Boston - A new study by Boston University and Boston Medical Center (BMC) researchers reveals that U.S. states with stronger alcohol policies have lower rates of youth overall drinking and binge drinking. The study's results, published in the journal Pediatrics, further suggest that the link is largely a result of policies intended mostly for adults and their effects on reducing adult binge drinking.
The first-of-its kind study, led by a multi-disciplinary research team at BMC and the BU School of Public Health (BUSPH), reviewed data on 29 youth-specific and adult policies on drinking to establish scores characterizing each state's alcohol policy "environment." Higher scores were given to states with more effective and better-implemented policies. The research team then related those policy scores to youth drinking data from states' Youth Risk Behavior Surveys from 1999 to 2011.
The study found that each 10 percentage point increase in the strength of a state's policy environment was related to an 8 percent reduction in the likelihood of youth drinking any alcohol, and a 7 percent reduction in the likelihood of binge drinking, defined as drinking past the point of intoxication.
"Our results strongly support other evidence about the power of public policies to reduce excessive drinking and related medical and social problems," said Timothy Naimi, MD, MPH, a pediatrician at BMC and associate professor of public health and medicine at BUSPH, who was the study's lead investigator.
By subcategorizing policies into youth-specific and adult laws, researchers were able to explore the associations of youth drinking with adult alcohol policies, independent of the association between youth drinking and youth-targeted policies. Examples of adult alcohol policies include higher alcohol taxes, having fewer outlets licensed to sell alcohol, bans on happy hours, restricted hours of alcohol sales, and laws prohibiting service to intoxicated adults.
"Overall, these findings lend support to the Institute of Medicine's judgment that parents and adults must be a key target of strategies to reduce and prevent underage drinking," the authors concluded.
Naimi said the study does not "discount" the value of youth-specific laws.
"Raising the minimum legal drinking age to 21, for example, has saved thousands of lives," Naimi said. However, he added, "adults matter, and when it comes to influencing kids, how adults drink is more important than what they might say about underage drinking."
Ziming Xuan, ScD, SM, MA, assistant professor of community health sciences at BUSPH and the study's first author, said the aggregation and categorizing of state policies was, in itself, an innovation in alcohol policy evaluation.
"By investigating how these relationships with youth drinking interplay with the adult drinking environment, we were able to take our analyses much further," Xuan said. "Adult-oriented alcohol policies likely influence youth via parallel pathways: Some of the effect is directly on youth, and some is indirect through its effects on adults."
Naimi said, "When it comes to saving young people's lives, the bottom line is that state legislators can make improvements by adopting and strengthening policies that curb excessive drinking among the entire population. Youth drinking is too often treated as an age-specific problem, and focusing solely on youth-specific interventions, while ignoring adult drinking behavior, is a bit like putting a screen door on a submarine."
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The study was supported in part by the National Institutes of Health under notice of grant award number AA018377. Additional authors include Jason Blanchette, MPH; Toben Nelson, ScD, MPH; Thien Nguyen, MPH; Scott E. Hadland MD, MPH; Nadia Oussayef, JD, MPH; and Timothy Heeren, PhD.
About Boston Medical Center
Boston Medical Center is a private, not-for-profit, 482-bed, academic medical center that is the primary teaching affiliate of Boston University School of Medicine. It is the largest and busiest provider of trauma and emergency services in New England. Committed to providing high-quality health care to all, the hospital offers a full spectrum of pediatric and adult care services including primary and family medicine and advanced specialty care with an emphasis on community-based care. Boston Medical Center offers specialized care for complex health problems and is a leading research institution, receiving more than $118 million in sponsored research funding in fiscal year 2014. It is the 11th largest recipient of funding in the U.S. from the National Institutes of Health among independent hospitals. In 1997, BMC founded Boston Medical Center Health Plan, Inc., now one of the top ranked Medicaid MCOs in the country, as a non-profit managed care organization. It does business in Massachusetts as BMC HealthNet Plan and as Well Sense Health Plan in New Hampshire, serving more than 315,000 people, collectively. Boston Medical Center and Boston University School of Medicine are partners in the Boston HealthNet - 14 community health centers focused on providing exceptional health care to residents of Boston. For more information, please visit http://www.bmc.org.
About Boston University School of Public Health
The Boston University School of Public Health, founded in 1976, offers master's and doctoral-level education in eight public health concentrations including biostatistics, environmental health, epidemiology, health law, bioethics & human rights; health policy & management, international health, and community health sciences. The faculty conducts policy-changing public health research around the world with the mission of improving the health of populations, especially the disadvantaged, underserved and vulnerable, locally, nationally and internationally.
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PEDIATRICS