; and, demonstrating the effectiveness of alcohol control policies in reducing harmful alcohol consumption) and practice (the relative lack of implementation of evidence-based alcohol policies to reduce cancer incidence and mortality) with regard to alcohol-related cancers, this session will explore the topic of alcohol control as cancer control. In an effort to bridge this gap, the U.S. Alcohol Policy Alliance, the American Institute for Cancer Research, and IOGT International together convened a groundbreaking event at Johns Hopkins University this past January entitled "Alcohol control as cancer control: A policy and practice symposium."  That symposium gathered researchers in cancer epidemiology and cancer prevention, cancer control experts, alcohol policy experts, community-level alcohol policy advocates, and others.  Participants presented on the state-of-the-science in these fields, offered case studies of effective alcohol policy campaigns, surveyed the current cancer control landscape, and discussed concrete ways for cancer control advocates to reduce alcohol-related cancers.  There were also presentations on the response of the alcohol industry to the growing research and how advocacy to reduce alcohol-related cancers fits in with international advocacy movement to reduce and control non-communicable diseases (NCDs). This session will provide an overview of that symposium, including summaries of panel presentations, key learnings, and selected themes of the group discussion.  In addition, there will be a special emphasis on the seminal report "Alcohol and Cancer: A Statement of the American Society of Clinical Oncology."

C-2 ALCOHOL MESSAGING: FROM INDUSTRY TO PUBLIC HEALTH

Studio E
Description:

A Guide to Alcohol Control Messaging

Rebecca Perl, MS AND Laura Brotzman, MPH
Vital Strategies

Despite evidence that alcohol is a major determinant of ill health and a leading cause of death and disability worldwide, governments and global public health organizations pay relatively little attention to alcohol policy, leaving the alcohol industry - and its interest in promoting as much business as possible - as the primary framer of how alcohol is viewed and consumed. The alcohol control effort suffers from the absence of clear messaging around the problem of excessive drinking and the appropriate policy responses to address it. Collaborating with leading global agencies and public health organizations, we have identified key issues in the area of alcohol control policy development. Using evidence from global research, policy documents and consulting alcohol control thought leaders, we have developed a practical guide for alcohol control and policy messaging. This guide highlights both challenges and evidence-based policy solutions for alcohol control, contributing to more effective advocacy and encouraging the engagement of a wider circle of public health partners in the effort to combat the health, social and economic harms of excessive alcohol use.

Deceptive Industry Messages of “Healthy Drinking”

Carson Benowitz-Fredericks, MSPH, CHES
Alcohol Justice

Excessive drinking kills thousands of people in the U.S. yearly with many of these deaths coming as a result of chronic health issues. Despite U.S. Tax and Trade Bureau regulations prohibiting the use of “any health-related statement … that is untrue . . . or tends to create a misleading impression as to the effects on health of alcohol consumption,” a lack of enforcement has freed the alcohol industry to answer only to internal standards, resulting in a growing body of deceptive health claims in the United States. The idea of ‘responsible drinking’ has supplanted meaningful data regarding quantities and effects of alcohol intake. The ‘j-curve’ arguments use a small range of health outcomes to justify regular alcohol intake. Through the promotion of ‘healthy’ alcohol products, alcohol companies deny the toxic nature of ethanol. Through participation in breast cancer and other health charities, the industry ‘pink-washes’ away the carcinogenic properties of its products. As the alcohol industry consolidates and grows into new markets domestically and worldwide, public health advocates and promoters must anticipate and offset these practices and push for transparency where possible. This workshop presents the scientific evidence for the range of alcohol harm, identifies situations where the alcohol industry uses deceptive messaging or lie by omission, and helps develops strategies for counter-messaging and policy.

Changing the ‘Do as I Say, Not as I Do’ Narrative of Alcohol Advocacy

Laura Brotzman, MPH and Rebecca Perl, MS
Vital Strategies

Alcohol consumption is a behavior strongly influenced by the social context and profit-driven corporate strategy. As such, the public health policy response resembles that for tobacco, fast food, or sugary beverages: price increases via taxation; marketing restrictions, especially to children; and reasonable controls on availability. However, in contrast to these other drivers of non-communicable diseases (NCDs), many public health professionals do not readily view or frame alcohol consumption as unhealthy behavior or socially undesirable in control efforts or policies. Alcohol use is enjoyed, expected, and encouraged among health-conscious friends and colleagues at times without consideration of the risks. Health experts, physicians, public health professionals, and public figures often consume alcohol without considering limits, criticism, or social consequence - at times, its place in society may feel inescapable. As such, those who consume alcohol occasionally, or even frequently, often feel a sense of hypocrisy that holds them back from advocacy in a way they may not for fast food, soda, or tobacco use. When building a movement for alcohol control policy, it is time to ask: how do we change the narrative from “do as I say, not as I do” to a narrative of population health promotion? Removing hypocrisy from the alcohol control narrative is key to framing, designing, and implementing alcohol policy that reduces alcohol-related disease, disability, morbidity, and mortality globally.

Addressing the Structural Drivers of Alcohol Misuse: Developing an Alcohol Counter Marketing Campaign for Vulnerable Youth in Uganda

Monica Swahn, PhD
Georgia State University

While alcohol research in Africa has been scarce, alcohol misuse in primarily Sub-Saharan Africa has been found to be prevalent and also associated with other health concerns among underage youth. Research also shows that out-of-the-home alcohol marketing exposure among youth is very high, particularly in Uganda, and is associated with problem drinking and drunkenness. This is of great concern given the surge of alcohol production and marketing directed at vulnerable populations across Africa. Unfortunately, this issue remains largely unaddressed as very few prevention or intervention efforts have sought to address the structural drivers of alcohol misuse among underage youth in Uganda or the broader region. This interdisciplinary and mixed methods project, funded by the NIH/NIAAA, sought to address this gap by developing an alcohol counter marketing campaign specifically targeting youth in the slums of Kampala, Uganda. Formative research through focus groups and surveys of youth (N=1134) and NGO leaders (N=55) were conducted to better understand the context of alcohol marketing exposure and alcohol misuse. Additionally, we conducted an environmental scan of alcohol marketing across five slums to identify placement, location and messaging used in the marketing of commercially available alcohol. A very interactive and collaborative approach was used to integrate the information and to develop and pilot test intervention strategies and counter marketing messages. The presenter will share strategy, findings and preliminary campaign concept and discuss lessons learned in this process.

C-3 U.S. ALCOHOL LAW ENFORCEMENT: DATA TRENDS AND PRACTICES IN ENFORCEMENT OPERATIONS TO PREVENT ALCOHOL-RELATED HARM

Studio C
Presenters:

Rebecca Ramirez, MPH
National Liquor Law Enforcement Association
Carol Cannon, MA
CDM Group
Justin Nordhorn
Washington State Liquor and Cannabis Board
Skyler Genest
Vermont Department of Liquor Control

Description:

A large body of existing research supports the idea that enforcement of alcohol policies is critical to the reduction of underage drinking and other alcohol-related public health outcomes. This panel will present an overview of U.S. alcohol enforcement data collected at the national level. We will begin with a summary of underage drinking enforcement data collected over the past seven years by the STOP (Sober Truth on Preventing Underage Drinking) State Survey as part of a Congressionally-mandated effort to collect data on state efforts to enact, enforce, and create laws, regulations, and programs to prevent or reduce underage drinking. The panel will also summarize data collected by the National Liquor Law Enforcement Association (NLLEA) on alcohol-related enforcement activities conducted in addition to underage drinking enforcement. The overview of alcohol law enforcement data will highlight trends in areas including compliance checks, minor in possession arrests, sales to intoxicated persons violations, source investigations, sanctions against licensed retailers for underage alcohol furnishing, and place of last drink data collection. The panel will then turn to two alcohol law enforcement chiefs to discuss the successes and challenges in conducting alcohol-focused enforcement operations, how they use data to identify enforcement priorities and strategies, and will conclude with an overview of NLLEA’s new national initiative to collect and utilize place of last drink data to reduce over-service and impaired driving as well as other recommendations for future alcohol law enforcement priorities and initiatives.

C-4 POLICIES AND ACTIONS LIMITING ALCOHOL’S PHYSICAL AVAILABILITY

Salon 2
Description:

Preemption and Policy: State Law and its Potential Impact on Local Policymaking

Ryan Treffers, JD
Pacific Institute for Research and Evaluation

Local policymaking is often the best place to start when working to reduce alcohol-related harm. And while there are many proven policies that can be implemented, state law can limit the specific actions that local government can take. As a result, it is always recommended that before efforts begin to implement policy at the local level that a review be conducted evaluating whether any specific policies under consideration may be preempted by state law. This presentation will provide a review of the manners in which preemption can arise at the state level, methods and strategies for evaluating whether a specific policy may be preempted, and examples from across the country of how communities have worked to establish policies aimed at reducing alcohol-related harm despite state laws that, on their face, looked to preempt action by the local government.

Working with Festival Organizers to Change the Drinking Culture in “Event City” Oshkosh, WI

Autumn Linsmeier
Winnebago Public Health Department

From high-resourced fundraisers to community festivals, alcohol is prevalent at nearly every event in Event City. After bringing together coalition members from law enforcement, health care, and nonprofits, the Winnebago County re:TH!NK Alcohol Action Team investigated how, by working with community festival organizers, we could change the way alcohol is served and sold at events. In this breakout session, the presenter will discuss evaluating how alcohol is served and sold at community festivals, best practices to reduce the occurrence of underage and binge drinking at community festivals, and the steps necessary to implement this in your community. Learn how to (1) engage coalition members in nontraditional ways, (2) create a festival assessment scan tool, (3) conduct, score, and evaluate festival scans, (4) craft policies that festival organizers support, (5) develop festival champions, (6) organize an event gathering for festival organizers, and (7) change the alcohol environment at community festivals.

Last Call: Evidence and Campaigns to Reduce Trading Hours

Bruce Livingston, MPP, and Sara Cooley Broschart, MPH
Alcohol Justice
Tim Stockwell, PhD
University of Victoria, Canada

A growing body of international studies shows that reducing bar trading hours decreases violence, nuisance, emergency room utilization and drunk driving, and extending last call has a reverse, harmful effect. This panel will summarize the evidence from studies of Australia, the UK, Canada, the U.S. and Iceland. The U.S. Community Preventive Services Task Force recommends: “. . . maintaining existing limits on the hours during which alcoholic beverages are sold at on-premises outlets as another strategy for preventing alcohol-related harms.” Ongoing struggles in Australia to roll back bar closure times from 5am to 2 or 3am have ensued with efforts to maintain those standards against political pressure from the late-night industry. Evidence of harm reduction in Australia is overwhelming and will be shown. In 2006, 2013 and 2017, there were attempts to extend last call in California from 2am to 4am with local options. The recent successful campaign to defeat that by California Alcohol Policy Alliance will be presented, referred to as ‘Stop Wiener's 4am Bar Bill’ campaign. While the late-night bars and their advocates shift arguments continually, what is clear is that the evidence against later last call is overwhelming. Further, in the U.S., the Miami Beach government is trying to curtail late night hours, and results of the recent initiative there will be discussed.

Mobilizing a Community to Keep Powdered Alcohol Off the Shelves

Sachin Kamble, MD
Texans Standing Tall

Numerous public health, alcohol policy, and medical experts have voiced serious concerns about the dangers of powdered alcohol. As a result, more than 30 states have already banned the product. Despite these concerns, the Texas Legislature recently made moves to regulate and sell the product in the state. Because powdered alcohol poses many potential harms related to misuse and overconsumption (especially among young people), Texans Standing Tall (TST) worked with coalition members and other community partners to advocate against making the product available in Texas. The presentation will cover TST’s recent community organizing efforts to prevent the regulation and sale of powdered alcohol in Texas. It will discuss specific strategies used to educate and empower coalition members and lawmakers, such as 1) holding an Advocacy Day training and event at the Capitol; 2) organizing and providing testimony at House and Senate hearings; 3) employing a media strategy that garnered attention throughout state and in local publications; and 4) developing and executing a grassroots plan that called on community leaders and advocates to reach out to specific lawmakers at different points throughout the process. The presentation will demonstrate how community organization efforts can successfully fight against organizations with deep pockets and encourage lawmakers to put public health and safety interests ahead of business interests. The presenter will also encourage attendees to think creatively about ways they can mobilize their communities to take a stand, even when the odds seem stacked against them.

C-5 U.S. ALCOHOL POLICY ENVIRONMENT AND ALCOHOL-RELATED INJURY AND VIOLENCE MORTALITY

Studio B
Presenters:

Timothy S. Naimi, MD, MPH and Marlene Lira
Boston Medical Center
Ziming Xuan, ScD, SM, MA
Boston University School of Public Health
Monica Swahn, PhD
Georgia State University

Description:

Excessive alcohol consumption is a leading preventable cause of death in the U.S. and is related to fatal motor vehicle crashes, suicides, and homicides. For each of these mortality outcome, we will present descriptive statistics on the number and/or proportion of alcohol-involved (BAC >0.01%) and alcohol-related (BAC >0.08%) deaths overall and by demographic characteristics. In addition, we will examine the association between state-level alcohol policies and each of these mortality outcomes, including the independent effects of policy subgroups (e.g., driving-oriented policies vs. drinking-oriented policies, tax magnitude). For motor vehicle crashes, we will also assess the impact of policies on crashes below the legal BAC limit; for suicides we will focus on youth and the effect of taxes; and for homicides, the focus will be on those involving intimate partners. Preliminary findings indicate that stronger alcohol policy environments are associated with reduced odds for each of the three outcomes examined. The state-level alcohol policy ‘environment’ will be characterized using the Alcohol Policy Scale (APS). The APS is based on summing the presence of 29 alcohol policies in each state-year after weighting each policy by its relative efficacy and level of implementation. Modified scores for policy subgroups are derived using identical methods but include fewer policies. Analyses of fatal motor vehicle crashes use data from the Fatality Analysis Reporting System, those for suicide and homicide use data from the National Violent Death Reporting System. Because a large proportion of these fatalities involve alcohol, strengthening alcohol policies will likely reduce these deaths.

4:30pm - 6:00pm Concurrent Sessions

C-6 THE INTERNATIONAL MODEL OF ALCOHOL HARMS AND POLICIES: TWO CASE STUDIES ILLUSTRATING THE APPLICATION OF A NEW INTERNATIONAL RESOURCE FOR ALCOHOL POLICY RESEARCH

Studio B
Presenters:

Adam Sherk, MA, PhD Candidate, and Tim Stockwell, PhD
Canadian Institute for Substance Use Research
Timothy S. Naimi, MD, MPH
Boston Medical Center
Nicole April, MD
Institut national de santé publique du Québec

Description:

This panel presentation will describe two alcohol policy studies in global context and a new toolbox for estimating alcohol-attributable harms, the International Model of Alcohol Harms and Policies (InterMAHP). The first presenter will describe the methods and advancements made in InterMAHP, which can be used by countries and states to estimate region-specific alcohol-attributable harms, given standard and typically available inputs such as per capita consumption and drinking prevalence. InterMAHP was used as the harm calculator in both following studies. The first study describes the application of InterMAHP to estimating public health consequences of privatizing one of the major remaining government alcohol retail monopolies:  Sweden’s Systembolaget. Drawing upon systematic reviews, expert advice and local data, InterMAHP generated estimates of the changes in alcohol attributable harm which would occur if alcohol was allowed to be sold in: (1) specialty private stores and (2) grocery stores. The second study focuses on the Canadian province of Québec where minimum prices are currently applied only to beer and are very low level compared with other provinces. InterMAHP was used to estimate alcohol attributable morbidity and mortality for Québec in 2014 assuming: (1) the status quo, (2) the introduction of a CAD $1.50 minimum price per standard drink and (3) a CAD $1.75 per standard drink. The first case study will present estimates of increases in harm with loosening of alcohol policies (privatization), while the second will estimate reductions in harm that would flow from a comprehensive pricing policy based on a uniform minimum price per standard drink.

C-7 PROVIDING SUPPORT FOR POLICY CHANGE AT THE LOCAL LEVEL: THE MARYLAND EXPERIENCE

Studio C
Presenters:

Shayna Dee
Maryland Behavioral Health Administration
Beth Creek
Youth Empowerment Source
Nicole Sealfon
University of Maryland Behavioral Health Resources Team
Molly Mitchell, JD
Johns Hopkins Bloomberg School of Public Health

Description:

Maryland’s Strategic Prevention Framework Project (MSPF2) uses Partnership for Success funds to reduce underage drinking among 18-20-year olds and binge drinking among 18-25-year olds. In 2016, the state required that each grantee select an alcohol policy most likely to reduce excessive and/or underage drinking in their jurisdiction and work with a local coalition to implement it. The nine local coalitions identified either local social host ordinances, stronger responsible beverage service training requirements, or conditional use permits and performance standards for alcohol outlets as the policies most likely to be effective in their local jurisdictions.  This panel will describe the key roles that state funders, technical assistance and training providers, and local coalition leadership have played in leveraging state funding to promote alcohol policy reforms at the local level. The presenters in this panel will discuss how they used the structure of the SPF grant to successfully guide coalitions through the process of policy change. A state administrator will discuss how the SPF structure was used to leverage local coalitions to work on policy change, a training and technical assistance provider from the Johns Hopkins Bloomberg School of Public Health will talk about their role in guiding grantees through the ten-step process through which the grantees identified and pursued specific policies; an evaluator will discuss their role and process, and a leader of a local coalition will share her experience in choosing and successfully implementing their chosen policy strategy of strengthening the local responsible beverage service training requirements.

C-8 ALCOHOL REGULATION, LITIGATION AND PUBLIC HEALTH

Studio E
Presenters:

J. Neal Insley, JD
National Alcohol Beverage Control Association
Pam Erickson
Public Action Management
Kathleen Hoke, JD
The Network for Public Health Law

Description:

In the U.S., the marketing, promotion and sale of alcohol are systematically regulated per the 21st Amendment and through a state-based regulatory system. As part of a growing trend to treat alcohol like any other commercial product, some have questioned if alcohol should be deregulated in the United States. To answer this question, one need only look at the recent experiences of the United Kingdom on whether liberalized alcohol laws are optimal. For example, today in the U.K., all forms of alcohol are available in bars, clubs and grocery stores 24 hours a day, 7 days a week, resulting in substantial public health and safety challenges. Yet, research from public health experts, including CDC and WHO, has confirmed the effectiveness of basic alcohol regulations which are widely supported by the public.  Often these deregulatory changes end up in state and federal courts with little input from public health and safety experts to explain the connection between well-regulated systems and their value to the well-being of the population and the marketplace. Examining the role public health can play in litigation will provide participants with 1) a review of recent U.S. court cases that pose direct threats to dismantling the controls set in place to regulate alcohol, 2) an historical perspective of why the regulations are important to public health and safety in creating a balanced and fair alcohol marketplace, and 3) a case study for how public health advocates in the tobacco control movement impacted litigation to advance their mission.

C-9 PUBLIC AWARENESS OF THE ALCOHOL-CANCER LINK; PERSPECTIVES ON WOMEN AND ALCOHOL

Studio D
Description:

Developing Evidence-Based Alcohol and Pregnancy Policy

Sarah Roberts, PhD
University of California, San Francisco
Meenakshi S. Subbaraman, PhD
Alcohol Research Group, Public Health Institute

This workshop will include presentation of research findings to inform new approaches to evidence-based alcohol and pregnancy policies. Methods: Findings come from two studies: 1) A study of the impact of state-level policies targeting alcohol use during pregnancy, which uses state policy data, alcohol consumption during pregnancy data from BRFSS from 1985-2013, and Vital Statistics data from 1972-2013, and 2) A qualitative study exploring how state legislators use evidence in policymaking on alcohol use during pregnancy. Results: Both Mandatory Warning Signs and Child Abuse/Neglect were associated with less drinking during pregnancy, but also with poorer birth outcomes (birthweight and preterm birth) and less prenatal care utilization. Priority Treatment was associated with more pregnant women drinking at all, but lower volume, and was associated with both better and poorer birth outcomes. Civil Commitment was associated with more drinking during pregnancy, but not with birth outcomes. White and Hispanic/Latina women experienced more benefits and Black women experienced more harms from these policies. Alcohol policies not focused on pregnancy (e.g., government-controlled wine retail) were also associated with better birth outcomes; increased population-level alcohol consumption was associated with poorer birth outcomes. Alcohol use in pregnancy is not a salient issue for many state lawmakers; instead they focus on opioid use, which they believe to be more harmful during pregnancy than alcohol use. Conclusions: Policies targeting alcohol use during pregnancy do not improve public health outcomes. Policy efforts to reduce harms from alcohol use during pregnancy should instead focus on alcohol policies that focus on population-level consumption.

Policies and Advocacy on Alcohol Control: Growing Involvement by Cancer Societies Globally

Don Zeigler, PhD
University of Illinois at Chicago

A growing body of research has established that alcohol is a known human carcinogen and that alcohol consumption is an important risk factor for cancers of the pharynx/oral cavity, larynx, esophagus, liver, colon, rectum, and breast. Cancer risk increases considerably at high consumption levels with no sensible limit of drinking below which the risk of cancer is decreased. Accordingly, to reduce cancer risk, if not avoided entirely, one should have only limited consumption of alcohol. Cancer is one of the major non-communicable diseases addressed by the High-Level Meeting of the United Nations with harmful use of alcohol being identified as a preventable risk factor. The WHO has identified effective population-level alcohol control measures (reducing availability, affordability, and promotion/marketing) and called for a 10% reduction in global alcohol consumption by 2025. Moreover, Sustainable Development Goal 3 calls for strengthening the prevention and treatment of the harmful use of alcohol. However, examination reveals a significant contrast between national and international cancer associations pertaining to their degree of acknowledging the need for and their actual advocacy of comprehensive alcohol control policies. North American cancer societies fall far behind those in Europe and South East Asia in policy advocacy. However, positive changes have taken place among cancer associations and oncology groups in North America and Africa since 2013. What strategies can influence associations to become more proactive advocates for evidence-based alcohol policies?


Influencing the Mommy Drinking Culture

Ann Dowsett Johnston
National Roundtable on Girls, Women and Alcohol

An award-winning journalist shares her experience with influencing Mom’s TO, a Toronto-based mother’s group whose tagline is: “Baby on the hips, wine of the lips.” Ann Dowsett Johnston, author of Drink: The Intimate Relationship Between Women and Alcohol-named one of the top 10 books of 2013 by the Washington Post-is the founder of the National Roundtable on Girls, Women and Alcohol, a Canadian advocacy group. Until recently, she believed that the two-martini playdate had gone the way of the dodo bird - not so: last September, the 500-member Mom’s TO launched a “very mommy wine festival,” inviting mothers to “get their wine on, big time”-babies in tow. The group also claimed to be re-inventing maternity leave with its weekly “very boozy rose playdates”-which start at 11:30 on “Fri-yay” mornings. Dowsett Johnston took on the organizers of Mom’s TO in the media, using her profession to suggest that the group promote messaging on FASD statistics and breastfeeding information on just how much alcohol is shared with the feeding baby when a mother drinks. She also used recent evidence on female risky drinking to promote public education. Join this workshop to learn how a journalist with more than three decades of experience uses advocacy journalism to influence the trajectory of a public health message on risky alcohol use, educating the readership on a difficult subject. The take-away message: with the right tools of evidence and persuasion, all can use the media to influence risky alcohol consumption.

Evaluating Predictors of Awareness of the Association between Drinking too Much Alcohol and Cancer in the U.S. Population

Kara Wiseman, PhD, MPH
National Cancer Institute

Awareness that alcohol consumption is associated with cancer is low in the U.S. and predictors of awareness are not well understood. Data from the Health Information National Trends Survey (HINTS 5) were used to describe knowledge of the association between too much drinking and cancer (Yes, knew of the association; No; or Don’t know). Weighted multinomial multivariable logistic regression modelling was used to determine characteristics associated with reporting Yes or Don’t know compared to No. Results: Thirty-eight percent of the U.S. population knew about the association between drinking too much alcohol and cancer (38.3%), 36.2% did not know of the association, and 25.5% believed that there was no association. Compared to people who were completely confident in their ability to take care of their health, people only somewhat confident had 2.19 higher odds of reporting don’t know (95% CI: 1.18-4.07). Compared to people who were 60+ years old, those 18-39 and 40-59 were 59% and 48% less likely to report Don’t know (ORs: 0.41, 0.52; 95% CIs: 0.21-0.80, 0.36-0.74, respectively). People believing that everything causes cancer and being a race other than white or black had 1.70 and 1.97 higher odds of reporting Yes (95% CIs: 1.15-2.53, 1.06-3.67, respectively). Conclusions: A majority of the U.S. population either does not know about or believes that there is no association between drinking too much alcohol and cancer, indicating a significant knowledge gap in the population. Characteristics associated with lack of awareness helps identify groups in most need of educational intervention.

C-10 BUILDING A DATASET TO SUPPORT POLICY DEVELOPMENT THAT ADDRESSES ALCOHOL OUTLET DENSITY AND RELATED CONSEQUENCES

Salon 2
Presenters:

Daniela Marquez, MPH
Annette Torres
YMCA of El Paso, Shift +
Michael Sparks, MS
SparksInitiatives
Alicia Sparks, PhD, MPH
Abt Associates

Description:

In this interactive panel session, we discuss how alcohol policy advocates in El Paso, TX, have gathered a comprehensive dataset that tells the story of alcohol outlet density and related consequences in the city. Building a dataset that allows communities to describe the retail alcohol environment is crucial for the advancement of alcohol policy efforts.  A local-level focus on retail availability is new to Texas. El Paso’s retail work may provide a road map for other cities that want to address their alcohol retail environment. Panelists will discuss the different sources of data and the process used to gather the information needed to launch a retail policy campaign that aims to reduce alcohol outlet density and related consequences. We provide an overview of the GIS mapping techniques that have been used to visually represent the dataset that is composed of alcohol outlets, police calls for service, alcohol volume sales data, environmental scans, and community outreach. This session provides a forum for panel members and participants to discuss replicable strategies relevant for communities committed to creating healthy environments that reduce the risk for alcohol related-harm.  At the end of the session, participants will be able to identify sources of data and the process to obtain it, potential partners and resources for GIS mapping.  

7:30am - 9:00am Registration open
7:30am - 9:00am Poster Session/Continental Breakfast
Pre-function Area
Description:

P-1 Building Support for Change: The Benefits of an NCD Alliance
Alison Douglas
Alcohol Focus Scotland

P-2 Patterns of Alcohol Consumption and Outcomes in Youth in Low- and Middle-Income Countries
Raimee Eck, PhD, MPH
Johns Hopkins Bloomberg School of Public Health

P-3 License Suspension as a Sanction for DWI: Does Length of Suspension Matter?
James Fell, MS
National Opinion Research Corporation (NORC)

P-4 Translating Effective Alcohol Policies into Public Health practice
Gregory Miao, JD
ChangeLab Solutions

P-5 Towards an Alcohol-Free Childhood: Combining Academic Expertise and Effective Advocacy to Kick-Start a Social Movement
Gemma Crompton, MSc
Alcohol Focus Scotland

P-6 Can a Child Care Provider Consume Alcohol Around Your Child? A Comparison of State Child Care Regulations to National Alcohol Standards
Elyse Grossman, JD, PhD
Johns Hopkins Bloomberg School of Public Health

P-7 How Alcohol Regulation Works to Foster Public Health and Safety
Pamela Erickson
Public Action Management

P-8 A Coalition Model for Advocacy: California Alcohol Policy Alliance
Bruce Livingston, MPP
Alcohol Justice

P-9 The Relationship between Youth-Appealing Advertising Content and Beer Brand Popularity among Youth
Ziming Xuan, ScD, SM, MA
Boston University School of Public Health

P-10 Awareness of the Link between Alcohol Consumption and Cancer across the World: A Review
Jennifer Scheideler, MPH, MBA
Johns Hopkins Bloomberg School of Public Health

P-11 Analyses of 2014 and 2016 Liquor Prices in Washington Following the 2012 Liquor Privatization
Edwina Williams, MPH
Alcohol Research Group, Public Health Institute

P-12 Examining the Impact of the Mental Health Parity and Addiction Equity Act on Alcohol Treatment Admissions
Camillia Lui, PhD
Alcohol Research Group, Public Health Institute

P-13 The Global Partnership and Consortium on Trans-Disciplinary Public Health Law Research (PHLR) and Prevention of Substance Use
Qing Li, MD, DrPH
University of Colorado Denver

P-14 College Student Helping Behavior in Alcohol-Related Situations: Assessing the Need for, Level of Implementation of, and Effectiveness of Medical Amnesty
Julia Sanem, PhD
University of Minnesota School of Public Health

9:15am - 10:45am PLENARY SESSIONS

Plenary 1 - SECONDHAND EFFECTS OF ALCOHOL

Salon 5-7
Presenters:

Kate Karriker-Jaffe, PhD
Alcohol Research Group, Public Health Institute
Tim Stockwell, PhD
University of Victoria
Steve Teutsch, MD, MPH
UCLA Fielding School of Public Health

Deb Evensen, MA
Fetal Alcohol Consultation and Training services
Pam Trangenstein, MPH, PhD Candidate - Session chair
Johns Hopkins Bloomberg School of Public Health

Plenary 2 - ALCOHOL INDUSTRY RESEARCH AND ACTIVITIES

Salon 4
Presenters:

Richard Saitz, MD, MPH, FACP, DFASAM
Boston University School of Public Health
Alison Douglas
Alcohol Focus Scotland
Thomas F. Babor, PhD, MPH
University of Connecticut School of Medicine
Steve Schmidt
National Alcohol Beverage Control Association

11:00am - 12:30pm Concurrent Sessions

C-11 SECONDHAND HARMS FROM ALCOHOL: RECENT U.S. EVIDENCE WITH IMPLICATIONS FOR PUBLIC HEALTH PRACTICE AND POLICY ACTION

Room: Studio D
Presenters:

Tom K. Greenfield, PhD, Kate Karriker-Jaffe, PhD, and Won K. Cook, PhD
Alcohol Research Group, Public Health Institute
Robin Room, PhD
La Trobe University, Melbourne

Description:

A NIAAA-supported Alcohol Harms to Others (AHTO) among US Adults: Individual and Contextual Effects project, including large-scale U.S. telephone surveys (n≈8,750), has generated evidence with strong implications for action on state alcohol policies to reduce heavy drinking and suggesting strategies to curb workplace and child harms.  The panel, moderated by Tom Greenfield, will feature added presentations by multiple-PI: Kate Karriker-Jaffe, co-investigator Won Cook, and discussant Robin Room. After introducing panel goals and speakers, Greenfield will present new findings such as the surprisingly large proportion of alcohol-related absenteeism from others’ drinking, extensive work problems from drinking coworkers, and numerous other serious secondhand harms reported, challenging us to design new public health and policy interventions.  The introductory review also provides a context for the subsequent policy presentations. Won Cook will summarize new analyses showing that Naimi project’s Alcohol Policy Scores (APS-binge / APS-impairment) were associated with significantly reduced aggression- and driving-related harms from others’ drinking one year later, controlling for state-level policing and numerous individual covariates. With an eye to public support for action, Kate Karriker-Jaffe will report on the policy opinions among important population subgroups, considering whether those harmed by others’ drinking in the past year and other key subgroups are more or less favorable to enacting stronger alcohol policies, including raising alcohol taxes. Robin Room will synthesize these new U.S. findings in light of the multinational GENAHTO project and draw out further policy and public health practice implications.  Ample time for audience engagement will follow each presentation and the discussion.  

C-12 PERSPECTIVES ON INDUSTRY’S ROLE IN SHAPING ALCOHOL POLICY

Studio B
Description:

Role of the Alcohol Industry in Policy Interventions for Alcohol-impaired Driving

Thomas Babor, PhD, MPH
University of Connecticut School of Medicine

The objectives of this presentation are to: a) review commercial and political activities of the alcohol industry that may increase alcohol-related harms, particularly in the area of drinking and driving, and b) evaluate drinking and driving initiatives advanced by the alcohol industry from a public health perspective. Methods: Two methods were used: a narrative review of the relevant literature and a content analysis of industry activities related to drinking and driving. Findings: evidence suggests that some of the alcohol industry’s commercial activities have the potential to not only increase the frequency and amount of alcohol consumption but also the likelihood of alcohol-impaired driving. Corporate political activities are conducted in many parts of the alcohol industry to create a favorable regulatory environment. A content analysis of 97 industry actions provides strong evidence that the alcohol industry does not fund or support public health policies that have been shown to affect alcohol-impaired driving and reduce alcohol-related harm. Conclusions: Some of the industry’s promotional activities, combined with product innovations, have the potential not only to increase the frequency and amount of alcohol consumption but also the likelihood of impaired driving. Many of the alcohol industry’s corporate political activities are used to oppose effective alcohol policies whereas others are used to improve the public image of the producers as good corporate citizens. Based on current scientific research, neither of these activities is likely to reduce the incidence of impaired driving because the policies and programs favored by the alcohol industry are ineffective.

Public Health Countermeasures to Minimize the Harmful Effects of the Alcohol Industry

Kate Robaina, MPH
University of Connecticut School of Medicine

There is growing evidence that the alcohol industry opposes effective alcohol policies and is actively engaged in activities that have a negative impact on public health. This presentation reviews research and theory on countermeasures that have been used by the public health community to minimize the harms resulting from alcohol industry tactics. Methods: a review of the academic and grey literatures including scholarly articles, editorials, press releases and WHO background documents. Results: a variety of activities are being used by public health professionals, the academic community, Nongovernmental Organizations (NGOs) and other segments of civil society to address alcohol industry tactics and influence. The activities include: 1) surveillance of alcohol industry corporate social responsibility activities, corporate political activities, and compliance with marketing regulations; 2) research on the alcohol industry itself both as an inducer of alcohol-related problems and as an influence on alcohol policy; 3) formulation of conflict of interest policies, transparency declarations and risk assessments; 4) including public health considerations in trade agreements; and 5) community action projects. Conclusion: The alcohol industry needs to be studied more systematically as an inducer of alcohol-related problems and an influence on the policy development process. If the alcohol field is to overcome its “policy dystopia,” it will need to construct a more compelling meta-narrative to promote the value of public health policies and disseminate this narrative through a global health policy network composed of key constituency groups.

‘Modernization’ Misnomer in Massachusetts: A Public Health Professional’s Experience of Fighting to be Heard in Massachusetts’ Efforts to ‘Modernize’ Alcohol Laws

Elizabeth Parsons, MA
Mystic Valley Public Health Department

Across the country, states are attempting to ‘modernize’ state alcohol laws in response to changes in the alcohol industry such as the growth of local craft brewers and online delivery sales. While many public health advocates were not included in states’ ‘modernization’ attempts, in Massachusetts, the public health voice was acknowledged early in the process, suggesting this might be more than another attempt to deregulate the industry. The presenter will share a public health professional’s experience of working with the state treasurer’s office to review alcohol laws, from the creation of a state alcohol task force in July 2016 to the present. The presenter is a member of a working group convened by the treasurer to recommend policy changes and will discuss how public health professionals participating in the process confronted issues such as leveraging prevention professionals’ voices amidst an opioid crisis and marijuana legalization, including staying on message with prevention science when media and industry distractions surfaced. Further, information will be shared outlining why public health professionals remain concerned about potential conclusions of the process.

Think Locally, Act Globally: Why Global Alcohol Policy Issues Matter to Americans

David Jernigan, PhD, MPH
Johns Hopkins Bloomberg School of Public Health

Alcohol is now the seventh leading cause of death and disability in the world, and the leading cause of death and disability of young people ages 15-49. The global alcohol industry views every local market as an opportunity and seeks out changes at the global level - influencing global and regional trade agreements, global health policies, global product standards, and so on - to facilitate the global marketing of its products. The U.S. alcohol market is now dominated by foreign companies, and their global lobbying and corporate social responsibility programs affect and have implications for alcohol control policy in the USA. This presentation will review the size and structure of the global industry, summarize some of its key recent activities at the global level, outline the implications for Americans of these actions, and suggest concrete steps that can be taken to participate in and influence global developments.

C-13 DETERRING HOUSE PARTIES: LESSONS LEARNED ON ENFORCING SOCIAL HOST ORDINANCES

Studio C
Presenters:

Jeremy Jordan, MPA
YMCA of El Paso, Shift +
John Adams
El Paso Independent School District
Dylan Ellerbee, MA
U.S. Alcohol Policy Alliance
Michael Sparks, MA
SparksInitiatives

Description:

Cities across the country are adopting social host ordinances to prevent social access to alcohol among youth. Locally adopted social host ordinances hold people accountable for furnishing alcohol to minors and/or hosting an environment where underage drinking and related nuisances occur. Social host ordinances provide law enforcement with an important tool to reduce some of the riskiest drinking by youth and young adults. Successful implementation of social host ordinances is crucial for the deterrence of underage drinking and related consequences at home parties. This panel explores the critical issue of enforcing social host ordinances from two perspectives: 1) the City of El Paso adopted a civil social host ordinance in December 2016. In June 2017 the ordinance became effective. As of October 2017, the ordinance had been used in 16 loud/noise party incidents. This presentation highlights the obstacles that emerged during the enforcement-implementation process despite strong support from city council when passing the ordinance, and 2) the Study to Prevent Underage Drinking is a multi-community randomized community trial focused on using a comprehensive set of strategies including policy, enforcement and awareness, to reduce underage drinking parties and associated consequences. Most of the communities that adopted social host ordinances experienced challenges with enforcement and implementation of their policy.  The presentation discusses the barriers to implementation and enforcement within the context of variation in the ordinances (e.g., civil versus criminal), engagement of local law enforcement, and the political environment surrounding alcohol policy.   

C-14 ADVOCATING FOR HEALTHY COMMUNITIES: AWARENESS RAISING ACTIONS ON THE DANGERS OF ALCOHOL IN CANCER PREVENTION CAMPAIGNS

Studio A
Presenters:

Emma Woodford; Lena Sharp, PhD; and Lisa Kennedy Sheldon, PhD, APRN-BC, AOCNP
European Oncology Nursing Society
Mariann Skar
European Alcohol Policy Alliance

Description:

Due to the presence of cancer-causing ethanol and acetaldehyde in alcoholic beverages, in 2012 the World Health Organization’s body, The International Agency for Research on Cancer (IARC), confirmed the carcinogenicity of alcoholic beverages for at least 10 different kinds of cancers.  Due to a number of campaigns across Europe and the U.S., qualitative indications suggest that awareness of alcohol as a common cause of cancer is on the increase. However, a lot of work remains to be done before there is acceptance of this fact, and concrete connections are made in people’s minds about the link between the two. Bringing together researchers, alcohol control advocates and clinical cancer nurses, this session aims to enhance collaboration between these actors to strengthen alcohol control campaigns and information provision from the grassroots to policy makers. Goals: (1) to share information about the role of cancer nurses and campaigners in raising awareness about cancer prevention and the links between alcohol and cancer, and (2) to strengthen the network of collaborators working on alcohol and cancer in Europe and the U.S. and identify concrete steps for follow-up.  Panel presentations (followed by chaired discussion):  (1) Alcohol and cancer: the facts and science-based messaging: Promoting the European Code Against Cancer, (2) policy action for alcohol control: why we need better labeling on alcoholic beverages, (3) getting the message out to the grassroots through health systems, the role of cancer nurses in Europe, and (4) U.S. perspective on alcohol and cancer risk.  

C-15 CDC GUIDE FOR MEASURING ALCOHOL OUTLET DENSITY: FROM THEORY TO PRACTICE

Studio E
Presenters:

Robert Brewer, MD, MSPH
National Center for Chronic Disease Prevention and Health Promotion/CDC
Laura Tomedi, PHD, MPH
New Mexico Department of Health
Mary Elizabeth Cox, MPH
North Carolina Department of Health and Human Services, Division of Public Health

Description:

Regulating alcohol outlet density (AOD) is an effective strategy for preventing excessive drinking; however, there is no standard methodology for assessing AOD in states and communities.  Methods: In May 2011, the CDC Alcohol Program convened a Workgroup on Measuring AOD. The Alcohol Program then worked with Sue Binder Consulting and workgroup participants to develop a Guide for Measuring Alcohol Outlet Density, which was released on the CDC Alcohol and Public Health website (https://www.cdc.gov/alcohol/research-in-action.html) in July 2017. The state public health departments in New Mexico (NM) and North Carolina (NC) have also used the guide to conduct public health surveillance for AOD in their jurisdictions. Results: The guide describes key issues that need to be considered before measuring AOD; the steps involved in performing this public health surveillance activity; various approaches to measuring AOD and their pros and cons; and CDC guidance on measuring AOD. Using measurement strategies discussed in the guide, NM and NC worked with local coalitions to assess high-density clusters of alcohol outlets, and plan to use these results to guide the regulation of AOD in these target areas. Conclusion: Monitoring AOD is an essential public health function that supports the regulation of this environmental risk factor for excessive drinking. State and local public health agencies can use the CDC Guide for Measuring Alcohol Outlet Density to inform the regulation of this environmental risk factor and thus support the prevention of excessive alcohol use and related harms at the state and local levels.  

12:30pm - 2:00pm LUNCHEON
Salon 4
Presenters:

Josefine Haynes-Battle, MSN, BSN, RN
SAMHSA’s Center for Substance Abuse Prevention
Cynthia Abrams, MDiv
General Board of Church and Society, Methodist Church

2:15pm - 3:45pm Concurrent Sessions

C-16 COMMUNITY ALCOHOL PROBLEMS RELATED TO OFF-PREMISE SALES OUTLETS: PRELIMINARY RESULTS OF SIX-CITY STUDY OF STORE AND NEIGHBORHOOD CHARACTERISTICS

Studio A
Presenters:

Juliet Lee, PhD; William Ponicki, MA; and Lina Ghanem
Prevention Research Center/PIRE
Christina F. Mair, PhD and Lauren Torso Orkis, PhD Candidate
University of Pittsburg School of Public Health
Natalie Sumetsky, MS
SAMHSA'S Center for Substance Abuse Prevention

Description:

We are assessing whether and how off-premise sales outlet characteristics, operating conditions, and neighborhood characteristics contribute to community alcohol-related problems. Community members frequently report that “liquor stores” generate problems, but scientific analyses linking off-premise outlets and crime have shown mixed results. Analyses may not be conducted at small enough scale to detect effects, and/or may not account for the many different kinds of stores licensed to sell alcohol in many U.S. states. In six contiguous California cities, we have conducted structured premise assessments of all licensed off-premise alcohol sales outlets (N=402 stores); in-depth, semi-structured interviews with managers from a subset of these stores (n=40 stores) representing a range of store and neighborhood conditions, as well as naturalistic observations in stores where we obtained manager consent for this (n=20 stores). We have also obtained area census data for the entire study region and crime data, e.g. police-reported crimes, in 4 of the 6 cities. We are conducting Bayesian analysis of causal relationships identifying effects on crime and related social and health outcomes. We will present characteristics of stores including license type and salience of alcoholic beverages inside stores (product availability) and outside (neighborhood presence). Using data collected in and around all off-premise alcohol outlets in Oakland, CA, we will show which outlet characteristics are associated with crimes in close proximity to each outlet. From analyses of interview and observation data, we will describe how store managers understand and address problems, including their experiences with their customers, neighborhoods, and with law enforcement.

C-17 ALCOHOL TAXES: HOW MUCH, WHO LEVIES, WHO PAYS?

Studio B
Presenters:

 

Gregory Miao, JD
ChangeLab Solutions 
Timothy S. Naimi, MD, MPH
Boston Medical Center
Meenakshi Subbaraman, PhD
Alcohol Research Group, Public Health Institute

Description:

Impact of State Preemption on Local Authority to Impose Alcohol Taxes

Gregory Miao, JD
ChangeLab Solutions

An extensive research literature demonstrates that increasing alcohol prices reduces excessive alcohol consumption and related harms. Most efforts to increase alcohol taxes have been at the federal or state level; however, local governments may also have the authority to use taxes to raise alcohol prices. Local governments’ ability to increase alcohol taxes depends on state preemption, the legal doctrine that determines the extent to which states allow local governments to adopt policies and enact legislation, including with respect to taxes. This presentation describes the types of taxes available to federal, state, and local governments, with a particular focus on local policy options. It analyzes the impact of state preemption on local alcohol tax authority in all 50 states and the District of Columbia, as well as the extent to which this authority is used in states that grant it. Data was collected and analyzed between 2013 and 2015, and results reflect state laws in effect as of January 1, 2015.


State Alcohol Taxes in the U.S.: Types, Amounts, and Comparison to Alcohol-Related Costs

Timothy S. Naimi, MD, MPH
Boston Medical Center

Despite the fact that alcohol taxes are effective for reducing excessive drinking and alcohol-related harms, the nature and size of state alcohol taxes is not well understood, even by policy makers and public health professionals. For example, specific excise taxes (which are based on volume) are based on arcane units of measure (e.g., per barrel of beer) which makes them difficult to grasp on a per-drink basis. In addition, ad valorem taxes and sales taxes are based on a percent of price, which can vary widely. This presentation will discuss the three tax types applied in U.S. states and provide an overview of how many states use each type or combination of tax types. We will focus on the current magnitude of state excise taxes by beverage type and their inflation-adjusted erosion during the past 25 years and since their inception. We will then examine the average magnitude of all tax types combined and compare the average tax-per-drink to the average cost-per-drink, overall and by state. The Alcohol Policy Information, Tax Foundation, Impact Databank, and other sources were used in analyses. Cost-per-drink estimates come from a Sacks et al. study using a cost-of-illness approach. The major findings are that the average state excise tax is less than 5 cents per U.S. standard drink for all beverage types, state excise taxes have eroded by approximately 35% in real terms since 1991, and total taxes (including state and federal taxes) cover only a small fraction of their alcohol-related costs.


The Association between Beverage-Specific Taxes and Drinking Patterns Among Traditionally Disadvantaged Subgroups

Meenakshi Subbaraman, PhD
Alcohol Research Group, Public Health Institute

Alcohol taxation is one of the most powerful strategies for reducing alcohol consumption and harms. However, whether taxes affect traditionally disadvantaged groups differentially remains unknown. Aims: To assess the relationship between state-level, beer- and spirit-specific taxes and individual-level past-30-day alcohol consumption across racial/ethnic subgroups, as well as subgroups defined by income. Methods: State-level beverage-specific alcohol tax data come from the Alcohol Policy Information System and the National Alcoholic Beverage Control Association. Consumption data come from the 1999-2013 Behavioral Risk Factor Surveillance System surveys (N= 5,483,830). Multivariable fixed effects regressions with survey sample weights were used for analyses. All regression models controlled for individual-level age, gender, education, income, marital status, and race, as well as state-level unemployment, poverty, median household income, fixed effects for state and year, and a previously published Alcohol Policy Score, which represents the strength of alcohol policies within states. Results: Preliminary estimates indicate that neither beer nor spirits taxes were significantly associated with odds of any alcohol or any binge drinking in the sample overall, though increases in both were positively associated with slight increases in both overall volume and binge frequency. These associations persisted across White, Black, and Hispanic subgroups, as well as across all income quartiles. Beverage-specific taxes were not more strongly associated with consumption than overall sales tax. Conclusions: Beverage-specific alcohol taxes appear to affect both overall consumption, as well as consumption within racially or income-defined subgroups, though not necessarily differentially.

C-18 WHO GETS SERVED? SOCIAL AND COMMERCIAL HOST POLICIES

Studio E
Description:

Responsible Merchant Program in Ciudad Juarez Mexico

Cesar Solis, MBA
Paso Del Norte Health Foundation/FECHAC, Jaurez, MX
Priscila Dominguez
Shift +, Juarez, MX

This panel will discuss our efforts to reduce underage drinking through changing access to alcohol in off-premise alcohol outlets in Ciudad Juarez, Mexico. Through a cross-border alliance between El Paso-based Paso Del Norte Health Foundation (PDNCHF) and Juarez-based Fundación del Empresariado Chihuahuense (FECHAC), the Shift+ Initiative was launched in 2015. Based on high rates of sales to minors in off-premise alcohol outlets of 77 percent, Shift+ staff determined the number one priority was to reduce sales of alcohol to minors. The focus of the intervention includes the development of a Responsible Merchant Program with the following components: voluntary server training, consistent clerk checking of IDs, reductions in alcohol outlet exterior alcohol advertising, interior ID checking signage, mystery shopper compliance checks, youth engagement in painting murals at selected locations and media advocacy. The results of the intervention pilot reduced the rate of sales to minors from 77 percent to 37 percent. Based on pilot results, we applied the intervention to more than 500 chain stores in Juarez, in which 82.6 percent sold alcohol to minors. Post intervention saw a reduction of sales to minors to 34 percent. This type of prevention work is unusual with efforts primarily focusing on educational strategies. We are actively working on a proposal to stop selling alcohol 24/7. Concurrently, we are working with state lawmakers to: establish mandatory server training for all alcohol outlets; establish regulations on alcohol advertising; use the ability to use minors under 18 years old in outlet compliance checks; enhance enforcement; and increase penalties for sales.

A Case Study of the Passage of a Civil Social Host Ordinance in San Antonio

Nicole Holt
Texans Standing Tall

Civil social host ordinances are a promising practice in reducing underage drinking as well as the consequences associated with underage drinking parties. In Texas, since December 2016, four cities have passed social host ordinances, and several other cities are currently in the process of deciding whether a social host ordinance makes sense for their community. In a unanimous city council vote on December 15, 2016, San Antonio became the largest city in the country to pass a civil social host ordinance. To many at the time, the outcome was never in doubt, but the process began two years earlier at a training in Austin. The team that saw this campaign through from conception to passage successfully followed a tailored ten-step process introduced that day. The process was established by national experts and introduced statewide by Texans Standing Tall (TST) to lead prevention coalitions through the treacherous territory utilizing the local policy process to create community change. This presentation will offer lessons learned from the process in San Antonio, information about the ten steps toward passing a civil social host ordinance, and practical information about anticipated challenges in passing a civil social host ordinance. The presentation will go over how TST and Circles of San Antonio, a local coalition, engaged in community-based efforts to reduce underage social access to alcohol.

Social Host Ordinances and Off-Campus Drinking: The Impact in a Maryland Community

Paul Hartman
Greater Towson Council of Community Association

In January 2016, Baltimore County enacted the Social Host-Unruly Social Gatherings ordinance, a two-year pilot program to reduce disruptive behavior associated with large house parties in Towson, Maryland, home to many college students. Since the ordinance’s adoption, community complaints to one local university declined 75 percent, and an annual student survey shows a decline in student drinking at off-campus parties. The pilot ordinance has already been expanded twice to include additional neighborhoods, and it is set to be expanded once more and reauthorized in 2018. The social host implementation was a collaborative effort between Towson University, local neighborhood associations, law enforcement, and county representatives. This presentation will describe the collaboration between Towson University officials, surrounding residential neighborhood associations, the local police force and county officials to implement the ordinance. The presenter will also describe the pilot program - its measurable results, expansion and reauthorization.

Lessons Learned from Evaluations of Different Approaches to Responsible Beverage Service Management Training

Traci Toomey, PhD
University of Minnesota School of Public Health

Responsible beverage service (RBS) training is still commonly used to prevent alcohol sales to underage individuals and obviously intoxicated patrons as well as to prevent alcohol intoxication levels among patrons. Although RBS training is probably not sufficient for preventing these problems on its own, it can be an important part of an overall strategy to reduce illegal alcohol sales and related issues. When RBS training is used as part of a comprehensive strategy, it is important to ensure that the training is of high quality and contributes to the effectiveness of the overall strategy. In this presentation, we will provide the results of evaluations of three different versions of high-intensity RBS training management training. The three programs were composed of different types of components, as follows: Program 1: four face-to-face sessions; Program 2: two face-to-face sessions and interactive online, skill building training; and Program 3: two face-to-face sessions and telephone-based follow-up sessions that incorporated motivational interviewing techniques. We found different strengths and weaknesses across these different versions of management training. The goal of this presentation is to discuss these strengths and weaknesses and provide recommendations that could inform development of RBS training programs and policies targeting alcohol-related problems.

C-19 USING HEALTH DATA TO ASSESS THE IMPACT OF ALCOHOL POLICY ON YOUR COMMUNITY

Studio D
Presenters:

Laura Tomedi, PhD, MPH
New Mexico Department of Health
Anna M. Buckner, MPH
Utah Department of Health
Kacy Crawford, MPH
Colorado Department of Public Health and Environment
Kari Gloppen, PhD, MPH
Minnesota Department of Health
Patrick J. Hindman, MPH, BSN
Michigan Department of Health and Human Services

Description:

Many communities are not familiar with how to utilize public health surveillance data to assess the health impact of excessive alcohol consumption and policies designed to reduce it. In this workshop, state and local alcohol epidemiologists will provide a basic introduction and examples of how communities can use health data and existing resources to track alcohol consumption, alcohol policies, and their resulting health impacts. Goals: 1) introduce participants to using surveillance data to describe the impact of alcohol policy in their communities 2) describe strategies and methods for tracking alcohol policy development and implementation. Outline and components of session: 1) describe public health data available to assess excessive alcohol consumption and alcohol-related harm; 2) identify alcohol policies that impact communities and potential policy resources (e.g., bill tracking websites, Prevention Status Reports); 3) introduce basic epidemiologic methods and give examples of data analysis resources; and 4) explain how to leverage existing partnerships, to build new partnerships, and to assess alcohol policy. Activity: Using a real policy example, brainstorm how to track changes in the policy and assess the health impact of the policy. At the end of this session, participants will be able to: 1) utilize data to evaluate the health impact of alcohol policy, 2) identify resources to track and understand local alcohol policies, and 3) formulate a plan to assess the health impact of alcohol policies  

C-20 IMPAIRED DRIVING AND ITS ENFORCEMENT

Studio C
Description:

Potential Effectiveness of Lowering the BAC Limit to .05 in the U.S.

James Fell, MS
National Opinion Research Center (NORC)

Numerous independent studies in the United States indicate that lowering the illegal BAC limit from .10 to .08 has resulted in 5 percent to 16 percent reductions in alcohol-related crashes, fatalities, or injuries. Several international studies indicate that lowering the illegal per se limit from .08 to .05 BAC reduces alcohol-related fatalities. The literature has shown the efficacy of lowering the BAC limit: (1) from .10 to .08, (2) from .08 to .05, (3) from .05 to .03 or .02, and (4) for youth to any measurable amount of alcohol (zero tolerance laws). This study sponsored by the National Institute on Alcohol Abuse and Alcoholism was undertaken to contribute to the scientific evidence as to whether lowering the BAC limit to .05 will be an effective alcohol policy in the United States. The objectives of the study were to: (a) conduct a meta-analysis of qualifying international studies to estimate the range and distribution of the most likely effect size from a reduction to .05 BAC or lower; (b) translate this synthesis toward estimating the effects of reducing the current .08 BAC limit to .05 in the U.S.; and (c) estimate the life-saving benefits of the proposed reduction in the driving limit from .08 to .05 BAC. The meta-analysis of studies on lowering the BAC limit in general found an 11.1 percent decline in fatal alcohol-related crashes from lowering the BAC to .05 or lower. It was estimated that 1,790 lives would be saved each year if all states adopted a .05 BAC limit.

Compliance Checks in the Age of Social Media

Chris Wagner, MA
Project Extra Mile

Project Extra Mile, a statewide network of community partnerships to prevent and reduce alcohol-related harms, has collaborated with local and statewide law enforcement agencies to conduct retail alcohol compliance checks across Nebraska since 1997. Twenty years of consistent compliance checks have driven Nebraska’s non-compliant rate from a high of 41 percent to a record low of 6 percent. But was 6 percent artificially low? Long suspected to be influencing the compliant rate, social media took on a new role during compliance checks in August 2016 when an Omaha restaurant owner tweeted a picture of minors that were working with officers that evening. While the restaurateur justified his action as freedom of speech, he was charged with obstructing a government operation. The resulting trial ignited a public conversation on why and how compliance checks are conducted in today’s alcohol market place. Revealing the minors’ identity prompted additional consideration: can checks be accurate in the age of social media when visual/identifying alerts can be sent and received in real time? How can agencies better protect minors’ safety in these operations? What role can advocacy organizations play in addressing these concerns? Alcohol industry members and their activists saw an opportunity to erode support for enforcements they described as ‘outdated.’ Despite objections and the acquittal of the restaurateur, multi-agency, productive compliance checks have continued to take place in Omaha with deliberate strategic changes. Join us to discover how the subsequent charges and legal battle impacted future operations.

Evaluation of Maryland’s State Police Impaired Driving Reduction Effort

James Fell, MS
National Opinion Research Center (NORC)

An evaluation was conducted of Maryland’s State Police Impaired Driving Reduction Effort (SPIDRE). This enforcement effort consisted of a select team of seven police officers from the Maryland State Police who engaged in high intensity driving under the influence (DUI) enforcement. Initially, this SPIDRE team operated in one county for about one month. They then operated in other counties for 2 - 3 months at a time, rotating among three counties. This evaluation sought to determine the impact of the SPIDRE program on DUI arrests, impaired driving crashes and public perceptions of DUI enforcement. These seven SPIDRE officers made numerous DUI arrests and were very successful at producing positive adjudicative outcomes for the DUI arrests they made. The crash analyses indicated no significant DUI crash reduction effect was associated with the SPIDRE team using police reported impaired driving. However, a ratio of single vehicle nighttime (SVN) (6pm - 6am) crashes to multiple vehicle daytime (MVD) (6am-6pm) was used as a different perspective on measuring impaired driving crashes (serving as a surrogate measure of impaired driving crashes to account for underreporting of impaired drivers by police). There was a statistically significant decrease of 0.009 in the ratio of SVN to MVD crashes in the SPIDRE counties, but not in any other counties, implying that there was an effect by the SPIDRE program in this measure. Together these findings suggest the benefits of the SPIDRE team and indicate that the level of improvements in enforcement and adjudicative outcomes is worth the cost.

4:00pm - 5:30pm PLENARY SESSIONS

Plenary 3 - ALCOHOL AND HEALTH DISPARITIES

Salon 5-7
Presenters:

John F. Maisch, JD
University of Central Oklahoma
Abram Neumann
Lakota Hope Ministry
Dallas Pettigrew, MSW
University of Oklahoma
Wandra Ashley-Williams
Maryland NAACP
Debra Furr-Holden, PhD - Session chair
Michigan State University

Plenary 4 - PRICE, PROMOTION, PLACE, PRODUCT AND THE PUBLIC HEALTH RESPONSE

Salon 4
Presenters:

Matt Rossheim, PhD
George Mason University
Robert Pezzolesi, MPH
New York Alcohol Policy Alliance
Bonnie Patten, Esq.  
truthinadvertising.org
David Jernigan, PhD, MPH
Johns Hopkins Bloomberg School of Public Health
Raimee Eck, PhD, MPH - Session chair
Johns Hopkins Bloomberg School of Public Health

7:00pm - 9:30pm WHITECLAY IN CONVERSATION
Studio B
Presenters:

Deb Evensen,
Fetal Alcohol Consultation and Training Services
Frank LaMere
Four Directions Center
John F. Maisch, JD
University of Central Oklahoma
Abram Neumann
Lakota Hope Center
Nora Boesem
FASD/Community Advocate

Description:

Join the conversation of advocates and activists who worked tirelessly to change the conditions in Whiteclay, Nebraska, by stopping the flow of alcohol to the nearby, dry Pine Ridge Indian Reservation. The evening will also include the opportunity to view the documentary Sober Indian|Dangerous Indian.

7:30am - 8:30am Poster Session/Continental Breakfast
Pre-function Area
Description:

P-15 My Family and Alcohol: Using Digital Media to Engage with Families on Alcohol Harm
Alison Douglas
Alcohol Focus Scotland

P-16 Annual Total Binge Drinks Consumed by U.S. Adults, 2015
Dafna Kanny, PhD
National Center for Chronic Disease Prevention and Health Promotion/CDC

P-17 A Statewide Tool to Enhance Collaboration among Local Coalitions
Kaleigh Becker, MPH
Texans Standing Tall

P-18 Enhancing Access to Alcohol Screening, Brief Intervention, and Referral to Treatment to Better Serve Individuals and Populations
Jonathan Noel, PhD
Johnson and Wales University

P-19 Postsecondary Education Partnership on Alcohol Harms
Catherine Paradis, PhD
Canadian Center of Substance Use and Addictions

P-20 Earlier Screening and Brief Intervention to Prevent Alcohol-Related Harms among College Students
Tammy Peck, MA
Texans Standing Tall

P-21 Do Recreational Cannabis Laws Follow the Alcohol Policy Model? – A Preliminary Study
Elyse Grossman, JD, PhD
Johns Hopkins Bloomberg School of Public Health

P-22 Effectiveness of Alcohol Ignition Interlock Laws in the U.S.
James Fell, MS
National Opinion Research Corporation (NORC)

P-23 Mobile Device Data Collection to Assess Physical and Social Context During Drinking Events
Spruha Joshi, MPH
University of Minnesota

P-24 Alcohol Policies to Prevent and Reduce Youth Violence: Lessons Learned from a Cross-Sectional Analysis
Victoria Nelson, MPH
Michigan State University, Division of Public Health

P-25 Privatization of Liquor Distribution and Retail Sales in Washington: Self-Reported Alcohol Consumption
Sarah Beth Barnett, PhD
Alcohol Research Group, Public Health Institute

P-26 State Legislators’ Use of Evidence in Making Policy on Alcohol Use in Pregnancy
Katie Woodruff, DrPH
University of California - Berkeley

P-27 Neighborhood Coethnic Density, Nativity, and Alcohol’s Harm from Others
Christina Tam, PhD, MSW
Alcohol Research Group, Public Health Institute

8:45am - 10:15am Concurrent Sessions

C-21 THE WHITECLAY EXPERIENCE: A STORY OF HOPE, HEALING, AND HARM PREVENTION

Studio B
Presenters:

John A. Maisch, JD
University of Central Oklahoma
Deb Evensen,
Fetal Alcohol Consultation and Training Services
Abram Neumann
Lakota Hope Center
Frank LaMere
Four Directions Center
Nora Boesem
FASD/Community Advocate

Description:

The Pine Ridge Indian Reservation is located in southwest South Dakota. Despite a 125-year prohibition on the sale and consumption of alcoholic beverages, Pine Ridge’s addiction rates are among the highest in the nation. Four beer stores located in Whiteclay, Nebraska, an unincorporated town of less than 12 residents located less than 300 feet from the reservation’s border, was considered by many the primary source of alcoholic beverages. The four beer stores sold more than 3.5 million cans of beer annually, or the equivalent of about 10,000 cans per day, primarily to tribal residents who were able to walk or drive across the state line. Infant mortality, teen suicide, Fetal Alcohol Spectrum Disorder (FASD) and other adverse health outcomes accompanied the high addiction rates. Whiteclay beer sales continued unimpeded until April 30, 2017, when the Nebraska Liquor Control Commission’s order denying the beer stores’ re-licensure applications went into effect. A month earlier, The New York Times declared that the past year had witnessed “a powerful surge of action from advocates . . . that seems to have imperiled the stores for the first time in memory.” A collaborative partnership between Native-American activists, public health advocates, community and spiritual leaders, a former state liquor prosecutor, and a young girl suffering from FASD provided the momentum necessary to close the stores. ‘The Whiteclay Experience’ is the story of a unique collaborative-model that may lead to future successes for those fighting exploitive business practices directed at vulnerable populations.

C-22 ALCOHOL ADVERTISING AND MARKETING: A POTPOURRI

Salon 2
Description:

Alcoholic Beverages Advertisement in Printed Media and Youth Drinking: A Case Study of University Students in Bangkok, Thailand

Nithat Sirichotiratana, PhD, MPH
Mahidol University, Thailand

The objectives for this research were to study the frequencies of alcoholic beverages drinking and the brand commonly drunk by university students; another objective was to analyze association of seeing alcoholic beverages advertisement as sponsor for sports program, music (concert) program by the alcoholic beverage industry and consumption of alcoholic beverages by university students. The research method used was a quantitative method through a self-administered questionnaire among 200 university students - 100 each from an autonomous (formerly government) university and a private university - in Bangkok, Thailand. Results indicated that majority of students from both universities agreed that seeing alcoholic beverage advertisements increased drinking (71.6 percent from autonomous university and 56.8 percent from private university). A majority of students from both universities agreed that sales promotion of alcoholic beverage increased drinking (75.8 percent from autonomous university and 73.7 percent from private university). When analyzed by Chi-square, gender (p-value = 0.000) and sales promotion (p-value = 0.037) were variables associated with alcoholic beverage with statistical significant. Recommendation: Prohibition of advertisement, sales promotion and events sponsorship by alcoholic beverage industry was a necessary measure for alcoholic beverage consumption control among adolescent and youth.

Alcohol Labeling - Consumers’ Right to Know

Mariann Skar
European Alcohol Policy Alliance

European legislation has failed to ensure that consumers are informed about their chosen alcoholic beverages. In 2011, Regulation 1169/2011 on the provision of food information to consumers exempted drinks with greater than 1.2% ABV from that obligation. In March 2017, the European Commission (EC) published a report clearly stating that no objective grounds had been identified which would justify the absence of information on ingredients and nutritional information for alcoholic beverages. More recently, WHO placed alcohol labelling on the Codex Alimentarius agenda. For years, Eurocare has led advocacy efforts in this field. With the majority of alcohol companies being multinational corporations, the issue itself is international, too. As such, Eurocare would like to present its work spanning research to policy and align public health advocacy on both sides the Atlantic. Eurocare’s policy objective is to erase the exemption afforded to alcoholic beverages in Regulation 1169/2011 and align their obligations with those of other food products. The Commission’s March 2017 report is an important step forward. The European Union Joint Action on Reducing Alcohol Related Harm saw Eurocare gathering consumer perceptions and comprehension of communication about alcohol-related risks. Data analysis highlighted differences among countries, genders and social backgrounds. Consumers are eager to be better informed, with 50.4% desiring more information about ingredient listing; 43.2% for calorie content and 37.9% for nutritional value. Eurocare will present a legislative analysis, complemented by a mention of the relevant academia and recent developments.


Development of the Alcohol Marketing Assessment Rating Tool (AMART)

Jonathan Noel, PhD
Johnson & Wales University

Current national responses to the monitoring and prevention of alcohol promotion to vulnerable populations, such as youth, typically rely on partial bans, co-regulation and industry self-regulation; however, efforts to determine compliance with existing regulations are often cumbersome and resource intensive. We sought to develop a short-form questionnaire that can be rapidly implemented to assess compliance of alcohol advertising to existing alcohol industry self-regulated marketing codes. Methods: Questions for the Alcohol Marketing Assessment Rating Tool (AMART) were taken from a longer rating instrument that was originally developed to detect violations of a self-regulated alcohol marketing code. Secondary analysis of data from three samples of alcohol advertisements was performed to determine the reliability and validity of AMART at detecting code violations. One sample was used as an exploratory set. Two samples were used to validate the questionnaire. Results: In the exploratory set, the reliability of AMART was considered near perfect (kappa = 0.92). Sensitivity was 97%, and specificity was 100%. PPV was perfect and NPV was approximately 90%. In the validation sets, reliability was considered substantial to near perfect (kappa = 0.71-0.94). Specificity and PPV remained perfect, and NPV was 86%-90%. Conclusion: The AMART is a reliable tool to detect violations of a self-regulated marketing code in alcohol advertising. Moreover, it significantly decreases the amount of resources needed to evaluate a finite number of ads.


Regulating Alcohol Point-of-Sale Advertising in Light of the First Amendment: A Legal Analysis

Elyse Grossman, JD, PhD
Johns Hopkins Bloomberg School of Public Health

Alcohol marketing - both through traditional means (e.g. print media) and nontraditional means (e.g. point-of-sales advertising) - is pervasive in our society. Although every state now prohibits individuals under 21 years of age from purchasing or publicly possessing alcoholic beverages, these individuals are constantly being exposed to alcohol marketing through mass media, the Internet, and other promotional activities. Research has shown that increases in exposure to alcohol advertisements and in brand recognition are associated with increases in the prevalence and intensity of youth alcohol consumption, which leads to increases in alcohol-related consequences. Part of the increase in alcohol marketing is due to a change in the legal landscape regarding protections on commercial speech. Since the 1970s, when courts first applied First Amendment protections to commercial speech, these protections have gradually increased, thus resulting in state and local governments facing greater challenges when trying to impose restrictions on commercial speech. This presentation will provide an in-depth review of First Amendment case law and an overview of the current legal landscape with regards to commercial speech. These will provide the context for recommendations for advocates, lawyers, and policymakers on how state and local governments may be able to place restrictions on point-of-sale advertising in order to prevent and reduce underage drinking and related harms.

C-23 METHODS, RESOURCES AND TOOLS FOR ALCOHOL SURVEILLANCE AND POLICY DEVELOPMENT

Studio E
Description:

Assessing College Campus Alcohol Policies

Molly Mitchell, JD
Johns Hopkins Bloomberg School of Public Health

The Maryland Collaborative to Reduce College Drinking and Related Problems provides training and technical assistance to colleges in Maryland, guiding them in how to adopt effective policies and practices in their campus communities to reduce excessive student drinking. While a plethora of research points to effective policies that can reduce excessive drinking in the communities surrounding the campuses, there is little research to guide campuses seeking to adopt and implement effective policies on their own campuses. In response, the Maryland Collaborative, during the 2016-2017 academic year, assessed existing on-line campus alcohol policies at 15 college campuses in Maryland, and rated them for clarity, accessibility and effectiveness. Effectiveness ratings were derived from a two-part Delphi panel process, incorporating expert opinion from both alcohol policy researchers and campus practitioners. The Maryland Collaborative used this assessment to provide feedback to the colleges and provide recommendations on how to make their policies more accessible, clear, and effective. The presentation will describe the procedures used to assess policies for accessibility, clarity, and effectiveness, how the results were shared with the campuses, and how this review process can be used by other campuses to assess their campus policies and guide them in creating campus policies that are clearer, more accessible, and more effective.

Objective, Continuous Field Measurement of Alcohol for Event-Level, Population, and Policy Research

Toben Nelson, ScD
University of Minnesota

Alcohol researchers rely on self-report measures of consumption, which are subject to bias and underreporting. We tested the feasibility of using biosensors in a 7-day field study of fraternity members (n=45) at two college campuses. Subjects wore a SCRAM alcohol monitor (Alcohol Monitoring Systems, Inc.) on their ankle that collected data every 30 minutes on transdermal alcohol concentration (TAC) in units that roughly correspond to blood alcohol concentration. Subjects were instructed to engage in normal activities and were notified that they would not receive their own data. Subjects complied with the study protocol with two exceptions: one subject cut off the device band and one loosened it to where the sensor did not make regular contact with the skin. We obtained 13,622 discrete measurements over the course of 7 days, of which 1665 (12.2%) were valid, non-zero TAC readings. Mean TAC readings for all valid drinking events were 0.08 g/dL and peak TAC reached 0.44 g/dL. We created variables to reflect TAC for each day of the week and in 6
hour increments (6am-noon; noon-6pm; 6pm - midnight; midnight-6am). Valid, non-zero TAC readings were observed on each day of the week, with lowest average readings on Monday and highest average readings on Friday. Average TAC readings were higher on weekends and at night. In some cases, non-zero TAC readings remained past 6am. Lessons learned from this pilot investigation will be shared including, comparisons with objective monitoring for physical activity (accelerometers), logistics, administration, data management, variable construction, interpretation, policy implications, advantages and limitations.

Deaths AND Diseases of Despair: The Disproportionate Role of Alcohol in Minnesota’s Mortality and Morbidity

Jon Roesler, MS; Dana Farley, MS, and Kari Gloppen, PhD, MPH
Minnesota Department of Health

In 2015, Princeton economists Anne Case and Angus Deaton described ‘deaths of despair:’ deaths by suicide, unintentional drug overdose, alcoholic liver disease and cirrhosis. They noted how the increase in these deaths outweigh progress in reducing overall mortality. In Minnesota, there is increased interest in these deaths, with strategies being developed to inform and empower local communities. Methods/Approach: Expanding the concept to ‘diseases of despair,’ we looked at deaths and hospital treatment from 2000 to 2016. We broadened the definition for 100 percent alcohol-attributable conditions to include alcohol poisoning/overdose. We also included alcohol-attributable falls in our analysis of hospital-treated morbidity. Results/Findings: We found that 100 percent alcohol-attributable deaths are comparable in numbers, and in the rate of increase, to drug overdose deaths. In hospital discharge data, the rate of increase is comparable, and the overall numbers greater, for alcohol morbidity compared to unintentional drug overdoses; the leading cause of alcohol-associated morbidity is falls. Conclusions: This analysis is allowing us to communicate to policy makers and the public that the significant mortality and morbidity attributable to alcohol is comparable to, or even exceeds, that of unintentional drug overdose. Minnesota’s participation in CDC’s National Violent Death Reporting System (NVDRS) and State Unexplained Drug Overdose Reporting System (SUDORS) will allow us to better describe the role of alcohol in these deaths. A sample of fall deaths should be included in the NVDRS/SUDORS sample abstraction to help describe the role of alcohol and other drugs among elders that fall.

Update on Federal Activities under the Sober Truth on Preventing Underage Drinking (STOP) Act

Robert Vincent, MSEd
Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention

In an effort to create a coordinated federal approach to preventing and reducing underage drinking, Congress enacted the Sober Truth on Preventing Underage Drinking Act (the STOP Act) in 2006 and reauthorized it in 2016. The STOP Act contains three key elements: 1) the Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD) which includes 15 federal agencies that play a role in underage drinking prevention, and the ICCPUD’s annual Report to Congress on the Prevention and Reduction of Underage Drinking. The Report includes information on the most recent federal survey data; federal prevention activities; and state-level prevention policies, activities and expenditures on underage drinking prevention, 2) the National Media Campaign, developed by SAMHSA’s Center for Substance Abuse Prevention, known as Talk. They Hear You., the media campaign’s goal is to reduce underage drinking by providing parents and caregivers of children ages 9-15 with information and resources to discuss the issue of alcohol with their children, 3) funding for annual grants to community coalitions working to prevent and reduce underage drinking. Currently, STOP Act grants fund 97 community coalitions in 29 states. This presentation will provide a summary of current activities under the STOP Act and will discuss whether they may be having an effect as reflected in the latest national data on underage drinking. The presentation will also highlight the ways the STOP Act is relevant to the prevention community, including federal, state and local government agencies; law enforcement; nonprofit organizations; schools; parents; and others.

C-24 MEASURING ALCOHOL OUTLET DENSITY AND ASSESSING ITS IMPACT

Studio D
Description:

Changes in Spirits Purchasing Behaviors after Privatization in Washington

William Kerr, PhD
Alcohol Research Group, Public Health Institute

The privatization of the Washington Liquor Monopoly in 2012 offered a unique opportunity to study spirits purchasing behavior changes from a government to licensed system. Four representative surveys of adults (aged 18 and over) in Washington state were recruited in January-April 2014 (Wave 1, N=1202), August-October 2014 (Wave 2, N=804), March-May 2015 (Wave 3, N=823) and August-October 2015 (Wave 4, N=662). Analyses focus on changes in spirits purchasing behavior from before privatization retrospective reports to current reports in the areas of travel distance, spirits quality, purchase frequency and size of bottle. Respondents also directly reported on changes in convenience, selection and prices. Results did not find any significant changes in these aspects of purchasing; however, subgroup analyses found that younger drinkers 18-29 reduced travel distance and increased purchase frequency while older drinkers 50+ traveled further. Shorter travel distances were associated with grocery and drug stores while longer travel distances were associated with liquor superstores, wholesale stores and government stores in bordering states. Respondents reported that liquor purchasing was more convenient after privatization but that the selection of spirits and prices were better in the government-controlled stores. These results show that government monopolies can deliver better selection and better prices than a licensed system. The variety of store types in the licensed system allows drinkers to select stores based on convenience, selection or prices, so that for some travel times will increase even in this case where there are five times as many stores.

Examining Alcohol Outlet Density in Semi-Rural Communities: A Use of a Spatial Access Measure

Naomi Greene, PhD Candidate
Johns Hopkins Bloomberg School of Public Health

Few studies have assessed alcohol outlet density in small municipalities; this study looked at Gallup and Las Cruces. The New Mexico Department of Health conducted a cross-sectional study to examine the association between the density of alcohol outlets and violent crime in two small communities in 2015. We geocoded liquor licenses and violent crime cases. We operationalized alcohol outlet density and violent crime using a special access measure. This measure was calculated for each census block in each community. We assessed the relationship between alcohol outlet and density and violent crime using linear regression. Models were adjusted for proportions of age group, gender, race-ethnicity, and poverty as the census block level. We found a statistically significant association between alcohol outlet density and violent crime in both study areas. A one unit increase in the alcohol index was associated with a 0.40 (±0.04) increase in the crime index in Gallup and a 0.75 (±0.10) increase in the crime index in Las Cruces, after adjusting for sociodemographic factors. The burden of excessive alcohol consumption and related-harms is high in many rural and small metropolitan communities. Appropriately measuring alcohol outlet density in these communities is critical for understanding its impact and developing interventions.

Co-Production to Action: Empowering Communities to Influence Change in Alcohol Licensing Practice in Scotland

Gemma Crompton, MSc
Alcohol Focus Scotland

The vast majority (91%) of people in Scotland think there are already enough or too many licensed premises, yet, on average, only 5 percent of license applications are refused each year. Since 2015, Alcohol Focus Scotland (AFS) has supported communities in Edinburgh to participate in the alcohol licensing process. Despite communities being best placed to provide views on the impact of alcohol availability in their local area, even those who engaged regularly struggled to overcome the bureaucracy. Communities felt disempowered and had lost faith in the accountability of the system. To address these challenges, AFS collaborated with local community members to develop a practical toolkit, Alcohol Licensing in Scotland: how you can get involved. The toolkit aims to: (1) make it easier to participate in the licensing system by removing knowledge barriers, and (2) make engagement more effective by building skills and confidence to participate through the use of practical tips. Since its launch in January 2016, the toolkit has clearly met a need amongst communities. It has been distributed widely through licensing and community contacts and used to train community members who have used it to object to licenses. It has also been welcomed by government ministers. This presentation will focus on learning from this project, including: (1) how advocacy organizations can engage effectively to mobilize communities and ensure their voices are heard, (2) how to maximize reach and impact through co-production, and (3) how to utilize project outcomes and insight to support ongoing policy advocacy.


Racial/Ethnic Trends in Public Opinions toward Alcohol-Related Policies in the U.S., 1995-2015

Camillia Lui, PhD
Alcohol Research Group, Public Health Institute

Alcohol policies are effective for reducing alcohol-related problems, and public opinions are integral in shaping these policies. Policymakers should know where public opinion lies as they weigh strategies for addressing harmful drinking, including the disproportionate burden of alcohol problems in racial/ethnic minority communities. This study examined racial/ethnic differences in attitudes toward alcohol policies from 1995 to 2015 using data from five National Alcohol Surveys, a U.S. adult population survey conducted every five years. Bivariate and multivariate models examined time trends and race/ethnicity controlling for demographics, religiosity, and drinking status. Overall, public support was strongest for warning labels (92%), increased prevention (81%), health insurance coverage of alcohol treatment (78%), and ban on corner store alcohol sales (62%). Increasing alcohol taxes was the least favorable policy (38%). Over time, support for alcohol control via increased taxes and limited availability has significantly declined from 1995 to 2015. However, racial/ethnic minorities were significantly more likely to support these alcohol control policies compared to whites. While support for warning labels and prevention has also significantly declined over time, support for insurance coverage of treatment has significantly increased (76% in 1995 to 82% in 2015). Black and Hispanics favored increased prevention/treatment more than whites. While increasing alcohol taxes may be effective in reducing alcohol-related problems, the American public is less supportive of this compared to policies supporting prevention/treatment. However, policy efforts to reduce alcohol-related disparities might be able to capitalize on strong support for limiting alcohol in corner stores in Black and Hispanic communities.

C-25 HARM REDUCTION AND HEALTH PROMOTION: ALCOHOL CONTROL POLICIES AND BEYOND

Room: Studio C
Presenters:

Norman Giesbrecht, PhD
Centre for Addiction and Mental Health
Linda M. Bosma, PhD
Bosma Consulting
Laura Schmidt, PhD
UCSF School of Medicine
Robin Room, PhD
La Trobe University, Australia

Description:

This panel will consider alcohol, tobacco, marijuana, and food policy. How can these separate and often isolated experiences inform each other? Norman Giesbrecht will discuss lessons from alcohol control: focus on effective vs. popular interventions; evidence to inform policy; beware of harm reduction claims from vested interests; pay attention to enforcement; engage young adults in alcohol control issues. Linda Bosma will discuss similarities between alcohol and tobacco: legal substances with a minimum age of purchase, major influential industries with global reach, and substantial research demonstrating harm. Lessons from tobacco control include: promotion of a Framework Convention, emphasis on harm to others, and the current funding environment. Robin Room will indicate that a legal regime on marijuana was sold to voters in some U.S. states with claims that it would be controlled ‘like alcohol.’ This turned out to be the weakened form of alcohol control of these deregulated times, not as instituted at repeal of alcohol prohibition.  Public health discussions of marijuana legalization should pay more attention to alcohol control, both currently and in the past -- and initiatives to control of problematic commodities would benefit from more cross-commodity comparisons and analysis. Laura Schmidt will summarize how the history of alcohol control policy has directly informed the current debates over sugary beverage reforms both internationally and within the U.S.  There are recent efforts to apply lessons learned from alcohol control policies-including taxation and warning labels-to sugary beverages in the interests of stemming rising rates of obesity and cardio-metabolic disease.  

10:30am - 11:30am Concurrent Sessions

C-26 DEVELOPING EFFECTIVE MESSAGES ABOUT EXCESSIVE ALCOHOL CONSUMPTION: THE RESULTS OF FORMATIVE QUALITATIVE RESEARCH

Room: Studio D
Presenters:

Jessica Mesnick, MPH
National Center for Chronic Disease Prevention and Health Promotion/CDC
James Khun; and Caitlin Moynihan, MPH
Fors Marsh Group

Description:

Excessive alcohol use is an important yet under-recognized public health problem. Improved communication strategies are therefore needed to: (a) raise awareness of the public health impact of excessive drinking; (b) encourage excessive drinkers to drink less; and (c) increase support for evidence-based prevention strategies.  Methods: In 2015, the CDC Alcohol Program contracted with the Fors Marsh Group (FMG) to conduct an audience segmentation analysis and focus group research to assess the knowledge, perceptions, and attitudes of U.S. adults toward excessive drinking. SalterMitchell developed messaging guidance that could be used to encourage consumers to moderate their drinking. FMG also coordinated the development of survey questions to assess knowledge and attitudes toward excessive drinking at a population level and communication messages on excessive drinking.  Results: Focus group participants considered binge and heavy drinking to be excessive. However, many questioned the definitions of these drinking patterns and perceived the acceptability of excessive drinking to be situationally-defined. Survey questions to assess knowledge and attitudes toward excessive drinking at a population level and communication messages emphasizing the public health impact of excessive drinking were developed based on these findings.  Conclusions: Many U.S. adults seem unaware of the negative consequences of excessive drinking, and the social acceptability of this behavior is situationally-defined. Public health surveillance of knowledge, perceptions, and attitudes toward excessive drinking is needed to assess these beliefs at a population level.  Targeted public health messages could help change attitudes about the acceptability of excessive drinking and build support for effective prevention strategies.  

C-27 USING DATA TO INFORM AND EVALUATE LOCAL POLICY CHANGE IN MARYLAND

Studio E
Presenters:

Debra Furr-Holden, PhD and Mieka Smart, PhD
Michigan State University

Pamela Trangenstein, MPH, PhD Candidate
Johns Hopkins Bloomberg School of Public Health

 

Description:

From Research to Policy to Practice and Back to Research

Debra Furr-Holden, PhD and Mieka Smart, PhD
Michigan State University

Research is often used to bolster support for policies to regulate alcohol availability. Broadly, the research suggests that alcohol outlets create and exacerbate negative public health outcomes ranging from excessive consumption to related constructs like community violence. Once policies are enacted, it is important that those policies be evaluated so we can determine their impact and also identify possible opportunities for optimal implementation, de-implementation and/or enforcement. We are evaluating two specific research-driven policies enacted in Maryland. First, in June, 2017, Baltimore enacted an extensive zoning rewrite, TransForm Baltimore, that gives residents a tool in fighting alcohol outlet oversaturation through land use regulation. We examined three components of TransForm Baltimore: (1) a requirement that all alcohol outlets be at least 300 feet from other outlets; (2) a requirement that outlets licensed to sell alcohol on-and-off premise generate 50 percent of their business from on-premise sales; and (3) a requirement to close, repurpose, or relocate all liquor stores that have been operating as “non-conforming” in residential zones since 1971. Our follow-up evaluations indicate that (1) implementation of the policy will require additional municipal support to ensure that further inequitable distribution of retail outlets does not occur, and (2) with active enforcement, TransForm Baltimore offers the opportunity to decrease outlet density by up to 20 percent. Second, we evaluate the Maryland’s 2011 alcohol tax increase and found that although the tax increase was associated with reductions in consumption and associated harms among adults, the effect on college students’ drinking related harms were limited.

Generating Local Estimates of the Burden of Alcohol Using Administrative Data

Pamela Trangenstein, MPH, PhD Candidate
Johns Hopkins Bloomberg School of Public Health

Measurement of heavy and hazardous drinking, alcohol use disorders, and associated harms at the local or city level are often incomplete or non-existent. These data are critical to inform local-level alcohol policies. The purpose of this presentation is to describe how to generate local estimates of the morbidity, mortality, and cost of alcohol use with alcohol-attributable fractions (AAFs) (the proportion of outcomes that are attributable to alcohol use). Data from Baltimore City, MD, are used as an example. Methods: Researchers used CDC’s alcohol-related disease impact (ARDI) tool and Bouchery et al.’s (2010) study on the cost of alcohol use in the United States in 2006 to determine outcomes that are causally related to alcohol consumption. The study then identified available administrative data sources with information about those outcomes. Researchers used AAFs to quantify the burden of alcohol use in Baltimore City, MD. Results: Preliminary data show there were 9,175 alcohol-attributable crimes in 2013, and these crimes cost a total of $1.7 billion. Of this, $1.4 billion was borne by persons other than the drinker, and $102 million was borne by the Baltimore City government. There were also 4,871 admissions for substance use disorders and 10 alcohol-attributable deaths from motor vehicle crashes. Medical examiner vital statistics, hospital records, and emergency transport records are also available. Conclusions: The morbidity, mortality, and cost of alcohol use is substantial, and it is possible to quantify this burden at the local level using existing data.

C-28 LOCAL CONTROL FOR RETAIL ALCOHOL AVAILABILITY: OPPORTUNITIES FOR MUNICIPAL PREVENTION POLICy

Studio C
Presenters:

Friedner Wittman, PhD
Clew and Associates
Albert Melena
San Fernando Valley Partnership
Dana Stevens
Community Action Service Agency of El Cajon

Description:

California localities and the state both control retail alcohol outlets. The California Alcoholic Beverage Control Department (ABC) issues licenses to operators of retail outlets.  Local jurisdictions grant land-use permits (zoning permits) for locations (addresses) and types of settings where privileges of the licenses are exercised.  Since the 1970s cities developed a graduated system for zoning permits to reduce public health and safety problems attributable to retail alcohol outlets.  We reported at AP17 (‘Halfway There’ presentation) how this system provides increasing levels of local control ranging from ‘defensive zoning’ (nuisance abatement) to ‘problem-solving zoning’ for new/expanded outlets (CUPs or conditional use permits) and from ‘oversight zoning’ for all outlets (DAOs) to ‘community management zoning’ (preventive surveillance) for full implementation of CUP/DAO requirements.  We found this system ‘halfway there’ between passing ordinances but not implementing them.  This panel reports on promising efforts to address three major challenges to full implementation: (1) overcome resistance by off-sale retail operators to CUP/DAO ordinances; (2) expand RBS training requirements from Tier 1 training (individual server) to include Tier 2 consultation (alcohol management policies for owner/manages); and (3) establish oversight by local officials to fully implement recently-passed ordinances. Two case studies explore complementary approaches to resolving these issues:  a grassroots prevention advocacy organization works independently and directly with city government (CASA, El Cajon, California), and a community organization works first with the retail community and then with city government (Retail Framework Project, San Fernando Valley / City of Los Angeles).  

C-29 FRAMING DATA FOR MAXIMUM POLICY IMPACT

Studio B
Presenters:

David Jernigan, PhD, MPH
Boston University
Sue Thau
Community Anti-Drug Coalitions of America

Description:

This session will teach the participants how to take facts and data and reduce them to their essence for use in educating elected officials and other key influential individuals. Participants will also learn how to connect alcohol and underage drinking issues to the other public policy issues that are of utmost concern to policy makers in the current political environment. Finally, participants will be updated on federal legislation and funding proposals related to underage drinking.

C-30 YOUTH ENGAGEMENT AND ALCOHOL-RELATED HARM IN ADOLESCENTS

Salon 2
Description:

Effectively Engaging Youth in Policy Advocacy

Georgianne Crowell
Texans Standing Tall

Youth involvement in policy advocacy is key to effective decision making and positive community outcomes. The focus of this presentation is to provide best practices for engaging youth in policy-level prevention efforts. Texans Standing Tall’s Sedrick Ntwali, Youth Engagement Specialist; Atalie Nitibhon, Director of Advocacy and Research; and Youth Leadership Council (YLC) Co-Chairs Andrea Marquez and Katy Turner will be discussing policy advocacy and the principles for success. For coalitions, youth engagement in policy advocacy means partnering with youth to make positive changes versus making decisions on their behalf or only providing services to them. Engaging this population not only benefits the individual youth who learn to be engaged civic leaders, it also benefits organizations and communities as a whole that can increase their sustainability and the overall success of their policy goals. Participants will learn how to collaborate with youth effectively in to prevent underage alcohol use and order to create positive change and safer communities.

Alcohol-Related Violence and Suicide in Adolescents: Harm Beyond the Wheel

Carson Benowitz-Fredericks, MSPH, CHES
Alcohol Justice

Alcohol-related causes kill over 4,300 adolescents in the United States each year. Much attention has been paid to the contribution dangerous driving makes to this tally. While government agencies have generated comprehensive strategy guides aimed to control this cause of death, and laudable efforts such as National Teen Driver Safety Week garner headlines, it often overlooks violence. California data show that deaths from alcohol-related homicides outnumber death from dangerous driving among residents under 21 years of age, with suicides a close third; nationally, the combined incidence of suicide and homicide equals or exceeds motor vehicle deaths. These rates are driven in part by high rates of homicide deaths in males. Racial and ethnic minorities may be more vulnerable to alcohol-related violence as well. This suggests that, as valuable as anti-drunk-driving campaigns are, they could be neglecting large swaths of the United States. This presentation seeks to show the current state of knowledge, examine current prevention messaging and campaigns, and suggest further directions of research and health promotion to strengthen our response to adolescent alcohol-related deaths from violence.

11:45am - 1:00pm CLOSING SESSION - A SOCIAL MOVEMENT BEGINS
Salon 4
Presenters:

Timothy S. Naimi, MD, MPH
Boston Medical Center
Maristela Montiero, PhD
Pan American Health Organization
Robin Room, PhD
La Trobe University, Australia
Diane Riibe
U.S. Alcohol Policy Alliance