Impact  of  Washington  State  Initiative  1183    (alcohol  system  de-­‐regulation)  Na#onal  Preven#on  Network  (NPN)  Conference  November  17,  2015    

Mary  Segawa,  Washington  State  Liquor  &  Cannabis  Board  Rusty  Fallis,  JD,  Washington  State  Office  of  the  AQorney  General  

Grace  Hong,  PhD,  Washington  State  Division  of  Behavioral  Health  &  Recovery  Julia  Dilley,  PhD,  Multnomah  County  Health  Department/Oregon  Public  Health  Division    

Acknowledgements  Many  thanks  to  mul.ple  partners  who  supported  this  study  

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•  I-­‐1183  Study  Advisory  Team  •  Rusty  Fallis,  Washington  State  Office  of  the  

ACorney  General  –  advisory  chair  •  Rick  Garza  &  Mary  Segawa,  WA  State  Liquor  and  

Cannabis  Board  •  Michael  Langer,  WA  State  DSHS-­‐Div.  of  Behavioral  

Health  &  Recovery  •  Steve  Schmidt,  Natn’l  Alcohol  Beverage  Control  

AssociaUon  •  Katrina  Hedberg,  PhD,  Oregon  Health  Authority  •  Judy  Cushing,  Oregon  Partnership  •  Leslie  Walker  MD,  SeaCle  Children’s  Hospital  •  Denise  Fitch,  EducaUon  advocate  •  Myra  Parker,  PhD  JD,  University  of  Washington  •  Bill  Kerr  PhD  and    Tom  Greenfield  PhD,    Public  

Health  InsUtute  Alcohol  Research  Group  •  Sondra  Storm,  Multnomah  County  Health  

Department  Strategic  PrevenUon  Framework  

Coordinator  

•  Study  Staff  Team  Members  and  Key  Partners  •  Myde  Boles  PhD,  Susan  Richardson  MPH,  Julie  

Maher  PhD  –  PDES  Oregon  •  Erica  AusUn  PhD,  Bruce  Pinkleton  PhD,  Stacey  

Hust  PhD  –  Washington  State  University  •  Nancy  Sutherland,  University  of  Washington  

Alcohol  and  Drug  Abuse  InsUtute  (ADAI)  •  Atar  Baer  PhD  ,  Jeff  Duchin  MD  and  Nadine  

Chan  PhD,  Public  Health  SeaCle  &  King  County  •  Principal  InvesUgators  

•  Julia  Dilley,  PhD  MES  –  Program  Design  &  EvaluaUon  Services,  Multnomah  County  &  Oregon  Health  Authority    

•  Linda  Becker  PhD  –  Washington  State  Department  of  Social  &  Health  Services    

•  This  study  is  funded  by  Public  Health  Law  Research,  a  naUonal  program  of  the  Robert  Wood  Johnson  FoundaUon  

Objectives  

• Describe  WA  CiUzens’  IniUaUve  1183  

• Discuss  study  findings  regarding  impact  

• Describe  potenUal  policy  implicaUons  

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“Control  State”  •  State  controls  wholesale  level  sales;  some  also  control  retail  •  “State  monopoly”  

“PrivaUzed  State”  (or  privaUzaUon)  •  Private  sector/free  market  -­‐  sUll  with  regulaUons    

Comparing  “apples  and  oranges”  •  Some  states  have  very  good  pracUces  in  privaUzed  systems,  and  some  states  have  poor  pracUces  in  control  systems…  

4  

Vocabulary  Check  

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Background:  Change  in  Law  WA  Ini.a.ve  1183:  PrivaUzaUon  and  deregulaUon  (Nov  2011)    

• Washington  and  Oregon  -­‐  research  grant  to  study  the  real  impacts  

 

6  

Ini.a.ve  Promises   Cri.cal  Concerns  

• More  tax  revenue  

• Greater  convenience  

•  Tight  restricUons  to  protect  youth    

•  Increase  in  availability        

•  Increase  in  negaUve  public  health  outcomes    

Model  for  Change  

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I-­‐1183  

Change  in  Regulatory  Environment    

•  Change  in  Consump.on  (or  predictors)  

•  Benefits  •  Revenue    

•  Costs  •  ER  Visits  •  Thems  

•  Traffic  Crashes  •  AddicUons  Treatment  

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Summary  of  Findings  Implementation date: June 1, 2012 I-­‐1183  

Change  in  Regulatory  Environment    

Change  in  Consump.on  (or  predictors)  

Benefits     Costs  

May  31,  2012  and  before…  

 June  1,  2012  and  amer…  

Changing  Spirits  Sales  Laws  &  Policies    

9  

Summary  of  Findings  to  Date  

10  

I-­‐1183  

Change  in  Regulatory  Environment    

Change  in  Consump.on  (or  predictors)  

Benefits     Costs  

Spirits  Regulatory  Environment  1-­‐2  years  aWer  the  change  in  law    

Increased  availability  •  Spirits  retailers    

•  328  to  1400+  •  PotenUal  maximum  hours  of  sale    

•  73  to  140  

Similar  resources  for  enforcement    •  #  of  State  Liquor  Control  Board  (LCB)  officers  

Similar  compliance    •  90%+  refuse  sales  to  underage  operaUves  

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Grace  

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Summary  of  Findings  to  Date  

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I-­‐1183  

Change  in  Regulatory  Environment    

Change  in  Consump.on  (or  predictors)  

Benefits     Costs  

Methods  •  Interrupted  Ume  series  regression  models  

• Main  effect  date:  June  1,  2012  • AdjusUng  for  background  trend,  demographic  changes,  seasonality  

• Generally  looking  at  changes  for  men  and  women,  by  age  group,  when  possible  

   

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Statewide  Youth  Surveys:  5  months  and  2  ½  years  aWer  change  in  law      

Overall,  youth  alcohol  use  &  binge  drinking  con.nued  to  decline  similar  to  recent  trends  &  the  US  trend    

However,  some  predictors  of  future  youth  drinking  ini.ally  increased    

YOUTH:  Alcohol  Consumption  &  Predictors  of  Consumption  

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Current  Alcohol  Use  (30  day)  •  Alcohol  use  conUnued  to  decline  in  all  grades  

•  No  significant  effect  of  policy  on  current  drinking  (30  day)  or  binge  drinking  for  any  age/gender  group  

•  Early  increase  in  days  of  drinking  for  HS  boys  appears  diminished    

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I-1183

•  12th grade boys: 4.2 days/mo in 2010; 4.5 in 2012; 4.2 in 2014

Good  

“Easy  to  get”  Alcohol    •  Previous  reported  increase  in  access  (2012)  for  12th  grade  youth  seems  to  have  diminished  

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I-1183

Good  

Perceived  Peer  Beliefs  •  Overall  significantly  more  pro-­‐alcohol  beliefs  perceived  among  peers  post-­‐law  

 

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I-1183

Good  

Perceived  Parent  Beliefs  •  RelaUvely  pro-­‐alcohol  direcUon  seen  in  2012  seems  stabilized  or  improving  

•  Slight  relaUve  improvement  in  community  adult  beliefs  

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I-1183

“

Good  

Other  measures  •  No  change  in  other  negaUve  impacts  

•  Driving/riding  with  impaired  drivers  

•  About  7%  of  youth  in  all  grades  say  “stole  from  a  store”  is  a  usual  source  of  alcohol  •  Increase  from  3%  in  2008  

•  Among  youth  who  drink,  liquor/spirits  is  the  preferred  beverage  for  •  27%  of  8th  grade  •  39%  of  10th  grade  (41%  among  girls  vs.  35%  boys)  •  42%  of  12th  grade  (46%  among  girls  vs.  38%  boys)   20  

Adult  Alcohol  Consumption  •  Generally,  alcohol  behavior  “bump”  seemed  to  flaCen  out  •  For  example,  increases  in  “binge  drinking”  (below)  we  saw  in  2012  among  men  dropped  back  to  pre-­‐law  levels  

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Source: WA BRFSS 2009-2014, June-December combined. *Data before 2011 may not be comparable to data from 2011 and after due to weighting changes.

I-1183

Adult  Liquor  (Spirits)  Drinking  •  Percent  of  adults    drinking  liquor  increased  

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Source: WA BRFSS 2012-2013, January-May combined

I-1183

Young  Adult  Study  •  Partnered  with  Washington  State  University  on  panel  surveys  (ages  18-­‐29)  and  mulUple  focus  groups  (ages  21+)  

•  Change  in  law  did  not  affect  young  adult  behaviors  •  College  students  may  have  already-­‐high  drinking  rates  

•  Students  think  the  change  in  law  made  spirits  more  accessible,  but  also  more  expensive  •  Easier  to  ask  over-­‐21  peers  to  buy  liquor  •  Easier  to  get  late-­‐night  liquor  •  Easier  for  women  to  buy  liquor  without  feeling  judged    

•  The  influence  of  alcohol  adverUsing  is  strong:  increased  presence  of  alcohol  (spirits)  adverUsing  post-­‐law  could  have  an  effect  on  behaviors   23  

Youth  alcohol  use  &  binge  drinking  con.nued  to  decline  similar  to  recent  trends  &  the  US  trend  •  Some  predictors  of  future  youth  drinking  iniUally  increased,  however  the  impact  diminished  over  Ume    

 

Adult  drinking  increased  slightly  •  “any  alcohol  drinking”  and  spirits-­‐specific  drinking  

Summary  

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Julia  

25  

Summary  of  Findings  to  Date  

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I-­‐1183  

Change  in  Regulatory  Environment    

•  Change  in  Consump.on  (or  predictors)  

Benefits     Costs  

Methods  • MulUple  exisUng  data  systems  in  Washington  • As  for  behaviors,  used  interrupted  Ume  series  regression  models  • Main  effect  date:  June  1,  2012  • AdjusUng  for  background  trend,  demographic  changes,  seasonality  

• Generally  looking  at  changes  for  men  and  women,  by  age  group,  when  possible  

• Summing  effect  sizes  over  24  month  post-­‐law  period    

   

 

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•  Data:  Washington  State  Department  of  Revenue,  total  sales  and  taxes  collected  per  month  

• More  spirits  were  sold  •  About  1.8  million  “extra”  liters  of  spirits  sold  in  Washington  State  by  off-­‐premise  retailers    

•  About  3-­‐4%  increase  overall  by  volume  •  EsUmated  “extra”  $45  million  in  revenue  for  off-­‐premise  sales    •  loss  of  about  $14  million  in  revenue  for  on-­‐premise  sales  

 

 Net  gain  in  spirits  revenue  about  $31  million    

BeneZits:  Revenue    

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Costs:  Alcohol  Thefts  •  No  systemaUcally  collected  total  market  data  available  •  Used  alternaUve  sources  to  summarize  what  is  known  

•  Youth  survey  reports  •  Media  Story  Analysis  •  Police  reports  

•  Themes  •  DramaUc  increase  from  low  them  rate  pre-­‐1183  •  Organized  thems  for  resale  •  Stores  avoid  intervenUon  

•  Conclusion:  theSs  are  a  substan.al  problem  resul.ng  in  increased  spirits  access  and  lost  revenue   29  

Costs:  Emergency  Department  Visits  •  Data:  King  County  (all  residents)  and  Medicaid  (minors)  Emergency  Department  (ED)  visits  •  Alcohol-­‐related  visits  –  direct  or  indirect  cause  

•  Sta.s.cally  significant  increases  in  alcohol-­‐related  ED  visits,  translaUng  to  thousands  of  extra  visits    

•  Minors  (<21):  14%  increase  for  youth  in  King  Co;  25%  increase  for  youth  on  Medicaid  

•  Ages  40+:  14%  increase  •  Effect  stronger  for  boys  vs.  girls  

•  No  change  for  adults  ages  21-­‐39  •  “Bump”  effect  

 

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Costs:  TrafZic  Crashes  Increased  crashes  among  young  drivers  

•  Data:  State  Department  of  TransportaUon  crash  data  for  monthly  Single  Vehicle  Nighwme  Crashes    •  proxy  for  alcohol  impaired  driving  

•  Among  minor  drivers  (<21)  vs.  predicted  crashes  •  35%  increase  among  males  (“extra”  21  crashes/month)  •  30%  increase  among  females*  (“extra”  9  crashes/month)  

•  EsUmated  total  of  700  excess  crashes  among  young  drivers  in  2  year  post-­‐law  period  

•  SubstanUal  “bump”  in  6  months  immediate  post-­‐law  period,  and  overall  rate  remains  higher  than  pre-­‐law  

No  significant  change  among  older  driver  groups    

*  Not  staUsUcally  significant  at  p<.05  

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Unclear  impact:  DUI  and  Alcohol-­‐related  Fatal  Crashes  •  Overall  counts  of  DUI  arrests  and  Fatal  Crashes  declining  –  similar  to  recent  historical  and  naUonal  trends  •  Some  research  on  fewer  DUIs  with  increased  density  of  off-­‐premise  alcohol  retailers  •  This  would  be  unlikely  to  apply  to  minor  drivers  

•  Other  intervenUons  also  implemented  to  reduce  those  impacts  during  this  period  

•  Changing  law  enforcement  capacity,  especially  at  State  Patrol,  impacts  ability  to  idenUfy  DUIs     32  

Costs:  Addictions  Treatment  •  Data:  Monthly  admissions  for  alcohol-­‐related  public-­‐paid  dependence  treatment  (inpaUent,  outpaUent,  detox)  since  January  2008  •  Used  “total  treatment  units”  in  model  to  adjust  for  changes  in  funding/treatment  capacity  

•  Overall  treatment  for  adult  alcohol  dependence  did  not  change  •  Adult  alcohol  re-­‐admission  treatment  significantly  increased  

•  Overall  youth  treatment  for  alcohol  as  the  primary  substance  increased  5-­‐6%  

•  Together,  more  than  2,000  “extra”  treatment  units  33  

Costs:  Crime  •  Data:  Crime  Incidence  (arrest)  data  from  Washington  State  police  jurisdicUons,  monthly  counts  of  specific  crimes  

•  Significant  increases  post-­‐law  in    •  Burglary  •  Larceny  (specifically  shopliming)  •  Stolen  property  

•  Note:  significant  decrease  in  drug  law  violaUons  in  same  period  (associated  with  marijuana  legalizaUon)  

•  Transla.ng  to  more  than  10,000  “extra”  crimes  during  the  post  law  period   34  

Was  that  a  realistic  expectation?  

35  

Summary:  Impacts  of  I-­‐1183    

Benefits  •  Tax  Revenue  

36  

Costs  •  Emergency  Dep’t  Visits    

•  Traffic  crashes    •  AddicUons  Treatment  

•  Crime  •  Alcohol  theWs  are  unmeasured  

~$31M ~$43 M

Additional  InZluences  • Spirits  prices  generally  increased  in  comparison  to  pre-­‐1183,  around  12%  • Price  increases  reduce  purchasing  •  Increased  price  of  alcohol  in  the  privaUzed  market  might  have  offset  some  of  the  negaUve  impacts  we  saw  

 

37  

Rusty  

38  

Control  vs.  Privatized  Systems  •  We  saw  changes  associated  with  movement  from  Controlled  to  PrivaUzed  Alcohol  Markets  •  A  movement  away  from  best  pracUce  policies  for  prevenUng  alcohol  abuse  (e.g.,  restricUng  places  &  Umes  for  purchase)  

•  Parallel  increases  in  alcohol  abuse-­‐related  outcomes  (crashes,  emergency  department  visits,  dependence  treatment,  etc.)  

•  State  policies  could  be  changed  to  alter  the  current  environment  and  “recover”  prevenUon  best  pracUce  policies  

 

39  

A  “Tobacco  Control”  Market  Contemporary  tobacco  retailing  policy  op.ons  gaining  currency:  •  LimiUng  number,  density,  days  or  hours  of  operaUon  for  tobacco  retail  sales    

•  LimiUng  products  and  packaging  types  for  sale  •  Retail  sewngs  that  are  “adult  only”    •  RestricUng  retail  environment  markeUng/promoUons  •  Providing  resources  for  quiwng  (state  quitline  promoUon)  in  all  retail  environments    

•  Standardizing  prices*/increasing  excise  taxes/prohibiUng  coupon  redempUons  

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* Following privatization in WA, alcohol prices generally increased. This was potentially a “prevention-friendly” change.

Can  we  get  “Control”  back?  Approaches  to  strengthen  alcohol  (or  tobacco,  or  marijuana)  market  systems  for  prevenUon  •  Applying  stronger  market-­‐based  policies  that  have  been  associated  with  fewer  alcohol  abuse  outcomes  (e.g.,  restric.ng  places  and  .mes  of  sale)  •  Similar  results  would  likely  be  seen  in  tobacco  markets  

•  Some  control-­‐like  policies  could  s.ll  be  enacted  in  a  private  market    •  It’s  just  harder  

•  Notably,  tobacco-­‐related  outcomes  take  longer  to  be  measured  and  therefore  any  market  changes  would  not  be  seen  as  quickly  as  alcohol  market  changes  •  May  be  hard  to  “sell”  the  benefits  of  stronger  policies  that  don’t  show  return  on  investment  for  a  long  Ume  

41  

Some  Approaches  in  WA  •  Integrated  alcohol,  tobacco  (and  marijuana)  enforcement  

•  Single  agency:  Washington  State  Liquor  and  Cannabis  Board  (LCB)  •  Integrated  licensing  procedures,  compliance  checks  

•  Inter-­‐agency  coordinaUon  

•  Engaging  private  sector  (businesses,  corporate  offices)  to  voluntarily  adopt  prevenUon-­‐friendly  pracUces  (e.g.,  products  placed  out  of  shopliming  reach,  limiUng  point  of  sale  markeUng)  

42  

Completing  the  Study  • Alcohol  study  was  funded  through  May  31,  2015      • New  study:  funded  by  NIH/NIDA  to  examine  marijuana  legalizaUon,  using  similar  approaches  

• Upcoming  data  releases  posted  at  hCp://adai.uw.edu/1183/  

 

43  

Thank  you!          

   

 

44  

Mary  Segawa  mary.segawa@lcb.wa.gov      Rusty  Fallis  RustyF@atg.wa.gov        

Grace  Hong  hongg@dshs.wa.gov      Julia  Dilley      julia.dilley@state.or.us