Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 75
4
INDIVIDUAL-ENVIRONMENT INTERACTIONS: FOCUS ON THE ENVIRONMENT
This chapter reviews research on a number of the environmental factors that influence the
choices individuals make about their use of alcohol. (In its use of the term environment
in this case, the committee refers to the drinking setting and the cultural and economic
milieu surrounding alcohol use.) Environmental factors can affect many people at a time
or only a few. This chapter considers those factors that affect broad populations (e.g.,
national legislation concerning minimum purchase age requirements, mass media
influences), as well as factors that do not have as broad a reach (e.g., the influences of a
local bar or restaurant). It will also discuss aspects of the workplace that influence alcohol
consumption.
Framing alcohol-related problems from an environmental perspective is part of the public
health approach described in Chapter 1 that views behavior as a function of the interaction
of individual and agent attributes with factors in the drinking environment. In the past,
alcohol abuse and alcohol problems have often been blamed on the "weak wills or
irresponsibility of the drinker. Demonstrating that conditions in the environment can affect
and alter behavior allows for understanding another part of the behavioral equation relating
to alcohol use. Selective modifications of these conditions represent promising approaches
to research on the prevention of alcohol-related problems.
ENVIRONMENTAL CONTROLS ON THE
AVAILABILITY OF ALCOHOLIC BEVERAGES
The focus of this section is on the mechanisms that influence the availability of alcoholic
beverages. The factors considered here include physical availability (e.g., minimum age
requirements, geographic density of alcohol outlets), as well as economic availability (the
price of alcohol relative to income and other goods).
Although availability and subsequent consumption of alcohol are affected by federal and
state restrictions concerning the production and distribution of alcoholic beverages, most
of these limits are no longer intended to prevent consumption. State statutes that
established alcoholic beverage control (ABC) commissions after the repeal of Prohibition
in this country were designed to prevent drunkenness and alcohol misuse. Today, however,
state and local control of alcoholic beverages is intended rather to ensure that taxes are
collected, that the marketplace is orderly, and that undesirable persons do not secure
licenses for retail sales (Rice, 1984~.
The study of alcohol availability and its relation to consumption has generally been
approached in one of two ways. Researchers have looked at aggregate indices of alcohol
availability (e.g., a combination of age restrictions, law enforcement, pricing structures, and
other factors thought to be important) and their relationship to the full range of alcohol
problems and consumption levels. Alternatively, researchers have studied such specific
alcohol availability policies as an increase in the minimum purchase age as it relates to
specific types of alcohol problems (e.g., auto crashes).
-75
OCR for page 76
Studies That Measure the Effect of Multiple Influences on Consumption
Studies of aggregate influences and results frequently show positive associations between
aggregate measures of alcohol availability and alcohol consumption. A combined
cross-sectional and longitudinal analysis of the consumption of distilled spirits by Hoadley,
Fuchs, and Holder (1984) showed that certain laws and restrictions do significantly hold
down distilled spirits consumption. In another effort, Rush, Gliksman, and Brook (1986)
conducted statistical analyses using linear structural relations applied to a set of county-level
data from Ontario, Canada. They found a high positive association among the retail
availability of alcohol, alcohol consumption, and alcohol-related morbidity and mortality.
These investigators concluded from their analyses that government policies that restrict the
availability of alcohol will reduce per capita consumption and indirectly lessen
alcohol-related damage.
Another set of studies, however (Popham, Schmidt, and DeLint, 1976; DeLuca, 1981),
concluded that state ABC laws and regulations have little or no effect on reducing per
capita consumption and alcohol-related problems. Watts and Rabow (1981) claim that
interstate tourism, particularly for Nevada, Vermont, New Hampshire, and the District of
Columbia, accounts for much of the association between availability and consumption.
Their conclusion, however, was based on 1972 state consumption data and on results from
a 1977 national survey--a period during which the minimum age for drinking was changed
in 29 states. In a study published later, the same research team found positive links
between availability and alcohol-related problems in California (Rabow and Watts, 1982~.
In addition, Colon and colleagues (1981), while controlling for tourism and urban
conditions, found a significant association between consumption and two types of composite
measures of availability.
Most of the studies noted above used state-level data. Yet it has been argued (Hooper,
1983) that the most appropriate unit of analysis for this type of research is the county
because of differences by county in alcoholic beverage regulation. For example, Those and
Holder (1987a) used an interrupted time-series analysis in a quasi-experimental design on
alcohol-related crash data in North Carolina following the legalization of liquor by the
drink (LBD). They found statistically significant increases in counties that permitted LBD
and~no changes in matched comparison counties that did not legalize LED (Blose and
Holder, 1987b).
MacDonald and Whitehead (1983) conducted a literature review of U.S. and Canadian
studies of the relationship between consumption and the frequency of outlets for alcoholic
beverages. As a group, these studies, along with cross-cultural analyses from other
countries (see DeLint, 1980; Makela et al., 1981; Single et al., 1981), have provided
evidence that environmental restrictions can affect both consumption levels (which are
linked to alcohol-related problems) and alcohol abuse. Room (1984, p.310), in reviewing
studies from the United States and other countries, concluded, "The evidence is thus by
now compelling that alcohol controls can affect the rates of alcohol-related problems, and
that they often particularly affect the consumption patterns of high-risk drinkers."
Other researchers have looked into the influence of such factors as statewide alcohol policy
changes or the pricing structure of alcoholic beverages as they relate to the level of alcohol
consumption. The committee has selected for review three such factors that have received
serious study and attention: (1) alcohol prices and taxation, (2) minimum age of purchase,
and (3) zoning and conditional-use permits. Certainly, there are other aspects of the
drinking environment (e.g., hours of sale, number of outlets, rationing, strikes among
-76
OCR for page 77
brewery workers) that have been investigated and that may provide useful insights into the
effects of environmental factors on alcohol-related problems. The committee chose to
discuss research on the three topics below as illustrative of the work in this area and as
offering particularly rich possibilities for further inquiry.
Studies That Measure the Effects of Specific Factors
upon Consumption Alcohol Prices and Taxation
Research has confirmed that alcoholic beverage sales are sensitive to price and that a
relationship ens Is between the price of alcoholic beverages, alcohol consumption, and
alcohol-related problems. Alcohol pricing and taxation policy, therefore, is an important
consideration in the development of an alcohol problem prevention strategy. Although
researchers have not reached a consensus on the exact level of price sensitivity, they agree
that alcoholic beverage consumption does respond to changes in price. Cook (1981), Cook
and Tauchen (1982), Levy and Sheflin (1983), Ornstein and Hanssens (1983), and Hoadley,
Fuchs, and Holder (1984) all confirm a relationship between price and total consumption
in the United States. Room (1984) summarized studies in other countries with similar
findings. The research of Cook (1981) and Cook and Tauchen (1982) has also shown a
strong relationship between cirrhosis mortality (as a surrogate measure of heavy, chronic
drinking) and the price of liquor. In addition. Cook (19811 found that increases in liquor
taxes tended to reduce auto fatalities.
Researchers differ in their estimates of the price sensitivity of alcoholic beverages.
Furthermore, there are likely to be different sensitivity levels for alcoholic beverages by
type of beverage and by age of the purchasers (Grossman, Coate, and Arluck, 1987; Saffer
and Grossman, 1987a). Young people, for instance, may exhibit a unique alcohol
consumption rate as a function of price because their relative inexperience as drinkers
also means that they will have less rigid drinking habits (Levy and Sheflin, 1983; Coate
and Grossman, 1986~. In addition, the marginal cost of alcohol relative to disposable
income is greater for young people (Coate and Grossman, 1986~.
Grossman, Coate, and Arluck (1987) determined the differential price sensitivity of
consumption by young people 16-21 years old. They concluded that youthful consumption
is sensitive to price changes in both beer and distilled spirits. They found that a 10-cent
increase in the price of beer will result in a 14.8 percent decrease in the number of
youthful heavy beer drinkers (defined as three to five drinks of beer per day) and that a
30-cent increase in distilled spirits would result in a 27.3 percent decline in the number of
youthful heavy liquor drinkers (three to five drinks of liquor per day).
Saffer and Grossman (1985) examined the association between beer prices and traffic
fatalities among young people. Separate analyses were performed for young men and
young women in three age groups (15-17, 18-20, and 21-24 years). Minimum purchase
age, demographic variables, and driving exposure were controlled. Findings indicated that
the states with higher beer prices had lower fatality rates for all of the age groups studied.
Studies of the specific drinking environment have also been undertaken to determine what
price-relevant factors in the immediate surroundings might contribute to alcohol-related
problems. Babor and his colleagues (1980) found that happy-hour promotions increased
consumption in laboratory and barroom settings, but Smart and Adlaf (1986), using
aggregate-level data, were unable to detect changes in consumption with the elimination of
happy hours in Ontario, Canada. In another study, Geller, Russ, and Altomari (1986)
-77
OCR for page 78
reported that the size of the serving was associated with overall consumption. Those who
ordered cups (10 ounces), bottles (12 ounces), or pitchers (40 ounces) of beer drank an
average of 10, 15.1, and 35.2 ounces per person, respectively. These differences do not
reflect different rates of consumption, however: the pitcher drinkers stayed in the bar
approximately three times longer than did the cup drinkers.
Based on the results of price sensitivity research, Cook (1984b), Harris (1984), Levy and
Sheflin (1983), Grossman, Coate, and Arluck (1987), Bruun and colleagues (1975), Saffer
and Grossman (1987a), and Phelps (in press) have pointed out the polisher potential of
increasing taxes to reduce or stabilize consumption and to reduce alcohol-related problems.
Several observations may be made on this issue, based on current research:
1. Taxes are politically viable as a prevention policy if voters understand that increased
prices can reduce alcohol misuse, particularly among the young (Levy and Sheflin, 1983;
Mosher and Beauchamp, 1983~.
2. Price increases are not regressive because consumption has been shown to increase
with income (Cook, 1981; Harris, 1984~.
3. Potential reductions in alcohol-related problems as a result of price increases are
substantial, even if one allows for overestimates of the reductions in cirrhosis deaths (Cook,
1984a; Harris, 1984~.
Minimum Age of Purchase
For the majority of young people, drinking is initiated before they finish their first year
of high school, at an average age of 13. By ages 14-15, about 85 percent have drunk
alcohol at least once, and 65-70 percent of 14 to 15 year aids drink on at least a monthly
basis (NIAAA, 1987~.
The early age of onset of drinking and the frequency of alcohol use among young people
lead to questions about the role alcohol plays in many social and medical problems that
affect teenagers. Alcohol is involved in as many as 50 percent of teen suicides and plays
a large role in car crashes, the number one killer of teenagers. There is also concern that
the early use of alcohol can lead to later drinking problems and drug use.
Historically, the minimum age of purchase has been used to reduce alcohol consumption
by the young and to prevent alcohol-related problems, particularly accidents and injuries,
involving young people. The effect of changes in the minimum purchase age on youthful
drinking and traffic accidents has been extensively researched. Overall, evidence suggests
that a higher minimum purchase age results in lower per capita consumption (Maisto and
Rachal, 1980~. Longitudinal analyses of aggregate sales, of which young purchasers
represent a small part, have shown that beer (and sometimes wine) sales are sensitive to
changes in the minimum purchase age (Douglas and Freedman, 1977; Smart and Goodstadt,
1977; Wagenaar, 1983~.
An exception to such findings occurred in Massachusetts, where the level of self-reported
alcohol consumption by young people did not change following an increase in the minimum
drinking age from 18 to 20 years (Hingson et al., 1983; Smith et al., 1984~. This exception
might be explained by the under-or overreporting of drinking by the young respondents, a
lack of compliance with the law, or a lack of enforcement. After the drinking age increase,
-78
OCR for page 79
teenage purchases of alcohol in liquor stores, bars, and restaurants in Massachusetts
declined sharply, but the proportion of teens who had other people purchase alcohol for
them almost doubled.
In the case of alcohol-related traffic accidents, however, research findings support the
conclusion that a higher minimum age of purchase can reduce the number of such
accidents. The longest time-series analysis of a state increase in the minimum age was
conducted by Wagenaar (1981, 1987) in Michigan. Michigan is a good state for such
analyses because the greatest population concentrations are sufficiently far from state
borders to reduce the "border effect" whereby underage youths cross to a state with lower
minimum-age requirements to purchase alcohol. Wagenaar (19813 found an 18 percent
reduction in alcohol-related crashes among young drivers in the first year following a
change in the minimum age of purchase from 18 to 21. His follow-up analysis, which was
carried out four years after the age change, showed a statistically significant 9 percent
reduction over the total five-year period (Wagenaar, 1987~. These findings are consistent
with those of Filkins and Flora (1981) in an independent analysis also conducted in
Michigan.
Other states show similar results. Maxwell (1981) found a statistically significant reduction
in alcohol-related accidents in Illinois for 18-to 21-year-old drivers following an increase in
the minimum purchase age to 21. These findings were confirmed by a nine-state analysis
conducted by Williams and colleagues (1983), who also found decreases in the number of
fatal crashes among young drivers following an increase in the minimum alcohol purchase
age requirement.
Massachusetts experienced the lowest reduction in fatal crashes following a one-year
increase in the minimum purchase age from 18 to 20. No statistically significant changes
in fatal crashes in Massachusetts were found by Hingson and coworkers (1983) for the
entire 16-to 20-year-old age group and by the same research team (Smith et al., 1984) for
the 16-to 17-year-old group. However, a statistically significant reduction in single-vehicle,
nighttime fatalities was found in Massachusetts for 18 to 19 year olds over the three years
following the increase in the minimum age requirement. These outcomes are consistent
with the findings by Williams and colleagues (1983) that Massachusetts had the lowest
reduction in fatalities of nine states that raised their minimum purchase age. Other states
that appear to have a higher level of enforcement of the minimum purchase age laws and
of compliance with the laws have recorded statistically significant reductions in
alcohol-related crash involvement among the age groups most affected by the raised
minimum ages. A recent study of 26 states by DuMouchel, Williams, and Zador (1987)
found similar results.
In an adjoining state, New York, which was used as a comparison state for the
Massachusetts study by Hingson and coworkers (1983), a subsequent purchase age change
from 18 to 19 yielded statistically significant changes in the auto accident rate. Lillis,
Williams, and Williford (1987) reported nearly a 21 percent decrease in fatal and injury
crashes and a 46 percent decrease in self-reported drinking and driving for New York young
people following the age requirement change. A recent study conducted in Texas also
showed that a one-year change in the minimum drinking age affected youthful crashes
(Wagenaar and Maybee, 1986~.
Taken as a group, such studies of individual states or clusters of states support the
conclusion that a higher minimum purchase age requirement has the potential to reduce
consumption by youth (particularly of beer, the beverage of choice of the young) and
-79
OCR for page 80
alcohol-related traffic accidents. The potential reduction, like the effects of most
restrictions on alcohol availability, appears to be a function of compliance and enforcement.
If compliance is poor as a result of the lack of diligence by retail establishments in
checking identification or the lack of enforcement by ABC authorities and law enforcement
officers, the decline in alcohol-related traffic accidents is reduced.
Three national studies are worthy of note. An analysis by Cook and Tauchen (1982) found
a 7 percent increase in the number of youths killed in automobile accidents that eras
associated with a lowering of the drinking age from 21 to 18. A national comparison by
the National Highway Traffic Safety Administration (1982) found that states with higher
drinking-age requirements had lower rates of serious injuries.
In a related study, Grossman, Coate, and Arluck (1987) conducted a national evaluation
of the sensitivity of youthful consumption of specific alcoholic beverages to minimum-age
changes. Based on their projections, they concluded that an increase in the minimum age
for the purchase of beer from 20 to 21 would yield a 10 percent drop in the number of
youths who drank beer, a 17 percent reduction in those drinking beer two to three times
a week, and a 17 percent reduction in the number drinking as many as three to five glasses
of beer on a typical drinking day (for a similar analysis, see Saffer and Grossman, 1987b).
A report by the National Highway Traffic Safety Administration (Arnold, 1985) analyzed
traffic crash data for drivers up to age 23 in 13 states that had raised their minimum
purchase age between 1975 and 1982. The study compared annual figures for drivers in
areas affected by minimum age changes who were involved in fatal crashes with those
drivers who were involved in fatal crashes in areas not affected by the law change. Pooled
data from all states revealed an average reduction of about 13 percent (with a range of 6-19
percent) in fatal accident involvement among the drivers affected by increased minimum-age
requirements.
Zoning and Conditional-Use Permits
Recently, decision makers in some municipalities have considered employing local land-use
zoning to directly limit the density of alcohol outlets. Another proposal has been to
employ conditional-use permits to place specific restrictions on the hours of operation,
decor, and perhaps serving practices of any business that plans to serve alcohol (see
Wittman, 1986~. However, relatively little research has been conducted to date on the
topics of zoning and conditional-use permits.
Published research on alcohol zoning practices appears to be limited to a single survey of
California cities reported by Wittman and Hilton (1987~. The survey's purpose was to
describe current zoning practices. It found that approximately 41 percent of the cities did
not regulate outlets, 29 percent required conditional-use permits for on-premises sales
outlets, and 30 percent required conditional-use permits for both on-and off-premises sales;
26 percent of the cities had incorporated restrictions on alcohol outlets into the local
zoning ordinance. It remains unclear what leads cities to adopt these restrictions, although
larger urban areas are more likely than smaller areas to adopt zoning regulations of all
types.
Although a basic relationship between the overall indicators of alcohol availability and
alcohol use and misuse has been demonstrated, research should be focused on the effects
of specific changes in the forms and types of restriction on alcohol availability.
-80
OCR for page 81
The following are some promising opportunities for research on alcohol availability:
· The differential effects of retail price changes for alcohol should be examined in
terms of their potential to affect heavy, high-risk drinking. Because age and gender are
related to some high-risk consumption behavior, age- and gender-specific studies of price
sensitivity for alcoholic beverages are needed to improve our understanding of the economic
dimensions of alcohol use and misuse. Current economic models of variables do not
differentiate among alcohol-dependent persons, heavy drinkers, and moderate consumers;
also, the relative sensitivity of alcoholics and nonalcoholics to price changes is not well
delineated.
· Elements of alcohol availability (e.g., happy hour price incentives) have economic
and social dimensions that have not been studied. Further investigations in this area could
provide direction for the formulation of policy concerning these sales strategies.
· The influence of location, density, and hours of sale of alcohol outlets, as well as the
types of outlets that should be permitted and their proximity to major driving locations,
is just now being investigated. This research may suggest additional prevention strategies
that can be instituted at many different levels of government. Recently, localities have
become more involved in the regulation of alcohol availability, a role previously dominated
by the state alcoholic beverage control authority.
· As communities become more involved in preventing alcohol problems, new territory
will be opened up for studies of the epidemiology of alcohol problems at the community
level. An equally important topic for investigation in itself is the use of local community
resources for the development of prevention initiatives. For instance, further research could
answer questions about (a) the effectiveness of existing local controls on alcohol outlets for
reducing alcohol-related problems; (b) the factors that stimulate action by communities to
use their own local resources to prevent alcohol problems related to alcohol availability;
and (c) the effect of using local proprietors to regulate alcohol availability.
Studies such as these can help to develop knowledge about the potential effectiveness of
local planning for alcohol availability and to support policy development. Major questions
include the following: Should controls on the distribution of availability remain at the state
level, where they have been since the repeal of Prohibition? Should the trend toward de
facto allocation of responsibility for control on availability to local authorities continue?
How is physical planning for alcohol availability related to other aspects of environmentally
based prevention planning (e.g., prices, alcohol advertising, media portrayals of alcohol,
age-related aspects of alcohol availability)?
ENVIRONMENTAL INFLUENCES ON INDIVIDUAL DRINKING BEHAVIOR
The environmental influences on an individual's drinking behavior are many and varied,
reaching out to encompass a wide range of forces that may affect the development of
alcohol problems. The committee discusses several of these influences in the following
pages: the normative environment and the mass media, the legal environment, and the
effects of drinking context and setting.
-81
OCR for page 82
The Normative Environment and the Mass Media
The standards set by a community and communicated both explicitly and implicitly play a
large role in shaping many different behaviors, including alcohol consumption. Appropriate
alcohol-use behavior in one era may not be appropriate in another. Similarly, appropriate
drinking behavior may change from setting to setting or from group to group. The
normative environment can be rather complex, with one level of norms operating in a local
area (e.g., a college campus or even a single dormitory) and a different, perhaps even
competing set of norms accepted in the society at large.
The media, especially television, play an increasingly substantive role in communicating
information of all kinds to the public, and they are thought to play a significant part in
shaping public perceptions and norms about alcohol use. Alcohol-related information is
conveyed through at least three media modes: (1) public information campaigns that are
designed to educate the public about alcohol (2) advertising by the alcohol industry and
(3) fictional television and movie programming that depicts drinkers and drinking situations.
The contribution that each is thought to play in shaping the environment in which we
operate has been the object of a great deal of research. As one might expect, observations
of the impact of commercial advertising and fictional media programming are necessarily
different from planning and testing intentional media campaigns as a mode of preventive
intervention.
Public Information Campaigns
In the 1970s, several efforts were made to educate the general public about the importance
of moderate drinking. A three-year mass media demonstration project in California that
promoted responsible drinking showed some increase in citizen awareness but no significant
changes in attitudes or behavior (Wallack, 1983~. A review of 15 mass media campaigns
conducted by Hewitt and Blane (1984) revealed that some campaigns were effective in
changing some audience attributes, including knowledge, attitudes, or behavior. In later
work, Wallack (1985, 1987) proposed that the mass media can be used as an intentional
change agent to alter the social agenda, increase awareness and knowledge, stimulate public
discussion, and provide a background of legitimacy for the problems that detract from the
health of society. Conclusions from the California campaign and others are that public
education may not be sufficient to change behavior, but it could be an important
component of a larger prevention effort. There are, however, serious reservations about
whether the potential of public education for changing behavior has been adequately tested,
especially in the context of a comprehensive program that integrates environmental and
regulatory changes with multichannel education.
It is not likely that significant changes in attitudes, behavior, or both, will occur primarily
through mass media campaigns (Farquhar, Maccoby, and Wood, 1985~. Rather, the
evidence from cardiovascular disease prevention programs (Farquhar et al., 1977; Puska et
al., 1981) suggests that change may be more likely to occur when a comprehensive
campaign involves several change agents in addition to the mass media. At the same time,
it is unlikely that a large-scale public health campaign directed at the general public can
be successful without mass media involvement.
Existing research indicates that the mass media may be most effective in inducing cognitive
(as opposed to behavioral) changes and setting the public agenda about an issue. From
reviews of health campaign research compiled in the late 1970s and the 1980s, the most
reasonable goals of mass media campaigns in the health area appear to be to increase
-82
OCR for page 83
awareness, information levels, and the salience of specific issues. When the mass media
focus on a topic, they create and reinforce public awareness about an issue and contribute
to its salience. In addition, continuing emphasis on the issue is likely to increase the
absolute level of its perceived importance. Unfortunately, when focus on an issue subsides,
so does public attention.
Health issues are brought to public attention in one of two ways: either through selection
by the media or through a targeted health education campaign. These two approaches
differ greatly because selection by the media is largely uncontrolled, whereas a health
organization's efforts generally are purposeful, with specific, measurable goals. Health
organizations often initiate efforts to make the public aware of, and informed about, health
issues, and these efforts are designed to affect the media agenda. Agencies create films,
public service announcements, news releases, photo and interview opportunities, television
and radio programs, and so forth, sometimes to stimulate direct public response but more
typically to trigger media response as well.
Another goal of mass media campaigns is to provide information in the form of new
knowledge, as well as knowledge to replace misinformation and correct myths. The goal
is a better informed public, and research indicates that this is a reasonable expectation of
a mass media campaign (although target groups are never as well informed as health agency
administrators might wish).
If public education campaigns are to be successful in reducing alcohol abuse, there is a
need periodically to monitor the target populations, usually through surveys, to accomplish
the following:
· assess areas of information and misinformation. (What do people know, and what
do they think they know? What should they know that they do not know?;
· determine the public's awareness of alcohol abuse and alcohol problems;
· determine the salience of those problems to the public, both in terms of personal
importance and in terms of perceived social importance;
· examine relevant beliefs and attitudes held by the public; and
· identify their alcohol-related behaviors.
This assessment should precede any concerted health campaign because it provides
background information for planning such efforts. It should also be the substance for the
formative evaluation of media campaign efforts and strategies discussed below. To the
extent that campaign themes and strategies are in a developmental phase, they should be
pretested through formative research and modified in preparation and design as such
evaluation suggests--not when it is too late to make changes. Another element that is
critical in developing mass media health messages is to specifier the target audience.
Specification allows research planners to assess more accurately the knowledge, awareness,
salience, and orientation toward alcohol use and abuse that is characteristic of target
subgroups. It also permits planners to use each group's message exposure habits to design
more effective media campaigns.
Formative research is a necessary tool to create campaign messages for media dissemination
and should be carried out in two phases. In the first phase (preproduction), a target group
is surveyed to determine members' cognitive knowledge and affective responses to alcohol,
their motives for drinking, and their media usage patterns as a way to identify potential
areas of "vulnerability" for change. The areas that are so identified are then examined by
media, content, and persuasion experts to design messages. Formative research in message
-83
OCR for page 84
design involves informal testing from early tentative versions of a message to the one that
Is ultimately used. Prototype messages emerging from this process can then be
experimentally tested with sample target audience groups in the second (or postproduction)
phase to determine whether the campaign's desired goals are being achieved. The results
of these tests can serve as the basis for improving the messages. Summative or final
evaluation research may follow in the waning days of the campaign or thereafter (Atkin and
Freimuth, in press).
Alternative modes of reaching target groups with media messages should also be devised
and tested. For example, the radio is a particular favorite of teenagers and could be used
for public service announcements directed toward them. In addition, drinking-and-driving
messages would appear to be most appropriate if received by radio while driving. Field
experiments in selected communities could assess the ability of radio to deliver such
messages. Furthermore, there are specialized magazines for virtually all groups that can
be appropriately used to deliver alcohol-related messages. Music, in any medium, is
another strong influence for young people. The demonstrated attractiveness of some
specialized cable channels, such as Music Television (M - , should be considered as a
means to reach this group.
Another major avenue for reaching adolescents is films. For teenagers, moviegoing is a
major social experience, often followed by drinking opportunities and incidents. The movie
theater is rich in possibilities for intervention: for example, it provides a forum for public
service announcements (PSAs) before the movie begins, acts as a venue to mount
antidrinking/driving posters, and offers the possibility of print messages on soda and
popcorn containers. Another way of reaching adolescents (and others) with alcohol-use
messages might be to approach videocassette producers and request the inclusion of PSA
messages as trailers on rental or purchase tapes.
A social inoculation approach (i.e., using media messages to ninoculaten individuals against
persuasion efforts) has been shown to be effective, not only against persuasion (Lumsdaine
and Janis, 1953; McGuire, 1973) but against the effects of counterpersuasive messages. This
approach has recently been demonstrated to be effective against social temptation (Killer,
1985) in smoking prevention research. The identification of effective inoculations against
some media messages could help to prevent young people from forming unhealthful and
dangerous patterns of alcohol use (see the discussion under Commercial Alcohol
Advertising" below).
The following are opportunities for research on public information campaigns and
education:
· The formative evaluation process is necessary to identify credible communicators for
different groups. The "sources used to present alcohol-related messages to any particular
target audience must be credible. It is as unlikely that there are universally credible sources
for different audiences as it is that there is a universal antialcohol message. Questions that
require answers include: When are women credible commentators on alcoholism
prevention, as well as which women and for whom? Who is a hero to adolescents and, as
a hero, an effective spokesperson? A wealth of literature exists on source credibility, little
of which is linked to specific content areas. Especially for such contemporary issues as
driving after drinking or after using drugs, it may be particularly difficult to predict credible
sources accurately. In these cases, pretesting is essential.
· Preproduction research on media campaigns should identify which media are accessible
and are used by particular target groups, how often they are used, and when. For example,
-84
OCR for page 85
if a substantial subset of problem drinkers or individuals consists of late-night television
fans, that characteristic suggests a time and medium in which to reach them with media
messages.
· The coverage of alcohol issues in local newspapers and television programs should
be sampled.
Commercial Alcohol Advertising
The majority of the information on alcohol use is presented by the alcoholic beverage
industry. About $1 billion is spent annually on alcohol advertising, an amount that greatly
exceeds the public education budgets both of federal and state governments and of
nonprofit agencies. The messages that are common in alcohol advertising promote drinking
as a healthy, attractive, and success-oriented activity (Minkler, Wallack, and Madden, 1987~.
However, research on the effects of that advertising is conflicting. Smart (1988, p.321)
reports that "injo study (with one exception) has concluded that alcohol advertising has a
substantial effect on alcohol consumption.... Current research suggests that advertising
is, at best, a weak variable affecting alcohol consumption." Strickland (1983, p.221) concurs,
concluding that televised advertising has "meager effects on the level of consumption" by
adolescents in school. According to him, television advertising to promote alcohol use is
"rarely translated into effects on alcohol problems.
In a notable exception to these studies, Atkin and Bloch (1981) and Atkin, Hocking, and
Bloch (1984) concluded that schoolchildren who have seen more television and magazine
ads for alcohol generally drink more than those who have seen fewer ads; in addition,
among those who do not yet drink, those who have seen more ads report that they are
more likely to begin. In his most recent review, Atkin (1988b, p.ii) found the following:
Despite ambiguities about causal direction, the findings indicate that televised beer
ads mildly increase beer drinking, magazine liquor ads have a modest positive
influence on consumption of spirits, and that the impact of traditional wine
advertising is weak.
In reference to the several dozen studies he critiqued in the article, Atkin (1988b, p.iii)
concluded,
Although each technique and most specific executions can be attacked, rendering
conclusions suggestive and tentative, the preponderance of the evidence from the
alcohol advertising literature indicates that ads stimulate higher consumption by both
adults and adolescents. . There is sufficient basis for rejecting the inference of null
effects and for rejecting claims that advertising exerts a powerful influence on drinking
behavior. It appears that advertising is a contributing factor that increases
consumption to a modest extent.
Other researchers agree that advertising may be a contributing factor to increased alcohol
use. Farrell (1985, p.27) notes that advertising is "only one element of a complex mix of
marketing techniques. . .whose combined impact may well be substantially greater. She
also points out that there are no studies that explore the cumulative, long-term effects of
advertising on alcohol consumption and alcohol-related problems over the course of a
generation, no studies of the impact of a sharp reduction in advertising where it has been
pervasive, and no research on the impact of a sharp increase in advertising in cases in
which it has been largely unknown (e.g., Third World countries).
-85
OCR for page 98
Bruun, K, G. Edwards, M. Lumio et al. Alcohol control policies in public health
perspective. Helsinki: Finnish Foundation for Alcohol Studies, 1975.
Cassel, J. C. The contribution of the social environment to host resistance. Am. J.
Epidemiology 104:107-123, 1976.
Caudill, B. D., and G. ~ Marlatt. Modelling influences in social drinking: An
experimental analogue. J. Consult. Clin. Psychol. 43~3~:405-415, 1975.
Coate, D., and M. Grossman. Effects of Alcoholic Beverage Prices and Legal Drinking
Ages on Youth Alcohol Use. Cambridge, MA: National Bureau of Economic Research,
1986.
Coleman, D. H., and M. ~ Strauss. Alcohol abuse and family violence. Pp. 104-124 in
E. Gottheil et al., eds. Alcohol, Drug Abuse and Aggression. Springfield, IL: Charles
C. Thomas, 1983.
Collins, J. I., and W. E. Schlenger. Acute and chronic effects of alcohol use on violence.
J. Stud. Alcohol 49~6~:516-521, 1988.
Collins, J. J., Jr., ed. Drinking and Crime: Perspectives on the Relationships Between
Alcohol Consumption and Criminal Behavior. New York: The Guilford Press, 1981.
Colon, I., H.S. Cutter, and W.C. Jones. Alcohol control policies, alcohol consumption,
and alcoholism. Am. J. Drug Alcohol Abuse 8:347-362, 1981.
Cook. P. J. The effect of liquor taxes on drinking. cirrhosis. and auto accidents. Po.
, it, As, , ~
at, ~ ~ ~ . %, . . %, . _ ~ ~ . . . ~ . . . _ . . . _ . . _ .
Z55-Zd5 in M. H. Moore and D. R. Gerstein, eds. Alcohol and Public Polipy: Beyond
the Shadow of Prohibition. Washington, DC: National Academy Press, 1981.
Cook, P. J. The economics of alcohol consumption and abuse. Pp. 56-77 in L. J. West,
ed. Alcoholism and Related Problems: Issues for the American Public. Englewood
Cliffs, NJ: Prentice-Hall, 1984a.
Cook, P. J. Increasing the federal alcohol excise tax. Pp. 24-33 in D. R. Gerstein, ed.
Toward the Prevention of Alcohol Problems. Washington, DC: National Academy
Press, 1984b.
Cook, P. J., and G. Tauchen. The effect of liquor taxes on heavy drinking. Bell J. Econ.
13~2~:379-390, 1982.
Cosper, R. Drinking as conformity: A critique of sociological literature on occupational
differences in drinking. J. Stud. Alcohol 40:868-891, 1979.
DeLint, J. E. Alcohol control policy as a strategy of prevention. J. Public Health Policy
1:41-49, 1980.
DeLuca, J. R., ed. Fourth Special Report to the U.S. Congress on Alcohol and Health.
U.S. Department of Health and Human Services. USDHHS Publ. No. (ADM)81-1080.
Washington, DC: Government Printing Office, 1981.
-98
OCR for page 99
DeRicco, D. ~ Effects of peer majority on drinking rate. Addictive Behaviors 3:29-34,
1978.
DeRicco, D. As, and W. K Garlington. The effect of modeling and disclosure of
experimenter's intent on drinking rate of college students. Addictive Behaviors
2:135-139, 1977.
DeRicco, D. A, and J. E. Niemann. In viva effects of peer modeling on drinking rate.
J. Appl. Behav. Anal. 13~1~:149-152, 1980.
Douglas, R. L., and J. ~ Freedman. Alcohol-Related Casualties and Alcohol Beverage
Market Response to Beverage Alcohol Availability Policies in Michigan. Ann Arbor:
University of Michigan, Highway Safety Research Institute, 1977.
DuMouchel, W., ~ Williams, and P. Zador. Raising the alcohol purchase age: Its effects
on fatal motor vehicle crashes in 26 states. J. Legal Stud. 16:249-266, 1987.
Farquhar, J., N. Maccoby, and P. Wood. Education and communication strategies. Pp.
207-221 in W. Holland, R. Detels, and G. Knox, eds. Oxford Textbook of Public Health,
vol. 3. London: Oxford University Press, 1985.
Farquhar, J., N. Maccoby, P. Wood et al. Community education for cardiovascular health.
Lancet 1:1192-1195, 1977.
Farrell, S. Review of National Policy Measures to Prevent Alcohol-Related Problems.
Geneva: World Health Organization, 1985.
Fennel, M.L., M. Rodin, and G.K Kantor. Problems in work settings, drinking, and
reasons for drinking. Social Forces 60:114-132, 1981.
Filkins, C. D., and J. D. Flora. Alcohol-related accidents and D.U.I. arrests in Michigan:
1978-1979. Ann Arbor: University of Michigan, Highway Safety Research Institute,
1981.
Fillmore, K M., and R. Caetano. Epidemiology of alcohol abuse and alcoholism in
occupations. Pp. 21-88 in Occupational Alcoholism: A Review of Research Issues.
NIAAA Research Monograph No. 8. USDHHS Publ. No. (ADM)82-1184. Washington,
DC: Government Printing Office, 1982.
Foy, D. W., and S. J. Simon. Alcoholic drinking topography as a function of solitary
versus social context. Addict. Behav. 3:39-41, 1978.
Geller, E. S., N. W. Russ, and M. G. Altomari. Naturalistic observations of beer drinking
among college students. J. Applied Behavior Analysis 19:391-396, 1986.
Graham, K Determinants of heavy drinking and drinking problems: The contribution of
the bar environment. In E. Single and T. Storm, eds. Public Drinking and Public
Policy. Toronto: Addiction Research Foundation, 1985.
99
OCR for page 100
Graves, T., N. Graves, V. Semu et al. The social context of drinking and violence in New
Zealand's multi-ethnic pub settings. In T. Harford and L. Faines, eds. Social Drinking
Contexts: Proceedings of a Workshop, September 17-19, 1979. NIAAA Research
Monograph No. 7. Washington, DC: NIAAA, 1981.
Greenberg, B. Smoking, drinking and drugging in top-rated TV series. J. Drug Educ.
11:227-233, 1981.
Greenberg, B., C. Collado, C. Atkin et al. Sexual intimacy and drug use in TV series. J.
Communications 28:30-37, 1978.
Greenberg, B., C. Collado, D. Graef et al. Trends in use of alcohol and other substances
on television. J. Drug Educ. 9:243-253, 1979.
Grossman, M., D. Coate, and G. M. Arluck. Price sensitivity of alcoholic beverages in
the United States: Youth alcohol consumption. Pp. 169-198 in H. D. Holder, ed.
Control Issues in Alcohol Abuse Prevention: Strategies for States and Communities.
Greenwich, CT: JAI Press, 1987.
Hannerz, U. Tales of the City: Inquiries Toward an Urban Anthropology. New York:
Columbia University Press, 1982.
Harford, T. Ecological factors in drinking. In H. T. Blane and M. E. Chafetz, eds. Youth,
Alcohol and Social Policy. New York: Plenum Press, 1979.
Harford, T., S. Feinhandler, J. O'Leary et al. Drinking in bars: An observational study
of companion status and drinking behavior. International Journal of the Addictions
18~7~:937-950, 1983.
Harris, J. E. More data on tax policy. Pp. 33-38 in D. R. Gerstein, ed. Toward the
Prevention of Alcohol Problems. Washington, DC: National Academy Press, 1984.
Heeran, T. R., S. Smith, S. Morelock et al. Surrogate measures of alcohol involvement
in fatal crashes: Are conventional measures adequate? J. Safety Res. 16:127-134, 1985.
Hewitt, L. E., and H. T. Blane. Prevention through mass media communication. Pp.
281-323 in P. M. Miller and T. D. Nirenberg, eds. Prevention of Alcohol Abuse. New
York: Plenum Press, 1984.
Hingson, R., and J. Howland. Alcohol as a risk factor for injury or death resulting from
accidental falls: A review of the literature. J. Stud. Alcohol 48:212-219, 1987.
Hingson, R., J. Howland, and S. Levenson. Effects of legislative reform to reduce drunken
driving and alcohol related fatalities. Public Health Reports 103:659-667, 1988.
Hingson, R., N. Scotch, T. Mangione et al. Impact of legislation raising the legal drinking
age in Massachusetts from 18-20. Am. J. Public Health 73:163-170, 1983.
Hingson, R., T. Heeran, S. Smith et al. Effects of Maine's 1981 and Massachusetts' 1987
driving under the influence legislation. Am. J. Public Health 77:593-597, 1987.
-100
OCR for page 101
Hingson, R., J. Howland, T. Heeran, et al. Effects of legal penalty changes and laws to
increase drunken driving convictions on fatal traffic crashes. Bull. N.Y. Acad. Med.
64:662~77, 1988.
Hoadley, I. F., B. C. Fuchs, and H. D. Holder. The effect of alcohol beverage restrictions
on consumption: A 25-year longitudinal analysis. Am. J. Drug Alcohol Abuse
10:375-401, 1984.
Holder, H. D., and J. O. Those. Impact of changes in distilled spirits availability on
apparent consumption: A time-series analysis of liquor-by-the-drink. Br. J. Addictions
82:623-631, 1987.
Homel, R. Drunk-driving countermeasures in Australia. Alcohol, Drugs, and Driving
4~2~:113-144, 1988a.
Homel, R. Policing and Punishing the Drinking Driver: A Study of General and Specific
Deterrence. New York: Springer-Verlag, 1988b.
Hooper, F. J. The relationship between alcohol control policies and cirrhosis mortality
in United States counties. Paper presented at meetings of the American Public Health
Association, Dallas, November 16, 1983.
Janes, C. R., and G. M. Ames. Men, Blue Collar Work and Drinking: Alcohol Use and
Misuse in an Industrial Subculture. Berkeley, CA: Prevention Research Center, 1986.
Killen, I. D. Prevention of adolescent tobacco smoking: The social pressure resistance
training approach. J. Child Psychiatry 26:7-15, 1985.
Lacey, J. H., L. Stewart, L. Marchette et al. Enforcement and Public Information Strategies
for DWI General Deterrence: Arrest Drunk Driving--The Clearwater and Largo, F-la.,
Experience. Doc. DOT HS 807 066.
Transportation, 1986.
-
Washington, DC:
_, , ,
U.S. Department of
Levy, D., and N. Scheflin. New evidence on controlling alcohol use through price. J.
Stud. Alcohol 44~6~:929-937, 1983.
Lillis, R. P., T. P. Williams, and W. R. Williford. The impact of the 19-year-old drinking
age in New York. Pp. 133-146 in H. D. Holder, ed. Control Issues in Alcohol Abuse
Prevention: Strategies for States and Communities. Greenwich, CT: JAI Press, 1987.
Lumsdaine, ~ A, and Janis, I. L. Resistance to counter propaganda produced by
one-sided and two-sided propaganda. Public Opinion Quarterly 17:311-318, 1953.
MacDonald, S., and P. C. Whitehead. Availability of outlets and consumption of alcoholic
beverages. J. Drug Issues, Fall: 477-486, 1983.
Maisto, S. A, and J. V. Rachal. Indication of the relationships among adolescent drinking
practices, and drinking-age laws. Pp. 155-176 in H. Webster, ed.
Minimum-Drinking-Age Laws. Lexington, MA: D.C. Heath, 1980.
-101
OCR for page 102
Makela, K, R. Room, E. Single et al. Drink in Finland: Increasing alcohol availability
in a monopoly state. Pp. 31-60 in Alcohol and the State. II. A Social History of
Control Policies in Seven Countries. Toronto: Addiction Research Foundation, 1981.
Maxwell, D. M. Impact Analysis of the Raised Legal Drinking Age in Illinois.
Washington, DC: National Highway Traffic Safety Administration, 1981.
McCarthy, J., M. Wolson, and D. Baker. The founding of local citizens groups opposing
drunken driving. In G. R. Caroll, ed. Ecological Models of Organizations. Cambridge,
MA: Cambridge Press, 1988.
McGuire, W. J. Persuasion, resistance and attitude change. In I. Pool, W. Schramm, F.
W. Fray, N. Maccoby, and E. B. Parker, eds. Handbook of Communications. Chicago,
IL: Rand McNally College Pub. Co., 1973.
Minkler, M., L. Wallack, and P. Madden.
Magazine. J. Public Health Policy 8~2~:164-179, 1987.
Alcohol and cigarette advertising in Ms.
Mitchell, J. C. The concept and use of social networks. In J. C. Mitchell, ed. Social
Networks in Urban Situations. Manchester, U.K: Manchester University Press, 1969.
Mosher, J. F. The impact of legal provisions on barroom behavior: Toward an alcohol
problems prevention policy. J. Stud. Alcohol 1:205-211, 1984a.
Mosher, J. F. Legal liabilities of licensed alcoholic beverage establishments: Recent
developments and policy implications. Paper presented at the Conference on Public
Drinking and Public Policy: A Symposium on Observational Studies, April 26-28, Banff,
Alberta, Canada, 1984b.
Mosher, J. F. The Model Alcoholic Beverage Retail License Liability Act of 1985.
Western States Law Review 12~2~:443-517, 1985.
Mosher, J. F., and D. Beauchamp. Justifying alcohol taxes to public officials. J. Public
Health Policy 4:422-439, 1983.
National Highway Traffic Safety Administration. Evaluation of Minimum Drinking Age
Laws Using the National Electronic Injury Surveillance System. Washington, DC:
National NHTSA, 1982.
National Institute on Alcohol Abuse and Alcoholism. Sixth Special Report to the U.S.
Congress on Alcohol And Health. USDHHS Publ. No. (ADM)87-1519. Rockville, MD:
NIAAA, 1987.
O'Donnell, M. Research on drinking locations of alcohol-impaired drivers: Implications
for prevention policies. J. Public Health Policy 6:510-525, 1985.
Ornstein, S. K, and D. M. Hanssens. Alcohol control laws and the consumption of
distilled spirits and beer. Working paper, Research Program in Competition and
Business Polipy, Graduate School of Management, University of California at Los
Angeles, 1983.
-102
OCR for page 103
Parker, D. A, and J. ~ Brody. Risk factors for alcoholism and alcohol problems among
employed women and men. In Occupational Alcoholism: A Review of Research Issues.
NIAAA Research Monograph No. 8. USDHHS Publ. No. (ADM)82-1184. Washington,
DC: Government Printing Office, 1982.
Pearl, D., L. Bouthilet, and J. Lazar, eds. Television and Behavior, vol. 2. Washington,
DC: National Institute of Mental Health, 1982.
Phelps, C. E. Death and taxes: An opportunity for substitution. J. Health Econ., in
press.
Popham, R. E., W. Schmidt, and J. DeLint. The effects of legal restraint on drinking.
Pp. 579-625 in B. Kissin and H. Begleiter, eds. Social Aspects of Alcoholism: The
Biology of Alcoholism, vol. 4. New York: Plenum Press, 1976.
Preusser, D. F., ~ F. Williams, P. L. Zador et al. The effect of curfew laws on motor
vehicle crashes. Law and Policy 6:115-128, 1984.
Puska, P., J. Tuomilehto, J. Salonen et al. The North Karelia Project: Evaluation of a
comprehensive community programme for control of cardiovascular diseases in 1972-77
in North Karelia, Finland. Public Health in Europe, WHOlEURO Monograph Series.
Copenhagen: World Health Organization, 1981.
Rabow, J., and R. K Watts. Alcohol availability, alcoholic beverage sales, and
alcohol-related problems. J. Stud. Alcohol 44:767-801, 1982.
Ratcliffe, W. D., R. W. Nutter, D. Hewitt et al. Amenities and drinking behaviors in
beverage rooms. Research report. Edmonton, Alberta: Alberta Alcoholism and Drug
Abuse Commission, 1980.
Reid, J. Study of drinking in natural settings. In G. Marlatt and P. Nathan, eds.
Behavioral Approaches to Alcoholism. New Brunswick, NJ: Rutgers Center of Alcohol
Studies, 1978.
Rice, B. The role of state alcoholic beverage control in alcohol abuse prevention. Pp.
23-26 in H. D. Holder and J. B. Hallan, eds. Control Issues in Alcohol Abuse
Prevention: Local, State and National Designs for the 80's. Columbia, SC: South
Carolina Commission on Alcohol and Drug Abuse, 1984.
Roman, P. M., and Trice, H. M. The development of deviant drinking behavior:
Occupational risk factors. Arch. Environ. Health 20:424-435, 1970.
Room, R. Alcohol control and public health. Annual Rev. Public Health 5:293-317, 1984.
Rosenbluth, J., P. E. Nathan, and D. M. Lawson. Environmental influences on drinking
by college students in a college pub: Behavioral obse~vation in the natural environment.
Addict. Behav. 3:117-121, 1978.
Ross, H. L. Deterring the Drinking Driver: Legal Polipy and Social Control. Lexington,
MA: Lexington Books, 1982.
-103
OCR for page 104
Rush, B., L. Gliksman, and R. Brook. Alcohol availability, alcohol consumption and
alcohol-related damage. I. The distribution of consumption model. J. Stud. Alcohol
47:1-10, 1986.
Russ, N. W., and E. S. Geller. Training bar personnel to prevent drunken driving: A
field evaluation. Am. J. Public Health 77~8~:952-954, 1987.
Rychtarik, R. G., J. ~ Fairbank, C. M. Allen et al. Alcohol use in television
programming: Effects on children's behavior. Addict. Behav. 8:19-22, 1983.
gaffer, H., and M. Grossman. Effects of Beer Prices and Legal Drinking Ages on Youth
Motor Vehicle Fatalities. New York: National Bureau of Economic Research, 1985.
Saffer, H., and M. Grossman. Beer taxes, the legal drinking age, and youth motor vehicle
fatalities. J. Legal Stud. 16:351-374, 1987a.
Saffer, H., and M. Grossman. Drinking age laws and highway mortality rates: Causes and
effect. Economic Inquiry 25:403-418, 1987b.
Saltz, R. The role of bars and restaurants in preventing alcohol- impaired driving: An
evaluation of server intervention. Evaluation and the Health Professions 10~1~:5-27,
1987.
Single, E., et al. Alcohol, Society and the State: A Social History of Control Policy in
Seven Countries. Toronto: Addiction Research Foundation, 1981.
Skog, O. Drinking behavior in small groups: The relationship between group size and
consumption level. Oslo: Statens Institutt for Alkoholforskning, 1979.
Smart, R. G. Does alcohol advertising affect overall consumption? A review of empirical
studies. J. Stud. Alcohol 49:314-323, 1988.
Smart, R. G., and E. M. Adlaf. Banning happy hours: The impact on drinking and
impaired-driving charges in Ontario, Canada. J. Stud. Alcohol 47~3~:256-258, 1986.
Smart, R. G., and M. S. Goodstadt. Effects of reducing the legal alcohol purchasing age
on drinking and drinking problems: A review of empirical studies. J. Stud. Alcohol
38:1313-1323, 1977.
Smith, R. A, R. W. Hingson, S. Morelock et al. Legislation raising the legal drinking
age in Massachusetts from 18-20: Effect on 16 and 17 year-olds. J. Stud. Alcohol
45:534-539, 1984.
Somer, R. The isolated drinker in the Edmonton beer parlor. Q. J. Stud. Alcohol
46~6~:4S9-466, 1965.
Storm, T., and R. Cutler. Observations of drinking in natural settings: Vancouver beer
parlors and cocktail lounges. J. Stud. Alcohol 42~11~:972-997, 1981.
-104
OCR for page 105
Strickland, D. E. Advertising exposure, alcohol consumption and misuse of alcohol. Pp.
201-222 in M. Grant, M. Plant, and ~ Williams, eds. Economics and Alcohol:
Consumption and Controls. New York:Gardner Press, 1983.
Trice, H. M., and~Roman, P. M. Spirits and Demons at Work: Alcohol and Other Drugs
On the Job. New York: New York State School of Industrial and Labor Relations,
Cornell University, 1978.
U.S. Department of Transportation. Fatal Accident Reporting System 1986. DOT HS
807 245. Washington, DC: National Highway Traffic Safety Administration, 1988.
U.S. General Accounting Office. Drinking Age Laws: An Evaluation and Synthesis of
Their Impact on Highway Safety. Doc. GAO/PEMD 87-10. Washington, DC: U.S.
Government Accounting Office, 1987.
Voas, R., and J. Hause. Deterring the drinking driver: The Stockton experience. Accident
Analysis and Prevention 19:81-90, 1987.
Voas, R., ~ E. Rhodenizer, and C. Lyon. Evaluation of a Charlottesville checkpoint
operation: Final report to the National Highway Traffic Safety Administration.
Charlottesville, VA, April 1986.
Wagenaar, ~ C. Effects of an increase in the legal minimum drinking age. J. Public
Health Policy 2:206-225, 1981.
Wagenaar, ~ C. Alcohol, Young Drivers, and Traffic Accidents. Lexington, MA: D.C.
Heath, 1983.
Wagenaar, ~ C. Effects of minimum drinking age on alcohol-related traffic crashes: The
Michigan experience five years later. Pp. 119-131 in H. D. Holder, ed. Control Issues
in Alcohol Abuse Prevention: Stategies for States and Communities. Greenwich, CT:
JAI Press, 1987.
Wagenaar, ~ C., and R. Maybee. The legal minimum drinking age in Texas: Effects of
an increase from 18 to 19. J. Safety Research 17:165-176, 1986.
Wallack, L. Alcohol advertising reassessed: The public health perspective. Pp. 243-248
in M. Grant, M. Plant, and ~ Williams, eds. Economics and Alcohol: Consumption and
Controls. New York: Gardner Press, 1983.
Wallack, L. The prevention of alcohol-related problems: Health educators and the "new
generation" of strategies. Inter. J. Health Educ. 4~2~:23-30, 1985.
Wallack, L. Mass media and health promotion: Ideological and practical foundations.
School of Public Health, University of California, Berkeley, 1987.
Wallack, L., W. Breed, and J. Cruz. Alcohol on prime-time television. J. Stud. Alcohol
48:33-38, 1987.
Watts, R. K, and J. Rabow. The role of tourism in measures of alcohol consumption,
alcohol availability and alcoholism. J. Stud. Alcohol, 42:797-801, 1981.
-105
OCR for page 106
Williams, ~ F., ~ K Lund, and D. F. Preusser. Night driving curfew in New York and
Louisiana: Results of a questionnaire survey. Accident Analysis and Prevention
17:461-466, 1984.
Williams, ~ F., P. L. Zador, S. S. Harris et al. The effect of raising the legal minimum
drinking age on involvement in fatal crashes. J. Legal Stud. 12:169-179, 1983.
Winslow, W.W., K Hayes, L. Prentice, et al. Some economic estimates of job disruption
from an industrial mental health project. Archives of Environmental Health, 13:213-219,
1966.
Wittman, F. Community planning for alcohol availability. Bull. Alcohol Policy, 5(1):9-10,
1986.
Wittman, F., and M. Hilton. Local regulation of alcohol availability: Uses of planning
and zoning ordinances to regulate alcohol outlets in California cities. In H. Holder, ed.
Control Issues in Alcohol Abuse Prevention: Strategies for States and Communities.
Greenwich, Cf.: JAI Press, 1987.
Zador, P., A. Lund, M. Fields et aL Fatal Crash Involvement and Laws Against Alcohol
Impaired Driving. Washington, DC: Insurance Institute for Highway Safety, 1988.
-106
OCR for page 107
Wittman, F., and M. Hilton. Local regulation of alcohol availability: Uses of planning
and zoning ordinances to regulate alcohol outlets in California cities. In H. Holder, ed.
Control Issues in Alcohol Abuse Prevention: Strategies for States and Communities
Greenwich, CT: JAI Press, 1987.
Zador, P., ~ Lund, M. Fields et al. Fatal Crash Involvement and Laws Against Alcohol
Impaired Driving. Washington, DC: Insurance Institute for Highway Safety, 19&8.
-107
OCR for page 108
Representative terms from entire chapter:
alcohol availability
