Impact of banning alcohol on outpatient visits in Barrow, Alaska.

CONTEXT: Community availability of alcohol affects alcohol consumption patterns and alcohol-related health and social problems. In Barrow, Alaska, an isolated community at the northernmost reaches of the United States, during a 33-month period, possession and importation of alcohol were legal, completely banned, made legal again, and then banned again. OBJECTIVE: To determine the impact of these public policy changes on alcohol-related outpatient visits at the area hospital. DESIGN: Retrospective review of outpatient records; time-series analysis of alcohol-related visits with respect to community alcohol policy. MAIN OUTCOME MEASURES: Total monthly outpatient visits for alcohol-related problems. RESULTS: There was a substantial decrease in the number of alcohol-related outpatient visits when the ban on possession and importation was imposed compared with baseline. When the ban was lifted, outpatient visits increased; when the ban was reimposed, the number of outpatient visits again decreased. Interrupted time-series analyses confirm that the alcohol ban, its lifting, and its reimposition had a statistically significant and negative effect on the number of alcohol-related outpatient visits (P<.05). CONCLUSION: In a geographically isolated community, the prohibition of alcohol can be an effective public health intervention, reducing the health problems associated with alcohol use.

The impact of alcohol beverage container warning labels on alcohol-impaired drivers, drinking drivers and the general population in northern California.

Using data collected in a random-digit dial telephone survey in a northern California county, an examination of the impact of alcohol beverage container warning labels was conducted. In a broadly conceived approach to the possible impact of warning labels, we examined recall and content as well as risk assessment and the use of warning labels as public policy to combat drunk driving. In a repeated measures pre- and post-design, respondents reported significantly higher recall of labels and their content in the post-introduction period. Evidence from a multivariate analysis of post-introduction data indicate that both drinking drivers and impaired drivers (based on self-reports) were more likely to recall the labels and their content, an indication that warning labels are reaching "at risk" individuals. In addition, increases in the perceived risk of driving and drinking are consistent with the notion that warning labels, as one part of a larger social movement, are helping to create an atmosphere in which drinking and driving is less acceptable. However, our findings also indicate that, at least among at risk drinking and impaired drivers, increased use of public policies such as warning labels in an effort to reduce the negative consequences of drinking and driving may generate a public opinion backlash.

Understanding U.S. alcohol consumption with social and economic factors: a multivariate time series analysis, 1950-1986.

The contribution of social and economic variables to changes in per capita alcohol consumption occurring between 1950 and 1986 is examined within a multivariate time series analysis framework. Specifically, we consider the net effects of family income, age structure of the population, marital instability, female labor force participation, real alcohol price and daily life routines on total alcohol consumption. Our findings indicate that changes in the population age structure and in daily life routines were associated with predicted changes in consumption over the period studied. They also indicate associations between marital instability and female labor force participation and consumption, although in the direction contrary to our prediction. Unlike a number of previous studies in which economic variables were found to be the major determinants of consumption trends, we find that family income and the price of alcohol play a minor role in the model we estimated. These results indicate that social structural factors have greater utility for our understanding of alcohol consumption patterns, and, by implication, for attempts to reduce alcohol-related social problems, than do economic factors.

Effect of alcoholism treatment on cirrhosis mortality: a 20-year multivariate time series analysis.

Substantial empirical evidence suggests that alcohol consumption is an important cause of cirrhosis mortality levels. However, recent research has failed to find the expected positive relationship between consumption and cirrhosis mortality, in both the United States and Canada, when data from the mid-1970s through the late 1980s are analysed. Although recent studies have investigated a number of possible explanations, this study examines the hypothesis that an increase in the provision of treatment for alcoholism resulted in a disjuncture in the established relationship between consumption and cirrhosis deaths. This hypothesis is evaluated with a multivariate time series model in which the relationship between consumption and cirrhosis mortality is estimated with controls for treatment and the unemployment rate, using data from the US state of North Carolina. The results indicate that with treatment controlled, changes in cirrhosis mortality are independent of consumption. Further, treatment has a significant short-term lagged effect on cirrhosis mortality, suggesting that the impact of treatment on chronic alcohol abusers may be one of delaying the consequences of such abuse.

Family, intimacy, and homicide: a macro-social approach.

The study of violence among sexual intimates and family members within sociology is currently developing along two lines that are methodologically distinct. A macrosocial approach analyzes rates of homicide for cities, metropolitan areas, and states, while a microsocial approach, which has focused largely on family violence, relies on surveys to study self-reports of assaultive violence. As the two traditions have developed, they have emphasized a different range of independent variables and types of violence. The macro-social tradition has focused on subcultures, economic deprivation, and trends in lifestyles and daily activity patterns. The micro-social researchers have emphasized the impact of social change on marital roles and expectations, conflict, power and exchange within interpersonal relationships, and the impact of historical patterns and cultural norms concerning the patterns of violence within families and sexually intimate relationships. Similarly, one tradition focuses almost exclusively on homicide while the other has generally studied serious, but not lethal assaults. Ultimately the two traditions could lead to similar conclusions about the causes of violence among intimates. A convergence of findings would enhance confidence in the validity of results, while discrepant findings would point to flaws in theory or method. This paper begins to consider convergences and differences by using the techniques that have been developed in the macro-social tradition along with hypotheses drawn from both traditions. Data on four specific types of homicide from a sample of 299 central cities are examined in a series of parallel models which include indicators of the causes of violence derived from both traditions.