Comments on Rossow: The alcohol advertising ban in Norway: Effects on recorded alcohol sales.

Rossow conducts an interrupted-auto-regressive integrated moving average (ARIMA) analysis of alcohol advertising bans in Norway for the 47-year period from 1960 through 2006. Norway's comprehensive restrictions on alcohol advertising occurred in 1975 and 1977. Rossow uses annual data on recorded alcohol sales (litres of pure alcohol per capita) to determine an 'immediate and lasting effect' from the July 1975 ban of about -7%. A lasting effect is not apparent from a plot of the sales data. The sales data are adjusted for changes in real wages and real prices, although the exact method of adjustment and empirical results are not reported, for example, do the wage and price variables have the expected signs? As part of the analysis, Rossow offers two critical comments on my own work in this area. Her comments are incorrect. The purpose of this commentary is to provide a correct reporting of my methods and results. Also, as I have conducted an interrupted-ARIMA analysis and engaged in a dynamic time-series analysis of alcohol advertising, I assess the appropriateness of Rossow's ARIMA analysis for Norway's advertising bans.

What happens to drinking when alcohol policy changes? A review of five natural experiments for alcohol taxes, prices, and availability.

Natural experiments are an important alternative to observational and econometric studies. This paper provides a review of results from empirical studies of alcohol policy interventions in five countries: Denmark, Finland, Hong Kong, Sweden, and Switzerland. Major policy changes were removal of quotas on travelers' tax-free imports and reductions in alcohol taxes. A total of 29 primary articles are reviewed, which contain 35 sets of results for alcohol consumption by various subpopulations and time periods. For each country, the review summarizes and examines: (1) history of tax/quota policy interventions and price changes; (2) graphical trends for alcohol consumption and liver disease mortality; and (3) empirical results for policy effects on alcohol consumption and drinking patterns. We also compare cross-country results for three select outcomes-binge drinking, alcohol consumption by youth and young adults, and heavy consumption by older adults. Overall, we find a lack of consistent results for consumption both within- and across-countries, with a general finding that alcohol tax interventions had selective, rather than broad, impacts on subpopulations and drinking patterns. Policy implications of these findings are discussed.

Alcohol prices, taxes, and alcohol-related harms: A critical review of natural experiments in alcohol policy for nine countries.

OBJECTIVE: Evidence for alcohol-price policy relies heavily on aggregate econometric studies for the United States. Prior reviews of prices and alcohol-related harms include only a few studies based on natural experiments. This study provides a comprehensive review of natural experiments for a wide variety of harms from studies published during 2003 to 2015. We examine policy changes that importantly affected alcohol taxes and prices, and related changes in availability. METHODS: Forty-five studies met inclusion criteria, covering nine countries: Australia, Denmark, Finland, Hong Kong, Iceland, Russia, Sweden, Switzerland, and United States. Some studies cover more than one harm or country, and there are 69 outcomes for review. Summaries are provided for five outcome groups: alcohol-related mortality and hospitalizations; assaults and other crime; drink-driving; intoxication; and survey-indexes for dependency. The review notes both positive/mixed results and negative/null results. RESULTS: Findings indicate that changes in taxes and prices have selective effects on harms. Mortality outcomes are positive for liver disease and older persons, especially in Finland and Russia. Mostly null results for assaults and drink-driving are found for five countries. Intoxication results for Nordic countries are mixed for selective subpopulations. Results for survey indexes are mixed, with no strong pattern of outcomes within or across countries. CONCLUSION: Prior reviews stress taxes as a comprehensive and cost-effective intervention for addressing alcohol-related harms. A review of natural experiments indicates the confidence placed on this measure is too high, and natural experiments in alcohol policy had selective effects on various subpopulations.

Binge drinking and alcohol prices: a systematic review of age-related results from econometric studies, natural experiments and field studies.

BACKGROUND: Heavy episodic ("binge") drinking of alcohol has serious public health implications, especially for youth and young adults. Previous summaries and surveys have failed to address in a comprehensive manner the effects of alcohol prices on binge drinking by gender or age group. METHODS: A qualitative systematic review is performed for effects of alcohol prices (or tax surrogates) on binge drinking for three age groups: youth, young adults, and adults. Outcomes examined include binge participation, intensity and frequency. Criteria for data collection and potential sources of bias are discussed, including adequacy of price data. Price-binge relationships are judged using a 95% confidence interval (p ≤ 0.05) for statistical significance. RESULTS: Fifty-six relevant econometric studies were found, with studies and results distributed equally among three age groups. Also found were five natural experiments for tax reductions and six field studies. Null results or mixed results are found in more than half of the studies. The body of evidence indicates that binge drinkers are not highly-responsive to increased prices. Non-responsiveness holds generally for younger and older drinkers and for male and female binge drinkers alike. A limitation of the current literature is that results are only available for higher-income countries. CONCLUSIONS: Increased alcohol taxes or prices are unlikely to be effective as a means to reduce binge drinking, regardless of gender or age group.

Alcohol affordability and alcohol demand: cross-country trends and panel data estimates, 1975 to 2008.

BACKGROUND: Relatively little is known about cross-country differences in alcohol affordability or factors that determine differences in affordability over time. This information is potentially important for alcohol policy, especially policies that focus on higher taxes or prices to reduce total alcohol consumption. This study estimates cross-country alcohol consumption relationships using economic models incorporating income and prices and alternative models based on alcohol affordability. The data and analysis are restricted to higher income countries. METHODS: Data for alcohol consumption per capita (ages 15+) are analyzed for 2 samples: first, 17 countries in the Organisation for Economic Co-operation and Development for the period 1975 to 2000; second, 22 countries in the European Union for the period from 2000 to 2008. Panel data models are utilized, with country and time fixed-effects to control for confounding influences. In economic demand models, covariates are real per capita income and real alcohol price indices. In affordability models, income is divided by prices to yield an index of alcohol affordability. RESULTS: Analysis of data trends reveals that much of the increase in affordability is due to rising real incomes, and not falling real prices. Economic models of demand perform slightly better statistically, but differences are not substantial as income and affordability are highly correlated. For both samples, exogenous rates of growth of alcohol consumption are negative. Price and income elasticities, on average, are within the range of prior estimates. Affordability elasticities are between 0.21 and 0.25. CONCLUSIONS: Although alcohol affordability is a valid concept statistically, its use in policy discussions tends to hide underlying causes of changes in affordability. A better approach is a comparison and analysis of trends and cross-country differences in real incomes and real alcohol prices together with the affordability index. Country-level analysis of income and price elasticities also is required.

Gender differences in alcohol demand: a systematic review of the role of prices and taxes.

Gender differences in drinking patterns are potentially important for public policies, especially policies that rely extensively on higher alcohol taxes and prices. This paper presents a systematic review of alcohol prices and gender differences in drinking and heavy drinking by adults and young adults. Starting with a database of 578 studies of alcohol demand and other outcomes, 15 studies are reviewed of adult drinking including discussion of samples, measurement issues, econometric models, special variables, and key empirical results. A similar discussion is presented for eight studies of drinking by young adults, ages 18-26 years. Four conclusions are obtained from the review. First, adult men have less elastic demands compared with women. Second, there is little or no price response by heavy-drinking adults, regardless of gender. Third, although the sample is small, price might be important for drinking participation by young adults. Fourth, the results strongly suggest that heavy drinking by young adults, regardless of gender, is not easily dissuaded by higher prices. Policy implications, primary study limitations, and suggestions for future research are discussed.

Estimating the price elasticity of beer: meta-analysis of data with heterogeneity, dependence, and publication bias.

Precise estimates of price elasticities are important for alcohol tax policy. Using meta-analysis, this paper corrects average beer elasticities for heterogeneity, dependence, and publication selection bias. A sample of 191 estimates is obtained from 114 primary studies. Simple and weighted means are reported. Dependence is addressed by restricting number of estimates per study, author-restricted samples, and author-specific variables. Publication bias is addressed using funnel graph, trim-and-fill, and Egger's intercept model. Heterogeneity and selection bias are examined jointly in meta-regressions containing moderator variables for econometric methodology, primary data, and precision of estimates. Results for fixed- and random-effects regressions are reported. Country-specific effects and sample time periods are unimportant, but several methodology variables help explain the dispersion of estimates. In models that correct for selection bias and heterogeneity, the average beer price elasticity is about -0.20, which is less elastic by 50% compared to values commonly used in alcohol tax policy simulations.

Meta-analysis of alcohol price and income elasticities - with corrections for publication bias.

BACKGROUND: This paper contributes to the evidence-base on prices and alcohol use by presenting meta-analytic summaries of price and income elasticities for alcohol beverages. The analysis improves on previous meta-analyses by correcting for outliers and publication bias. METHODS: Adjusting for outliers is important to avoid assigning too much weight to studies with very small standard errors or large effect sizes. Trimmed samples are used for this purpose. Correcting for publication bias is important to avoid giving too much weight to studies that reflect selection by investigators or others involved with publication processes. Cumulative meta-analysis is proposed as a method to avoid or reduce publication bias, resulting in more robust estimates. The literature search obtained 182 primary studies for aggregate alcohol consumption, which exceeds the database used in previous reviews and meta-analyses. RESULTS: For individual beverages, corrected price elasticities are smaller (less elastic) by 28-29 percent compared with consensus averages frequently used for alcohol beverages. The average price and income elasticities are: beer, -0.30 and 0.50; wine, -0.45 and 1.00; and spirits, -0.55 and 1.00. For total alcohol, the price elasticity is -0.50 and the income elasticity is 0.60. CONCLUSIONS: These new results imply that attempts to reduce alcohol consumption through price or tax increases will be less effective or more costly than previously claimed.

What is learned from longitudinal studies of advertising and youth drinking and smoking? A critical assessment.

This paper assesses the methodology employed in longitudinal studies of advertising and youth drinking and smoking behaviors. These studies often are given a causal interpretation in the psychology and public health literatures. Four issues are examined from the perspective of econometrics. First, specification and validation of empirical models. Second, empirical issues associated with measures of advertising receptivity and exposure. Third, potential endogeneity of receptivity and exposure variables. Fourth, sample selection bias in baseline and follow-up surveys. Longitudinal studies reviewed include 20 studies of youth drinking and 26 studies of youth smoking. Substantial shortcomings are found in the studies, which preclude a causal interpretation.

Effects of youth, price, and audience size on alcohol advertising in magazines.

In this paper, we study the effects of youth readership, price of advertisements, and audience size on alcohol advertising in 35 major magazines. The regressions also account for readership demographics (adult reader age, income, gender, race), magazine characteristics (newsstand sales, number of annual issues), and type of beverage (beer, wine, spirits). Using count data models, the results indicate significant effects for price, audience size, and adult demographics, but fail to support claims that alcohol advertisers target adolescent readers.