On High
The Minimum Legal Drinking Age and Public Health
Christopher Carpenter & Carlos Dobkin
Journal of Economic Perspectives, Spring 2011, Pages 133-156
Abstract:
The Amethyst Initiative, signed by more than 100 college presidents and other higher education officials calls for a reexamination of the minimum legal drinking age in the United States. A central argument of the initiative is that the U.S. minimum legal drinking age policy results in more dangerous drinking than would occur if the legal drinking age were lower. A companion organization called Choose Responsibility explicitly proposes "a series of changes that will allow 18-20 year-olds to purchase, possess and consume alcoholic beverages." Does the age-21 drinking limit in the United States reduce alcohol consumption by young adults and its harms, or as the signatories of the Amethyst Initiative contend, is it "not working"? In this paper, we summarize a large and compelling body of empirical evidence which shows that one of the central claims of the signatories of the Amethyst Initiative is incorrect: setting the minimum legal drinking age at 21 clearly reduces alcohol consumption and its major harms. We use a panel fixed effects approach and a regression discontinuity approach to estimate the effects of the minimum legal drinking age on mortality, and we also discuss what is known about the relationship between the minimum legal drinking age and other adverse outcomes such as nonfatal injury and crime. We document the effect of the minimum legal drinking age on alcohol consumption and estimate the costs of adverse alcohol-related events on a per-drink basis. Finally we consider implications for the correct choice of a minimum legal drinking age.
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Are Underground Markets Really More Violent? Evidence from Early 20th Century America
Emily Greene Owens
American Law and Economics Review, Spring 2011, Pages 1-44
Abstract:
The violent nature of illegal markets is one rationale for legalizing the sale of narcotics. High U.S. crime rates during the 1920s are regularly presented as evidence of the strong positive relationship between market illegality and violence. The author tests this theory by exploiting state-level variation in homicides and in the passage and repeal of temperance laws before and after Federal Prohibition. Support for the "wet" cause was positively associated with homicides in dry states. However, on average, murder rates did not increase when alcohol markets were criminalized. Observed crime trends during the early 20th century are primarily explained by demographic changes.
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Minimum Wages and Alcohol-Related Traffic Fatalities among Teens
Scott Adams, McKinley Blackburn & Chad Cotti
Review of Economics and Statistics, forthcoming
Abstract:
Using cross-state variation in minimum wages, we observe a positive relationship between the minimum wage and the number of alcohol-related accidents involving teen drivers. A similar effect is not observed when examining accidents among adults. The results are consistent with a positive income elasticity for alcoholic beverages and driving activities among young people, in particular for consumption out of discretionary income accorded by higher minimum wages. Evidence of a sizeable impact of beer taxes on alcohol-related accidents among youths suggests that beer taxes are one avenue for policy makers to consider in counteracting this unintended consequence of minimum wages.
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Do blue laws save lives? The effect of Sunday alcohol sales bans on fatal vehicle accidents
Michael Lovenheim & Daniel Steefel
Journal of Policy Analysis and Management, forthcoming
Abstract:
This paper analyzes the effect of state-level Sunday alcohol sales restrictions ("blue laws") on fatal vehicle accidents, which is an important parameter in assessing the desirability of these laws. Using a panel data set of all fatal vehicle accidents in the U.S. between 1990 and 2009 combined with 15 state repeals of blue laws, we show that restricting alcohol sales on Sunday has at most a small effect on fatal accident rates. Using American Time Use Survey data, we find no effect of blue laws on the location of consumption, and we show that the group whose drunk driving behavior is most affected by these laws is underage men. Overall, these results suggest that Sunday alcohol sales restrictions have fewer secular public health benefits, at least in terms of vehicle fatalities, than previously believed.
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Garen Wintemute
Injury Prevention, forthcoming
Abstract:
Alcohol use and firearm ownership are risk factors for violent injury and death. To determine whether firearm ownership and specific firearm-related behaviours are associated with alcohol-related risk behaviours, the author conducted a cross-sectional study using Behavioral Risk Factor Surveillance System data for eight states in the USA from 1996 to 1997 (the most recent data available). Altogether, 15 474 respondents provided information on firearm exposure. After adjustment for demographics and state of residence, firearm owners were more likely than those with no firearms at home to have ≥5 drinks on one occasion (OR 1.32; 95% CI 1.16 to 1.50), to drink and drive (OR 1.79; 95% CI 1.34 to 2.39) and to have ≥60 drinks per month (OR 1.45; 95% CI 1.14 to 1.83). Heavy alcohol use was most common among firearm owners who also engaged in behaviours such as carrying a firearm for protection against other people and keeping a firearm at home that was both loaded and not locked away. The author concludes that firearm ownership and specific firearm-related behaviours are associated with alcohol-related risk behaviours.
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Heroin purchasing is income and price sensitive
Juliette Roddy, Caren Steinmiller & Mark Greenwald
Psychology of Addictive Behaviors, June 2011, Pages 358-364
Abstract:
Semi-structured interviews were used to assess behavioral economic drug demand in heroin dependent research volunteers. Findings on drug price, competing purchases, and past 30-day income and consumption, established in a previous study, are replicated. We extended these findings by having participants indicate whether hypothetical environmental changes would alter heroin purchasing. Participants (n = 109) reported they would significantly (p < .005) decrease heroin daily purchasing amounts (DPA) from past 30-day levels (M = $60/day) if: (a) they encountered a 33% decrease in income (DPA = $34), (b) family/friends no longer paid their living expenses (DPA = $32), or (c) they faced four-fold greater likelihood of police arrest at their purchasing location (DPA = $42). Participants in higher income quartiles (who purchase more heroin) show greater DPA reductions (but would still buy more heroin) than those in lower income quartiles. For participants receiving government aid (n = 31), heroin purchasing would decrease if those subsidies were eliminated (DPA = $28). Compared to participants whose urine tested negative for cocaine (n = 31), cocaine-positive subjects (n = 32) reported more efficient heroin purchasing, that is, they live closer to their primary dealer; are more likely to have heroin delivered or walk to obtain it (and less likely to ride the bus), thus reducing purchasing time (52 vs. 31 min, respectively); and purchase more heroin per episode. These simulation results have treatment and policy implications: Daily heroin users' purchasing repertoire is very cost-effective, more so for those also using cocaine, and only potent environmental changes (income reductions or increased legal sanctions) may impact this behavior.
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Injury, pain, and prescription opioid use among former National Football League (NFL) players
Linda Cottler et al.
Drug and Alcohol Dependence, 1 July 2011, Pages 188-194
Background: Athletes with injury-related pain, especially National Football League (NFL) players, are at increased risk for opioid use and misuse which may result in medical, psychiatric and social problems. This is the first study to evaluate the intersection of sports pain and opioid use and misuse among former NFL players.
Methods: A telephone survey of 644 retired NFL players from the 2009 Retired Players Association Directory was conducted (53.4% completion rate) from March to August 2010.
Results: Over half (52%) used opioids during their NFL career with 71% reporting misuse. Additionally, 15% of NFL misusers currently misused vs. 5% among players who used just as prescribed during their NFL career. Prevalence of current opioid use was 7%-3 times the rate of the general population. Multivariate analyses indicated that significant NFL pain increased the adjusted odds (AOR) of any current opioid use vs. non-use (AOR 6.76, 95%CI 2.88-15.87), as did moderate to severe mental impairment (AOR 1.88, 95%CI 1.19-2.98) and heavy drinking in the past week (AOR 2.15, 95%CI 1.17-3.98). Undiagnosed concussions singly predicted current misuse vs. use just as prescribed (AOR 4.25, 95%CI 1.12-16.22). Three variables predicted current misuse vs. non-use: significant pain (AOR 8.33, 95%CI 1.98-35.04), undiagnosed concussions (AOR 3.51, 95%CI 1.98-35.04) and heavy drinking (AOR 3.48, 95%CI 1.63-7.41).
Conclusions: Players who misused during their NFL career were most likely to misuse currently compared to others. Current misuse was associated with more NFL pain, undiagnosed concussions and heavy drinking. Longitudinal studies are needed to determine the long term effects of opioid misuse among athletes.
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Getting a Grip on Drinking Behavior: Training Working Memory to Reduce Alcohol Abuse
Katrijn Houben, Reinout Wiers & Anita Jansen
Psychological Science, forthcoming
Abstract:
Alcohol abuse disrupts core executive functions, including working memory (WM)-the ability to maintain and manipulate goal-relevant information. When executive functions like WM are weakened, drinking behavior gets out of control and is guided more strongly by automatic impulses. This study investigated whether training WM restores control over drinking behavior. Forty-eight problem drinkers performed WM training tasks or control tasks during 25 sessions over at least 25 days. Before and after training, we measured WM and drinking behavior. Training WM improved WM and reduced alcohol intake for more than 1 month after the training. Further, the indirect effect of training on alcohol use through improved WM was moderated by participants' levels of automatic impulses: Increased WM reduced alcohol consumption in participants with relatively strong automatic preferences for alcohol. These findings are consistent with the theoretical framework and demonstrate that training WM may be an effective strategy to reduce alcohol use by increasing control over automatic impulses to drink alcohol.
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Decisional styles and risk of problem drinking or gambling
J.G. Phillips & R.P. Ogeil
Personality and Individual Differences, September 2011, Pages 521-526
Abstract:
Addictive behaviours indicate a deficit in self regulation, with a general predisposition towards addiction implied by comorbid addictive behaviours. To determine whether common or differing decisional styles were associated with alcohol and gambling problems university students (n = 462) completed online the Melbourne Decision Making Questionnaire, Alcohol Use Disorders Identification Test, and the South Oaks Gambling Screen to assess their alcohol use, and gambling patterns. There was some comorbidity between those at risk for alcohol and gambling-related problems, with both groups frequenting more gaming venues, however, participants at risk for alcohol related problems differed in their decisional styles from those at risk for gambling problems. A greater risk of alcohol related problems was linked to lower vigilance scores and increased tendencies towards procrastination. A higher risk of gambling problems was associated with lower decisional self-esteem and an increased proneness to hypervigilance or panic. Therefore, while a predisposition towards addiction manifests as a preference for addictive behaviour, it is associated with different decisional styles. Problem drinkers are more likely to have an avoidant decisional style, while problem gamblers are not confident in their ability to make decisions, and their decisions feel pressured.
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Stephen Brown & Miles Richardson
Health Education & Behavior, forthcoming
Background: Distressing imagery may inhibit health communications by inducing audiences to reduce distress by avoiding attention to persuasive messages.
Method: This study used eye-tracking methods to compare gaze time allocated to a persuasive textual message, accompanied by either distressing high-resolution color images or less distressing two-color images with degraded outline and detail.
Results: Participants in the distressing images condition showed lower intentions to reduce drinking in the following 3 months, which may have been mediated by lower gaze time to textual elements of the message. The effect was stronger in participants who both scored lower on dispositional mental disengagement and were more vulnerable to alcohol-related problems.
Conclusions: These findings suggest that distressing imagery may inhibit persuasion by reducing audience attention to message components. Implications for message design are discussed.
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Growing Internet Use May Help Explain The Rise In Prescription Drug Abuse In The United States
Anupam Jena & Dana Goldman
Health Affairs, June 2011, Pages 1192-1199
Abstract:
The rising availability through the Internet of commonly abused prescription drugs has raised public health concerns. We examined whether the growth of US prescription drug abuse may be explained by the parallel growth in high-speed Internet use. We find that for every 10 percent increase in high-speed Internet use at the state level, associated treatment facility admissions for prescription drug abuse rose by 1 percent. Admissions for abuse of alcohol, cocaine, and heroin, which are not readily purchased online, had minimal or negative growth during the same period. The results suggest that better surveillance of online prescription drug sales is warranted, and aggressive efforts to curb illegitimate online pharmacies may be necessary.
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City-wide drug testing using municipal wastewater: A new tool for drug epidemiology
Caleb Banta-Green & Jennifer Field
Significance, June 2011, Pages 70-74
Abstract:
Drug users do not want to be identified and do not want to reply to surveys. So how do you find out how many of them there are? The answer lies below the city streets. Caleb Banta-Green and Jennifer Field delve deep.
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Patrick Quinn & Kim Fromme
Journal of Studies on Alcohol and Drugs, July 2011, Pages 622-632
Objective: Although alcohol use and related problems are highly prevalent in emerging adulthood overall, college students drink somewhat more than do their peers who do not attend college. The personal or social influences underlying this difference, however, are not yet well understood. The present study examined whether personality traits (i.e., self-regulation and sensation seeking) and peer influence (i.e., descriptive drinking norms) contributed to student status differences.
Method: At approximately age 22, 4-year college students (n = 331) and noncollege emerging adults (n = 502) completed web-based surveys, including measures of alcohol use, alcohol-related problems, personality, and social norms.
Results: College students drank only slightly more heavily. This small difference, however, reflected personality suppression. College students were lower in trait-based risk for drinking, and accounting for traits revealed a stronger positive association between attending college and drinking more heavily. Although noncollege emerging adults reported greater descriptive drinking norms for social group members, norms appeared to more strongly influence alcohol use among college students. Finally, despite drinking less, noncollege individuals experienced more alcohol-related problems.
Conclusions: The association between attending college and drinking heavily may be larger than previously estimated, and it may be masked by biased selection into college as a function of both self-regulation and sensation seeking. Differing patterns of alcohol use, its predictors, and its consequences emerged for the college and noncollege samples, suggesting that differing intervention strategies may best meet the needs of each population.
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William Rauch et al.
Journal of Experimental Criminology, June 2011, Pages 127-148
Abstract:
This study investigated, under real-world conditions, whether a statewide 2-year administrative ignition interlock license restriction program in Maryland was effective in reducing subsequent alcohol-related traffic violations among multiple offenders and whether any reductions in recidivism could be maintained after the program ended and interlock license restrictions were removed. A total of 1,927 drivers eligible for relicensure were randomly assigned to either the 2-year interlock license restriction program or the normal and customary sanctions afforded multiple offenders in Maryland. Recidivism was defined as incurring a subsequent alcohol-impaired driving violation during the 2-year intervention or 2-year postintervention periods. Compared to the control group, participation in the interlock license restriction program reduced drivers' hazard (or risk) of a subsequent alcohol-impaired driving offense by a statistically significant 36% during the 2-year intervention, 26% during the 2-year postintervention period, and 32% during the entire 4-year study period. This investigation of interlock program effectiveness is the first to report significantly lower recidivism among the interlock group than its control group after the ignition interlock license restriction program ended. Possible reasons for this novel finding and areas for future research are discussed.
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Sheryl Hemphill et al.
Health Education & Behavior, forthcoming
Context: School suspension may have unintended consequences in contributing to problem behaviors, including dropping out from school, substance use, and antisocial behavior. Tobacco use is an early-onset problem behavior, but prospective studies of the effects of suspension on tobacco use are lacking.
Method: Longitudinal school-based survey of students drawn as a two-stage cluster sample, administered in 2002 and 2003, in Washington State, United States, and Victoria, Australia. The study uses statewide representative samples of students in Grades 7 and 9 (N = 3,599).
Results: Rates of tobacco use were higher for Victorian than Washington State students. School suspension remained a predictor of current tobacco use at 12-month follow-up, after controlling for established risk factors including prior tobacco and other drug use for Grade 7 but not Grade 9 students.
Conclusions: School suspension is associated with early adolescent tobacco use, itself an established predictor of adverse outcomes in young people. Findings suggest the need to explore process mechanisms and alternatives to school suspensions as a response to challenging student behavior in early adolescence.
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The Effects of Family Structure on African American Adolescents' Marijuana Use
Jelani Mandara, Sheba Rogers & Richard Zinbarg
Journal of Marriage and Family, June 2011, Pages 557-569
Abstract:
The relationship between family structure and marijuana use throughout adolescence was assessed among 1,069 African Americans from the NLSY. A model was also tested suggesting that the effects of family structure on marijuana use would be mediated by poverty, neighborhood quality, and adolescents' self-control. As most prior studies have found, family structure was not related to female adolescents' marijuana use. For young men, being raised with both biological parents was associated with less marijuana use throughout adolescence compared to those whose mothers never married, divorced early and never remarried, or divorced and remarried. Some support for the model was also found. We concluded that being raised without the presence of a biological father is a risk factor for marijuana use among young men, but African American young women from single-parent households have unique resources that protect them from marijuana use. Understanding those resources may offer insight into prevention programs for other youth.
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Drug and Alcohol Involvement in Four Types of Fatal Crashes
Eduardo Romano & Robert Voas
Journal of Studies on Alcohol and Drugs, July 2011, Pages 567-576
Objective: The aim of this study was to explore the relationship of drunk and drugged driving to the occurrence of fatal crashes associated with speeding, failure to obey/yield, inattention, and seat belt nonuse.
Method: We examined data for fatally injured drivers involved in single-vehicle crashes killed in states in which more than 79% of the drivers were tested for drugs other than alcohol and had a known result.
Results: About 25% of the drivers tested positive for drugs, a figure almost double that estimated by the 2007 National Roadside Survey. Cannabinoids and stimulants each contributed to about 23% of the drug-positive results (6% among all fatally injured single-vehicle drivers). Stimulants more than cannabinoids were found to be associated with the four types of crashes under study. Some drugs showed a protective effect over the four crash types under study. Significant interactions between drugs and alcohol were observed. Stimulants contributed to the different types of fatal crashes irrespective of the levels of alcohol consumed by the drivers.
Conclusions: This study provides further evidence of a link between drug consumption and fatal crashes. It also opens the door to some interesting and sometimes unexpected questions regarding the way drugs contribute to crashes, which we found varies depending on the type of crash considered, the class of drug, and the presence of alcohol. Research is also needed on drugs that could have a protective effect on the occurrence of fatal crashes. These findings could be highly relevant to the design of drug-related traffic laws and programs targeted at curbing drugged driving.
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James Nonnemaker & Matthew Farrelly
Journal of Health Economics, May 2011, Pages 560-567
Abstract:
Existing evidence for the role of cigarette excise taxes and prices as significant determinants of youth smoking initiation is mixed. A few studies have considered the possibility that the impact of cigarette taxes and prices might differ by gender or race/ethnicity. In this paper, we address the role of cigarette taxes and prices on youth smoking initiation using the National Longitudinal Survey of Youth 1997 cohort and discrete-time survival methods. We present results overall and by gender, race/ethnicity, and gender by race/ethnicity. We examine initiation over the age range during which youth are most at risk of initiation and over a period in which substantial changes have occurred in tax and price. The result for cigarette excise taxes is small and mixed across alternative specifications, with the effect strongest for black youth. Cigarette prices are more consistently a significant determinant of youth smoking initiation, especially for black youth.
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Dan Werb et al.
Journal of Epidemiology & Community Health, forthcoming
Background: Anti-illicit-drug public-service announcements (PSAs) have become a cornerstone of drug policy in the USA. However, studies of the effectiveness of these interventions have not been subjected to a systematic evaluation.
Methods: The authors searched 10 electronic databases along with major conference abstract databases (from inception until 15 February 2010) for all articles and abstracts that evaluated the effectiveness of anti-illicit-drug PSAs. The authors evaluated all studies that assessed intention to use illicit drugs and/or levels of illicit-drug use after exposure to PSAs, and conducted meta-analyses of these studies.
Results: The authors identified seven randomised trials (n=5428) and four observational trials (n=17 404). Only one randomised trial showed a statistically significant benefit of PSAs on intention to use illicit drugs, and two found evidence that PSAs significantly increased intention to use drugs. A meta-analysis of eligible randomised trials demonstrated no significant effect. Observational studies showed evidence of both harmful and beneficial effects.
Conclusion: Existing evidence suggests that the dissemination of anti-illicit-drug PSAs may have a limited impact on the intention to use illicit drugs or the patterns of illicit-drug use among target populations.
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Economic Analysis of Methamphetamine Prevention Effects and Employer Costs
Max Guyll, Richard Spoth & Max Crowley
Journal of Studies on Alcohol and Drugs, July 2011, Pages 577-585
Objective: The goal of this research was to evaluate economically three interventions designed to prevent substance use in general populations of adolescents, specifically focusing on the prevention of methamphetamine use and its subsequent benefits to employers.
Method: In a randomized, controlled trial, three preventive interventions were delivered to 6th- or 7th-grade youth in 58 Iowa school districts, with 905 of these youth (449 girls) providing follow-up assessments as 12th graders. Intervention conditions included the family-focused Iowa Strengthening Families Program (ISFP), the school-based Life Skills Training (LST) program, and a combined condition of both the Strengthening Families Program: For Parents and Youth 10-14 (SFP10-14; an ISFP revision) plus LST (LST + SFP10-14). Analyses based on intervention costs, 12th-grade methamphetamine use rates, and methamphetamine-related employer costs yielded estimates of intervention cost, cost-effectiveness, benefit-cost ratio, and net benefit.
Results: The ISFP lowered methamphetamine use by 3.9%, cost $25,385 to prevent each case, and had a benefit-cost ratio of 3.84, yielding a net benefit of $2,813 per youth. The LST program reduced methamphetamine use by 2.5%, required $5,122 per prevented case, and had a benefit-cost ratio of 19.04, netting $2,273 per youth. The combined LST SFP10-14 prevention condition lowered methamphetamine use rates by 1.8%, cost $62,697 to prevent each case, had a benefit-cost ratio of 1.56, and netted $620 per youth. Findings were robust after varying a number of key parameters across a range of plausible values.
Conclusions: Substance use prevention programming is economically feasible, particularly for effective interventions that have lower per person treatment delivery costs.