The Role of Society in Promoting or Deterring Alcohol Use and Addiction

AreAlcoholpricesandtaxesanevidencebasedapproachtoreducingalcoholrelatedharmandpromotingpublichealthandsafety.pdf

Home >Psychology homework help >The Role of Society in Promoting or Deterring Alcohol Use and Addiction

Contemporary Drug Problems 39/Spring 2012

Are alcohol prices and taxes an evidence-based approach to reducing aicohol-reiated harm and promoting pubiic heaith and safety? A literature review

BY JAYADEEP PATRA, NORMAN GIESBRECHT, JÜRGEN REHM, DENNIS BEKMURADOV, AND SVETLANA POPOVA

This literature review examines alcohol prices and taxes as potential prevention strategies—examining the links with high-risk drinking and drinking patterns and alcohol-related harm. A literature search of the studies on alcohol price and taxation was conducted using multiple electronic bibliographic databases. Examined outcomes were a) drinking patterns and high risk drinking: and b) harm from alcohol. Fift}'-four relevant studies were evaluated, and the majority found that a change in price or taxes on

AUTHOR'S NOTE: Philip Cook and Frank Chaloupka provided resource material. William Kerr offered comments on an earlier version of this man- uscript. We also thank the anonymous reviewers and journal editors for their feedback on an earlier version. This work was supported, in part, by a contribution of the Department of Health Promotion and Protection, Hali- fa.x. Nova Scotia, to the second author Support to the Centre for Addiction and Mental Health for salaries of scientists and infrastructure has been provided by the Ontario Ministry of Health and Long Term Care. The views expressed in this paper do not necessarily reflect those of the persons noted above nor the policies of the institutions acknowledged. No conflict of interest is declared. For further information about this article please con- tact Svetlana Popova, CAMH, 33 Russell Street, Room #T507, Toronto, CA M5S2S1. E-mail: ¡[email protected].

ALCOHOL PRICES AND TAXES

alcohol had an impact on one or more of the two main outcome variables. Significant variations exist across studies in terms of designs, settings, effects across groups, and types of harm. In order to reduce alcohol-related trauma, chronic disease, and other consequences of high-risk drinking, an increase in pricing/taxation is a central component of an overall alcohol strategy.

KEY WORDS: Alcohol, price, tax, drinking patterns, morbidity, mortality.

Background

Alcohol is a major risk factor for disease and disability. Using 2004 data the World Health Organization analyzed the impact of 26 risk factors on the global burden of disease (World Health Organization, 2009). In high-income countries like Canada and the United States, alcohol was the second leading contributor to disability-adjusted life years (DALYs) after tobacco (WHO, 2009). A comparison with the result of an ear- lier WHO report (2004) indicates that the alcohol-attributable burden of disease worldwide increased from 4.0% to 4.6% of DALYs between 2000 and 2004 (Rehm, Balkunas, et al., 2009). In some jurisdictions, such as low-mortality countries in Latin America, the disease burden from alcohol is greater than tobacco (Monteiro, 2007; WHO, 2009).

Alcohol has been associated with numerous diseases and con- ditions that have been linked with morbidity, mortality and high health and social costs in many countries (Anderson & Baumberg, 2006; Collins & Lapsley, 2008; Ezzati et al., 2002), including Canada (Rehm et al., 2006a; Rehm, Giesbrecht, Patra, & Roerecke, 2006). The evidence of the burden from alcohol is substantial and more extensive than

some years ago, showing negative effects on populations, groups, and individuals (Rehm et al., 2009). Alcohol-related harm affects drinkers, abstainers, and innocent victims (Connor & Casswell, 2009; Laslett et al., 2010). Three generic vari- ables have been shown to be especially relevant to the rates of alcohol-related harm in a population: the per capita rates of consumption, extent of high-risk drinking, and cultural toler- ance of drunkenness and excessive drinking (Babor et al., 2003, 2010; Edwards et al., 1994; Mäkelä et al., 1981).

Evaluations have shown a number of effective policies and interventions aimed to reduce alcohol-attributable burden. For example, an evaluation of the most common 42 strategies and interventions assessed if there was sufficient evidence of pub- lic health impact in terms of reducing overall consumption, high-risk drinking, and/or alcohol-related harm in the focus population (Babor et al., 2010). It is noteworthy that in this evaluation the authors decided that alcohol taxes be given the highest rating with regard to all three criteria, namely, evi- dence of support, breadth of research support, and cross- national testing (Babor et al., 2010). The authors note that there have been dozens of studies on alcohol prices and taxes that point to an impact in reducing overall consumption, con- sumption in specific sectors, and/or alcohol-related harms. They also note that alcohol taxes are among the most cost- effective ways to reduce harm from alcohol both in developed and developing countries (Babor et al., 2010).

In some studies the research examined the relationship between the price/tax intervention and harm from alcohol, e.g., adverse health consequences (Cook & Tauchen, 1982). In other research the focus was on the association between price/taxes and drinking patterns and levels (e.g., Wagenaar, Salois, & Komro, 2009). Other work considered the effect of price/tax on mediating both the alcohol exposure variables (consumption) and outcome variables such as harm from alco- hol (Chaloupka, Grossman, & Saffer, 2002; Cook, 2007; Österberg, 1995).

ALCOHOL PRICES AND TAXES

There are indications from several countries that per capita alcohol sales are increasing in recent decades, including, for example, Canada since 1996 (Statistics Canada, 2002, 2009); the United States (Greenfield, Ye, & Giesbrecht, 2007); Finland (Mäkelä & Österberg, 2009); and the United Kingdom (Anderson, 2007; British Medical Association Board of Science, 2008); as well as in the emerging economies (Rehm, Patra et al., 2006; WHO, 2004). Given the accumulated evidence of the associations between overall consumption rates and alcohol- related harm (Babor et al., 2003, 2010; Edwards et al., 1994), these developments are considered to be a public health issue worthy of attention.

This article focuses on alcohol prices and taxes as potential essential components of a comprehensive and evidence-based approach to reducing high-risk drinking and harm from alco- hol and promoting greater health and safety. It addresses the following question: What is the recent evidence of price and taxation in reducing the harm from alcohol? It also considers new or refined topics for future research to better understand and assess the relationships between price/taxation of alcohol and impacts on drinking levels and harm.

This articles builds on the evidence reported in earlier publi- cations, including narrative reviews and overviews published in the recent decades (Babor et al., 2003, 2010; Chaloupka et al., 2002; Edwards et al., 1994; Ornstein, 1980; Ornstein & Levy, 1983; Österberg, 1995). It is complementary with sever- al publications: meta-analyses by Gallet (2007) and Wagenaar, Salois et al. (2009), a subsequent paper by Wagenaar, Tobler, and Komro (2010) focusing on alcohol tax and prices policies and harm, and a systematic review by Elder et al. (2010) on the effectiveness of tax-policy interventions in reducing excessive alcohol consumption and alcohol-related harm.

The Wagenaar, Salois et al. (2009) meta-analysis focused on price elasticities and examined 112 papers published over sev- eral decades—focusing on price elasticities by total consump-

tion and type of beverage. However, it is different from the analyses in this article that provide enhanced details on each study analyzed, and focuses on those studies that report on the impact of drinking patterns and high-risk drinking and/or harm from alcohol. Similarly, while the general orientation of our article is consistent with that of Wagenaar et al. (2010), our presentation of the main original studies provides system- atic details on the design, sample, interventions, findings, and policy implications that are unique to our article. Examining articles published to June 2011, our article also covers a more recent time frame than Gallet (2007) (1945-2003) or Elder and colleagues (2010) (to July 2005).

Methods

AMSTAR, a measurement tool to assess the methodological quality of systematic reviews (Shea et al., 2007), and the overview by Egger, Smith, and Altman (2001) were used as a guide to conduct this literature review.

A computerized literature search was undertaken using journal databases (MEDLINE, EMBASE, CINHAL, and Psyclnfo) with the following keywords in different combinations: (alcohol* OR ethanol OR drinking) AND (sales OR price OR tax) AND (pattern* OR morbidity OR mortality OR driving* OR injuries OR crime OR violence). Search was restricted to the English language. Studies were included for review if they were pub- lished between January, 1980 and June, 2011 in the English language in a peer-reviewed journal; if they included data on the relevant outcome measures: a) drinking patterns and high- risk drinking; and b) alcohol-attributable harm (including morbidity, mortality, drinking and driving, injuries, crime, and violence). Studies were excluded if the study (a) was only available in abstract form; (b) had insufficient data on alcohol taxation and pricing and their consequences (outcome meas- ures); (c) was a commentary or editorial on the topic; (d) only focused on overall consumption as an outcome variable; (e)

12 ALCOHOL PRICES AND TAXES

was a duplicate publication; or (f) was a meta-analysis or sys- tematic review.

Titles and abstracts (if present) of all studies identified were reviewed independently by three members (JP, SP, and DB) of the research team in order to identify potentially relevant arti- cles; differences were resolved by discussion.

A data extraction sheet was designed, piloted, and revised. The data were extracted by a member of the study team; a sec- ond and third member checked table entries for accuracy against the original article. The following variables were abstracted from the studies: reference; place and years of the study; design/sample/main indicators; intervention and time lag regarding the impact; findings, including a) drinking pat- terns and high risk drinking and b) alcohol-related harm and policy implications.

Training of coders to achieve sufficient (> 0.80) interrater reli- ability was conducted. In order to calculate interrater reliability, Fleiss' kappa statistics using the attribute agreement analytic method was used (Eleiss, 1971).

The quality of the data from individual articles was assessed based on the following domains as recommended by U.S. Depart- ment of Health and Human Services: comparability of subjects, exposure, outcome measurement, and funding or sponsorship.

Results

The combined search strategy from different databases result- ed in 2,035 hits. After the removal of duplicates (n = 663), the abstracts or complete publications, if abstracts were unavail- able, were reviewed and excluded if they contained no rele- vant information (n = 1,372). Of the 149 abstracts left, after screened for eligibility, 50 did not contain relevant information on the association between alcohol and taxation or alcohol and pricing; 27 studies did not have sufficient data on taxation/ pricing and relevant outcome measures; 10 studies were fur-

ther excluded due to their previous publications with the same data; and last, 8 studies were systematic reviews or meta- analyses. In total, 54 original studies were extracted for this review. Of the 54 studies, 36 studies were on alcohol and tax- ation and 18 studies were on alcohol and pricing.

The results of the search strategy are shown in Figure 1.

FIGURE 1

Results of literature review of the relationship between alcohol and taxation/price and its consequences

Potentially rcievani references identified from MEDLÍNE, EMBASE, CrNAHL &

Fsycl.nfo(n=2,035)

Poteníialíy relevant reièrcncus uftyr removal of daplication (¡1=1,372)

Cixîetî abstracts that are potentially useful for the review (n=149)

No relevant info on association between alcohol and taxation/price (n=50)

Insufficient data on taxation/priciiig and consequences (n=27)

Multiple articles on same study {n= 10)

Systematic reviews and meta-analysis (n=8)

Studies identified for data abstraction {n"54)

Studies identified on aicohoi and taxation Cni~36)

Studies identified on alcohol and pricing (n2-i8)

14 ALCOHOL PRICES AND TAXES

i2 85

i-lfS Pli

CM „

S ^ ¥ M ô= =

s|"S i I "s :

"S 2 •g ""

• i î .

i -Si -a ^ CO «> " Í Q U -

£.5 "g i.g

« 1S i

I S i 11 i ^ J 1 1 55 i o ra m o "g- Í

I s 2-11 =

' ï l l l S Q.7

iiilSl

l l l f l : Ä ^ O ™ E2

• è " | § I i 5 |

•> ™ : i c l ? *

[ c' i "o "̂ "

I II f I ï I

- - ci o "ô. o "ë .9' ̂ r> -5

• § > !

~ o tS

1-s i'

'S II

.- Q. g 5

f s ? " Ijll

Si •g "

_ o o "S 1 ¿ I ¡g

o 1 Ä .

Il 1 s

lâi t3 en s

S S S

"m ^ o

: i F « 'S o - a. Q. E 1= t ; G w «1

¡ S i

1 1 8 3 l a

SC:

16 ALCOHOL PRICES AND TAXES

.h= CZ Q " ™ ' S

"m'A â .̂ J ;w

— " ** o C* ^ — -^ M ^ -a .=>

ä .Ï J 1 s ° Í

á l i l l

| || |

f i .11.1 f

S 1 s J

i2 o

! . ~ en g)

; t« E :g -ë S

.= 1 1 Ï ä- i ^ ä s ^ g 1 1 -s s 2

.xz

" .S

C "5 < ^

il si

s B' a s

o 'S s g

8 "

S e i - s s ^ : •E 3 " 3 .

|f|iis||̂ --

C Û S . S s

: S S

filîîfi lllSlîi

TS g »

•i -S 1

F "m ^

5 f - g l 1/1 îe c: .'

O 11 i : .2 Sis < < §

o ¿5-

ifllllj |î ï a) "̂ ra 5 ^

; "? g -g = g" 8 = LU S E Q T O

if.ii

in <

X3 o uO^ Q O) Ils.s

18 ALCOHOL PRICES AND TAXES

i f f E _¿

ifï III -T 3 « „ ,/, s -o -

f i " ! i î-Sg

L U ^ Sc:-ci^tl>Sma> | - i ~ J = V £ S i — ? r o £

rl'â •^"IIÎl^"

SIII11 s -2 a. s 'S 0) filial a ^ s.s¿-8

8 - S g m

ï I Se f

Ii = â

o o

"o .« c ' o> m ^̂=.»̂ ^ . s 0) ra TO

llpli -*^ .,2 u _L 1^

en "J 9 - •

î a> _^ g

il 1-1 . .H5 Q . en c

g = :

, iS .= 'g, " s I ro s â •=

= > . = • = o " .0)

I -3 „- S I g. -̂ o c "? ¿ 3 ^

Ils1ll

il il

s F "*-- 9 ^ § - O) 3 g -s 2 o : £5 — *= t n •'^ ^ .

"i 1 R

! ro "

i l s

ro .S Ö a-

7^ w^ * " ^_j ;_ (¿J

ill 0 ) <U <1J

s-=

m a n y

; ha

ro o

" ' a

m \ SO

g- -—

ro ^ Q> ro

•ê 'S ^ Lu

ve ls

s. E1SU

-S. 8

ve ra

ll i

in g

t a>

o ^

8 s â

lo re

â-

in g

1 e

d ri n k

•S 5

'S e O) —

§1 s i

j a ) « * - ' i 15 S g •-

»! S = 'S c

m il

liiili^âi "S-g 3 1 w £ a. äj

;5 'S p ^ S

{ijfl If iii

I g : -g ^

;.f .s

"tifi::

;.™ 8 8 s

•̂ s - ë

- S I

'S o S

l a g §>

§ ».i

- i« cf o o fS J

i 2 I Ï . E :

.1 f « 1 m.S

-lîîlilïl îlîilHil

î | 8 " s -

Î Î I . Ï

s s 8 - I .M „̂ 'g- n T G) Iv f̂ ^ t :

? •§ S -E -s .g i .

? l g 1^

il il

sSg:-°'f i 8f Ill-tilllS s r s i-s ïï s î § S

l i a

| ^ 5 I i i

Iff

S 8ä g i ^ " Í5 D « a> o •

. IÎHÎ; Í B i »1•

0 's

; 11 - ̂ '̂ I > ï 3 .g ra § s

8 ¡.S'il. llllliilliSt'»•5 s c tS s c g

liîlll ä . g - s -

ï s g s'^ liîli;

| | | | l ' l _ 's. .1 s S -"i i ^

s-g g.-g s

lial|i|î_ ||||ij.||â|

flIff¡ill f I f'il 11 f _ < S S ä ' £ O i S M a

0 S

"TO S

20 ALCOHOL PRICES AND TAXES

•o = E £ a , - o . v - i - S ™ ^ o , « g o 55

8-^ Së%^^^

£ I ^ -s I g I-i S-|f.|

liillî Si = B iî

! .8 2 5.6 illlil

o s f Qj y ; (y (U C

1|iSI ^ ^ ^ d) g

s ^ a, " s.

Illili S i

.S e o Ci

11 il

iilli 11 illliill i - i u c i e g s î g ' - sl

s s â en c roaT:3"os â o

S a s

I! i"

o o

> t= Í2 f s-

> «) u 8 CN] ï ^

î 3 s "° ~3 ̂ c

L c- - o T3 - ^ "J

äS I g. s -g .g i

S -g "- S S

S f 1 1

¡IIIJ illlï

ililsî

Í 4̂ . -Sä - I .

* "S s • I l

s. s J>o>

! ill 1 "o o LU a t= 3 Ö

iiiïsiiiii;llllfpî

•g 8 s 8x>

5£¡r

§ 1 " Siî s û3 • §

¡II s ^ g'i

Si " = = 5 - g - " - ••

l u i s î t

g 8 S^ä

S S I ' S ^ — p r o to i —

? I s I .9 S'

" ro o> o u>

s Si -s 1= — S.—

ï ä B .E .E £ .E T£ Ï

î li

siltî s g a â 5 S.s|.|8

11:i § g s s, g .i

(11 ÍÜ m . S "O

j - s € J

" •g ÍS

.£ ro '"g J

l ? l |

'S -i •-

I I loi t g-S S'a i i s is

Pïtis

E l S I S

^ . | ;£ .S .E *" ~ ^ "-= m

I §1 8-|l .12 8 - U

> .. O..Í

\^5

.1S " s. si

•s s "S 8 a

5ï:f i l l

i fil

li o >,^Ci

S c: ^ E ro o O

~ E *< S

S .S S

« -s s- &

s ë " -g -B

B t̂ 2 "

i l i

22 ALCOHOL PRICES AND TAXES

(O 0)

E S

•D

• o

¡2

ra a. Ul

o a.

Ü ra a

y =5

î ê t

Íl.i

1.6

II SI

¡ s a s ~S8 E.

S ï S

g i I gro

•o « "S . . n 3

S o

S- S"! i °

.2 8 ï - i

ililml . E - g S ï t n ^ ^ w j

i l g i 11 t l

B .2!

• e i - i I- ' û) ro (/J .t: s;

i ¿111

S.S

ml » g -i i

Cl Qj d di

^ f S -IQ. . ^ Ê O

.fis f ES

r l l .!« "5

TS .g S "5 0) '

8 i" a i s œ t* S c 3 Jl ai ^ g

S5 g Si a.s

f S8 g _

^ ' o ^ 5 ^ <u wí ^

(U o o . Q . £ ro ro •S ^ 'ro § ;; "i S -g•in jS "g g ra g ä g

lililí il ^ "̂ "o 's i § (J5 ?"

o QJ Q t« yj (3 CP

il.. •s = i f s

:> ^ s o «3 (J -o a.

5 OT-C: O - ., Ö E g 5 $"- o I .9 Q. B

ms S §

o E

:áS^'

i ë;

E1 of I .2 J . | S-B

ili-

1 1 I I

ä S S5 S = .s

S I I I isif

îliP ^ S- 'S "c ¿ - - c/j i£ Q. rs

75 •g.ib" eu ^ S î

" 1 ro ro

Hi i

5 1

i 1

if î l i

1 1

I-' li';.^ g--

' ^ QJ tn ™ Ö c > TO " Q . " '

lilli:

îli:

I till E ^-.Ts ro 2 '

-s 1111 i -̂ -- "̂

° ,_ = œ

l!Ill

i l

s :s -= ~ rô s 1 S 5 -a

i tK s i l Q> aj o "^ Í i2

•^-ii J E^

ll!I ilillilílilí lili lilil

i ™

2 -a à?

_ Jgf i -rö S j=

«> .£ -o w

îlîl: s-Jo's. o E s g •

<-£ .S O -g S

g oi g S ä î '™

Í5 CL to îy (U -.=;

E £ ïï I i f

s ; O ü K ,_ " 5 ro <-> Ö S Ä S c a i l <-S Sa 1 ä 8 .S -

Ö I

s s," = °

l l l l l l l l ¿7) O

•S.ç

, „ O _j Ol ^ _C0

s i' i i I i • £ S g 8 ^ t :

= -§§ î 8-sr

•? s .§ .£ S â S f i l si, iiillî

o f .s |

.s 1 ro bi á S i

8 g i -g

f i -5-go 3 g

1 = -S s i s

lltllli ^ -g ¿ J s -g I

liJ -ê "S ro

_ -^ ^ c tu 03 O - O O ; •

iPliip •ï g J S -S -S i g

8 -o o

ro ë. f S i s

llii|l I" s --s 8 1 Si -J i

iili

24 ALCOHOL PRICES AND TAXES

li •s g ' .

-"'IÎ

III ill? I l l s

o .o ,

Ë S';

si:

'ai g's- $1

s ? 7^-1 s' ; i

4 t s t g .s

I I '

i l l

! S-S i

i l .2

• - I I

llff i

llí

ra ai.í l

Î . S g.

S -ë '

m III: fîS'Ilit i

§ 1

^ » 1

llli Í g E

ril i S 5 1 . Q> •

ä 's .< ' s ! I l ° - i 1 § 7

L I I - B S

Lis

ëS s

| | |

tn E .E

ai I 03 ^ t j oí) a -O

< 2 s

l l l f l l 2-œ 8 «> é § «

iJllÎJl i 5 'l I < i f

II ^ i l of •i ^ -a s: .y ^ ^

ISS

Si »îi'L ^ ° i l

'!=.. S

• a. g > - 5 "

¡•S *

Le e

CD o •-- 4)

I i

_ s .s p:

r E

11 £.1

i'i 1 a

CD <

Idl § 1 - l l

i »i«

9-1 § ^ É §

I t l a-g i 1^1 111^

O eu ° ° .

\ -§tS-g- [a||i|:

; i^lSi

: O 3 o I

n i TO

Ht II ^ '

J - - O . O)

!Îi I

-.SE S

ill! •3 g

llli

— s .s?

"5 s î -D ...gas

Í 2 •-= tf? F

• S " 1 " S5

I i-

! o i I 1 g

. I i

.s i 8 il

Hl̂

4 » ï

" t o •— O l

illl Í Si s s i* gj # = -g -g , Q. g " -S ^ 5 I s al:! i .i E 2 S 2 ^ -S -Si s s — o

s ¡5 . ^ Ü1

fit««S

I Ipil

Lîfii

Istl "sil

I i i

— d ) ai -c: 5 ^ ^ ^

<2 ^ 53 "g

•|î|lilSfis

2 6 ALCOHOL PRICES AND TAXES

All Studies were published in English, with the earliest being published in 1987. About half of the studies focused on data from the United States (25) and the others (29) in other jurisdic- tions including: Australia, Canada, Denmark, Finland, Germany, Sweden, Switzerland and the United Kingdom. While 15 of the studies examined the effects of alcohol taxes or prices on drinking patterns and high-risk drinking, 28 examined the effects on alcohol-related harm, and the remaining 11 examined both drinking patterns and harm (Tables 1 and 2).

The studies reviewed include both archival statistics (such as alcohol sales, drinking and driving statistics, mortality data) and self-reported data based on surveys. Several publications provide models of future scenarios with a rise or decline in taxes or prices (e.g., Farrell, Manning, & Finch, 2003; Holling- worth et al., 2006; Meier, Purshouse, & Brennan, 2009; Ponicki & Gruenewald, 2006; Purshouse, Meier, Brennan, Taylor, & Rafia, 2010; Rehm, Gnam, Popova, Patra & Sarnocinska-Hart, 2008; Rehm, Patra, Gnam, Sarnocinska-Hart, & Popova, 2011; Van den Berg et al., 2008). The results of natural experiments are reported in this collection (e.g., Heeb, Gmel, Zurbrugg, Kuo, & Rehm, 2003; Herttua, Mäkelä, Martikianen, & Siren, 2008; Wagenaar, Salois, & Komro., 2009).

The following brief synopsis is organized by type of impact— drinking patterns and high risk drinking and alcohol-related harm, and then by exposure variable: first studies focusing on tax (Table 1) and then those on price (Table 2).

Studies focusing on alcohol taxation

The studies summarized in Table 1 and highlighted below focused on both increase and decrease in taxes on alcohol. Overall, the majority focused on the impacts of increased taxes, although in recent years there were more studies that focused on a decrease in taxes.

Impact of taxes on high-

risk drinking or harm from

alcohol

As presented in Table 1, there were six papers that examined the impact of taxes on drinking patterns and high risk drinking only and did not focus on harm from alcohol (Adams & Effertz, 2010; Gmel, Wicki, Rehm, & Heeb, 2008; Grittner, Gustafsson, & Bloomfield, 2009; Laixuthai & Chaloupka, 1993; Mäkelä, Bloomfield, Gutfreund, Huhtanen, & Room, 2008; Müller, Piontek, Pabst, Baumeister, & Kraus, 2010). Eight papers focused both on drinking patterns and harm from alcohol (Andreasson, Holder, Norstrom, Österberg, & Rossow, 2006; Byrnes, Cobiac, Doran, Vos, & Shakeshaft, 2010; Elder et al., 2010; Gustafsson & Ramstedt, 2011; HoUingworth et al., 2006; Kenkel, 1993; Mäkelä & Österberg, 2009; Van den Berg et al., 2008).

Several studies are highlighted that focus on the impacts of an increase in taxation. In a study based on the United States (Laixuthai & Chaloupka, 1993), it was estimated that if taxa- tion on alcohol were to keep with inflation this would lead to a 19% reduction in heavy drinking by youth and a 6% reduction in high-risk drinking. A study based in Germany noted that rel- ative to overall price levels, during the past 40 years alcohol beverage prices in Germany have decreased by 30%. If taxes were up to the European average it was estimated that per capi- ta alcohol consumption in Germany would be reduced by one liter of pure alcohol, and underage binge drinking by 37% (Adams & Effertz, 2010). In contrast, there was limited effec- tiveness reported in connection with a tax levied on alcopops in Germany. While a decrease in alcopop preference was noted, an increased preference for beer and spirits with associated riskier drinking patterns was noted (MuUer et al., 2010).

Studies focusing on both drinking patterns and one or more types of harm from alcohol reported that increased taxes were associated with a reduction in heavy drinking and various types of alcohol-related harm, including drunk driving (Mäkelä & Österberg, 2009; Kenkel, 1993), arrests, mortality, and morbidity due to liver cirrhosis (Mäkelä & Österberg, 2009).

2 8 ALCOHOL PRICES AND TAXES

A modeling study by Hollingworth et al. (2006) focusing on United States youth projected that if a tax increase equivalent to $1 were added per six-pack of beer, then the proportion of 20-30 year olds engaged in episodic drinking would substan- tially decrease: 13-14% for females and 24-27% for males. It was also noted that an increase in taxes on alcohol in the United States would reduce mortality and potential years of life lost.

An Australia-based study estimated that an introduction of volumetric tax may result in an estimated annual increase in taxation revenue of $492 million, a 2.8% reduction in annual consumption of pure alcohol, and an estimated net health gain of 21,000 disability-adjusted life years, with the potential costs offsets of $110 million per annum (Byrnes et al., 2010).

Several studies examined the impacts of reduced taxes on alcohol. An economic model by Gmel and colleagues (2008) assessed a tax cut in Switzerland, noting that while high-level drinkers increased their consumption more than lighter drinkers in the short-term, there was not a persistent effect. The intervention affected mainly light and moderate drinkers and contributed to increased consumption of alcohol in these sectors of the population. Another study examined a decrease in alcohol taxation in Denmark and Finland and a large increase in travelers' allowances in Finland and Sweden, not- ing a short-term change in alcohol consumption and that they were not larger among heavier drinkers (Mäkelä et al., 2008).

An assessment of the change in Finnish alcohol policy of 2004 found that a reduction in excise duties on alcohol combined with the abolishment of travellers' import quotas contributed to a 10% increase in alcohol consumption in 2004 (Mäkelä & Österberg, 2009). This study found that a reduction in excise duties impacted a wide spectrum of alcohol-related harm— including drinking and driving, arrests, plus mortality and morbidity due to liver cirrhosis. These impacts were most severe for young drinkers, the unemployed, early pensioners.

Impact of taxes on

various alcohol-

related harms

and people living alone (Mäkelä & Österberg, 2009). A subse- quent article based on the same project by Gustafsson and Ramstedt (2011) found the following differential impact from a reduction in Danish spirits taxes in October, 2003, and increase in Swedish travelers' quotas in January, 2004. In general, there was an increase in alcohol-related harm in the northern area and decrease in southern Sweden. The increase among men was associated with an increase in alcohol-related problems, but overall there was no substantial change in the number of persons reporting alcohol-related problems. Andreasson et al. (2006) estimated that a tax cut of 40% on spirits and 15% on wine in Sweden would lead to an increase in overall consump- tion and about 289 additional deaths, 1,627 additional assaults, and 1.6 million additional sickness absenteeisms.

As summarized in Table 1, there were 22 studies that focused primarily on the impact of tax changes on one or more types of harm from alcohol (Bloomfield, Wicki, Gustafsson, Mäkelä, & Room, 2010; Chaloupka, Saffer, & Grossman, 1993; Chesson, Harrison, & Kassler, 2000; Chikritzhs, Stockwell, & Pascal, 2005; Dee & Evans, 2001; Gustafsson & Ramstedt, 2011; Henderson, Xinhua, Roux, Link, & Hasin, 2004; Herttua, Mäkelä, & Martikainen, 2010; Koski, Siren, Vuori, Poikolainen, et al., 2007; Maldonado-Molina & Wagenaar, 2010; Markowitz & Grossman, 2000; Markowitz, Chatterji, & Kaestner, 2003; Mohler-Kuo, Rehm, Heeb, & Gmel, 2004; Ohsfeldt & Morrisey, 1997; Ponicki, Gruenewald, & LaScala, 2007; Ponicki & Gruenewald, 2006; Rehm et al., 2008, 2011; Sabia, 2004; Saffer, 2001; Stockwell et al., 1998; Wagenaar, ALOIA, et al., 2009; Yamasaki et al., 2005).

The exposure variables ranged from overall changes in taxes to taxes on specific beverages, with a number of the American studies focusing on beer taxes. Most studies examined the impact of increased taxes on one or more outcome variables, although a few examined a decrease in taxes (Bloomfield et al., 2010; Koski et al., 2007; Mohler-Kuo et al., 2004). The foci of these 22 studies included the following: alcohol-related

3 0 ALCOHOL PRICES AND TAXES

problems, traffic crashes, crime, violence, sexually transmit- ted diseases (STD), and premature mortality (Table 1).

Generally, when taxes on alcohol are increased the rates for the alcohol-related problems typically decline; when taxes are decreased the rates tend to increase. However an exception is noted in a study by Sabia (2004) in which the author examined the impact of higher liquor taxes and more stringent alcohol control regulations on the incidence of domestic abuse. Using a national survey the author found little evidence that these interventions had significantly reduced domestic violence against mothers. Other studies found an impact in the expect- ed direction, with a number of studies considering the impacts associated with increased taxes. For example, a study based in the United States by Henderson et al. (2004) noted that an increase in beer taxes was associated with a reduced preva- lence of alcohol dependence and reduction in the prevalence of dependence symptoms.

Chaloupka and colleagues (1993) concluded that beer taxes have a negative effect on drunk driving in the United States— an effect that is larger for young drivers compared with older drivers. Dee and Evans (2001) noted a significant negative effect from an increase in beer tax and motor vehicle mortali- ty. Ponicki and colleagues (2007) examined the interaction between the minimum legal drinking age (MLDA) and beer taxes in the United States: They note that a given change in MLDA caused a larger proportional change in fatalities when beer taxes were low than when they were high.

Assaults and other types of violence have also been the foci in several studies. Stockwell and colleagues (1998) found Commonwealth government tax increase on cask wine and high strength beer in the Northern Territory, Australia, was significantly associated with declines in rates of nighttime assaults. In a study based in the United States, Markowitz et al. (2000) found that an increase in beer tax was estimated to decrease the probability of violence.

Alcohol taxes have also been associated with a number of other social problems and types of morbidity and mortality. Ohsfeldt and Morrisey (1997) noted that an increase in beer tax is estimated to result in a decrease in reported lost-work days. Chesson and colleagues (2000) estimated that an increase in the beer tax can reduce gonorrhea and syphilis rates. Ponicki and Gruenewald (2006) concluded that cirrhosis mor- tality rates were significantly related to taxes on distilled spir- its but not to tax on beer and wine.

In a study based in Alaska, Wagenaar, Maldonado-Molina, and Wagenaar (2009) noted that a 1983 tax increase was followed by a 29% change in the number of deaths averted. A Florida-based study found significant reductions in chronic heavy consumption and frequency and rate of deaths following a legislated induced increase in alcohol taxes (Maldonado-Molina & Wagenaar, 2010).

A Canadian study on the avoidable costs of alcohol abuse con- cluded that increasing alcohol taxation is one of the most effective interventions in terms of reducing the burden and cost of health care, criminality, and productivity losses due to alcohol abuse. A 25% increase in tax was projected to result in cost savings from more than $175.2 million to $211.3 million in Canada per year (Rehm et al., 2008, 2011).

Turning briefly to studies that examined decreased taxes, Mohler-Kuo and colleagues (2004) noted that, with a decrease in tax in Switzerland, alcohol problems increased significantly, but that significance disappeared after controlling for spirits consumption. In an example from Finland, Koski et al. (2007) concluded that there was a significant impact on mortality from an alcohol-related tax cut, resulting in an estimated 8 additional alcohol positive deaths per week. Overall, these researchers found an increase of 17% in alcohol-related deaths associated with the tax decrease on alcohol in 2004.

Bloomfield et al. (2010) examined the impact of a combina- tion of an abolition of travelers' allowances for alcohol imports

32 ALCOHOL PRICES AND TAXES

to Denmark, Sweden, and Finland in 2004 with a lowering of excise taxes in 2003 and 2005 in Denmark and 2004 in Einland; in general, alcohol problems decreased and only in selected groups did problems increase. A report by Gustafsson and Ramstedt (2011) noted that the findings from their study (see Table 1) were not consistent with increased access to alcohol in Denmark and southern Sweden: They found an increase in acute alcohol poisonings, particularly in the 50-69 age group, but no increase was found in violent assaults and drunk driving.

Studies focusing on alcohol prices

Impact on Table 2 provides a synopsis of eight articles that examined the drinking association between alcohol prices and drinking patterns patterns (Chaloupka et al., 1993; Chaloupka & Wechsler, 1996; Coate &

or alcohol- Grossman, 1987, 1988; Heeb, Gmel, Zurbrugg, Kuo, & Rehm, related harm 2003; Helakorpi, Mäkelä, & Uutela, 2010; Kuo, Heeb, Gmel, &

Rehm, 2003; Kuo, Wechsler, Greenberg, & Lee, 2003; Kuo, Heeb, Gmel, & Rehm, 2004; Meier et al., 2009). There were also four papers that examined the associations between alcohol prices and both drinking patterns and alcohol-related harm (Earrell et al., 2003; Gruenewald, Poicki, Holder, & Romelsjön, 2006; Purshouse et al., 2010; Stockwell et al., 2001).

Considering first those focusing on drinking patterns, a domi- nant finding is that an increase in prices is associated with a decline in drinking, as indicated by several studies (Chaloupka & Wechsler, 1996; Coate & Grossman, 1987; O'Mara et al., 2009; Stockwell et al., 2001 ). Conversely, a reduction in prices appears to stimulate consumption, including consumption of spirits among younger drinkers as shown in Switzerland (Kuo, Heeb, et al., 2003) or among those of middle age as shown in Finland (Helakorpi et al., 2010).

Farrell and colleagues (2003) note that higher prices can reduce important dimensions of alcohol dependence and

Impact of prices on

various types of harm from

alcohol

abuse. Meier et al. (2009) and Purshouse et al. (2010) con- clude the pricing policies, especially minimum prices, can promote harm reduction among heavy drinkers, and thus reduce health harms and costs related to heavy consumption. However, as noted by Meier et al., pricing policies vary in their impact on different subgroups and this needs to be taken into account in determining the most effective interventions. Similarly, Gruenewald and colleagues (2006) caution that the potential for differential impacts of a price increase on differ- ent brands must be considered, noting that consumers from a range of socioeconomic strata may respond differently to price changes.

There were six studies that focused primarily on alcohol-related harm (Adrian, Ferguson, & Her, 2001; Grossman & Markowitz, 2001; Herttua et al., 2008; Markowitz, 2000; O'Mara et al., 2009; Sloan, Reilly, & Schenzler, 1994). Three main outcome variables were evident in these studies: mortality; alcohol- involved traffic accidents, and violence. Sloan et al. (1994) noted that while alcohol prices were associated with mortality, they were not found to be a statistically significant contribut- ing factor to falls, fires and other accidents. Markowitz (2000) found that an increase in the price of alcohol reduced the like- lihood of severe violence aimed at wives and reduced the probability of being a victim of wife abuse by 5.3%. In a sub- sequent study he and Grossman found an inverse relationship between an increase in beer prices and violence (Grossman & Markowitz 2001). In contrast, Herttua et al. (2008) report that interpersonal violence rates did not increase after a large reduction in alcohol prices occurred in Finland.

Discussion and impiications

This literature review included recent studies, published between 1987 and 2011, that met our inclusion criteria. It is noteworthy that almost all of the studies found some impact in the expected direction—an increase in alcohol tax or price of alcohol was

3 4 ALCOHOL PRICES AND TAXES

associated with reduced high risk drinking or alcohol-related harm, and a reduction in tax or price was associated with increased high risk drinking or harm.

It is important to discuss some of the limitations and strengths of this literature and our assessment of it. First, due to the het- erogeneity of the examined studies in terms of their study designs and settings, studies summarized in this review did not arrive at identical quantitative conclusions. As noted above, in some studies, the impacts were limited to one beverage (e.g., spirits, or some sectors of the population). There were sizable variations in the effects of taxation and/or pricing across groups and types of harm. However, this is not surprising, given the fact that it is not feasible to conduct laboratory-type highly controlled experiments when it comes to examining the impact of alcohol taxes and prices in the real world and involving total populations and various subpopulations.

Second, a change in taxation is typically not the only thing that is going on during the intervention phase that might potentially impact drinking patterns or rates of alcohol-related harm, and including but not limited to changes in alcohol marketing or promotion, density of outlets, or type of control system—such as privatization of off-premise retailing. The authors of the orig- inal research typically did not consider such confounding effects of interventions that could impact drinking patterns and their consequences, and therefore this review did not consider these dimensions. Such effects would be better addressed in a meta-analysis study rather than a systematic literature review.

Third, we have studied the effects of alcohol price and taxa- tion intervention designed to prevent harmful drinkers but not on the beneficial effects of moderate alcohol consumption. It is possible that the alcohol-related harms saved due to this intervention could be somewhat counterbalanced by the potential reduction in the beneficial effects of alcohol. However, such a counterbalancing effect would only be seen if tax-related interventions led moderate drinkers to abstain from

drinking in their later adult years. Furthermore, beneficial effects of alcohol consumption occur in older age groups (Markowitz, 2000; Rehm et al., 2009), whereas most studies in this review showed taxation or price interventions have a substantial impact on youth and young adults.

Finally, several modeling studies were included in the current analysis. The quality of the results of the modeling studies is dependent on the sources, appropriateness, and accuracy of the assumptions. Subsequently, the assumptions made in these studies may be limited, and involve uncertain parameters.

Considered together, the studies reviewed in this article found that a change in price or taxes of alcohol had an impact on one of the two main outcome variables: drinking patterns, includ- ing high risk drinking, or one or more types of alcohol-related harm. Changes in alcohol taxes or price of alcoholic beverages was inversely associated with the following: alcohol-related problems as measured by the AUDIT; motor vehicle mortality rates; rates of STD; rapes and robberies; spousal abuse and crime involving youth and young adults; premature mortality; suicide; and cirrhosis mortality. In other words, if there was restriction in access through higher taxes or prices on alcohol, there tended to be a decrease in harm; or if there was an increase in access through lower taxes or prices there tended to be a decrease in alcohol-related harm. In a number of stud- ies, more than one outcome measure was used to assess the impact of tax or price intervention on harm from alcohol. Since increases in alcohol consumption rates have been linked with increases in alcohol-related harm, there are public health and safety benefits in maintaining the real price of alcohol and, alternatively, in not resorting to discount pricing as a way of stimulating consumption.

The findings of this literature review are consistent with reviews and meta-analyses that concluded that a reduction of prices is expected to stimulate alcohol consumption and an increase tends to curtail overall consumption (e.g.. Babor et al..

3 6 ALCOHOL PRICES AND TAXES

2003, 2010; Booth et al., 2008; Chaloupka et al., 2002; Edwards et al., 1994; Elder et al. 2010; Gallet, 2007; Meier et al., 2009; Österberg, 1995; Stockwell et al., 2007; Wagenaar, Salois, et al., 2009; Wagenaar et al., 2010).

Chaloupka and colleagues (2002, 2004) noted a number of associations between alcohol prices, drinking and harm. An increase in beer taxes contributed to a significant decrease in the fatality rate of drivers involved in: nighttime single-vehicle crashes; self-reported drinking and driving involved in nonfatal crashes; and rapes and robberies. The authors also noted the limited impact of alcohol prices on assaults and homicides. In addition, price increases on alcoholic beverages contributed to a reduction in liver cirrhosis mortality and suicide rates. Health benefits from tax/price policies impact heavy and frequent drinkers and studies that focus on youth tended to report larger effects from prices and taxes than those found for the overall population (Chaloupka, 2004). Because of the lower average disposable income among youth and young drinkers, changes in controlled access to alcohol through price or tax increases are expected to have an especially strong harm-reduction impact on this sector of the population (Saffer, 2001).

Furthermore, publicafions by Bray, Loomis, and Engelen have looked at volume-based price discounts for beer and their impacts on sales. They estimated that individuals were more likely to buy a higher-volume package of the same brand of beer than to switch brands (Bray et al., 2009). Their analysis showed that in-store merchandising and promotion can substantially increase beer sales, and that the purchasing of large package sizes may also increase overall consumption (Bray et al., 2007). This research points to the synergy of two marketing tech- niques—average lower price per unit (due to large number of units per package) combined with promotion and advertising— potentially contributing to higher overall consumption.

The findings from this literature review are relevant to inter- national developments. In Canada, they have a bearing on the

erosion of the real value of excise taxes and failure to tax according to alcohol content (Stockwell, 2006). Also, in Finland the alcohol tax cuts of a few years led to increased consump- tion and alcohol-related harm (Mäkelä & Österberg, 2009). They are also relevant to alcohol-policy developments in South Africa (Parry, 2010) and Australia (Doran, Hall, Shake- shaft, Vos, & Cobiac, 2010) as well as specific alcohol taxa- tion policies (Armstrong et al., 2009). It is noteworthy that for our review, which goes back to the 1980s, there was a 28% increase in the quantity of research articles on taxation in the past 12 months, mainly from Nordic countries and North America. This temporal pattern may reflect a contemporary sociopolitical and health policy research shift in concern about problematic alcohol use, or in interest among various parties in changing the taxation regimes for alcoholic beverages.

Furthermore, a United States-based analysis by Cook (2007) reports that a 10-cent increase in excise taxes per ounce of pure ethanol was expected to significantly reduce pure ethanol consumption per capita (-12%), the motor vehicle fatality rate (-7%), and the cirrhosis mortality rate (-32%). On an interna- tional basis, Anderson et al. (2009) have also indicated the impact of alcohol taxes as a prevention and harm reduction tool (see Babor et al., 2010).

The literature reviewed here also points to several new or emerging topics for future research that might be organized along three dimensions: interventions, impact, and implemen- tation. Future studies might assess the results of price/taxation according to the size of the increase or decrease in the real price, the use of minimum prices as an intervention, and to assess the interaction between price changes and beverage strength. Furthermore, natural experiments might compare phased-in price/tax changes with a different change every year with, for example, a one-time change.

While there is extensive literature on the impacts of price/ taxation, special studies might look more closely at certain sec-

3 8 ALCOHOL PRICES AND TAXES

tors of the population—including the high-risk drinkers, mar- ginalized consumers, or those with easy access to alternative and unofficial sources of alcohol—such as smuggled products. In previous studies the measurement of the "impact decay'" is not systematically addressed and is a topic for future work.

It is feasible that price/taxation could involve several alternative implementation scenarios and a systematic assessment of their divergent impacts is a topic for future research. One might be by "stealth" (Giesbrecht, Greenfield, Anglin, & Johnson, 2004), where governments raise or lower taxes on alcohol without great fanfare and without a clear link to either a public health agenda or efforts to increase popularity among voters. Alternatively, tax measures might be implemented with a clearly proclaimed pub- lic health and safety agenda and with support from advocates of these agenda. The increase in taxes on alcohol might be linked with information campaigns about the merits of higher taxes as a public health tool, or they might be associated with other changes in alcohol availability, such as a decrease in alcohol marketing or restrictions on the density of outlets. Therefore, despite the extensive evidence summarized here, there are nev- ertheless a number of topics for investigators to explore.

Conclusion

In order to reduce the harm from alcohol and high health care and other alcohol-attributable costs, a comprehensive approach is needed (see Department of Health Promotion and Protection, 2008; National Strategy Working Group, 2007; Office of the Provincial Health Officer, 2008; Sixty-First World Health Assembly, 2008). The literature summarized in this article points to the importance of alcohol taxes and prices as a tool for pro- moting public health and safety. There are important chal- lenges faced by policy advisors and policy makers in deciding how these changes might be implemented, which beverages to focus on, and whether the policies should target alcoholic bev- erages that are particularly attractive to high-risk groups.

Appendix: Glossary of terms

Per adult consumption rate: In order to standardize the infor- mation so that it can be combined, beer, wine and spirits are con- verted to the equivalent in pure alcohol—i.e., 100% ethanol, and this volume is divided by the population aged 15 and older. This is the international convention, since a substantial portion of the population in the countries where the studies were conducted has consumed some alcohol by age 15.

5+ drinks per occasion: This is a frequently used measure to assess high-risk drinking. The low-risk drinking guidelines, cur- rently used in Ontario, recommend no more than 2 drinks a day per person of legal drinking age, and no more than 9 per week for women and 14 per week for men. http://www.camh.net/About _Addiction_Mental_Health/Drug_and_Addiction_Information /low_risk_drinking_guidelines.html. National drinking guidelines are being developed by the Advisory Committee of the National Alcohol Strategy.

Price elasticity: Price elasticity refers to the "sensitivity of demand to price change . . . deñned as a unit change in the demand caused by a unit change in price." In other words, if a beverage is price elastic, it is responsive to a change in price, and price inelastic if it is not very responsive to a change in price (see Edwards et al., 1994, p. 110).

4 0 ALCOHOL PRICES AND TAXES

R e f e r e n c e s Adams. M . . & Effertz. T. (2010). Effective prevention against risky under- age drinking—The need for higher excise taxes on alcoholic bever- ages in Germany. Alcohol and Alcoholism. 45. 387-394.

Adrian, M.. Ferguson. B.S.. & Her. M. (2001). Can alcohol price policies be used to reduce drunk driving? Evidence from Canada. Journal of Substance Use, 36. 1923-1957.

Anderson, P. (2007). A safe, sensible and social AHRSE: New labour and alcohol policy. Addiction, 102. 1515-1521.

Anderson, P., & Baumberg, B. (2006). Alcohol in Europe. A report of the European Commission. London: Institute of Alcohol Studies.

Andreasson, S.. Holder. H., Norstrom, T., Osterberg, E., & Rossow, I. (2006). Estimates of harm associated with changes in Swedish alcohol policy: Results from past and present estimates. Addiction, 101. 1096-1105.

Armstrong, B., Wodak, A., Walsh, N., Conigrave, K., Rubin, G., Chikritzhs, T., et al. (2009). Alcohol taxation policy in Australia: Public health imper- atives for action. The Medical Journal of Australia, 190{S), 437-439.

Babor, T., Caetano, R., Casswell. S., Edwards. G., Giesbrecht, N., Graham, K., et al. (2003). Alcohol: No ordinary commodity. Research and pub- lic policy. Oxford and London: Oxford University Press.

Babor, T., Caetano, R., Casswell, S., Edwards, G.. Giesbrecht, N., Graham, K., et al. (2010). Alcohol: No ordinary commodity. Research and pub- lic policy (2nd ed.). Oxford and London: Oxford University Press.

Bloomfield, K., Wicki, M., Gustafsson. N.K., Mäkelä, R, & Room, R. (2010). Changes in alcohol-related problems after alcohol policy changes in Denmark, Finland, and Sweden. Journal of Studies on Alcohol and Drugs, 71. 32-40.

Booth, A., Brennan, A.. Meier, P.S.. O'Reilly, D.T., Purshouse, R., Stockwell, T., et al. (2008). The Independent review of the effects of alcohol pricing and promotion: Systematic review. United Kingdom: School of Health and Related Research, University of Sheffield.

Bray, J.W., Loomis, B.. & Engelen, M. (2007). Correlates of in-store promo- tions of beer: Differential effects of market and product characteris- tics. Journal of Studies on Alcohol and Drugs, 68. 220-227.

Bray, J.W., Loomis, B.R., & Engelen, M. (2009). You save money when you buy in bulk: Does volume-based pricing cause people to buy more beer? Heaith Economics, 18, 607-618.

British Medical Association Board of Science. (2008). Alcohol misuse: Tackling the UK epidemic. London: BMA Science and Education Department of the Board of Science.

Byrnes. J.M.. Cobiac. L.J., Doran, C M . . Vos. T.. & Shakeshaft. A.P. (2010). Cost-effectiveness of volumetric alcohol taxation in Australia. Medical Journal of Australia, 192. 439-443.

Chaloupka, F.J. (2004). The effects of price on alcohol use, abuse, and their consequences. In R. Bonnie & M. O'Connell (Eds.). Reducing under- age drinking: A collective responsibility. Washington. DC: The National Academies Press.

Chaloupka. F.J.. Grossman, M., & Saffer, H. (2002). The effects of price on alcohol consumption and alcohol-related problems. Alcohol Research & Heaith, 26. 22-34.

Chaloupka, F.J., Saffer. H., & Grossman, M. (1993). Alcohol-control policies and motor-vehicle fatalities. Journal of Legal Studies, 22., 161-186.

Chaloupka, F.J.. & Wechsler, H. (1996). Binge drinking in college: The impact of price, availability and alcohol control policies. Contemporary Economic Policy, 14, 112-124.

Chesson, H., Harrison, P . & Kassler. W.J. (2000). Sex under the influence: The effect of alcohol policy on sexually transmitted disease rates in the United States. The Journal of Law and Economics, 43. 215-238.

Chikritzhs. T., Stockwell, T., & Pascal, R. (2005). The impact of the Northern Territory's Living with Alcohol program. 1992-2002: Revisiting the evaluation. Aûfd/cn'on, 100, 1625-1636.

Coate, D.. & Grossman. M. (1987). Change in alcoholic beverage prices and legal drinking ages: Effects on youth alcohol use and motor vehicle mortality. Alcohol Health and Research World, 12. 22-25.

Coate. D.. & Grossman. M. (1988). Effects of alcoholic beverage prices and legal drinking ages on youth alcohol use. Journal of Law and Economics, 31. 145-171.

Collins. D.J., & Lapsley, H.M. (2008). The costs of tobacco, alcohol and illicit drug abuse to Australian society in 2004/05: Summary version. Canberra. Australia: Department of Health and Ageing.

Connor, J.. & Casswell. S. (2009). The burden of road trauma due to other people's drinking. Accident Analysis and Prevention, 4L 1099-1103.

Cook. P.J. (2007). Paying the tab: The economics of alcohol policy. Princeton University Press: Princeton. N.J.

Cook. P.J.. & Tauchen. G. (1982). The effect of liquor taxes on heavy drink- ing. The Bell Journal of Economics, 13. 379-390.

4 2 ALCOHOL PRICES AND TAXES

Dee, T.S.. & Evans. W.N. (2001 ). Teens and traffic safety. In J. Gruber (Ed.). Risky behaviour among youth: An economic analysis (pp. 121-166). Chicago: National Bureau of Economic Research.

Department of Health Promotion and Protection. (2008). Summary of issues and potential solutions from a health promotion perspective. Current discussions re licensed establishments. Nova Scotia: Author.

Doran. CM., Hall. W.D.. Shakeshaft, A.P., Vos, T., & Cobiac. L.J. (2010). Alcohol policy reform in Australia: What can we learn from the evi- dence? The Medical Journal of Australia, 192. 468-470.

Edwards, G., Anderson, P , Babor, T.F., Casswell, S., Ferrence, R., Giesbrecht, N., et al. (1994). Alcohol policy and the public good. Oxford: Oxford University Press.

Egger, M., Smith, G.D., & Altman, D.G. (2001). Systematic reviews in health care: Meta-analysis in context. London: British Medical Journal Books.

Elder, R.W., Lawrence, B., Ferguson, A., Naimi, T.S., Brewer, R.D., & Chattopadhyay, S.K., et al. (2010). The effectiveness of tax policy interventions for reducing excessive alcohol consumption and related harms. American Journal of Preventative Medicine. 38, 217-229.

Ezzati, M., Lopez, A.D., Rodgers, A.D., Vander Horn, S.. Murray, C.J.L., & Comparative Risk Assessment Collaborating Group. (2002). Selected major risk factors and global and regional burden of disease. Lancet, 360, 1347-1360.

Farrell, S., Manning, W.G.. & Finch, M.D. (2003). Alcohol dependence and the price of alcoholic beverages. Journal of Health Economics, 22. 117-147.

Fleiss, J.L. (1971). Measuring nominal scale agreement among many raters. Psychological Bulletin, 76. 378-382.

Gallet, C A . (2007). The demand for alcohol: A meta-analysis of elasticities. Australian Journal of Agricultural and Resource Economics, 51, 121-135.

Giesbrecht, N., Greenfield, T.K., Anglin. L., & Johnson, S. (2004). Changing the price of alcohol in the United States: Perspectives from the alcohol industry, public health, and research. Contemporary Drug Problems. 31,7\\-736.

Gmel, G., Wicki, M.. Rehm, J.. & Heeb, J.L. (2008). Estimating regression to the mean and true effects of an intervention in a four-wave panel study. Addiction, 103, 32-41.

Greenfield, T.K..Ye. Y.. & Giesbrecht. N.A. (2007). Alcohol policy opinions in the U.S. over a 15-year period of dynamic per capita consumption changes: Implications for today's public health practice. Con- temporary Drug Problems, 34. 649-680.

Grittner, U., Gustafsson. N.K.. & Bloomfield. K. (2009). Changes in alco- hol consumption in Denmark after the tax reduction on spirits. European Addiction Research, 15. 216-223.

Grossman, M., & Markowitz, S. (2001). Alcohol regulation and violence on college campuses. In M. Grossman & C.R. Hsieh (Eds.). Economic analysis of substance use and abuse: The experience of developed countries and lessons for developing countries, (pp. 257-289). Cheltenham, UK: Edward Elgar.

Gruenewald. PJ.. Ponicki. W.R.. Holder. H.D.. & Romelsjö. A. (2006). Alcohol prices, beverage quality, and the demand for alcohol: Quality substitutions and price elasticities. Alcoholism: Clinical and Experimental Research, 30, 96-105.

Gustafsson. N.K.. & Ramstedt. M.R. (2011). Changes in alcohol-related harm in Sweden after increasing alcohol import quotas and a Danish tax decrease—An interrupted time-series analysis for 2000-2007. International Journal of Epidemiology, 40, 432-440.

Heeb, J.. Gmel. G.. Zurbrugg. C . Kuo. M.. & Rehm. J. (2003). Changes in alcohol consumption following a reduction in the price of spirits: A natural experiment in Switzerland. Addiction, 98, 1433-1446.

Helakorpi, S.. Mäkelä. P.. & Uutela. A. (2010). Alcohol consumption before and after a significant reduction of alcohol prices in 2004 in Finland: Were the effects different across population subgroups? Alcohol and Alcoholism, 45. 286-292.

Henderson. C , Xinhua, L., Roux. A.V.D., Link, B.G.. & Hasin. D. (2004). The effects of US state income inequality and alcohol policies on symptoms of depression and alcohol dependence. Social Science & Medicine, 58, 565-575.

Herttua, K.. Mäkelä. P . Martikainen. P. & Siren. R. (2008). The impact of a large reduction in the price of alcohol on area differences in inter- personal violence: A natural experiment based on aggregate data. Journal of Epidemiology and Community Health, 62, 995-1001.

Herttua. K.. Mäkelä. P , & Martikainen. P (2010). The effects of a large reduction in alcohol prices on the hospitalizations related to alcohol: A population-based natural experiment. Addiction, 106, 759-767.

Hollingworth, W.. Ebel. B.E.. McCarty. C.A.. Garrison, M.M.. Christakis. D.A.. & Rivara. F.P (2006). Prevention of deaths from harmful drink- ing in the United States: The potential effects of tax increases and advertising bans on young drinkers. Journal of Studies on Alcohol, 67, 300-308.

4 4 ALCOHOL PRICES AND TAXES

Kenkel, D.S. (1993). Drinking, driving and deterrence: The effectiveness and social costs of alternative policies. The Journal of Law and Economics, 33, 877-914.

Koski, A., Siren. R., 'Vuori, E., & Poikolainen. K. (2007). Alcohol tax cuts and increase in alcohol-positive sudden deaths: A time-series inter- vention analysis. Addiction, 102, 362-368.

Kuo, M., Heeb, J.. Gmel, G., & Rehm. J. (2003). Does price matter? The effect of decreased price on spirits consumption in Switzerland. Alcoholism: Clinical and Experimental Research, 27, 720-725.

Kuo, M., Heeb. J.. Gmel. G., & Rehm, J. (2004) Does price matter? The effect of decreased price on spirits consumption in Switzerland. In R. Müller & H. Klingemann (Eds.), from science to action? 100 years later—Alcohol politics revisited, (pp. 113-123). London: Kluwer Academic Publishers.

Kuo, M., Wechsler. H., Greenberg, P , & Lee, H. (2003). The marketing of alcohol to college students: The role of low prices and special promo- tions. American Journal of Preventive Medicine, 25, 204-211.

Laixuthai. A., & Chaloupka, F. (1993). Youth alcohol use and public policy. Contemporary Policy Issues, 11, 70-81.

Laslett, A-M.. Catalano, P., Chikritzhs, Y., Dale, C , Doran, C , Ferris, J., et al. (2010). The range and magnitude of alcohol's harm to others. Fitzroy, 'Victoria: Turning Point Alcohol and Drug Centre.

Mäkelä, K., Room, R., Single, E., Sulkunen, P., Walsh, B., Bunce, R., et al. (1981). Alcohol, society and the state, volume I: A comparative study of alcohol control. Toronto: Addiction Research Foundation.

Mäkelä, P., Bloomfield, K.. Gutfreund, K.S., Huhtanen, P., & Room, R. (2008). Changes in volume of drinking after changes in alcohol taxes and travellers' allowances: Results from a panel study. Addiction, 103. 181-191.

Mäkelä, P., & Österberg. E. (2009). Weakening of one more alcohol control pillar: A review of the effects of the alcohol tax cuts in Finland in 2004. Addiction, 104, 554-563.

Maldonado-Molina, M.M., & Wagenaar. A.C. (2010). Effects of alcohol taxes on alcohol-related morality in Florida: Time-series analysis from 1969-2004. Alcohol Clinical Experimental Research. 34. 1915-1921.

Markowitz, S. (2000). The price of alcohol, wife abuse and husband abuse. Southern Economic Journal, 67, 279-303.

Markowitz, S., Chatterji, P., & Kaestner. R. (2003). Estimating the impact of alcohol policies on youth suicides. The Journal of Mental Health Policy and Economics, 6. 37-46.

Markowitz, S., & Grossman, M. (2000). The effects of beer taxes on physi- cal child abuse. Journal of Health Economics, 19, 271-282.

Meier, P.S., Purshouse, R., & Brennan, A. (2009). Policy options for alcohol price regulation: The importance of modeling population heterogene- ity. Addiction, 105, 383-393.

Mohler-Kuo, M., Rehm, J., Heeb, J.. & Gmel, G. (2004). Decreased taxation, spirits consumption and alcohol-related problems in Switzerland. Journal of Studies on Alcohol, 65. 266-273.

Monteiro. M.G. (2007). Alcohol and public health in the Americas: A case for action. Washington, D . C : Pan American Health Organization.

Müller, S., Piontek, D., Pabst, A.. Baumeister, S.E., & Kraus, L. (2010). Changes in alcohol consumption and beverage preference among ado- lescents after the introduction of the alcopops tax in Germany. Addiction, 105, 1205-1213.

National Strategy Working Group. (2007). Reducing alcohol related harm in Canada: toward a culture of moderation. Recommendations for a national alcohol strategy. Retrieved November 1. 2011, from http://www .nationalframework-cadrenational.ca/uploads/files/FINAL_NAS_EN _April3 _07pdf

Office of the Provincial Health Officer. (2008). Public health approach to alcohol policy, an updated report from the Provincial Health Officer, PR.W. Kendall. Victoria, BC: Author.

Ohsfeldt, R.L., & Morrisey, M.A. (1997). Beer taxes, workers' compensa- tion and industrial injury. The Review of Economics and Statistics, 79, 155-160.

O'Mara, R.J., Thombs, D.L., Wagenaar. A.C., Rossheim, M.E., Merves, M.L.. Hou. W., et al. (2009). Alcohol price and intoxication in college bars. Alcoholism: Clinical and Experimental Research, 33, 1973-1980.

Ornstein, S.I. (1980). Control of alcohol consumption through price increases. Journal of Studies on Alcohol, 41, 807-818.

Ornstein, S.I., & Levy, D. (1983). Price and income elasticities and the demand for alcoholic beverages. In Recent developments in alco- holism, (pp 303-345). New York: Plenum.

Österberg E. (1995). Do alcohol prices affect consumption and related prob- lems? In H.D. Holder & G. Edwards (Eds.), Alcohol and public poli- cy: Evidence and issues. Oxford: Oxford University Press.

4 6 ALCOHOL PRICES AND TAXES

Parry. C D . (2010). Alcohol policy in South Africa: A review of policy development processes between 1994 and 2009. Addiction, 705(8), 340-345.

Ponicki. W.R.. & Gruenewald. P.J. (2006). The impact of alcohol taxation on liver cirrhosis mortality. Journal of Studies on Alcohol. 67. 934-938.

Ponicki. W.R.. Gruenewald. PJ., & LaScala. E.A. (2007). Joint impacts of minimum legal drinking age and beer taxes on US youth traffic fatal- ities, 1975 to 2001. Alcoholism: Clinical and Experimental Research, 57,804-813.

Purshouse, CR.. Meier. PS.. Brennan, A., Taylor. K.B.. & Rafia, R. (2010). Estimated effect of alcohol pricing policies on health and health eco- nomic outcomes in England: An epidemiological model. The Lancet, 375, 1355-1364.

Rehm. J.. Baliunas. D., Brochu. S.. Fischer. B.. Gnam. W.. Patra. J.. et al. (2006). The costs of substance abuse in Canada 2002. Highlights. Ottawa, ON: Canadian Centre on Substance Abuse.

Rehm, J., Giesbrecht, N., Patra. J., & Roerecke, M. (2006). Estimating chronic-disease deaths and hospitalizations due to alcohol use in Canada in 2002. Implications for policy and prevention strategies. Preventing Chronic Disease, 5, A121.

Rehm, J., Gnam, W., Popova. S.. Patra. J.. & Sarnocinksa-Hart. A. (2008). Avoidable cost of alcohol abuse in Canada 2002. Toronto. ON: Centre for Addiction and Mental Health.

Rehm. J., Mathers. C , Popova. S., Thavomcharoensap. M.. Teerawattananon, Y.. & Patra. J. (2009). Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet, 373. 2223-2233.

Rehm, J., Patra, J.. Baliunas. D., Popova. S.. Roerecke. M.. & Taylor. B. (2006). Alcohol consumption and the global burden of disease 2002. Geneva. Switzerland: WHO.

Rehm. J.. Patra. J.. Gnam. W.. Sarnocinska-Hart, A.. & Popova. S. (2011). Avoidable cost of alcohol abuse in Canada. European Addiction Research. 17. 12-19.

Sabia. J.J. (2004). Alcohol consumption and domestic violence against moth- ers. The Journal of Mental Health Policy and Economics, 7, 191-205.

Saffer, H. (2001). Substance abuse control and crime: Evidence from the national Survey of Drug Abuse. In M. Grossman & CR. Hsieh (Eds.), Economic analysis of substance use and abuse: The experience of developed countries and lessons for developing countries (pp. 291- 307). Cheltenham, UK: Edward Elgar.

Shea, B.J., Grimshaw, J.M., Wells, G.A., Boers, M., Andersson, N., Hamel, C , et al. (2007). Development of AMSTAR: A measurement tool to assess the methodological quality of systematic reviews. BMC Medical Research Methodology, 7, 10.

Sixty-First World Health Assembly. (2008). Strategies to reduce the harm- ful use of alcohol. Geneva, Switzerland: WHO.

Sloan, F.A., Reilly, B.A., & Schenzler, C (1994). Effects of prices, civil and criminal sanctions, and law enforcement on alcohol-related mortality. Journal of Studies on Alcohol, 55, 454-465.

Statistics Canada. (2002). The control and sale of alcoholic beverages in Canada. (Rep. No. 63-202-XIB). Ottawa, ON: Author.

Statistics Canada. (2009). Volume of sales of alcoholic beverages In litres of absolute alcohol and per capita 15 years and over, fiscal years ended March 31, annual fCANSIM Table 183-0019). Ottawa, ON: Author.

Stockwell, T. (2006). Alcohol supply, demand, and harm reduction: What is the strongest cocktail? International Journal of Drug Policy, 17, 269-111.

Stockwell, T., Chikritzhs, T., Hendrie, D., Fordham, R.. Ying, F.. & Phillips. M. (2001). The public health and safety benefits of the Northern Territory's Living with Alcohol programme. Drug Alcohol Review, 20, 167-180.

Stockwell, T., Masters, L., Philips, M., Daly, A., Gahegan, M., Midford, R., et al, (1998). Consumption of different alcoholic beverages as predic- tors of local rates of night-time assault and acute alcohol-related mor- bidity. Australian and New Zealand Journal of Public Health, 22,

Stockwell, T., Pakula, B., Macdonald, S., Zhao. J.. Reist, D., Thomas, G.. et al. (2007). Alcohol consumption in British Columbia and Canada: A case for liquor taxes that reduce harm (CARBC Statistical Bulletin no. 3). Victoria, BC: University of Victoria.

Van den Berg, M., van Baal, P.H.M., Tariq, L., Schuit, A.J., de Wit. G.A., & Hoogenveen, R.T. (2008). The cost-effectiveness of increasing alco- hol taxes: A modelling study. BMC Medical, 6, 1-11.

Wagenaar, A.C., Maldonado-Molina /M.M.. & Wagenaar, B.A. (2009). Effects of alcohol tax increases on alcohol-related disease mortality in Alaska: Time-series analyses from 1976 to 2004. American Journal of Public Health, 99, 1464-1470.

Wagenaar, A.C., Salois, M.J.. & Komro, K.A. (2009). Effects of beverage alcohol price and tax levels on drinking: A meta-analysis of 1003 esti- mates from 112 studies. Addiction, 104, 179-190.

4 8 ALCOHOL PRICES AND TAXES

Wagenaar. A.C.. Tobler, A.L., & Komro. K.A. (2010) Effects of alcohol tax and price policies on morbidity and mortality: A systematic review. American Journal of Public Health, /00(l 1). 2270-2278.

World Health Organization. (2004). Global status report on alcohol 2004. Geneva. Switzerland: Author.

World Health Organization. (2009). Global health risks: Mortality and bur- den of disease attributable to selected risk factors. Geneva, Switzeriand: Author.

Yamasaki, A.. Chinami. M.. Suzuki. M., Kaneko.Y. Fujita, D., & Shirakawa, T. (2005). Tobacco and alcohol tax relationships with suicide in Switzeriand. Psychological Reports, 97(1). 213-216.

may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express

written permission. However, users may print, download, or email articles for individual use.