Alcohol Policies in U.S. States, 1999-2018

Abstract

Objective: U.S. policymakers and public health practitioners lack composite indicators (indices) to assess and compare the restrictiveness of state-level alcohol policy environments, conceptualized as the presence of multiple policies in effect in a particular place and time. The purposes of this study were to characterize the alcohol policy environment in each U.S. state and Washington, DC, in 2018, and to examine changes during the past 20 years.

Method: State-specific Alcohol Policy Scale (APS) scores from 1999 to 2018 were based on 29 policies, after weighting each present policy by its efficacy and degree of implementation. Modified APS scores were also calculated on the basis of two sets of mutually exclusive policy subgroups.

Results: APS scores in 2018 varied considerably between states, ranging from 25.6 to 67.9 on a theoretical scale of 0 to 100; the median score was 43.5 (based on a 0-100 range), and 43 states had scores less than 50. The median change in state APS scores from 1999 to 2018 was positive (+4.9, range: -7.4 to +10.3), indicating increases in the restrictiveness of policy environments, with decreases in only five states. The increases in APS scores were primarily attributable to the implementation of stronger impaired-driving laws, whereas policies to reduce excessive drinking were unchanged. There was no correlation between states' excessive drinking policy scores and their impaired-driving scores (r = .05, p = .74).

Conclusions: Based on this policy scale, few states have restrictive policy environments. Although states adopted policies targeting impaired driving during the study period, there was no change in policies to reduce excessive drinking.

Figure 1.

Rankings of states based on the restrictiveness of alcohol policy environment characterized by Alcohol Policy Scale scores. States are organized from most restrictive to least restrictive policy environment, with higher scores representing more restrictive policies.

Figure 2.

Relationship between policies targeting excessive consumption versus policies targeting impaired driving,^a and relationship between policies targeting adults versus policies targeting underage youth,^b U.S. states, 2018. ^aPolicies targeting excessive consumption consisted of 21 policies that regulate alcohol production, sales, consumption, or furnishing practices. Policies targeting impaired driving consisted of 8 policies aimed at preventing an already intoxicated person from driving a motor vehicle. ^bPolicies targeting adults consisted of 19 policies that are aimed at the general population and not specific to targeting individuals under the legal drinking age (<21 years of age), whereas policies targeting youth consisted of 10 policies aimed at reducing or preventing access to alcohol specifically among individuals under the legal drinking age (<21 years of age).

Figure 3.

Change in median scores for state alcohol policy subgroups, 1999–2018. Lines consist of two sets of mutually exclusive policy subgroups. The first set of mutually exclusive subgroups of policies consisted of adult policies as a subgroup and youth policies as a subgroup. Adult policies consisted of the 19 policies that were not specific to individuals under the legal drinking age, whereas youth policies consisted of 10 policies aimed at reducing or preventing access to alcohol specifically among individuals under the legal drinking age. The second set of mutually exclusive subgroups of policies consisted of excessive drinking policies as a subgroup and impaired driving policies as a subgroup. Excessive drinking policies consisted of 21 policies that regulate alcohol production, sales, consumption, or furnishing practices. Impaired driving policies consisted of 8 policies aimed at preventing an already intoxicated person from driving a motor vehicle.